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At least 163 records · Page 9Linked to original sources

PubMed2000

[Pharmaco-epidemiological study on the prophylactic treatment of migraine. National inquiry on attitude to prescription practices by primary care physicians and neurologists in Franceø].

A pharmacoepidemiological survey was conducted in order to understand the pattern of migraine prophylactic drug utilization by French physicians. Neurologists and primary care physicians completed a phone-mail-phone questionnaire which inquired about migraine prophylactic treatment. French neurologists and PCP made the same use of migraine prophylaxis in terms of indication, time interval between treatment onset and evaluation, and duration. The two most commonly chosen migraine prophylactic agents were dihydroergotamine and beta-blockers. This study also showed the importance of considering quality of life to evaluate efficacy of migraine prophylaxis.

Adrenergic beta-Antagonists↗

PubMed2001

[Surgical treatment of refractory childhood epilepsy with special reference to the role of pediatric neurologists: introductory remarks].

There are many differences between children and adult patients regarding the selection of candidates for epilepsy surgery, decision about the timing of surgery, pre- and intra-surgical evaluation and follow-up. A comprehensive approach by an epilepsy surgery team consisting of pediatric neurologists, neurosurgeons and other medical staffs is absolutely necessary for successful surgical treatment of refractory childhood epilepsy and the improvement of the patient's quality of life. The potential risks and benefits of the surgery must be carefully weighed for each child from various aspects. Pediatric neurologists should make a more active contribution to this whole process.

Child↗

PubMed2003

[Diagnosis and treatment of carcinoid meningitis: a challenge to the neurologist and oncologist].

BACKGROUND: Two clinical types of leptomeningeal metastases from solid tumors are observed: local and disseminated. The former (meningeal carcinomatosis) consists in nodular infiltration of leptomeninges, while the latter (carcinomatous meningitis)--in tumor cells free floating in the cerebrospinal fluid and adhering as a monolayer to the surface of neural structures. Despite the same etiology, the two types of metastasis differ in their clinical manifestation and prognosis. Meningeal carcinomatosis is more frequently diagnosed nowadays due to advances in neuroimaging techniques and the long survival of breast cancer patients. Patients with local, nodular infiltration of leptomeninges may survive many years without symptoms of the disease. On the other hand, carcinomatous meningitis, with its usually violent course and short survival, has become a major problem for oncologists and neurologists because of limited efficacy and considerable toxicity of the treatment. AIMS: The purpose of this article is to review the current knowledge about carcinomatous meningitis in breast cancer patients, taking into account pathophysiology, clinical symptoms, diagnosis, treatment and prognosis. The second aim was to present the authors' experience with the treatment of breast cancer patients suffering from carcinomatous meningitis. MATERIAL AND METHODS: 37 patients with breast cancer and carcinomatous meningitis were treated in the Oncology Center, Warsaw, in the years 2000-2002. Their mean age was 51. The diagnosis was based on results of neurological examination, MRI scan, and the presence of neoplastic cells in the cerebrospinal fluid. In a majority of cases combined treatment was applied, including intrathecal administration of cytostatics, intravenous systemic chemotherapy and radiotherapy. RESULTS: The observation period ranged from 2 to 33 months. A response to the treatment was achieved in 76% of the patients. Their median overall survival was 19 weeks, mean 18 weeks. Seven patients (19%) survived for over 6 months. CONCLUSIONS: The ever-growing incidence of carcinomatous meningitis in the course of breast cancer has become a serious clinical problem for neurologists and oncologists. Treatment results are disappointing, although the combined modality treatment appears to be the best option. New pharmacological approaches to the treatment of meningeal malignancy are required to improve the outcome of patients with carcinomatous meningitis.

Adult↗

PubMed2005

[The direction of Japanese Society of Child Neurology: a message to young doctors who aim to be child neurologists].

The bylaws of Japanese Society of Child Neurology (JSCN) declare that the purpose of this Society is to promote research activity, educational programs for child neurologists, and cooperation with other related organizations. It also has a large role to provide the results of research to the wider community. As for promotion of research, acquisition of research funding is quite important. It is necessary to increase applications for grants and to be well known by other researchers, and especially by the relevant authorities. One way to do this is to send reprints to the authorities in various research fields. Participating to the congress party to let lots of people notice his/her activity may also be effective. To promote the Impact Factor of the official journal of JSCN, Brain & Development (B & D), members should cite as many articles from B & D as possible when they submit a manuscript. The members of JSCN must respond to the demands of patients and family members as specially trained child neurologists. I am pleased that the newly founded Social Activity and Public Relations Committee has acted vigorously. I want to ask all the young members to participate positively in our activities and support the Society.

Japan↗

PubMed2005

[Pediatric neurologist and medical practice after adolescence: introductory remarks].

