Background: On July 19, 2006, the US Food and Drug Administration (FDA) issued an alert, "Potenti... more Background: On July 19, 2006, the US Food and Drug Administration (FDA) issued an alert, "Potentially Life-Threatening Serotonin Syndrome With Combined Use of SSRIs or SNRIs and Triptan Medications." However, the cases that were the basis for the alert were not made available. The FDA recommends that patients treated concomitantly with a triptan and a selective serotonin reuptake inhibitor (SSRI)/selective norepinephrine reuptake inhibitor (SNRI) be informed of the possibility of serotonin syndrome. Methods: Following a Freedom of Information Act request, the FDA provided the 29 cases that they evaluated as the basis for the alert. I summarize the cases, rate the quality of the cases on the basis of the information provided, and then determine whether the cases fulfill the Sternbach and Hunter criteria for serotonin syndrome. Results: Seven cases met the Sternbach criteria but did not meet the Hunter criteria. No cases met both criteria or just the Hunter criteria. Conclusions: Triptans when administered with SSRIs or SNRIs might rarely precipitate serotonin syndrome. The data do not support prohibiting the use of triptans with SSRIs or SNRIs. With increased physician awareness of serotonin syndrome, it is possible that additional cases may be reported.
Whatever the level of your neurological expertise, this issue of "Medical Clinics of North A... more Whatever the level of your neurological expertise, this issue of "Medical Clinics of North America" reviews common neurological disorders that the practicing internist encounters every day, including migraine, vertigo, neck and low back pain, entrapment neuropathies, peripheral neuropathies, seizure disorders, cerebrovascular disease, movement disorders, memory complaints and dementia, sleep disorders, syncope, and multiple sclerosis. As a change from the usual Clinics format, the articles use a question and answer approach to facilitate review of the topics and stimulate the internist's interest in neurology.
n 5 1. That’s the formula for the clinical interactions of neurologists, diagnosing and treating ... more n 5 1. That’s the formula for the clinical interactions of neurologists, diagnosing and treating patients one by one, with their unique genomics, demographics, comorbidities, and clinical presentations. As we all know too well, evidence-based medicine is sometimes helpful, often not. Perhaps 40%ofmedical practice is either not effective or harmful, and often we don’t know. The art of medicine is flourishing in clinical neurology. The May 2006 issue, “Neurology Case Studies,” was very well received. We are again providing you with another case-based issue, which is an excellent exercise in active learning where you can consider each case, come to your own conclusions, and then compare them to the subspecialty experts who review the latest evidence and give their opinions. This issue of the Neurologic Clinics reviews cases and topics in cerebrovascular disease, multiple sclerosis, syncope, neuromuscular disease, sleep disorders, epilepsy, neuro-ophthalmology, headache, tremor, functional neurologic disorders, neurocritical care, dementia, neurology of pregnancy, sports neurology, and neurologic malpractice. The disorders range from the rare to the commonplace, and the issues range from the most controversial to those widely accepted. We hope you find this issue as educational and stimulating to read as we did to write. I thank our distinguished contributors for their outstanding articles. I also thank Lauren Elise Boyle, Clinics editor, Donald Mumford, senior developmental editor, and the Elsevier production team for an excellent job. Finally, I am grateful for the support of my wife, Marilyn, and our children, Elliott, Rochelle, son-in-law, Corry, and Jonathan.
ObjectiveTo provide updated evidence‐based recommendations about when to obtain neuroimaging in p... more ObjectiveTo provide updated evidence‐based recommendations about when to obtain neuroimaging in patients with migraine.MethodsArticles were included in the systematic review if they studied adults 18 and over who were seeking outpatient treatment for any type of migraine and who underwent neuroimaging (MRI or CT). Medline, Web of Science, and Cochrane Clinical Trials were searched from 1973 to August 31, 2018. Reviewers identified studies, extracted data, and assessed the quality of the evidence in duplicate. We assessed study quality using the Newcastle‐Ottawa Scale.ResultsThe initial search yielded 2269 publications. Twenty three articles met inclusion criteria and were included in the final review. The majority of studies were retrospective cohort or cross‐sectional studies. There were 4 prospective observational studies. Ten studies evaluated the utility of CT only, 9 MRI only, and 4 evaluated both. Common abnormalities included chronic ischemia or atrophy with CT and MRI scanni...
