By T. Marik. University of Wisconsin-Stout.

Kaplan generic 200 mg ansaid fast delivery, MD PhD Department of Neurology Cornell Medical School North Shore University Hospital Manhasset purchase 200 mg ansaid free shipping, NY 11030 USA Thomas J. Kiresuk, PhD Department of Psychiatry University of Minnesota Medical School Minneapolis, MN and Minneapolis Medical Research Foundation Minneapolis, MN 2605 Valley View Road Burnsville, MN 55306–5230 USA Michael L. Mueller, MD Division of General Internal Medicine Mayo Clinic 200 First Street SW Rochester, MN 55905 USA Michael R. Nash Department of Psychology and Anthropology University of Texas—Pan American 1201 West University Drive Edinburg, TX 78541 USA Elizabeth A. North, DO Oregon Stroke Center Oregon Health & Science University 3181 SW Sam Jackson Park Road Portland, OR 97201–3098 USA Robert Nickel, MD 2338 Harris Street Eugene, OR 97405 USA Barry S. Oken, MD Departments of Neurology and Behavioral Neuroscience Oregon Health & Science University 3181 SW Sam Jackson Park Road Portland, OR 97201–3098 USA David Riley, MD 6 Amigos Lane Santa Fe, NM 87508 USA Lynne Shinto, MD Department of Neurology Oregon Health & Science University 3181 SW Sam Jackson Park Road Portland, OR 97201–3098 USA Amala Soumyanath (née Raman), PhD Department of Neurology Oregon Health & Science University 3181 SW Sam Jackson Park Road Portland, OR 97201–3098 USA Rand S. Swenson, DC MD PhD Department of Medicine (Neurology) and Anatomy Dartmouth Medical School One Medical Center Drive Lebanon, NH 03756 USA Alan I. Trachtenberg, MD MPH Office of Pharmacologic and Alternative Therapies Center for Substance Abuse Treatment Substance Abuse and Mental Health Services Administration United States Public Health Service and George Washington University School of Public Health and Health Services 2300 I Street, NW Ross Hall 106 Washington, DC 20037 USA Marian Wolfe Dixon, MA LMT Oregon Center for Complementary and Alternative Medicine 2341 SE 32nd Avenue Portland, OR 97214 USA Vijayshree Yadav, MD The Multiple Sclerosis Center of Oregon Department of Neurology Oregon Health & Science University 3181 SW Sam Jackson Park Road Portland, OR 97201–3098 USA Preface There is a significant use of complementary and alternative therapies throughout the world. Some of these benefits are proven, some are not well studied, and some of these purported benefits have already been shown to be lacking. These complementary therapies may interact with conventional treatments, so it is critical for conventionally trained health-care providers to be knowledgeable about the complementary therapies their patients are using. Despite these facts, there is a lack of knowledge of complementary therapies by many conventionally trained physicians. For all these reasons, it seemed an appropriate time to provide a book focusing on complementary therapies for neurological disorders. This book is targeted to any health-care provider who sees people with neurological diseases. While there are other books in the general area and even one for neurological disorders, the scientific level of all the chapters, especially those sections organized by disease states or conditions, should be accessible to even the most scientifically stringent, conventionally trained physicians, including neurologists.

Several brain regions and numerous neurotransmitters are involved with the function and regulation of neuronal activity within the basal ganglia purchase 200 mg ansaid with amex. The direct pathway (2) the striatum to SNpr) becomes less active generic ansaid 200 mg, whereas the indirect pathway (3) striatum to globus pallidus to STN to SNpr) increases in activity. The consequence is an enhanced activation of SNpr outflow neurons (4), which exert an overall reduction of the thalamic–cortical pathway (5). DA, dopamine; Glu, glutamate, excitatory transmitter; GABA, - amino butyric acid, inhibitory transmitter; ACh, acetylcholine, excitatory intrastriatal transmitter. GP, globus pallidus; SNpc, substantia nigra pars compacta; SNpr, substantia nigra, pars reticulate; STN, subthalamic nucleus. Dopamine is a catecholamine (see Chapter 10 and The inability of the neurons to eliminate the oxidative Fig. Dopamine actions on D3 4 1 receptors ex- source of oxidative stress may be dopamine metabolism ert an excitatory effect, whereas the actions of (Fig. The stantia nigra created by the loss of dopamine actions loss of striatal dopamine produces an imbalance in in- within the striatum could lead to excitotoxicity that is formation processing in the neostriatum that modifies mediated by glutamate. Also impor- tant in neural transmission are the striatal interneurons Therapy of Parkinsonism that are found within the confines of the striatum, that use the excitatory neurotransmitter acetylcholine, and Since there is no cure for parkinsonism, the aim of phar- that modulate the activity of striatal output neurons. This is obtained through the use of drugs that either in- crease dopaminergic actions or diminish neuronal out- Possible Mechanisms flow from the striatum. These drugs include levodopa, of Neurodegeneration which increases brain dopamine levels; dopamine ago- The mechanisms responsible for the degeneration of nists, which directly stimulate dopamine receptors; dopamine neurons are not known, but hypotheses in- monoamine oxidase (MAO) inhibitors, which prevent clude effects such as oxidative stress and excitotoxicity. Dopamine itself does not cross the Levodopa and Carbidopa blood-brain barrier and therefore has no CNS effects. Levodopa (L-DOPA), the most reliable and effective However, levodopa, as an amino acid, is transported drug used in the treatment of parkinsonism, can be con- into the brain by amino acid transport systems, where it SYNTHESIS COOH CH2 CH NH2 HO Tyrosine Tyrosine Hydroxylase COOH HO CH2 CH NH2 HO DOPA Aromatic Amino Acid Decarboxylase HO CH2 CH2 NH2 HO DA METABOLISM 2 H2O Catechol-O-methyl Monoamine H2O2 2 Oxidase Fe Transferase • OH OH Fe 3 CH3O CH2 CH2 NH2 HO CH2COOH HO HO MTA DOPAC Monoamine Catechol-O-methyl Oxidase Transferase CH3O CH2COOH HO HVA FIGURE 31.

Clinical research into acupuncture has largely consisted of uncontrolled trials for the treatment of chronic pain in adults ansaid 200 mg generic. While beneficial results have been frequently demonstrated generic ansaid 200mg free shipping, the flawed design of many studies gives limited value to the results. Several difficulties are inherent in the designing of valid blinded, randomized 22,23 controlled trials of acupuncture. The studies have to be, at best, single blind, as a trained acupuncturist must do the needling. Difficulties also arise in determining an appropriate placebo for the control group. This factor is important, since as many as 30% of subjects may respond positively to some placebos. There is little consistency in the literature pertaining to the criteria used for acupuncture research. Sham acupuncture is commonly used for the control treatment in research trials involving acupuncture, but it presents a unique problem as a placebo. The well-outlined energy channels of the acupuncture meridian systems cover the entire body, linking Wei- Qi (defence Qi), Rong-Qi (growth and development Qi) and Yuan-Qi (the original Qi inherited at birth). As the meridian systems affect the entire body, the sham acupuncture does have some acupuncture effects. To try to address this difficulty, a placebo acupuncture needle has been developed. The placebo acupuncture needle retracts back into the handle of the acupuncture needle and does not 24 penetrate the skin. Chronic pain 25 Richardson and Vincent reviewed 27 controlled studies of acupuncture for treating acute and chronic pain, as well as several large uncontrolled studies. Of the patients, 50– 80% showed that short-term data made assessment of long-term effectiveness difficult.