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By M. Kasim. Jewish Theological Seminary.

Spinal cord injuries occurring at T-1 or below result in paraplegia (paralysis of Treatment and Management of the lower extremities) purchase escitalopram 10mg amex. Upper extremities discount 10 mg escitalopram amex, Spinal Cord Injury for the most part, are unimpaired, with Initial Treatment of Spinal Cord Injury the exception of T-1 injuries, in which there may be slight weakness and some The initial treatment of spinal cord in- loss of flexibility in the hands. Individuals juries focuses on preventing further injury, with injury between T-1 and T-3 may stabilizing individuals’ physical condi- need a brace or other support to maintain tion, and in some instances performing posture in an upright position because surgery to realign the spinal column or even though the upper extremities are achieve decompression of the spinal cord. In most cases, individuals with injuries, especially those who received the injuries at T-1 through T-12 are able to injury as the result of an accident, will attain total independence in self-care, have other injuries, such as fractures, wheelchair ambulation, and transfer. In- injury to internal organs, or brain injuries, dividuals with injury at T-7 to T-12 may that further complicate their care. The “halo” is attached Many of the muscles of mobility are in- with two metal rods to a “vest” worn on tact with L-1 through L-5 injuries. The halo brace per body muscles and many of the leg is used to allow mobility while keeping muscles are functional. Although bowel and blad- der function are still impaired, reflex empty- Postacute Treatment and Rehabilitation ing of bowel and bladder may be possible. After the condition has been stabilized Spinal Cord Injuries at the Sacral Level and acute medical needs met, individuals (S1 through S-4) are usually transferred to a rehabilitation unit, where they learn skills or learn to Ambulation is usually possible with lit- use adaptive devices that will help them tle or no equipment. Bowel and bladder to achieve the maximum level of inde- 80 CHAPTER 3 CONDITIONS OF THE NERVOUS SYSTEM: PART II Figure 3–2 Halo Brace. A wide variety of health profes- extremities) placed into an upright posi- sionals are usually involved in this phase tion as soon as possible to prevent com- of rehabilitation, including physiatrists, plications such as respiratory problems physical therapists, rehabilitation nurses, from occurring. A tilt board or circular bed occupational therapists, orthotists, psycholo- is used to accomplish this goal. Individ- gists, social workers, and rehabilitation coun- uals are strapped securely to the tilt board selors. Physical therapy begins as soon as pos- The board is then gradually raised or the sible to prevent deformities such as con- circular bed rotated until the individual is tractures (permanent contractions of a upright. Most individuals with spinal cord to have individuals with either paraple- injury become mobile with a wheelchair. For able for individuals who have little or no example, because pain is not felt, appen- use of their upper extremities. These dicitis may not be discovered until the chairs are battery operated and can be appendix ruptures. In some instances controlled with a switch adapted to the symptoms may be expressed differently in particular individual’s ability.

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Because the glomerular filtrate is virtually protein- Chapter 16); therefore 10 mg escitalopram visa, it is determined by the same fac- free order escitalopram 20mg without prescription, we neglect the colloid osmotic pressure of fluid in tors that affect fluid movement across capillaries in gen- Bowman’s capsule. The net ultrafiltration pressure gradi- CHAPTER 23 Kidney Function 389 ent (UP) is equal to the difference between the pressures to blood flow, resulting in an appreciable fall in capillary favoring and opposing filtration: hydrostatic pressure with distance. Finally, note that in the glomerulus, the colloid osmotic pressure increases substan- GFR Kf UP Kf (PGC PBS COP) (10) tially along the length of the capillary because a large vol- where Kf is the glomerular ultrafiltration coefficient. Esti- ume of filtrate (about 20% of the entering plasma flow) is mates of average, normal values for pressures in the human pushed out of the capillary and the proteins remain in the kidney are: PGC, 55 mm Hg; PBS, 15 mm Hg; and COP, 30 circulation. From these values, we calculate a net ultrafiltration poses the outward movement of fluid. In the skeletal muscle capillary, the colloid osmotic pres- sure hardly changes with distance, since little fluid moves across the capillary wall. In the “average” skeletal muscle The Pressure Profile Along a Glomerular capillary, outward filtration occurs at the arterial end and Capillary Is Unusual absorption occurs at the venous end. At some point along the skeletal muscle capillary, there is no net fluid move- Figure 23. Filtration pressure equilibrium probably is not at- illary in other vascular beds (in this case, skeletal muscle). Also, capillary hydrostatic pres- sure declines little (perhaps 1 to 2 mm Hg) along the length Several Factors Can Affect GFR of the glomerular capillary because the glomerulus contains many (30 to 50) capillary loops in parallel, making the re- The GFR depends on the magnitudes of the different terms sistance to blood flow in the glomerulus very low. Therefore, GFR varies with changes in K ,f skeletal muscle capillary, there is a much higher resistance hydrostatic pressures in the glomerular capillaries and Bow- A. The middle line is the sum of PBS and the capillary and a glomerular capillary. The differ- the typical skeletal muscle capillary, filtration occurs at the arte- ence between PGC and PBS COP is equal to the net ultrafiltra- rial end and absorption at the venous end of the capillary. In the normal human glomerulus, fil- stitial fluid hydrostatic and colloid osmotic pressures are neg- tration probably occurs along the entire capillary.