Background and ObjectivesPostconcussion syndrome (PCS) has been controversial for more than 150 y... more Background and ObjectivesPostconcussion syndrome (PCS) has been controversial for more than 150 years. As there have not been any surveys of PCS among neurologists in the United States since 1992, another was performed using most of the prior items to assess current opinions and practices and whether there have been any changes since 1992.MethodsTwo hundred and eighty‐nine neurologists attending the Texas Neurological Society 20th Annual Winter Conference continuing medical education meeting in 2017 were supplied the survey instrument with registration materials. The 25 item instrument (including 7 new items) contained items on demographics, definitions, causation, prognosis, medicolegal aspects, testing, and treatment. Forty percent of attendees completed the survey.ResultsThe majority of respondents agree with the following: PCS is a clearly defined syndrome with a solid basis for determining prognosis with an organic basis; accept the authenticity of patients' reports of symp...
In the United States, up to 3.8 million people per year have sports‐related mild traumatic brain ... more In the United States, up to 3.8 million people per year have sports‐related mild traumatic brain injury frequently followed by a variety of headaches. Headaches associated with sports (exertional, weightlifter's, and external compression headache) are also reviewed.
When Ninan Mathew, MD, left us on July 27, 2015, neurology and headache medicine lost a clinical ... more When Ninan Mathew, MD, left us on July 27, 2015, neurology and headache medicine lost a clinical and research giant. Known for his description of transformed migraine, Dr. Mathew's medical practice was a living laboratory where astute clinical work helped thousands of patients and supported cutting-edge clinical research. By mentoring generations of clinicians, publishing frequently, lecturing widely, and leading national and international headache organizations, he left an enduring imprint on headache medicine in the United States and throughout the world.
Background: On July 19, 2006, the US Food and Drug Administration (FDA) issued an alert, "Potenti... more Background: On July 19, 2006, the US Food and Drug Administration (FDA) issued an alert, "Potentially Life-Threatening Serotonin Syndrome With Combined Use of SSRIs or SNRIs and Triptan Medications." However, the cases that were the basis for the alert were not made available. The FDA recommends that patients treated concomitantly with a triptan and a selective serotonin reuptake inhibitor (SSRI)/selective norepinephrine reuptake inhibitor (SNRI) be informed of the possibility of serotonin syndrome. Methods: Following a Freedom of Information Act request, the FDA provided the 29 cases that they evaluated as the basis for the alert. I summarize the cases, rate the quality of the cases on the basis of the information provided, and then determine whether the cases fulfill the Sternbach and Hunter criteria for serotonin syndrome. Results: Seven cases met the Sternbach criteria but did not meet the Hunter criteria. No cases met both criteria or just the Hunter criteria. Conclusions: Triptans when administered with SSRIs or SNRIs might rarely precipitate serotonin syndrome. The data do not support prohibiting the use of triptans with SSRIs or SNRIs. With increased physician awareness of serotonin syndrome, it is possible that additional cases may be reported.
Whatever the level of your neurological expertise, this issue of "Medical Clinics of North A... more Whatever the level of your neurological expertise, this issue of "Medical Clinics of North America" reviews common neurological disorders that the practicing internist encounters every day, including migraine, vertigo, neck and low back pain, entrapment neuropathies, peripheral neuropathies, seizure disorders, cerebrovascular disease, movement disorders, memory complaints and dementia, sleep disorders, syncope, and multiple sclerosis. As a change from the usual Clinics format, the articles use a question and answer approach to facilitate review of the topics and stimulate the internist's interest in neurology.
