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Intractable patients

Laura Vilella, Nuria Lacuey, Johnson P Hampson, M R Sandhya Rani, Kenneth Loparo, Rup K Sainju, Daniel Friedman, Maromi Nei, Kingman Strohl, Luke Allen, Catherine Scott, Brian K Gehlbach, Bilal Zonjy, Norma J Hupp, Anita Zaremba, Nassim Shafiabadi, Xiuhe Zhao, Victoria Reick-Mitrisin, Stephan Schuele, Jennifer Ogren, Ronald M Harper, Beate Diehl, Lisa M Bateman, Orrin Devinsky, George B Richerson, Adriana Tanner, Curtis Tatsuoka, Samden D Lhatoo
Introduction: Peri-ictal breathing dysfunction was proposed as a potential mechanism for SUDEP. We examined the incidence and risk factors for both ictal (ICA) and post-convulsive central apnea (PCCA) and their relationship with potential seizure severity biomarkers (i. e., post-ictal generalized EEG suppression (PGES) and recurrence. Methods: Prospective, multi-center seizure monitoring study of autonomic, and breathing biomarkers of SUDEP in adults with intractable epilepsy and monitored seizures. Video EEG, thoraco-abdominal excursions, capillary oxygen saturation, and electrocardiography were analyzed...
2019: Frontiers in Neurology
Nicole R Provenza, Evan R Matteson, Anusha B Allawala, Adriel Barrios-Anderson, Sameer A Sheth, Ashwin Viswanathan, Elizabeth McIngvale, Eric A Storch, Michael J Frank, Nicole C R McLaughlin, Jeffrey F Cohn, Wayne K Goodman, David A Borton
Mental disorders are a leading cause of disability worldwide, and available treatments have limited efficacy for severe cases unresponsive to conventional therapies. Neurosurgical interventions, such as lesioning procedures, have shown success in treating refractory cases of mental illness, but may have irreversible side effects. Neuromodulation therapies, specifically Deep Brain Stimulation (DBS), may offer similar therapeutic benefits using a reversible (explantable) and adjustable platform. Early DBS trials have been promising, however, pivotal clinical trials have failed to date...
2019: Frontiers in Neuroscience
Tadashi Ohara
BACKGROUND: Fecal microbiota transplantation (FMT) is an effective therapeutic approach for the treatment of functional gastrointestinal disease by restoring gut microbiota; however, there is a lack of sufficient understanding regarding which microbial populations successfully colonize the recipient gut. This study characterized microbial composition and diversity in patients diagnosed with chronic constipation at 1 month and 1 year after FMT. METHODS: We explored the microbial diversity of pre- and posttransplant stool specimens from patients using 16S rRNA gene sequencing, followed by functional analysis...
2019: PloS One
Chul Ho Shin, Yehree Kim, Myung Hoon Yoo, Tae Su Kim, Jun Woo Park, Byung Chul Kang, Hong Ju Park
OBJECTIVE: To report the incidence of vestibular migraine (VM) in patients with Ménière's disease (MD) and investigate whether management outcomes of MD differ by the association of VM. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary care academic center. PATIENTS: MD patients (n = 251) with/without VM who were managed for 5 years in a dizziness clinic. MAIN OUTCOME MEASURES: Influence of VM on management outcomes and hearing at the latest follow-up in stepwise management options...
March 13, 2019: Otology & Neurotology
C De Vloo, F Nevens
Pruritus is a common, troublesome symptom in patients with cholestatic liver diseases, especially frequent in intrahepatic cholestasis of pregnancy (ICP) and in primary biliary cholangitis (PBC). Cholestatic associated pruritus can have profound effects on the quality of life. The underlying mechanism is still poorly understood. Severe potential pruritogens have been discussed, such as bile salts, opioids, steroid and lysophosphatidic acid (LPA), but none of these are considered as key mediators. Because of this unraveling pathophysiology the treatment of hepatogenic pruritus often represents a clinical challenge...
January 2019: Acta Gastro-enterologica Belgica
Ayataka Fujimoto, Yosuke Masuda, Naoki Ichikawa, Keishiro Sato, Shimpei Baba, Shinji Itamura, Mitsuyo Nishimura, Hideo Enoki, Tohru Okanishi
BACKGROUND: Using a stereotaxic technique, surgeons can accurately place a depth electrode (DE), but sometimes the DE deviates from the intended target due to movement of the electrode or leakage of cerebrospinal fluid when placing the electrode. If DEs can be anchored before removing the catheter insertion guide pipe, more accurate placement may be possible. METHODS: We made a side slit guide pipe. When the DEs were anchored to the dura or the edge of the burr hole, the DE did not move when the guide pipe was removed...