Disler DG (1997) Fat-suppressed three-dimensional spoiled gra- of magnetic resonance image cheap escitalopram 20mg without prescription. J Pediatr Orthop 15(6):812- dient-recalled MR imaging: assessment of articular and physeal 816 hyaline cartilage buy 5mg escitalopram otc. Borsa JJ, Peterson HA, Ehman RL (1996) MR imaging of phy- BJ, Mulkern RV et al (1996) Gadolinium-enhanced MR imag- seal bars. Radiology 199:683-687 ing demonstrates abduction-caused hip ischemia and its rever- 54. AJR Am J Roentgenol 166:879-887 Pediatric knee MR imaging: pattern of injuries in the imma- 32. Jaramillo D, Villegas-Medina O, Laor T, Shapiro F, Millis MB ture skeleton. Radiology 190:397-401 (1998) Gadolinium-enhanced MR imaging of pediatric pa- 55. Fletcher BD (1991) Response of osteosarcoma and Ewing sar- tients after reduction of dysplastic hips: assessment of femoral coma to chemotherapy: imaging evaluation. AJR Am J head position, factors impeding reduction, and femoral head Roentgenol 157(4):825-833 ischemia. Bos CF, Bloem JL, Bloem RM (1991) Sequential magnetic loskeletal magnetic resonance imaging: how we do it. Sebag G, Ducou Le Pointe H, Klein I, Maiza D, Mazda K, formity secondary to brachial plexus birth palsy. J Bone Joint Bensahel H et al (1997) Dynamic gadolinium-enhanced sub- Surg Am 80(5):668-677 traction MR imaging–a simple technique for the early diagno- 58. Ruby L, Mital MA, O’Connor J, Patel U (1979) Anteversion sis of Legg-Calve-Perthes disease: preliminary results. Zurakowski D (1995) Cartilaginous abnormalities and growth Clin Orthop 120:159-163 disturbances in Legg-Calvé-Perthes disease: evaluation with 60. In: Rumack C, M, Montagne JP (1994) Legg-Perthes-Calve disease: staging Wilson S, Charboneau J (eds) Diagnostic ultrasound. Marks DS, Clegg J, al-Chalabi AN (1994) Routine ultrasound Clin N Am 6(3):627-641 screening for neonatal hip instability. Kaniklides C (1996) Diagnostic radiology in Legg-Calvé- senting congenital dislocation of the hip? Harcke HT (1994) Screening newborns for developmental loskeletal inflammatory and infectious disorders.