Medical practice after adolescence in child neurology was discussed. Major issues to be solved included; who should play major role in the practice, what medical facilities are available for inpatients, how medical networks are built in the community (especially for disabled patients), and which medical benefits were required to support patients after the cessation of support for childhood disorders. As child neurologists, we must decide whether we need training in adult neurology as an elective course or compulsory. All these considerations have to be solved by child neurologists for the benefit of maturing patients.

Adolescent↗

PubMedDate not supplied

[The treatment of multiple sclerosis in Latin America: current practice and optimal standards. The findings of a survey among neurologists at an interactive workshop].

INTRODUCTION: Considerable progress has been made in the treatment of patients with relapsing-remitting multiple sclerosis (MS) over the last decade. Exactly how these changes are reflected in daily practice, however, is still not very well known. AIM: To hold interactive workshops so as to be able to evaluate the opinions of Latin-American neurologists about the therapeutic decisions taken with regard to MS. MATERIALS AND METHODS: By means of an interactive voting system, professionals attending each workshop replied to ten pre-established questions about when to start treatment, the use of magnetic resonance imaging (MRI) to supervise treatment, the definition of therapeutic failure and the role of treatment using immunosuppressants. The results were compared with those obtained in similar workshops attended by European and North American neurologists held six months earlier. RESULTS: The use of immunomodulators was considered to be useful in isolated demyelinating syndromes, as 40-50% endorsed their use in clinically stable patients. MRI was seen to be the most sensitive method of monitoring the effectiveness of the therapy -70.6% of them proposed the application of annual scans, which suggests a more frequent use in Latin America than in Europe or the USA. On defining therapeutic failure, the clinical criteria were more important than the MRI scan, and a switch from beta interferons to glatiramer acetate or vice versa was recommended. Treatment with immunosuppressants was considered to be useful in reducing the accumulated disability, but there was no agreement on how to use them. In Latin America, decisions about when to begin treatment seem to lie somewhere between the more favourable posture adopted in USA and the more conservative stance in Europe. CONCLUSIONS: This survey reflects the controversies that affect the therapeutic decisions concerning MS in Latin America and highlights the areas in which more data are needed to optimise the standards of treatment.

Consensus Statements as Topic↗

PubMedDate not supplied

[Prior authorisation to visit the neurologist from primary care may not be necessary: the findings of a prospective, controlled study].

INTRODUCTION: The system by which approval must be given by the primary care physician before a patient can visit a specialist is known as gatekeeping and is aimed at preventing the mistaken or simple referral of patients to the next stage of health care services. We present a study that compares the final diagnoses of 400 patients who used a direct access model of referral (DAM) with those of 400 patients referred by a primary care physician in a prior authorisation model (PAM). PATIENTS AND METHODS: We conducted a prospective analysis of two cohorts of patients who visited the same neurologist in a PAM system versus a DAM system. The 800 patients were evaluated following similar diagnostic criteria. The primary objective of the study was to compare the patients who were referred with a final diagnosis of 'non-neurological pathology' in the PAM and the DAM systems. Secondary aims consisted in conducting an analysis of the diagnoses by different pathologies between the two models. RESULTS: No significant differences were found between the referrals that were considered to be non-neurological in the PAM and the DAM systems (27.0% versus 26.3%; p = 0.48). A logistic regression model was performed with 'non-neurological pathology' as the dependent variable and age, sex and type of model (PAM or DAM) as the independent variables, similar results being obtained in both cases. CONCLUSIONS: Our data suggest that the role played by the primary care physician is not effective when it comes to preventing mistaken referrals to the neurologist in our area. A populational study would be needed to evaluate the rate at which resources are used and the spending on health care in the two models.

Female↗

PubMed1991

Yugoslav Oto-Neuro-Ophthalmological Society (1926-1935)--the first professional association of Croatian neurologists.

From 1926 to 1935 in Zagreb was active the Yugoslav Oto-Neuro-Ophthalmological Society, professional association of otorhinolaryngologists, neurologists and ophthalmologists. Although it was conceived as Yugoslav, its members were mainly Croatian specialists of these disciplines. The Society had 74 members, of whom 14 were neurologists: J. Breitenfeld, D. Cop, I. Glavan, I. Herzog, A. Kuljzenko, D. Karminski, M. Lapinskij, R. Lopasić, H. Ortyński, V. Ostrovidov, F. Palmović, S. Poljak and D. Vranesić, all of them from Zagreb, and J. Robida from Ljubljana. The first president of the Society was M. Lapinskij, head of the Neuropsychiatric Department in Zagreb. In the journal "Lijecnicki vjesnik" the work of the Society at 41 professional meetings was registered at which 29 neurological lectures and demonstrations were held. During 10 years of its activities the Society give a significant impulse to the development of neurology, otorhinolaryngology and ophthalmology in Croatia. In 1937 a separate Neurophysiological Section was founded with in the Croatian Medical Association.