March 15, 2019: World Neurosurgery
Kazuhiko Uchiyama, Yuji Naito, Tomohisa Takagi
Recently, the pathogenesis of systemic inflammatory disease such as inflammatory bowel disease (IBD), multiple sclerosis (MS), systemic inflammatory arthritis, asthma, and non-alcoholic fatty liver disease has been reported to be related to the dysbiosis of gut microbiota. The contribution of special bacteria for the development of those diseases has been elucidated by disease animal models such as germ-free mice. Besides, the contribution by several bacteria for the pathogenesis of those diseases has been suggested by detailed analysis of the 16 small ribosomal subunit RNA (16S rRNA) from stool samples of the patients...
March 12, 2019: Pharmacology & Therapeutics
Saif Huda, Dan Whittam, Maneesh Bhojak, Jayne Chamberlain, Carmel Noonan, Anu Jacob
Neuromyelitis optica spectrum disorder (NMOSD) is an uncommon antibody-mediated disease of the central nervous system. Long segments of spinal cord inflammation (myelitis), severe optic neuritis, and/or bouts of intractable vomiting and hiccoughs (area postrema syndrome) are classic presentations of the disease and may alert the clinician to the diagnosis. Untreated, approximately 50% of NMOSD patients will be wheelchair users and blind, and a third will have died within 5 years of their first attack. Unlike multiple sclerosis, a progressive clinical course is very unusual and the accrual of disability is related to relapses...
March 2019: Clinical Medicine: Journal of the Royal College of Physicians of London
Yuyao Zhang, Jiangtao Fu, Hongbin Lin, Chuan Shen, Xiaofei Wang, Jueting Wu
OBJECTIVES: In recent decades, intratympanic gentamicin (ITG) has increasingly been used to treat intractable Menière's disease (MD). We performed a meta-analysis of pooled clinical outcomes, exploring whether ITG was effective and safe. DATA SOURCES: Cochrane Library database, Embase, and Medline. STUDY SELECTION: We searched scientific and medical databases to March 2018 for articles evaluating clinical outcomes after ITG treatment of intractable MD according to the American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) guidelines...
April 2019: Otology & Neurotology
Kazuhiro Mochizuki, Satoshi Kawana, Shoki Yamada, Moe Muramatsu, Hideki Sano, Shogo Kobayashi, Yoshihiro Ohara, Nobuhisa Takahashi, Michiyuki Hakozaki, Hitoshi Yamada, Yuko Hashimoto, Atsushi Kikuta
Long-term survival rates for pediatric patients with cancer have significantly improved, but novel approaches are desired for those with refractory/relapsed solid tumors. Recently, programed cell death-1/programed cell death-ligand-1 blockade has emerged as an effective option for many intractable cancers. However, not all patients show objective response to such therapy. On the other hand, several other checkpoint pathways, including Herpes virus entry mediator (HVEM)/B- and T-lymphocyte attenuator (BTLA), galectin-9 (GAL9)/T-cell immunoglobulin and mucin domain-3 (TIM3), and major histocompatibility complex class II (MHC-II)/lymphocyte activation gene-3 (LAG3), also regulate immune responses in the tumor microenvironment and may be alternative targets for novel immune therapies...
March 14, 2019: Pediatric Hematology and Oncology
Peng Huang, Deng Zheng-Dao, Bo-Min Sun, Yi-Xin Pan, Jing Zhang, Tao Wang, Wei Liu, Hai-Yan Jin, Shi-Kun Zhan
OBJECTIVES: Patients with epilepsy and refractory comorbid psychiatric disorders often experience functional impairments and a lower quality of life as well as showing a lack of compliance with anti-epileptic medication regimens. We reasoned that widespread clinical benefits could be gained if the psychiatric comorbidities among these patients were reduced. In this study, we assessed the utility of anterior capsulotomy in managing medication-refractory comorbid psychotic symptoms and aggression in patients with epilepsy...
March 13, 2019: CNS Neuroscience & Therapeutics
Ariel Morales, R Jason Yong, Alan D Kaye, Richard D Urman
PURPOSE OF REVIEW: The purpose of the present investigation is to summarize supporting evidence for novel sub-perception spinal cord stimulation (SCS) therapy over traditional paresthesia inducing low-frequency waveforms for the treatment of chronic pain. The focus of this review is to summarize key studies comparing traditional low-frequency tonic waveforms to modern high frequency and burst stimulation for the treatment of patients with chronic intractable low back pain and/or leg pain...
March 14, 2019: Current Pain and Headache Reports
Junji Kozawa, Masahiro Higashi, Iichiro Shimomura, Ken-Ichi Hirano
No abstract text is available yet for this article.