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CHAPTER 3 The Action Potential escitalopram 10 mg amex, Synaptic Transmission buy escitalopram 20 mg on-line, and Maintenance of Nerve Function 49 λ2 λ1 A Action λ2 potential λ1 Dendrite Em Length Synapse 1 Action FIGURE 3. The decay of the membrane potential, Em, as it proceeds along the length of the dendrite is affected by the space constant, m. Long space constants cause the electrotonic potential to de- cay more gradually. Profiles are shown for two dendrites with dif- ferent space constants, and. The electrotonic potential of Synapse 2 1 2 dendrite 2 decays less steeply than that of dendrite 1 because its space constant is longer. As with tem- poral summation, if the depolarizations resulting from spatial summation are sufficient to cause the membrane potential in the region of axon hillock to reach threshold, Current the postsynaptic neuron will generate an action potential (Fig. Axon hillock Because of the spatial decay of the electrotonic poten- Axon tial, the location of the synaptic contact strongly influ- ences whether a synapse can activate a postsynaptic neu- ron. For example, axodendritic synapses, located in distal segments of the dendritic tree, are far removed from the axon hillock, and their activation has little impact on the membrane potential near this trigger zone. In contrast, axosomatic synapses have a greater effect in altering the B membrane potential at the axon hillock because of their proximal location. NEUROCHEMICAL TRANSMISSION Neurons communicate with other cells by the release of chemical neurotransmitters, which act transiently on post- synaptic receptors and then must be removed from the Synapse 1 Synapse 2 Dendrite synaptic cleft (Fig. Transmitter is stored in synaptic length vesicles and released on nerve stimulation by the process of exocytosis, following the opening of voltage-gated calcium ion channels in the nerve terminal. Once released, the neu- rotransmitter binds to and stimulates its receptors briefly C before being rapidly removed from the synapse, thereby al- lowing the transmission of a new neuronal message. The most common mode of removal of the neurotransmitter fol- lowing release is called high-affinity reuptake by the presy- naptic terminal. This is a carrier-mediated, sodium-depend- ent, secondary active transport that uses energy from the Na /K - ATPase pump. Other removal mechanisms in- clude enzymatic degradation into a nonactive metabolite in the synapse or diffusion away from the synapse into the ex- tracellular space.

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More hope rests on a genetic approach and the mutated gene has in fact been identified and cloned but its precise role remains uncertain order 5 mg escitalopram overnight delivery. For details of its structure 5mg escitalopram visa, possible actions and appropriate models see Reddy, Williams and Tagle (1999). ADDENDUM The first proper double blind trial of embryonic implants in 40 PD patients (20 undergoing just surgery without any implant), has shown no improvement in patients over 60 years but some clinical benefit (fewer symptoms between levodopa dosing) in those below that age. Unfortunately some of these responders eventually developed dyskinesias, a sign of too much dopamine, and further implants were halted until the technique has been re-evaluated, see Freed, CR et al. Chesselet, M-F and Delfs, JM (1996) Basal ganglia and movement disorders. Chiara, G, Morelli, M and Consolo, S (1994) Modulatory function of neurotransmitters in the striatum: ACh/dopamine/NMDA interactions. Cotzias, GC, von Woert, MH and Schiffer, LM (1967) Aromatic amino acids and modification of Parkinsonism. Ehringer, H and Hornykiewicz, O (1960) Verteilung von Noradrenalin and Dopamin im Gehirn des Menschen und ihr Verholten bei Erkrankungen des Extrapyramidalen systems. Ferre, S, Fredholm, BB, Morelli, M, Popoli, P and Fuxe, K (1997) Adenosine±dopamine receptor±receptor interaction as an integrative mechanism in the basal ganglia. Hirsch, EC and Hunot, S (2000) Nitric oxide, glial cells and neuronal degeneration in Parkinsonism. Jolkkonen, J, Jenner, P and Marsden, CD (1995) L-Dopa reverses altered gene expression of substance P but not enkephalin in the caudate-putamen of common marmosets treated with MPTP. Kawaguchi, Y, Wilson, CJ, Augood, ST and Emson, PC (1995) Striatal interneurones: chemical physiological and morphological characterization. Maneuf, YP, Mitchell, IJ, Crossman, AR, Woodruff, GN and Brotchis, JM (1995) Functional implications of Kappa opioid receptor mediated modulation of glutamate transmission in the output regions of the basal ganglia in rodent and primate models. Mercuri, NB, Bonci, A and Bernardi, G (1997) Electrophysiological pharmacology of the autoreceptor mediated responses of dopaminergic cells to antiparkinsonian drugs. Piccini, P, Brooks, DJ, Bjorklund, A, Gunn, RN, Grasby, PM, Ornella, R, Brundin, P, Hagell, P, Rehncrona, S, Widner, H and Lindvall, O (1999) Dopamine release from nigral transplants visualised in vivo in a Parkinsonian patient. Treseder, SA, Jackson, M and Jenner, P (2000) The effects of central aromatic amino acid (dopa) decarbosylase inhibition on the motor actions of L-dopa and dopamine agonists in MPTP- treated primates. Edited by Roy Webster Copyright & 2001 John Wiley & Sons Ltd ISBN: Hardback 0-471-97819-1 Paperback 0-471-98586-4 Electronic 0-470-84657-7 16 The Epilepsies R. It is a considered and apt definition that highlights important aspects of the disorder that are relevant to our understanding and treatment of it.

