The development and selection of optimal outcome measures is increasingly recognized as a key component of evidence-based medicine, particularly the need for the development of a standardized set of measures for use in clinical trials. This process is particularly complex for functional neurological disorder (FND) for several reasons. FND can present with a wide range of symptoms that resemble the full spectrum of other neurological disorders. Additional physical (e.g., pain, fatigue) and psychological (e.g., depression, anxiety) symptoms are commonly associated with FND, which also can be highly disabling with implications for prognosis, and warrant concurrent assessment, despite an unclear etiological relationship with FND. Furthermore, several unique clinical aspects of FND make it likely that the usual prioritization of "objective" (or clinician-rated) over "subjective" (or patient-rated) measures might not be appropriate. Self-report measures may be more clinically meaningful in this patient population. Despite being a common and disabling disorder, there has been little research into outcome measures in FND, and to date trials have largely used measures designed for the assessment of other disorders. An international FND Core Outcome Measure group (FND-COM) has been established to develop a consensus battery of outcomes for FND: a "core outcome set." In this perspective article, the authors reviewed the process of outcome measure development and selection before considering the specific features of FND affecting the development of a core outcome set, as well as a research agenda to optimize outcome measurement in this complex neuropsychiatric disorder.
... CONTENTS -- Contributors, vii Preface, xv -- SECTION I Foundations for Clinical Practice in Neurological ... ... Umphred -- 5 Psychosocial Aspects of Adaptation and Adjustment During Various Phases of Neurological ... ... Hi ley -- 6 Differential Diagnosis of the Patient With a Neurological Condition, 139 -- John D. ... ... Lazaro -- 1 Examination and Evaluation of Functional Movement Activities, Body Functions and Structures ... ... Reina-Guerra -- SECTION II Physical Rehabilitation -- Management of Individuals With Neurological System ...
Seventh edition xviii, 1146 stran : ilustrace, tabulky ; 29 cm
- MeSH
- Nervous System Diseases rehabilitation MeSH
- Neurological Rehabilitation methods MeSH
- Physical Therapy Modalities MeSH
- Publication type
- Textbook MeSH
- Conspectus
- Učební osnovy. Vyučovací předměty. Učebnice
- Fyzioterapie. Psychoterapie. Alternativní lékařství
- NML Fields
- neurologie
- rehabilitační a fyzikální medicína
- NML Publication type
- kolektivní monografie
... Contents section I Foundations for Clinical Practice in Neurological Rehabilitation -- 10 Payment Systems ... ... MT-ВС, FAMI -- 6 Psychosocial Aspects of Adaptation 141 and Adjustment during Various Phases of Neurological ... ... Umphred, PT, PhD, FAPTA -- 8 Differential Diagnosis Phase 2: Examination 179 and Evaluation of Functional ... ... Movement Activities, Body Functions and Structures, and Participation -- Rolando T. ... ... Roller, PT, MS, DPT section II Rehabilitation Management of Clients with Neurological System Pathology ...
6th ed. xvii, 1262 s. : il., mapy ; 29 cm
- Conspectus
- Patologie. Klinická medicína
- NML Fields
- neurologie
- rehabilitační a fyzikální medicína
- NML Publication type
- kolektivní monografie
Nejvýznamnější mikrovaskulární neurologickou komplikací diabetu mellitu je diabetická neuropatie. Tento termín zahrnuje kromě nejčastější distální senzitivní či senzitivně‐motorické polyneuropatie také neuropatii autonomní a řadu fokálních forem (mononeuropatie, plexopatie). Diagnostika je založena na anamnéze a klinickém vyšetření, volba dalších diagnostických metod (elektromyografické vyšetření, testy autonomních nervových funkcí, hodnocení intraepidermální inervace apod.) záleží na typu postižených nervových vláknech. Základním opatřením v terapii i prevenci rozvoje a progrese diabetické neuropatie je dlouhodobá optimální metabolická kompenzace diabetu a dalších kardiovaskulárních rizikových faktorů a pohybová aktivita. U algických forem se dále uplatňují preparáty ovlivňující neuropatickou bolest, tedy antiepileptika ze skupiny modulátorů funkce α2δ podjednotky kalciových kanálů (gabapentin, pregabalin) a antidepresiva ze skupiny inhibitorů zpětného vychytávání serotoninu a noradrenalinu (duloxetin, venlafaxin) či tricyklických antidepresiv (amitriptylin). Analgetický efekt má i kyselina thioktová (alfa‐lipoová) a řada opioidů. Diabetes mellitus je také nezávislým cerebrovaskulárním rizikovým faktorem a podílí se tedy na vzniku ischemických cévních mozkových příhod. Signifikantně zvyšuje také riziko rozvoje kognitivních poruch
The most important microvascular neurological complication of diabetes mellitus is diabetic neuropathy. In addition to the most common distal sensory or sensory-motor polyneuropathy, this term also includes autonomic neuropathy and a number of focal forms (mononeuropathy, plexopathy). Diagnosis is based on history and clinical examination; the choice of other diagnostic methods (nerve conduction studies and needle electromyography, autonomic nerve function tests, assessment of intraepidermal innervation from skin biopsy, etc.) depends on the type of nerve fibers affected. The basic intervention in the therapy and prevention of the development and progression of diabetic neuropathy is long-term optimal control of diabetes and other cardiovascular risk factors, and physical activity. In painful forms, drugs affecting neuropathic pain are also used, i.e. antiepileptics from the group of modulators of the α2δ subunit of calcium channels (gabapentin, pregabalin) and antidepressants from the group of serotonin and noradrenaline reuptake inhibitors (duloxetine, venlafaxine) or tricyclic antidepressants (amitriptyline). Thioctic acid (alpha-lipoic acid) and a number of opioids also have an analgesic effect. Diabetes mellitus is also an independent cerebrovascular risk factor and thus contributes to the development of ischaemic stroke. It also significantly increases the risk of developing cognitive impairment.
