Treatment strategies for encephalopathy related to status epilepticus during slow sleep, a narrative review of the literature

2020 ◽  
Vol 31 (7) ◽  
pp. 793-802
Author(s):  
Ke Zhang ◽  
Yu Yan ◽  
Tangfeng Su
Keyword(s):  
Status Epilepticus ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Epileptic Activity ◽  
Neurodevelopmental Deficits ◽  
Slow Sleep ◽  
Long Term Prognosis ◽  
Insight Into ◽  
Review Current

AbstractEncephalopathy related to Status Epilepticus during slow Sleep (ESES) is an age-dependent syndrome characterized by the appearance of neuropsychological and behavioral disorders associated with extreme activation of epileptic activity during sleep. The major goal of therapy in ESES is to prevent neuropsychological deficits. Effective therapy to reduce seizures and resolve the EEG pattern of status epilepticus during sleep (SES) may be crucial to improve long-term prognosis. However, whether to improve neurodevelopmental deficits by suppressing or eliminating SES remains unknown. The purpose of this article is to review current therapeutic options in ESES, in order to provide better alternatives. Treatment options consist of antiepileptic drugs, steroids, immunoglobulins, the ketogenic diet, and surgery. Maybe therapy targeted mechanisms can be developed with deep insight into the etiology of ESES.

No-reflow in native coronaries and vein grafts: the role of drugs and distal protection

2018 ◽  
pp. 557-568
Author(s):  
Giovanni Luigi De Maria ◽  
Adrian Banning
Keyword(s):  
Treatment Strategies ◽  
Coronary Intervention ◽  
Vein Grafts ◽  
No Reflow ◽  
Percutaneous Coronary ◽  
Long Term Prognosis ◽  
Distal Protection ◽  
Successful Prevention

Restoration of normal coronary bloodflow and relieving myocardial ischaemia is the main goal of percutaneous coronary intervention (PCI). However, whilst reducing an epicardial coronary stenosis by balloon dilatation may appear to be a relatively easy task, subsequent detrimental changes in bloodflow can paradoxically result in reduced/impaired myocardial perfusion. This condition of mismatch between post-PCI epicardial coronary patency and impaired myocardial reperfusion is defined as slow-flow or no-reflow. It is typically caused by and related to the presence of a damaged, dysfunctional, and/or obstructed coronary microvasculature. When no-reflow occurs, it has an adverse effect on the subsequent mid- and long-term prognosis as it is associated with a higher risk of reinfarction, arrhythmias, heart failure, and a higher in-hospital and long-term cardiac mortality. Frustratingly, nearly four decades after the first PCI, there is still uncertainty about the pathophysiology of no-reflow and a need to define successful prevention and treatment strategies.

Treatment of medication-overuse headache: A systematic review

Cephalalgia ◽  
2015 ◽  
Vol 36 (4) ◽  
pp. 371-386 ◽  
Author(s):  
Chia-Chun Chiang ◽  
Todd J Schwedt ◽  
Shuu-Jiun Wang ◽  
David W Dodick
Keyword(s):  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Treatment Strategies ◽  
Preventive Treatment ◽  
Early Discontinuation ◽  
Level Of Evidence ◽  
Preventive Medication ◽  
Long Term Prognosis ◽  
Acute Headache

Introduction The objective of this review is to provide an evidence-based discussion of different treatment strategies for medication-overuse headache (MOH). Method We searched PubMed for articles discussing the treatment and prognosis of MOH published between 2004 and August 2014. Titles, abstract and articles were reviewed systematically. The level of evidence provided by each study of the included articles was determined according to the American Academy of Neurology Clinical practice guideline manual. We discuss the level of evidence to support the early discontinuation/withdrawal of overused medications, the level of evidence to support the use of preventive treatment, the short- and long-term prognosis, and the outcome according to the class of drug overused in patients diagnosed with MOH. Results The initial search resulted in 1313 articles; 68 articles met our inclusion criteria and were discussed. The level of evidence to support early discontinuation of overused medications alone is low due to the absence of controlled studies. Adding preventive medication to early discontinuation led to a better outcome than early discontinuation alone. For patients with chronic migraine (CM) and medication overuse (MO), there are large randomized control trials supporting the use of onabotulinumtoxinA and topiramate without early discontinuation of overuse; however, the evidence is limited since data were obtained from post hoc analysis. Conclusion Considering current available evidence and the systemic toxicity of overusing acute headache medication, we suggest discontinuation of the overused medication with the addition of preventive medication. Appropriately sized, randomized controlled trials evaluating the safety and long-term efficacy of preventive medication plus early discontinuation of overuse vs preventive medication alone vs early discontinuation of overuse alone are needed.

scholarly journals Long-term prognosis of Guillain-Barré syndrome not determined by treatment options?

