Edaravone, a novel free radical scavenger, demonstrates neuroprotective effects by inhibiting vascular endothelial cell injury and ameliorating neuronal damage in ischemic brain models. The present study was undertaken to verify its therapeutic efficacy following acute ischemic stroke. We performed a multicenter, randomized, placebo-controlled, double-blind study on acute ischemic stroke patients commencing within 72 h of onset. Edaravone was infused at a dose of 30 mg, twice a day, for 14 days. At discharge within 3 months or at 3 months after onset, the functional outcome was evaluated using the modified Rankin Scale. Two hundred and fifty-two patients were initially enrolled. Of these, 125 were allocated to the edaravone group and 125 to the placebo group for analysis. Two patients were excluded because of subarachnoid hemorrhage and disseminated intravascular coagulation. A significant improvement in functional outcome was observed in the edaravone group as evaluated by the modified Rankin Scale (p = 0.0382). Edaravone represents a neuroprotective agent which is potentially useful for treating acute ischemic stroke, since it can exert significant effects on functional outcome as compared with placebo.

BRIEF SUMMARYCurrent Knowledge/Study Rationale: Botulinum toxin type A (BoNT-A) has been used for managing involuntary orofacial movements and secondary bruxism in patients with movement disorders, but its usefulness and objective effects on sleep bruxism (SB) have not been evaluated using objective measures. The aim of this study was to investigate the effects of intramuscular BoNT-A injection on orofacial motor events during sleep in patients with clinical diagnosis of SB. Study Impact: A single injection of BoNT-A into jaw-closing muscles is an effective strategy for controlling SB for at least a month. It reduces the intensity rather than the generation of the contraction in the jaw-closing muscles. Establishing management of SB with BoNT-A awaits further studies on larger samples over a longer follow-up period. Medicine, Vol. 10, No. 3, 2014 YJ Shim, MK Lee, T Kato et al equally effective in pain reduction when compared with oral splint. 17,18 The result of these studies and case reports were based on the subjective evaluation of SB, not on the objective assessment using electromyography (EMG) or polysomnography (PSG). A study using portable electromyographic (EMG) device showed that the counts of sleep related masticatory EMG bursts, detected by the pre-defined threshold, were significantly reduced after a single injection of BoNT-A in the masseter muscle. 19 However, it remains unclear how BoNT-A injection works specifically for sleep-related masticatory EMG activity, as a variety of jaw motor activities occur in association with transient arousal changes during sleep. 20 Video-polysomnography (vPSG) can be a useful tool allowing discrimination of the types of sleep-related masticatory EMG events. 2 In previous case reports and studies, some cases injected BoNT-A into the masseter muscle only, [13][14][15]17,18 and others into both the masseter and temporalis muscles. 10,11,15 The masseter and temporalis muscles are synergetic muscles and activated during teeth grinding and clenching; however, there have been no studies assessing the difference between the choices or the combination of the injected muscles for motor activity control of the jaw during sleep. 292 Journal of Clinical SleepTherefore, the aims of this study were to investigate the effects of intramuscular BoNT-A injection on jaw motor episodes using vPSG. In addition to the use of vPSG, we compared the effects of BoNT-A on jaw motor episodes between the injection sites (i.e., the masseter muscle injection only versus injection of both masseter and temporalis muscles). METHODS SubjectsThe protocol of this study was undertaken with the approval of Korea Food & Drug Administration and Institutional Review Board of the Yonsei University Dental Hospital. All subjects were informed of the nature of the study, and written consent was obtained from each participant.Twenty-four subjects (M: 10; F: 14, age: 20.2-38.7 years) were selected from among outpatients at the Department of Orofacial Pain and Oral Medicine, Yonsei University Dental Hospital. A...

Summary:Purpose: To investigate the prognosis related to antiepileptic drug (AED) discontinuation after successful surgery for intractable temporal lobe epilepsy.Methods: The clinical courses after temporal lobectomies (TLs) were retrospectively analyzed in 88 consecutive patients. All the patients had TLs as the only surgical procedure, and they had been followed up for longer than 3 years. AED discontinuation was attempted if the patient had been seizure free without aura for ≥1 year during the follow-up period.Results: Sixty-six (75%) patients achieved complete seizure freedom for ≥1 year; 28 patients were seizure free immediately after surgery (immediate success); and 38 patients became seizure free after some period of recurrent seizures (delayed success). AED discontinuation was attempted in 60 (91%) of 66 patients with a successful outcome. In 13 (22%) patients, seizure relapse developed during AED reduction (n = 60), and in seven (12%) patients after discontinuation of AEDs (n = 38). The seizure recurrence rate was not different between the immediateand delayed-success groups. Among 20 patients with seizure relapse related to AED tapering, nine (45%) of them regained seizure freedom after reinstitution of AED treatment, and AEDs were eventually discontinued in six of them. Seizures that recurred after complete AED discontinuation had a better prognosis than did the seizures that recurred during AED reduction (seizure freedom in 86% vs. 23%). At the final assessment, 54 (61%) patients had been seizure free ≥1 year; 37 without AEDs and 17 with AEDs. The successful discontinuation of AEDs was more frequent for patients with a younger age at the time of surgery and for those patients with shorter disease duration.Conclusions: Our results suggest that seizure freedom without aura at ≥1 year is a reasonable indication for the attempt at AED discontinuation. The subsequent control of recurrent seizures was excellent, especially if seizures relapsed after the complete discontinuation of AEDs. Younger age at the time of surgery and a shorter disease duration seem to affect successful AED discontinuation for a long-term period. Key Words: Temporal lobe epilepsy-Epilepsy surgeryAntiepileptic drug discontinuation-Seizure recurrence.Temporal lobectomy (TL) is a well-recognized treatment modality for medically refractory temporal lobe epilepsy (TLE), which carries a wide range of seizurefree rates from 33 to 93% (median, 70%), according to a recent systematic review (1). Most outcome studies have adopted cross-sectional analysis methods, which have been problematic in understanding the longitudinal seizure outcome. From those studies, it is even more difficult to assess the surgical outcome related to alterations of antiepileptic drug (AED) therapy.The ultimate success of epilepsy surgery is to achieve a state of complete seizure freedom without AED treatment. However, trials of AED discontinuation for patients rendered seizure free by surgery is arduous for both paAccepted October 2, 2004. Address correspondence and ...

These results strongly suggest that the A-allele of the MRP2 single nucleotide polymorphism c.1247G>A is associated with adverse neurological drug reactions to carbamazepine.

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