- MeSH
- Antidepressive Agents administration & dosage therapeutic use MeSH
- Anticonvulsants administration & dosage therapeutic use MeSH
- Stroke prevention & control MeSH
- Diabetes Mellitus MeSH
- Diabetic Neuropathies * diagnosis drug therapy complications MeSH
- Diagnostic Techniques, Neurological MeSH
- Diabetes Complications diagnosis prevention & control therapy MeSH
- Thioctic Acid antagonists & inhibitors therapeutic use MeSH
- Humans MeSH
- Analgesics, Opioid administration & dosage therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
Stoupající zájem o zdravotní problémy ve starším věku je výsledkem změn ve věkové distribuci populace a stáří a nemoci spojené s vyšším věkem budou stále aktuálnějším problémem. V naší republice podíl osob ve věku 65 let a více byl v r. 2000 13,9 %, v r. 2010 již 15,53 % a tento podíl bude i nadále na základě demografického vývoje stoupat. Úloha neurologie v geriatrii je vysoká, protože mnoho funkčních poruch (disability) je vázáno na neurologický deficit. Neurologie stárnutí, nebo také geriatrická neurologie se vyčleňuje jako samostatná subspecializace. V přehledném článku je pojednáno o poruchách kognitivních funkcí, deliriu, problematice pádů, poruchách chůze, rovnováhy a závratí. Pády ve starším věku jsou jednou z častých příčin nemocnosti i úmrtí a je třeba věnovat pozornost jejich prevenci. Specifický přístup vyžaduje farmakoterapie ve vyšším věku vzhledem ke změněné farmakokinetice a farmakodynamice i vyššímu výskytu nežádoucích lékových reakcí. Jsou probrány základní principy lékové preskripce u starších nemocných a rizika neurologických poruch.
The increasing interest in health problems among the elderly is a result of changes in the age distribution in the population and age-related diseases are going to be an ever more pressing problem in the future. In this country the percentage of people aged 65 and more was at 13.9% in 2000 and in 2010, it already reached 15.53% and number is most likely going to be steadily increasing, according to demographic projections. The importance of neurology in geriatrics is high, since many functional disorders (disabilities) are linked to neurological problems. Neurology of aging or geriatric neurology is presently emerging as a separate sub-specialization. This paper is dealing with cognitive disorders, delirium, falling accidents and disorders of gait, balance and dizziness. Falls are a major cause of morbidity and mortality among the elderly and more consideration should be given to prevention of this. A specific approach is required in pharmacotherapy of the elderly, taking into account the changes in pharmacokinetics and pharmacodynamics that come with age as well as the increased risk of adverse effects and drug interactions. This paper reviews the basic principles of prescribing drugs to older patients and risks of drug-related neurological disorders.