Oncotarget ◽  
2017 ◽  
Vol 8 (45) ◽  
pp. 79991-80001 ◽  
Author(s):  
Ying Wang ◽  
Wenjuan Lang ◽  
Yaqian Zhang ◽  
Xiaoyi Ma ◽  
Chunkui Zhou ◽  
...  
Keyword(s):  
Treatment Options ◽  
Guillain Barre Syndrome ◽  
Guillain Barré Syndrome ◽  
Long Term Prognosis ◽  
Guillain Barré

scholarly journals Metabolomics in Psychiatric Disorders: What We Learn from Animal Models

Metabolites ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 72 ◽  
Author(s):  
Elke Humer ◽  
Thomas Probst ◽  
Christoph Pieh
Keyword(s):  
Animal Models ◽  
Psychiatric Disorders ◽  
Treatment Strategies ◽  
Mood Stabilizers ◽  
Psychiatric Medication ◽  
Mitochondrial Regulation ◽  
Novel Treatment Strategies ◽  
Insight Into ◽  
Test Treatment

Biomarkers are a recent research target within biological factors of psychiatric disorders. There is growing evidence for deriving biomarkers within psychiatric disorders in serum or urine samples in humans, however, few studies have investigated this differentiation in brain or cerebral fluid samples in psychiatric disorders. As brain samples from humans are only available at autopsy, animal models are commonly applied to determine the pathogenesis of psychiatric diseases and to test treatment strategies. The aim of this review is to summarize studies on biomarkers in animal models for psychiatric disorders. For depression, anxiety and addiction disorders studies, biomarkers in animal brains are available. Furthermore, several studies have investigated psychiatric medication, e.g., antipsychotics, antidepressants, or mood stabilizers, in animals. The most notable changes in biomarkers in depressed animal models were related to the glutamate-γ-aminobutyric acid-glutamine-cycle. In anxiety models, alterations in amino acid and energy metabolism (i.e., mitochondrial regulation) were observed. Addicted animals showed several biomarkers according to the induced drugs. In summary, animal models provide some direct insights into the cellular metabolites that are produced during psychiatric processes. In addition, the influence on biomarkers due to short- or long-term medication is a noticeable finding. Further studies should combine representative animal models and human studies on cerebral fluid to improve insight into mental disorders and advance the development of novel treatment strategies.

scholarly journals RESECTION AND REGENERATION- A HOPE FOR THE HOPELESS

2020 ◽  
pp. 1-5
Author(s):  
Apeksha Annigeri B. ◽  
Rajiv Nidasale Puttaswamaiah ◽  
Avinash Janaki Lingaraju
Keyword(s):  
Alveolar Bone ◽  
Treatment Plan ◽  
Treatment Options ◽  
Case Series ◽  
Cost Effective ◽  
Ridge Preservation ◽  
Tooth Structure ◽  
Implant Placement ◽  
Long Term Prognosis

Preservation of tooth structure has always been the prime aim of dental practice. Teeth with advanced periodontal disease in multirooted teeth often pose a significant challenge to the clinician, complicating the treatment plan and compromising long term prognosis. The outcome of the treatment is determined by proper case selection and surgical, endodontic and prosthetic parameters. Resective and regenerative osseous procedures are often employed to help preserve the tooth structure, alveolar bone involving the retained root of multirooted teeth and are cost effective over the other treatment options like ridge preservation/augmentation followed by implant placement. This case series describes application of resective and regenerative techniques for molars with extensive combined periodontal-endodontic disease.

scholarly journals What Type of Patients Did PARAGON-HF Select? Insights from a Real-World Prospective Cohort of Patients with Heart Failure and Preserved Ejection Fraction

2020 ◽  
Vol 9 (11) ◽  
pp. 3669 ◽  
Author(s):  
René Rettl ◽  
Theresa-Marie Dachs ◽  
Franz Duca ◽  
Christina Binder ◽  
Fabian Dusik ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Real World ◽  
Treatment Options ◽  
National Registry ◽  
Preserved Ejection Fraction ◽  
Eligibility Criteria ◽  
Patients With Heart Failure ◽  
Long Term Prognosis

