Clinical Review Recent developments

Recent developments in neurology

BMJ 2002; 324 doi: http://dx.doi.org/10.1136/bmj.324.7338.656 (Published 16 March 2002) Cite this as: BMJ 2002;324:656

This article has a correction. Please see:

  1. Samuel Wiebe, associate professor in neurology ([email protected]),
  2. Michael W Nicolle, associate professor in neurology
  1. Department of Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada
  1. London Health Sciences Centre, University Campus, 339 Windermere Road, London, ON, Canada N6A 5A5

    Neurology has evolved from a rich, descriptive discipline to one with many diagnostic and therapeutic options supported by an increasingly robust evidence base. This review looks at new evidence on the management of temporal lobe epilepsy, which shows that surgery can now prevent years of ineffective drug treatment and unnecessary disability. In stroke, simple clinical scales can accurately identify patients who will benefit most from evidence based treatments, although interventions of proved efficacy and safety continue to be underused. In dementia, while the promise of early preventive measures looms on the horizon, the clinical importance of available antidementia drugs continues to be investigated. Finally, the usefulness of the clinical neurological examination is being systematically analysed in specific conditions, such as migraine and carpal tunnel syndrome.

    Recent developments

    Patients with temporal lobe epilepsy should be considered for surgical treatment if more than two consecutive anticonvulsants fail to control the seizures

    The risk of stroke in patients with atrial fibrillation can be accurately predicted by the presence of risk factors such as congestive heart failure, hypertension, increased age, diabetes, and especially prior cerebral ischaemia

    Carotid endarterectomy for prevention of stroke in symptomatic carotid stenosis is more effective in patients aged over 75 than in younger patients

    Patients with ischaemic stroke who can be treated within three hours of onset should be considered for thrombolysis; larger strokes, as assessed with a simple computed tomography based scoring system, are less likely to be reversed

    Use of interferon for first demyelinating episodes may prevent progression to clinically definite multiple sclerosis

    Early corticosteroid treatment (within seven days of onset of symptoms) may be effective in Bell's palsy

    Methods

    We identified important neurological advances by canvassing subspecialty neurologists, performing hierarchical literature searches with SUMSearch (SUMSearch.UTHSCSA.edu/searchform4.htm), and reviewing medical collections such as bmj.com (www.bmj.com/collections/), Lancet Neurology Network (www.lancetneuronet.com/journal), Bandolier (www.jr2.ox.ac.uk/bandolier/), Health …

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