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By M. Kasim. Jewish Theological Seminary.

Spinal cord injuries occurring at T-1 or below result in paraplegia (paralysis of Treatment and Management of the lower extremities) purchase escitalopram 10mg amex. Upper extremities discount 10 mg escitalopram amex, Spinal Cord Injury for the most part, are unimpaired, with Initial Treatment of Spinal Cord Injury the exception of T-1 injuries, in which there may be slight weakness and some The initial treatment of spinal cord in- loss of flexibility in the hands. Individuals juries focuses on preventing further injury, with injury between T-1 and T-3 may stabilizing individuals’ physical condi- need a brace or other support to maintain tion, and in some instances performing posture in an upright position because surgery to realign the spinal column or even though the upper extremities are achieve decompression of the spinal cord. In most cases, individuals with injuries, especially those who received the injuries at T-1 through T-12 are able to injury as the result of an accident, will attain total independence in self-care, have other injuries, such as fractures, wheelchair ambulation, and transfer. In- injury to internal organs, or brain injuries, dividuals with injury at T-7 to T-12 may that further complicate their care. The “halo” is attached Many of the muscles of mobility are in- with two metal rods to a “vest” worn on tact with L-1 through L-5 injuries. The halo brace per body muscles and many of the leg is used to allow mobility while keeping muscles are functional. Although bowel and blad- der function are still impaired, reflex empty- Postacute Treatment and Rehabilitation ing of bowel and bladder may be possible. After the condition has been stabilized Spinal Cord Injuries at the Sacral Level and acute medical needs met, individuals (S1 through S-4) are usually transferred to a rehabilitation unit, where they learn skills or learn to Ambulation is usually possible with lit- use adaptive devices that will help them tle or no equipment. Bowel and bladder to achieve the maximum level of inde- 80 CHAPTER 3 CONDITIONS OF THE NERVOUS SYSTEM: PART II Figure 3–2 Halo Brace. A wide variety of health profes- extremities) placed into an upright posi- sionals are usually involved in this phase tion as soon as possible to prevent com- of rehabilitation, including physiatrists, plications such as respiratory problems physical therapists, rehabilitation nurses, from occurring. A tilt board or circular bed occupational therapists, orthotists, psycholo- is used to accomplish this goal. Individ- gists, social workers, and rehabilitation coun- uals are strapped securely to the tilt board selors. Physical therapy begins as soon as pos- The board is then gradually raised or the sible to prevent deformities such as con- circular bed rotated until the individual is tractures (permanent contractions of a upright. Most individuals with spinal cord to have individuals with either paraple- injury become mobile with a wheelchair. For able for individuals who have little or no example, because pain is not felt, appen- use of their upper extremities. These dicitis may not be discovered until the chairs are battery operated and can be appendix ruptures. In some instances controlled with a switch adapted to the symptoms may be expressed differently in particular individual’s ability.

discount 20 mg escitalopram

Because the glomerular filtrate is virtually protein- Chapter 16); therefore 10 mg escitalopram visa, it is determined by the same fac- free order escitalopram 20mg without prescription, we neglect the colloid osmotic pressure of fluid in tors that affect fluid movement across capillaries in gen- Bowman’s capsule. The net ultrafiltration pressure gradi- CHAPTER 23 Kidney Function 389 ent (UP) is equal to the difference between the pressures to blood flow, resulting in an appreciable fall in capillary favoring and opposing filtration: hydrostatic pressure with distance. Finally, note that in the glomerulus, the colloid osmotic pressure increases substan- GFR Kf UP Kf (PGC PBS COP) (10) tially along the length of the capillary because a large vol- where Kf is the glomerular ultrafiltration coefficient. Esti- ume of filtrate (about 20% of the entering plasma flow) is mates of average, normal values for pressures in the human pushed out of the capillary and the proteins remain in the kidney are: PGC, 55 mm Hg; PBS, 15 mm Hg; and COP, 30 circulation. From these values, we calculate a net ultrafiltration poses the outward movement of fluid. In the skeletal muscle capillary, the colloid osmotic pres- sure hardly changes with distance, since little fluid moves across the capillary wall. In the “average” skeletal muscle The Pressure Profile Along a Glomerular capillary, outward filtration occurs at the arterial end and Capillary Is Unusual absorption occurs at the venous end. At some point along the skeletal muscle capillary, there is no net fluid move- Figure 23. Filtration pressure equilibrium probably is not at- illary in other vascular beds (in this case, skeletal muscle). Also, capillary hydrostatic pres- sure declines little (perhaps 1 to 2 mm Hg) along the length Several Factors Can Affect GFR of the glomerular capillary because the glomerulus contains many (30 to 50) capillary loops in parallel, making the re- The GFR depends on the magnitudes of the different terms sistance to blood flow in the glomerulus very low. Therefore, GFR varies with changes in K ,f skeletal muscle capillary, there is a much higher resistance hydrostatic pressures in the glomerular capillaries and Bow- A. The middle line is the sum of PBS and the capillary and a glomerular capillary. The differ- the typical skeletal muscle capillary, filtration occurs at the arte- ence between PGC and PBS COP is equal to the net ultrafiltra- rial end and absorption at the venous end of the capillary. In the normal human glomerulus, fil- stitial fluid hydrostatic and colloid osmotic pressures are neg- tration probably occurs along the entire capillary.