The PARAGON-HF clinical trial suggested that sacubitril/valsartan may become a treatment option for particular subgroups of patients with heart failure and preserved ejection fraction (HFpEF). However, the proportion of real-world HFpEF patients who are theoretically superimposable with the PARAGON-HF population is yet unknown. The present study was performed to define the proportion of real-world PARAGON-HF-like patients and to describe their clinical characteristics and long-term prognosis in comparison with those who would not meet PARAGON-HF criteria. We systematically applied PARAGON-HF inclusion and exclusion criteria to a total of 427 HFpEF patients who have been participating in a prospective national registry between December 2010 and December 2019. In total, only 170 (39.8%) registry patients were theoretically eligible for PARAGON-HF. Patients not meeting inclusion criteria (41.0%) were less impaired with respect to exercise capacity (median 6-min walk distance: 385 m (IQR: 300–450) versus 323 m (IQR: 240–383); p < 0.001) had lower pulmonary pressures (mean pulmonary artery pressure (mPAP): 31.2 mmHg, standard deviation (SD): ±10.2 versus 32.8 mmHg, SD: ±9.7; p < 0.001) and better outcomes (log-rank: p < 0.001) as compared to the PARAGON-like cohort. However, patients theoretically excluded from the trial (19.2%) were those with most advanced heart failure symptoms (median 6-min walk test: 252 m (IQR: 165–387); p < 0.001), highest pulmonary pressures (mPAP: 38.2 mmHg, SD: ±12.4; p < 0.001) and worst outcome (log-rank: p = 0.037). We demonstrate here that < 40% of real-world HFpEF patients meet eligibility criteria for PARAGON-HF. We conclude that despite reasons for optimism after PARAGON-HF, a large proportion of HFpEF patients will remain without meaningful treatment options.

Aanpak en behandelingsopties voor congenitale melanocytaire naevi

2021 ◽  
Author(s):  
A. VANNESTE ◽  
M. GARMYN ◽  
M.-A. MORREN
Keyword(s):  
Treatment Options ◽  
Neurological Complications ◽  
Treatment Modalities ◽  
Melanocytic Nevi ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri ◽  
Long Term Prognosis ◽  
Congenital Melanocytic Nevi

Management and treatment options in congenital melanocytic nevi Congenital melanocytic nevi (CMN) are benign collections of nevus cells in the skin. They are present at birth or arise during the first weeks of life. Depending on the size, they appear in 1 in 100 to 500.000 live births. CMN are associated with a variety of benign conditions such as benign proliferations, certain facial characteristics or subtle endocrine dysfunctions as well as malign developments such as melanoma and neurological complications. The risk for these complications strongly depends on the clinical phenotype. Magnetic resonance imaging (MRI) has a strong value in estimating the risk of these complications. A normal MRI of the central nervous system results in a lower risk of developing melanoma and neurological complications because of the thorough follow-up and early capture. Although there are various treatment modalities, a shift to more conservative treatment is seen. Little is known about the long term prognosis after treatment of CMN. This article tries to give a recommendation for treatment and follow-up of CMN based on the current literature.

Newer Treatment Strategies for the Management of Type 2 Diabetes Mellitus

2004 ◽  
Vol 17 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Susan Cornell ◽  
Amber Briggs
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycosylated Hemoglobin ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Treatment Goals ◽  
Microvascular And Macrovascular Complications

Type 2 diabetes mellitus is a multiorgan, metabolic disease associated with multiple microvascular and macrovascular complications. The incidence of type 2 diabetes is growing at an alarming rate. Achieving and maintaining near-normal blood glucose and glycosylated hemoglobin levels (A1C) are of the utmost importance. Existing treatment options for managing type 2 diabetes, which have primarily included sulfonylureas and biguanides, are insufficient at achieving these treatment goals alone, particularly if used long term. The need to explore newer and better treatment options that provide longer lasting glucose control and at the same time focus on targeting cardiovascular risk factors to minimize and prevent the serious complications associated with this multifaceted disease becomes quite obvious.

Kawasaki disease

2020 ◽  
pp. 291-302
Author(s):  
Tarek Alsaied ◽  
Justin T Tretter ◽  
Andrew N Redington
Keyword(s):  
Kawasaki Disease ◽  
Treatment Options ◽  
Significant Risk ◽  
Developed Countries ◽  
Coronary Imaging ◽  
Coronary Aneurysms ◽  
Acquired Heart Disease ◽  
Immunoglobulin Treatment ◽  
Long Term Prognosis

Kawasaki disease is the most common acquired heart disease in children in developed countries. Coronary involvement is reported in 30% of patients with no treatment and decreases to 5% with intravenous immunoglobulin treatment. Given the significant risk for coronary involvement, understanding the long-term prognosis is paramount to guide outpatient follow-up and treatment. This chapter presents the case of a 20-month-old child with Kawasaki disease and giant coronary aneurysms. The chapter reviews the diagnostic criteria and coronary imaging aspects, delves into the treatment options and prognosis, including immunoglobulin treatment.

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