ABSTRACT
BACKGROUND: The concept of multimodal complex treatment combines treatment by physicians with intensive conservative treatment. The therapy duration is often 14-21 days. Investigations showing the benefit of this treatment for multiple sclerosis patients are currently missing. PATIENTS AND METHODS: A total of 220 patient records were retrospectively analyzed with respect to the Barthel index, the expanded disability status scale (EDSS) score and early rehabilitation assessment (Frühreha-Assessment). Subgroup analysis was used to examine variations in clinical severity, age and disease duration. RESULTS: The motor subscore was improved (p = 0.031) in the total sample. The subgroup analysis showed that in particular patients with an average disease duration (11-20 years) and age (41-60 years) showed the greatest benefits. In addition to the group of moderately affected patients the group of severely affected patients (Barthel index 36-64 and < 35) also showed an improvement in the Barthel index. CONCLUSIONS: Multimodal complex treatment for MS patients can lead to a significant improvement in motor abilities and reduction of the need of nursing. In particular intermediately affected patients showed the strongest improvement in contrast to the results of the current appraisal of the German Medical Review Board of the Health Insurance Funds (MDK).
Subject(s)
Cooperative Behavior , Interdisciplinary Communication , Multiple Sclerosis/rehabilitation , Patient Care Team , Activities of Daily Living/classification , Adult , Aged , Combined Modality Therapy , Disability Evaluation , Early Medical Intervention , Female , Humans , Length of Stay , Male , Middle Aged , Multiple Sclerosis/diagnosis , Neurologic Examination , Outcome and Process Assessment, Health Care , Retrospective StudiesSubject(s)
Anticonvulsants/adverse effects , Dyskinesia, Drug-Induced/diagnosis , Epilepsy, Temporal Lobe/drug therapy , Parkinson Disease/complications , Triazines/adverse effects , Dopamine Agonists/therapeutic use , Humans , Lamotrigine , Male , Middle Aged , Risk Assessment , Triazines/administration & dosageABSTRACT
A 64-year-old patient with symptomatic epilepsy developed thrombocytopenia during treatment with levetiracetam (LEV). As no other medical reason could be evaluated, a medication side effect was postulated. The only new drugs were valproic acid (since 3 weeks) and levetiracetam (since 3 days). After valproic acid medication was ended, thrombocytopenia did not improve and even worsened further. Finally levetiracetam administration was ended and trombocytopenia resolved rapidly and completely within few days.
Subject(s)
Anticonvulsants/adverse effects , Piracetam/analogs & derivatives , Thrombocytopenia/chemically induced , Epilepsy, Complex Partial/drug therapy , Female , Humans , Levetiracetam , Middle Aged , Piracetam/adverse effectsABSTRACT
Left cardiac myxoma and also consecutive embolization into the brain is well documented, whereas the association of myxomas with multiple fusiform cerebral aneurysms is rare. We analyze 33 previously reported patients and present a case of a 43-year-old woman with multiple cerebral infarctions 2 years after resection of a recurrent myxoma in the left atrium. Cerebral angiography displayed multiple fusiform aneurysms of several cerebral arteries, including a giant aneurysm of the basilar artery. Serum level of interleukin-6 (IL-6) was highly elevated. The clinical, radiological and pathological features of these aneurysms are summarized. The pathogenesis, including the role of IL-6 in the formation of myxomatous aneurysms, is discussed.
Subject(s)
Cerebral Arteries/physiopathology , Heart Atria/pathology , Heart Neoplasms/complications , Interleukin-6/blood , Intracranial Aneurysm/complications , Myxoma/complications , Adult , Cerebral Angiography , Cerebral Arteries/diagnostic imaging , Cerebral Arteries/pathology , Female , Heart Neoplasms/blood , Heart Neoplasms/immunology , Humans , Interleukin-6/immunology , Intracranial Aneurysm/pathology , Intracranial Aneurysm/physiopathology , Magnetic Resonance Angiography , Myxoma/blood , Myxoma/immunology , Neoplasm Recurrence, Local , Time FactorsABSTRACT
Dopamine (DA) promotes the morphological differentiation of striatal GABAergic neurons through D(1) receptor activation and cAMP/PKA signaling. In this study, we investigated the developmental role of DA on the expression of the two GAD(65/67) genes and the alternative splicing of GAD(67) transcripts in the rat striatum. In vivo, embryonic and adult GAD(67) splice variants and GAD(65) transcripts increased until E17 and E19, respectively. Thereafter, the embryonic GAD(67) isoform disappeared, whereas GAD(65) mRNA levels remained unchanged postnatally. The hypothesis that the prenatal ingrowth and functional maturation of nigrostriatal afferents may be responsible for these developmental events through DA-dependent signaling pathways was tested in E17 rat striatal cultures. Treatment with DA and D(1) but not D(2) agonists decreased the ratio of embryonic to adult GAD(67) mRNAs and increased GAD(65) mRNA levels as well as GABA synthesis rates. Our findings demonstrate a distinct developmental switch in the regulation of GAD(65) expression and GAD(67) splicing in the rat striatum which clearly depends upon D(1) receptor but not D(2) signaling. The dopaminergic input thus appears to control the functional differentiation of GABAergic neurons not only by upregulation of expression of the two GAD genes but also by regulating GAD(67) splicing.