Disler DG (1997) Fat-suppressed three-dimensional spoiled gra- of magnetic resonance image cheap escitalopram 20mg without prescription. J Pediatr Orthop 15(6):812- dient-recalled MR imaging: assessment of articular and physeal 816 hyaline cartilage buy 5mg escitalopram otc. Borsa JJ, Peterson HA, Ehman RL (1996) MR imaging of phy- BJ, Mulkern RV et al (1996) Gadolinium-enhanced MR imag- seal bars. Radiology 199:683-687 ing demonstrates abduction-caused hip ischemia and its rever- 54. AJR Am J Roentgenol 166:879-887 Pediatric knee MR imaging: pattern of injuries in the imma- 32. Jaramillo D, Villegas-Medina O, Laor T, Shapiro F, Millis MB ture skeleton. Radiology 190:397-401 (1998) Gadolinium-enhanced MR imaging of pediatric pa- 55. Fletcher BD (1991) Response of osteosarcoma and Ewing sar- tients after reduction of dysplastic hips: assessment of femoral coma to chemotherapy: imaging evaluation. AJR Am J head position, factors impeding reduction, and femoral head Roentgenol 157(4):825-833 ischemia. Bos CF, Bloem JL, Bloem RM (1991) Sequential magnetic loskeletal magnetic resonance imaging: how we do it. Sebag G, Ducou Le Pointe H, Klein I, Maiza D, Mazda K, formity secondary to brachial plexus birth palsy. J Bone Joint Bensahel H et al (1997) Dynamic gadolinium-enhanced sub- Surg Am 80(5):668-677 traction MR imaging–a simple technique for the early diagno- 58. Ruby L, Mital MA, O’Connor J, Patel U (1979) Anteversion sis of Legg-Calve-Perthes disease: preliminary results. Zurakowski D (1995) Cartilaginous abnormalities and growth Clin Orthop 120:159-163 disturbances in Legg-Calvé-Perthes disease: evaluation with 60. In: Rumack C, M, Montagne JP (1994) Legg-Perthes-Calve disease: staging Wilson S, Charboneau J (eds) Diagnostic ultrasound. Marks DS, Clegg J, al-Chalabi AN (1994) Routine ultrasound Clin N Am 6(3):627-641 screening for neonatal hip instability. Kaniklides C (1996) Diagnostic radiology in Legg-Calvé- senting congenital dislocation of the hip? Harcke HT (1994) Screening newborns for developmental loskeletal inflammatory and infectious disorders.

