Neurologist

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Three New Medical Findings

Vestibular migraine: a critical review of treatment trials;

Vestibular migraine (VM), also known as migraine-associated vertigo, is a common cause of dizziness in adults. We performed a comprehensive literature search regarding treatment for VM or migraine-associated vertigo during the period of 1990-2008 and used, individually or in combination, the search terms VM, migraine-associated vertigo, migraine-associated dizziness, migrainous vertigo, migraine and vertigo, migraine and disequilibrium, and headache and vertigo. We found nine publications that address treatment strategies for VM. One small randomized clinical trial found some benefit from the use of zolmitriptan for abortive treatment of VM. The other eight observational studies showed marginal improvement with migraine prophylactic medications such as nortriptyline, verapamil, or metoprolol. Until more specific treatment options become available, patients with VM need to be managed with similar prophylactic and abortive strategies as those used for migraine in adults.

Psychosis secondary to traumatic brain injury;

Background: Traumatic brain injury (TBI) can result in serious and disabling neuropsychiatric disorders. Method: The authors report a case of a 51-year old male, admitted to the psychiatric ward for acute psychosis and suicidal ideation, probably associated with TBI. After a temporal head trauma he initiated auditory/verbal hallucinations and subsequently developed paranoid delusions. The electroencephalography showed slow bilateral temporal activity and the neuropsychological testing showed several impairments. The patient improved with olanzapine at a dosage of 20 mg daily. Results: This case shows the difficulty of differential diagnosis between schizophrenia and psychotic disorder due to traumatic brain injury. Conclusions: The authors conducted a revision of literature about the diagnosis, epidemiology, clinical aspects, laboratory and structural investigations and the treatment of this condition. Based on this revision work, the authors sketch some recommendations about the work-up that should be done when faced with this diagnostic hypothesis.

enetic basis for idiosyncratic reactions to antiepileptic drugs;

PURPOSE OF REVIEW: In recent years, there has been an explosion of genetic research in epilepsy, including a search for genetic markers of adverse reactions to antiepileptic drugs. This article will focus on recent findings concerning genetic factors affecting susceptibility to idiosyncratic reactions to antiepileptic drugs. RECENT FINDINGS: Recent studies have investigated the role of genetic factors in the development of antiepileptic drug-induced cutaneous reactions, carbamazepine and valproate-induced liver toxicity, vigabatrin-induced visual field defects, and antiepileptic drug-induced teratogenicity. The greatest progress has been an improved definition of the role of human leukocyte antigen-related genes as predictors of the risk of serious antiepileptic drug-induced cutaneous reactions. This has led to the recommendation that patients of Asian ancestry be tested for the HLA-B*1502 allele, in order to identify those at high risk of developing Stevens-Johnson syndrome and toxic epidermal necrolysis after administration of carbamazepine and, possibly, phenytoin and other antiepileptic drugs. SUMMARY: Future research will probably lead to discovery of additional genetic predictors of susceptibility to adverse reactions to antiepileptic drugs. Identification of genetic markers should, in turn, allow unravelling of the molecular mechanisms underlying these reactions. Ultimately, these advances should lead not only to improved personalization of therapy but also to development of safer drugs.

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March 17, 2009 - Posted by | 1

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