Neurologist

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3 New Medical Items

1)Alzheimer’s disease (AD) is the leading cause of dementia. It is characterized by the presence of senile plaques and neurofibrillary tangles in the brain, and impairment of the central cholinergic system, which contribute to memory loss and cognitive dysfunction. Cholinesterase inhibitors prevent the hydrolysis of acetylcholine and are currently approved for the symptomatic treatment of Alzheimer’s disease. Donepezil, a piperidine-based, reversible and specific inhibitor of acetylcholinesterase, has been demonstrated to be clinically effective in the treatment of patients with mild to moderate AD. To date, clinical trials have not reported an association between treatment with donepezil and hepatotoxicity. We describe a case of toxic hepatitis, documented by liver biopsy, in a patient treated with donepezil.

Source: Acta Clin Belg

2)NEW YORK — February 6, 2009 — Losing weight is perhaps the single most effective way to reduce symptoms of obstructive sleep apnoea (OSA), according to a study published in the January issue of the American Journal of Respiratory and Critical Care Medicine.

“Very low calorie diet (VLCD) combined with active lifestyle counselling resulting in marked weight reduction is a feasible and effective treatment for the majority of patients with mild OSA, and the achieved beneficial outcomes are maintained at 1-year follow-up,” said lead author Henri P.I. Tuomilehto, MD, Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland.

The prospective, randomised trial included 81 patients with mild OSA. Patients were randomised to either a very low calorie diet combined with lifestyle counselling (n=40) or to lifestyle counselling alone (n=41).

Patients in the intervention arm who underwent a strict diet lost more than 10 kg (20 lbs) on average in 1 year and were able to keep the weight off resulting in markedly lower symptoms of OSA. The patients in the control arm lost on average less than 3 kg (6 lbs) and were much less likely to see improvements in their OSA.

“The greater the change in body weight or waist circumference, the greater was the improvement in OSA,” said Dr. Tuomilehto.

Mild OSA was objectively cured in 88% of the patients who lost more than 16.5 kg (33 lbs) — a statistic that declined with the amount of weight lost. Only in 62% of those who lost between 5.5 kg and 16.5 kg (11-33 lbs) were objectively cured of their OSA, as were 38% of those who lost between zero and 5.5 kg (0-11 lbs), and only 11% of those who had not lost weight or who had gained weight.

“…while we would not necessarily recommend the severe caloric restriction used in our study to every patient, one of the first treatment for OSA that should be considered in the overweight patient is clearly weight loss,” said Dr. Tuomilehto.

SOURCE: American Thoracic Society

Source: DGNews

3)The long-term effects of botulinum toxin A (BoNT-A) treatment in children with cerebral palsy (CP) are still elusive. We studied a prospective clinical cohort of 94 children with different subtypes (50% spastic diplegic CP, 22% hemiplegic CP, 25% tetraplegic CP, 3% dyskinetic CP), sex (55% male, 45% female), severity according to Gross Motor Function Classification System (29% Level I, 15% Level II, 16% Level III, 17% Level IV, 23% Level V), and age (median 5y 4mo, range 11mo-17y 8mo). The longest follow-up time was 3 years 7 months (median 1y 6mo) and included a maximum of eight injections per muscle (median two injections to a specific muscle). Outcome measurements were muscle tone (Modified Ashworth Scale) and joint range of motion (ROM). Assessments were made at a minimum before and 3 months after each injection. Ninety-five per cent confidence intervals for differences from baseline were used to identify significant changes. BoNT-A injections induced reduction of long-term spasticity in all muscle-groups examined: the gastrocnemius, hamstring, and adductor muscles. The reduction in tone was most distinct in the gastrocnemius muscle, and each repeated injection produced an immediate reduction in muscle tone. However, improvement in ROM was brief and measured only after the first injections, whereupon the ROM declined. Thus, the results suggest that BoNT-A can be effective in reducing muscle tone over a longer period, but not in preventing development of contractures in spastic muscles. The dissociation between the effects on muscle tone and ROM indicates that development of contractures is not coupled to increased muscle tone only, but might be caused by other mechanisms

Source: Dev Med Child Neurol

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February 11, 2009 - Posted by | Uncategorized |

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