History, 20th Century↗

PubMed1991

[Clinical and legal aspects of brain death criteria: evaluation of the degree of knowledge of neurologists and neurosurgeons].

The level of knowledge of clinical and legal aspects of brain death criteria was tested in 25 neurologists and 15 neurosurgeons. The answers were wrong or the questionnaire had not been responded in 36.9% of the cases. The highest percentage of mistakes concerned the apnea test and what Chilean law said regarding brain death. No differences were found between neurologists and neurosurgeons. Physicians with less than 10 years were better informed than those with more than 10 years of medical practice (p < 0.005). Although brain death as a criterion of death is accepted by Chilean law in order to donate organs for transplantation, a considerable percentage of physicians (30%) rejected this concept. The significant lack of knowledge found in this study may suggest that brain death diagnosis is being inadequately performed in many cases. This fact raises important medical, ethical and legal considerations.

Brain Death↗

PubMed1989

The neurologist as ethics consultant and as a member of the institutional ethics committee. The neuroethicist.

Because of the increasing number of neuroethical dilemmas in medicine, neurologists are becoming more involved with the activities of institutional ethics committees and also serving as ethics consultants. This article discusses the role and functions of a "neuroethicist" and gives common clinical examples that illustrate how a neurologist can be of value in these neuroethical dilemmas in the clinical setting.

Ethics, Medical↗

PubMed1996

[No uniformity in radiodiagnosis and advice by Dutch neurologists in patients with minor brain injuries].

OBJECTIVE: To determine diagnostic procedures and medical advice in cases of mild head injury in Dutch hospitals. DESIGN: Questionnaire. SETTING: Academic Medical Hospital, Maastricht, the Netherlands. METHOD: A questionnaire was sent to neurologists of 100 different Dutch hospitals. RESULTS: The response was 85%. X-rays of the skull were made by 73% of the respondents, of the cervical spine by 46%. CT scans of the brain were made only on indication. A waking advice for the first 12-24 hours following a mild head injury was given in 95%. Bed rest and work stoppage were prescribed in 37% and 80% respectively. The duration of this bed rest and work stoppage varied from 1 to 14 days and from 2 to 24 days respectively. In 59% pain medication was prescribed and 40% of the patients were seen at least once for a control visit. In 25% of the hospitals a protocol for the treatment of these patients was used, and 52% of the neurologists considered such a protocol desirable. CONCLUSION: This inquiry shows that no consensus exists regarding radiodiagnosis of patients with mild head injury in Dutch hospitals. Apart from the waking advice, the treatment also shows many discrepancies.

Bed Rest↗

PubMed1991

Access to health care. One neurologist's perspective.

Millions of residents of the United States have difficulty obtaining health care. Barriers impeding access to care include poverty, physical unavailability of health care services, absence of health insurance, and physicians unwilling to care for uninsured patients. Many patients do not successfully use health services because of educational, cultural, and language barriers. A major access barrier is lack of health insurance. Over 30 million people in the United States have none, the so-called medically indigent. Among them are over 3 million people with neurologic disorders. They have additional barriers to overcome because often they cannot work, cannot drive, have difficulty using public transportation, and have major cognitive and communication impairments. Medical and governmental bodies are debating solutions to the health care access crisis. Physicians should actively participate in this national debate. Neurologists should address the special needs of patients with neurological disorders.

Health Services Accessibility↗

PubMed1997

A neurologist's perspective on the aging brain.

I have worked as a neurologist in old age homes and chronic hospitals for 30 years, and over this period I have seen thousands of older patients with dementias and other degenerative neurological syndromes. A high proportion of these patients have steadily and sometimes rapidly advancing dementias of the type we now tend to call Alzheimer disease (AD) (although this term was used in a much narrower sense when I started seeing such patients in the mid-sixties).

Aging↗

PubMed1999

Stroke: how large a public health problem, and how can the neurologist help?

Stroke is an enormous public health problem, the magnitude of which can be reduced mainly by effective stroke prevention and less so by effective treatment of acute stroke. The greatest effect is likely to be achieved by a mass approach to prevention, which consists of modification of lifestyle behaviors (eg, less smoking and less intake of salt, alcohol, and fat) among the general population through public education and, more importantly, government legislation. The appropriate identification and treatment of high-risk individuals by neurologists is likely to have a smaller but complimentary impact on the population burden of stroke and a substantial impact on the burden of stroke among individuals. The most cost-effective interventions for patients with transient ischemic attack and ischemic stroke are organized multidisciplinary acute care and rehabilitation in a stroke unit and early secondary prevention with aspirin, blood pressure control, smoking cessation, and, in the appropriate patient, oral anticoagulant therapy and carotid endarterectomy. The cost-effectiveness of carotid endarterectomy for asymptomatic carotid stenosis is highly questionable until data from ongoing trials (eg, Asymptomatic Carotid Surgery Trial) become available. Screening for asymptomatic carotid stenosis is more likely to be harmful than helpful, except perhaps among populations with a very high prevalence (pretest probability) of severe carotid stenosis. It is essential that the impact of these strategies on the incidence, outcome, and cost of stroke is measured and monitored. Currently, this is done simply, but unreliably, by examining changes in statistics that are already being measured, such as mortality (eg, among those younger than 70 years old, for greater accuracy). A growing priority in many countries is the development and implementation of valid, reliable, practical, and inexpensive methods of routinely collecting and evaluating data on stroke incidence, outcome, and cost.