n 5 1. That’s the formula for the clinical interactions of neurologists, diagnosing and treating ... more n 5 1. That’s the formula for the clinical interactions of neurologists, diagnosing and treating patients one by one, with their unique genomics, demographics, comorbidities, and clinical presentations. As we all know too well, evidence-based medicine is sometimes helpful, often not. Perhaps 40%ofmedical practice is either not effective or harmful, and often we don’t know. The art of medicine is flourishing in clinical neurology. The May 2006 issue, “Neurology Case Studies,” was very well received. We are again providing you with another case-based issue, which is an excellent exercise in active learning where you can consider each case, come to your own conclusions, and then compare them to the subspecialty experts who review the latest evidence and give their opinions. This issue of the Neurologic Clinics reviews cases and topics in cerebrovascular disease, multiple sclerosis, syncope, neuromuscular disease, sleep disorders, epilepsy, neuro-ophthalmology, headache, tremor, functional neurologic disorders, neurocritical care, dementia, neurology of pregnancy, sports neurology, and neurologic malpractice. The disorders range from the rare to the commonplace, and the issues range from the most controversial to those widely accepted. We hope you find this issue as educational and stimulating to read as we did to write. I thank our distinguished contributors for their outstanding articles. I also thank Lauren Elise Boyle, Clinics editor, Donald Mumford, senior developmental editor, and the Elsevier production team for an excellent job. Finally, I am grateful for the support of my wife, Marilyn, and our children, Elliott, Rochelle, son-in-law, Corry, and Jonathan.
ObjectiveTo provide updated evidence‐based recommendations about when to obtain neuroimaging in p... more ObjectiveTo provide updated evidence‐based recommendations about when to obtain neuroimaging in patients with migraine.MethodsArticles were included in the systematic review if they studied adults 18 and over who were seeking outpatient treatment for any type of migraine and who underwent neuroimaging (MRI or CT). Medline, Web of Science, and Cochrane Clinical Trials were searched from 1973 to August 31, 2018. Reviewers identified studies, extracted data, and assessed the quality of the evidence in duplicate. We assessed study quality using the Newcastle‐Ottawa Scale.ResultsThe initial search yielded 2269 publications. Twenty three articles met inclusion criteria and were included in the final review. The majority of studies were retrospective cohort or cross‐sectional studies. There were 4 prospective observational studies. Ten studies evaluated the utility of CT only, 9 MRI only, and 4 evaluated both. Common abnormalities included chronic ischemia or atrophy with CT and MRI scanni...
Background and ObjectivesPostconcussion syndrome (PCS) has been controversial for more than 150 y... more Background and ObjectivesPostconcussion syndrome (PCS) has been controversial for more than 150 years. As there have not been any surveys of PCS among neurologists in the United States since 1992, another was performed using most of the prior items to assess current opinions and practices and whether there have been any changes since 1992.MethodsTwo hundred and eighty‐nine neurologists attending the Texas Neurological Society 20th Annual Winter Conference continuing medical education meeting in 2017 were supplied the survey instrument with registration materials. The 25 item instrument (including 7 new items) contained items on demographics, definitions, causation, prognosis, medicolegal aspects, testing, and treatment. Forty percent of attendees completed the survey.ResultsThe majority of respondents agree with the following: PCS is a clearly defined syndrome with a solid basis for determining prognosis with an organic basis; accept the authenticity of patients' reports of symp...
In the United States, up to 3.8 million people per year have sports‐related mild traumatic brain ... more In the United States, up to 3.8 million people per year have sports‐related mild traumatic brain injury frequently followed by a variety of headaches. Headaches associated with sports (exertional, weightlifter's, and external compression headache) are also reviewed.
When Ninan Mathew, MD, left us on July 27, 2015, neurology and headache medicine lost a clinical ... more When Ninan Mathew, MD, left us on July 27, 2015, neurology and headache medicine lost a clinical and research giant. Known for his description of transformed migraine, Dr. Mathew's medical practice was a living laboratory where astute clinical work helped thousands of patients and supported cutting-edge clinical research. By mentoring generations of clinicians, publishing frequently, lecturing widely, and leading national and international headache organizations, he left an enduring imprint on headache medicine in the United States and throughout the world.
Uploads
Papers by Randolph Evans