- Keywords
- farmakoterapie ve stáří, závratě, poruchy rovnováhy, poruchy chůze, pády, demografický vývoj,
- MeSH
- Delirium MeSH
- Drug Therapy methods utilization MeSH
- Geriatrics methods statistics & numerical data trends MeSH
- Cognition Disorders MeSH
- Comorbidity MeSH
- Frail Elderly statistics & numerical data MeSH
- Drug Interactions MeSH
- Humans MeSH
- Neurocognitive Disorders diagnosis drug therapy therapy MeSH
- Neurologic Manifestations MeSH
- Gait Disorders, Neurologic MeSH
- Drug-Related Side Effects and Adverse Reactions MeSH
- Polypharmacy MeSH
- Sarcopenia pathology MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Aging physiology pathology psychology MeSH
- Statistics as Topic MeSH
- Vertigo physiopathology pathology psychology MeSH
- Check Tag
- Humans MeSH
- Aged, 80 and over MeSH
- Aged MeSH
Vitamín B12 má v ľudskom organizme významnú úlohu ako kofaktor dôležitých enzýmov intermediárneho metabolizmu. Nedostatok vitamínu B12 môže spôsobiť malabsorpcia v tráviacom trakte, nedostatočný príjem potravy alebo geneticky podmienený deficit enzýmu metylmalonyl-CoA mutázy. Deficit vitamínu B12 sa prejavuje rôznymi hematologickými, neurologickými a psychiatrickými prejavmi. K neurologickým patria myelopatia, neuropatia a vzácne atrofia zrakového nervu. Myelopatia sa manifestuje ako subakútna kombinovaná degenerácia miechy (funikulárna myelóza) s charakteristickou degeneráciou postranných a zadných povrazcov. Neuropatia sa prejavuje ako prevažne senzitívna polyneuropatia, niekedy ako zmiešaná senzorimotorická forma. Atrofia zrakového nervu je podstatne zriedkavejšia, najčastejšie sa prejavuje postupným zhoršovaním vízu bilaterálne. Cieľom našej práce je poukázať na problematiku neurologických ochorení spôsobených deficitom vitamínu B12, poukázať na nutnosť zahrnúť tieto ochorenia do diferenciálno-diagnostickej úvahy.
Vitamin B12 plays an important role in organism as cofactor of important enzymes of intermediary metabolism. Lack of vitamin B12 is caused by malabsorption in the gastrointestinal tract, insufficient nourishment by food or genetic deficiency of methylmalonyl-CoA mutase enzyme. Vitamin B12 deficiency usually presents with various haematological, neurological and psychiatric manifestations. Neurological manifestations include myelopathy, neuropathy and, rarely, optic nerve atrophy. Myelopathy in vitamin B12 deficiency presents as subacute combined degeneration of spinal cord (funicular myelosis), characterised by degeneration of the lateral and posterior columns. Neuropathy usually presents as polyneuropathy with predominantly sensory symptoms, sometimes are combined also with motor symptoms. Optic atrophy is rare condition, chracterized by slow progressive worsening of vizus. The aim of our work is to highlight the iss ue of neurological diseases caused by vitamin B12 deficiency, identified the need to include these diseases in the differential diagnostic considerations. of vitamin B12.
- MeSH
- Optic Atrophy etiology drug therapy MeSH
- Diagnosis, Differential MeSH
- Clinical Laboratory Techniques MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Brain pathology MeSH
- Vitamin B 12 Deficiency * diagnosis etiology complications MeSH
- Spinal Cord Diseases diagnosis etiology drug therapy MeSH
- Nervous System Diseases * diagnosis etiology drug therapy MeSH
- Gait Disorders, Neurologic etiology drug therapy complications MeSH
- Neurologic Examination methods MeSH
- Polyneuropathies diagnosis etiology drug therapy MeSH
- Vitamin B 12 * administration & dosage metabolism therapeutic use MeSH
- Check Tag
- Humans MeSH
Acta universitatis upsaliensis. Comprehensive summaries of Uppsala dissertations from the Faculty of Medicine. 873, ISSN 0282-7476
78 s. ; 24 cm
Functional neurological disorder (FND) was of great interest to early clinical neuroscience leaders. During the 20th century, neurology and psychiatry grew apart - leaving FND a borderland condition. Fortunately, a renaissance has occurred in the last two decades, fostered by increased recognition that FND is prevalent and diagnosed using "rule-in" examination signs. The parallel use of scientific tools to bridge brain structure - function relationships has helped refine an integrated biopsychosocial framework through which to conceptualize FND. In particular, a growing number of quality neuroimaging studies using a variety of methodologies have shed light on the emerging pathophysiology of FND. This renewed scientific interest has occurred in parallel with enhanced interdisciplinary collaborations, as illustrated by new care models combining psychological and physical therapies and the creation of a new multidisciplinary FND society supporting knowledge dissemination in the field. Within this context, this article summarizes the output of the first International FND Neuroimaging Workgroup meeting, held virtually, on June 17th, 2020 to appraise the state of neuroimaging research in the field and to catalyze large-scale collaborations. We first briefly summarize neural circuit models of FND, and then detail the research approaches used to date in FND within core content areas: cohort characterization; control group considerations; task-based functional neuroimaging; resting-state networks; structural neuroimaging; biomarkers of symptom severity and risk of illness; and predictors of treatment response and prognosis. Lastly, we outline a neuroimaging-focused research agenda to elucidate the pathophysiology of FND and aid the development of novel biologically and psychologically-informed treatments.
- MeSH
- Conversion Disorder * MeSH
- Humans MeSH
- Nervous System Diseases * diagnostic imaging MeSH
- Neuroimaging MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
- Research Support, N.I.H., Extramural MeSH
- Research Support, N.I.H., Intramural MeSH
- Research Support, U.S. Gov't, Non-P.H.S. MeSH