Aged↗

PubMed2003

Neurological aspects of biological and chemical terrorism: a review for neurologists.

The Centers for Disease Control and Prevention urge physicians to become familiar with chemical and biological weapons. Preparedness among neurologists is especially important because several of these agents affect the nervous system. This article reviews 4 agents that have a history of military or terrorist use: cyanide poisons, organophosphate poisons, botulinum toxin, and anthrax. Cyanide and organophosphate poisons are characterized by dose-dependent impairment of neurological function with nonspecific symptoms such as headache or dizziness at one end of the spectrum and convulsions and coma at the other. Neurological examinations help clinicians to differentiate these agents from other intoxications. Botulinum toxin has a delayed onset of action and results in descending paralysis and prominent cranial nerve palsies. Anthrax frequently causes fulminating hemorrhagic meningitis. Early recognition of these chemical and biological weapons is key to instituting specific therapy and preventing casualties within the health care team and the community at large.

Bioterrorism↗

PubMed1983

The role of the neurologist in the decline of stroke.

Mortality from stroke in the United States has been declining since 1900. In the population of Rochester, Minnesota the primary cause of the decline was shown to be the decrease in the incidence of new cases of stroke from 1945 through 1979. The neurologist's primary contribution to stroke prevention is the identification and management of patients who have had transient focal cerebral ischemic attacks. Although the presence of these attacks is a powerful risk for stroke occurrence, their low prevalence and the lack of clearly effective medical or surgical treatment make it unlikely that management of transient focal cerebral ischemic attacks accounts for much of the decline in the incidence or mortality of stroke.

Anticoagulants↗

PubMed1991

Interobserver reliability between neurologists in training of Parkinson's disease rating scales. A multicenter study.

A multicenter study has been conducted to determine the interobserver reproducibility of four of the most frequently used rating scales for Parkinson's disease: the Columbia University Rating Scale (CURS) and the Webster Rating Scale (WRS), both for assessing clinical signs; the Northwestern University Disability Scale (NUDS); and the Hoehn and Yahr staging. Four resident neurologists, inexperienced in the use of the four scales, independently examined 48 parkinsonian patients. The extent to which their assessments agreed was determined by calculating the Cohen k index after the scores had been recodified. The physicians' scores agreed substantially for the CURS and the Hoehn and Yahr scale, while those for the NUDS and the WRS agreed only moderately. Analysis of individual item scores within the scales suggests improvements that would offer greater interobserver consistency.

Disability Evaluation↗

PubMed2004

Public health surveillance and incidence of adulthood Guillain-Barré syndrome in Spain, 1998-1999: the view from a sentinel network of neurologists.

Temporal variation in Guillain-Barré syndrome (GBS) warrants monitoring in certain situations. This study sought to describe a public-health-based GBS surveillance service in Spain and conduct pilot surveillance in the period 1998-1999. Neurologists from 11 hospitals countrywide, serving a population of 3.9 million, reported all patients, ages 20 years or over, admitted to hospital with suspected GBS. Cases that did not belong to the designated hospital catchment area or failed to fulfill diagnostic criteria after follow- up were excluded. Reported monthly incidence was compared against predicted incidence obtained from retrospective data (1985-1997) using a reported method based on 97.5% percentile values. Alarm thresholds for 2000 onwards were obtained by applying the same method to the updated 1985-1999 series. During the 2-year period, 98 GBS cases were reported, yielding an overall age-adjusted incidence of 1.26 per 100 000 population, with a breakdown by sex of 1.83 for males and 0.76 for females. Monthly incidence remained below or was similar to the corresponding threshold limit value. Seasonality with highest incidence in winter was more pronounced in the elderly. Preceding events, mainly respiratory infections, were identified in 71% of patients. Pilot two-year GBS surveillance in Spain resulted neither in alarm nor in preventive measures. Adult GBS incidence in Spain might be monitored by a surveillance system set up at short notice when a possible threat is perceived. A monthly incidence of over 3 per 100 000 person-years in the population aged 20 years or older would exceed threshold values.

Adult↗