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CHAPTER 3 The Action Potential escitalopram 10 mg amex, Synaptic Transmission buy escitalopram 20 mg on-line, and Maintenance of Nerve Function 49 λ2 λ1 A Action λ2 potential λ1 Dendrite Em Length Synapse 1 Action FIGURE 3. The decay of the membrane potential, Em, as it proceeds along the length of the dendrite is affected by the space constant, m. Long space constants cause the electrotonic potential to de- cay more gradually. Profiles are shown for two dendrites with dif- ferent space constants, and. The electrotonic potential of Synapse 2 1 2 dendrite 2 decays less steeply than that of dendrite 1 because its space constant is longer. As with tem- poral summation, if the depolarizations resulting from spatial summation are sufficient to cause the membrane potential in the region of axon hillock to reach threshold, Current the postsynaptic neuron will generate an action potential (Fig. Axon hillock Because of the spatial decay of the electrotonic poten- Axon tial, the location of the synaptic contact strongly influ- ences whether a synapse can activate a postsynaptic neu- ron. For example, axodendritic synapses, located in distal segments of the dendritic tree, are far removed from the axon hillock, and their activation has little impact on the membrane potential near this trigger zone. In contrast, axosomatic synapses have a greater effect in altering the B membrane potential at the axon hillock because of their proximal location. NEUROCHEMICAL TRANSMISSION Neurons communicate with other cells by the release of chemical neurotransmitters, which act transiently on post- synaptic receptors and then must be removed from the Synapse 1 Synapse 2 Dendrite synaptic cleft (Fig. Transmitter is stored in synaptic length vesicles and released on nerve stimulation by the process of exocytosis, following the opening of voltage-gated calcium ion channels in the nerve terminal. Once released, the neu- rotransmitter binds to and stimulates its receptors briefly C before being rapidly removed from the synapse, thereby al- lowing the transmission of a new neuronal message. The most common mode of removal of the neurotransmitter fol- lowing release is called high-affinity reuptake by the presy- naptic terminal. This is a carrier-mediated, sodium-depend- ent, secondary active transport that uses energy from the Na /K - ATPase pump. Other removal mechanisms in- clude enzymatic degradation into a nonactive metabolite in the synapse or diffusion away from the synapse into the ex- tracellular space.

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More hope rests on a genetic approach and the mutated gene has in fact been identified and cloned but its precise role remains uncertain order 5 mg escitalopram overnight delivery. For details of its structure 5mg escitalopram visa, possible actions and appropriate models see Reddy, Williams and Tagle (1999). ADDENDUM The first proper double blind trial of embryonic implants in 40 PD patients (20 undergoing just surgery without any implant), has shown no improvement in patients over 60 years but some clinical benefit (fewer symptoms between levodopa dosing) in those below that age. Unfortunately some of these responders eventually developed dyskinesias, a sign of too much dopamine, and further implants were halted until the technique has been re-evaluated, see Freed, CR et al. Chesselet, M-F and Delfs, JM (1996) Basal ganglia and movement disorders. Chiara, G, Morelli, M and Consolo, S (1994) Modulatory function of neurotransmitters in the striatum: ACh/dopamine/NMDA interactions. Cotzias, GC, von Woert, MH and Schiffer, LM (1967) Aromatic amino acids and modification of Parkinsonism. Ehringer, H and Hornykiewicz, O (1960) Verteilung von Noradrenalin and Dopamin im Gehirn des Menschen und ihr Verholten bei Erkrankungen des Extrapyramidalen systems. Ferre, S, Fredholm, BB, Morelli, M, Popoli, P and Fuxe, K (1997) Adenosine±dopamine receptor±receptor interaction as an integrative mechanism in the basal ganglia. Hirsch, EC and Hunot, S (2000) Nitric oxide, glial cells and neuronal degeneration in Parkinsonism. Jolkkonen, J, Jenner, P and Marsden, CD (1995) L-Dopa reverses altered gene expression of substance P but not enkephalin in the caudate-putamen of common marmosets treated with MPTP. Kawaguchi, Y, Wilson, CJ, Augood, ST and Emson, PC (1995) Striatal interneurones: chemical physiological and morphological characterization. Maneuf, YP, Mitchell, IJ, Crossman, AR, Woodruff, GN and Brotchis, JM (1995) Functional implications of Kappa opioid receptor mediated modulation of glutamate transmission in the output regions of the basal ganglia in rodent and primate models. Mercuri, NB, Bonci, A and Bernardi, G (1997) Electrophysiological pharmacology of the autoreceptor mediated responses of dopaminergic cells to antiparkinsonian drugs. Piccini, P, Brooks, DJ, Bjorklund, A, Gunn, RN, Grasby, PM, Ornella, R, Brundin, P, Hagell, P, Rehncrona, S, Widner, H and Lindvall, O (1999) Dopamine release from nigral transplants visualised in vivo in a Parkinsonian patient. Treseder, SA, Jackson, M and Jenner, P (2000) The effects of central aromatic amino acid (dopa) decarbosylase inhibition on the motor actions of L-dopa and dopamine agonists in MPTP- treated primates. Edited by Roy Webster Copyright & 2001 John Wiley & Sons Ltd ISBN: Hardback 0-471-97819-1 Paperback 0-471-98586-4 Electronic 0-470-84657-7 16 The Epilepsies R. It is a considered and apt definition that highlights important aspects of the disorder that are relevant to our understanding and treatment of it.

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