RESUMO
Obesity is a common outcome of traumatic brain injury (TBI) that exacerbates principal TBI symptom domains identified as common areas of post-TBI long-term dysfunction. Obesity is also associated with increased risk of later-life dementia and Alzheimer's disease. Patients with obesity and chronic TBI may be more vulnerable to long-term mental abnormalities. This review explores the question of whether weight loss induced by bariatric surgery could delay or perhaps even reverse the progression of mental deterioration. Bariatric surgery, with its induction of weight loss, remission of type 2 diabetes, and other expressions of the metabolic syndrome, improves metabolic efficiency, leads to reversal of brain lesions seen on imaging studies, and improves function. These observations suggest that metabolic/bariatric surgery may be the most effective therapy for TBI.
Assuntos
Cirurgia Bariátrica , Lesões Encefálicas Traumáticas , Diabetes Mellitus Tipo 2 , Obesidade Mórbida , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/cirurgia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/cirurgia , Humanos , Obesidade/complicações , Obesidade/cirurgia , Obesidade Mórbida/cirurgiaRESUMO
Obesity is a common outcome of traumatic brain injury (TBI) that exacerbates principal TBI symptom domains identified as common areas of post-TBI long-term dysfunction. Obesity is also associated with increased risk of later-life dementia and Alzheimer's disease. Patients with obesity and chronic TBI may be more vulnerable to long-term mental abnormalities. This review explores the question of whether weight loss induced by bariatric surgery could delay or perhaps even reverse the progression of mental deterioration. Bariatric surgery, with its induction of weight loss, remission of type 2 diabetes, and other expressions of the metabolic syndrome, improves metabolic efficiency, leads to reversal of brain lesions seen on imaging studies, and improves function. These observations suggest that metabolic/bariatric surgery may be a most effective therapy for TBI.
Assuntos
Cirurgia Bariátrica , Lesões Encefálicas Traumáticas , Diabetes Mellitus Tipo 2 , Obesidade Mórbida , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/cirurgia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/cirurgia , Humanos , Obesidade/complicações , Obesidade/cirurgia , Obesidade Mórbida/cirurgiaRESUMO
Obesity is a common outcome of traumatic brain injury (TBI) that exacerbates principal TBI symptom domains identified as common areas of post-TBI long-term dysfunction. Obesity is also associated with increased risk of later-life dementia and Alzheimer's disease. Patients with obesity and chronic TBI may be more vulnerable to long-term mental abnormalities. This review explores the question of whether weight loss induced by bariatric surgery could delay or perhaps even reverse the progression of mental deterioration. Bariatric surgery, with its induction of weight loss, remission of type 2 diabetes, and other expressions of the metabolic syndrome, improves metabolic efficiency, leads to reversal of brain lesions seen on imaging studies, and improves function. These observations suggest that metabolic/bariatric surgery may be a most effective therapy for TBI.
Assuntos
Cirurgia Bariátrica , Lesões Encefálicas Traumáticas , Diabetes Mellitus Tipo 2 , Obesidade Mórbida , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/cirurgia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/cirurgia , Humanos , Obesidade/complicações , Obesidade/cirurgia , Obesidade Mórbida/cirurgiaRESUMO
BACKGROUND: Many women who suffer from migraine and tension-type headaches (TTHs) have an improvement in the frequency of these headaches during pregnancy. At the same time pregnancy predisposes women to a number of potentially life-threatening conditions which can present with headache. Accurate diagnosis and treatment of headache during pregnancy is essential. REVIEW SUMMARY: The primary objectives of this review are to: (1) Summarize the natural history of primary headache disorders, including migraine, tension-type, and cluster headaches during pregnancy, as well as the impact of migraine on pregnancy outcomes and complications.(2) Summarize the therapeutic options and strategies for managing headaches in pregnancy and (3) Discuss the causes of secondary headaches and the diagnostic evaluation for new onset headache during pregnancy. CONCLUSION: Primary headache disorders, in particular TTHs and migraines, generally improve during pregnancy. However the frequency of improvement varies greatly. Because the pathophysiology of both migraines and TTHs is poorly understood, this limits our ability to predict improvement. Future research should be focused on headache pathophysiology and the effect of ovarian hormones and the pregnant state on headache pathogenesis.
Assuntos
Transtornos da Cefaleia Primários/terapia , Complicações na Gravidez/terapia , Feminino , Transtornos da Cefaleia Primários/etiologia , Transtornos da Cefaleia Primários/fisiopatologia , Humanos , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/fisiopatologia , Resultado da Gravidez , Fatores de RiscoRESUMO
Motor fluctuations, refractory to conventional medical management, are one of the most troubling aspects of Parkinson's disease. Apomorphine is a dopaminergic agent that has been known to the medical community for more than a century, but has only recently been developed to treat such motor fluctuations. In this article, the authors review the historical background, structure, mechanism of action, pharmacologic properties, clinical trials, indications and side effects, as well as avenues of further research, of apomorphine.
Assuntos
Antiparkinsonianos/uso terapêutico , Apomorfina/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Antiparkinsonianos/efeitos adversos , Antiparkinsonianos/química , Antiparkinsonianos/farmacocinética , Antiparkinsonianos/farmacologia , Apomorfina/efeitos adversos , Apomorfina/química , Apomorfina/farmacocinética , Apomorfina/farmacologia , Contraindicações , Vias de Administração de Medicamentos , Discinesias/tratamento farmacológico , Humanos , Doença de Parkinson/fisiopatologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
A considerable recent literature argues that the same representations, encoded by inferior prefrontal and parietal cells known as "mirror neurons", may be activated in both production and recognition of object-related actions. Here, we test several predictions derived from the contemporary literature on the parity between production and recognition and the putative emergence of the mirror neuron system from a system coding hand-object interactions. Forty-four patients with left-hemisphere stroke, 21 of whom exhibited ideomotor apraxia, performed a number of pantomime imitation and recognition tasks, and performance was scored with respect to hand posture, arm posture, amplitude, and timing. Consistent with predictions, there were strong relationships between object-related pantomime imitation and object-related pantomime recognition, and between imitation and recognition of the hand posture component of object-related actions. Skilled object-related gesture representations are likely to be closely tied to evolutionarily more primitive systems controlling object grasping, to emerge from a mapping between object and action information coded by ventral and dorsal streams, and to be lateralized to the left hemisphere in humans.