March 12, 2019: Diabetes Care
Eun Ae Kang, Kyungdo Han, Jaeyoung Chun, Hosim Soh, Seona Park, Jong Pil Im, Joo Sung Kim
The association of diabetes with inflammatory bowel disease (IBD) remains unclear. The risk of diabetes in patients with IBD compared with non-IBD controls was investigated. Using the National Health Insurance database of South Korea, 8070 patients with IBD based on the International Classification of Disease 10th revision (ICD-10) codes and rare intractable disease codes for Crohn's disease (CD) and ulcerative colitis (UC) were compared with 40,350 non-IBD individuals (2010⁻2014). Newly diagnosed diabetes identified using ICD-10 codes and the prescription of anti-diabetic medication by the end of the follow-up period (2016) was investigated...
March 11, 2019: Journal of Clinical Medicine
Dong-Guang Niu, Fan Yang, Wei-Liang Tian, Yun-Zhao Zhao, Chen Li, Lian-An Ding, Hong-Chun Fang, Qian Huang
RATIONALE: Currently, fistucolysis helps to establish intestinal nutrition and succus entericus reinfusion in the case of controllable mature high-output enterocutaneous fistula. However, if the tube cannot reach the distal limb of a fistula, fistuloclysis is not achieved. We proposed a strategy to establish succus entericus reinfusion for intractable intestinal fistula through percutaneous enterostomy. PATIENT CONCERNS: A 43-year-old man was transferred to our facility for postoperative enterocutaneous fistulae, sepsis, malnutrition, and electrolyte and fluid imbalance...
March 2019: Medicine (Baltimore)
Bradley G Leshnower, W Brent Keeling, Yazan M Duwayri, William D Jordan, Edward P Chen
OBJECTIVE: Acute type A dissection with mesenteric malperfusion is a rare but lethal variant of aortic dissection. This study examines outcomes from various treatment algorithms. METHODS: A review from 2003 to 2017 of the Emory Aortic Database identified 34 patients who presented with acute type A dissection with mesenteric malperfusion. Outcomes from 4 different treatment strategies were analyzed: ascending aortic/arch replacement followed by laparotomy (n = 13), axillary-bifemoral artery bypass followed by ascending/arch replacement (n = 3); ascending/arch and concomitant antegrade thoracic endovascular aortic repair (TEVAR) (n = 5), and TEVAR followed by delayed ascending/arch replacement (TEVAR-1st) (n = 13)...
February 11, 2019: Journal of Thoracic and Cardiovascular Surgery
Tara L Skarpaas, Beata Jarosiewicz, Martha J Morrell
Controlled clinical trials in adults with medically intractable focal seizures treated with the RNS® System demonstrate that closed-loop responsive neurostimulation to the seizure focus reduces the frequency of disabling seizures, is well tolerated, and is acceptably safe. Seizure reductions begin with initiation of treatment and continue over time, reaching median reductions of 75% after 9 years of treatment. Treatment with responsive cortical stimulation is also associated with improvement in quality of life and cognitive function related to the functional area being treated...
February 20, 2019: Epilepsy Research
Chan Hong Park, Sang Ho Lee
BACKGROUND: Radicular pain is related to lesions that either directly compromise the dorsal root ganglion (DRG) or indirectly compromise the spinal nerve and its roots by causing ischemia or inflammation of the axons. OBJECTIVE: Our study aimed to assess the outcomes of pulsed readiofrequency treatment (PRF) according to electrodiagnosis results in patients with chronic intractable lumbosacral radicular pain. METHODS: A total of 82 failed back surgery syndrome (FBSS) patients were included in this study...
March 8, 2019: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Wenbo Zhang, Yingshi Du, Yan Zou, Jing Luo, Yang Lü, Weihua Yu
Smad anchor for receptor activation (SARA) is an important regulator of transforming growth factor β (TGF-β) signaling by recruiting Smad2/3 to TGF-β receptors. We recently demonstrated that the expressions of SARA and level of downstream phospho-Smad3 (p-Smad3) were upregulated in the brain in the epileptic rat model, but were never examined in patients with temporal lobe epilepsy (TLE). In this study, we examined the expressions of SARA and level of p-Smad3 in brain tissues of TLE patients using immunohistochemistry and western blot to demonstrate that SARA activation in neurons is sufficient to facilitate TGF- β pathway in patients to regulate epilepsy...
March 7, 2019: Journal of Molecular Neuroscience: MN
Christian Denzer, Friederike Denzer, Belinda S Lennerz, Heike Vollbach, Robert H Lustig, Martin Wabitsch
BACKGROUND: A limited number of published case reports suggest a positive effect of dextroamphetamine, an adrenergic agonist affecting both the central nervous system (CNS) and peripheral nervous system, on physical activity and weight in patients with hypothalamic obesity (intractable obesity following CNS insult). Here, we present our clinical experience with dextroamphetamine treatment for hypothalamic obesity. METHODS: The clinical course of all patients started on dextroamphetamine treatment for severe hypothalamic obesity at our institution between 2010 and 2013 is reported...
March 7, 2019: Obesity Facts
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