Faculty Bibliography

Emerging research in neuroscience is bridging the gap between mind and body. Thought is brain based and influences brain function. The continuum and bidirectionality of mind and body, thought and brain, emotions and physiology forms the basis of understanding neuropathic pain, a neuropsychiatric condition with myriad clinical manifestations

Neuropathic pain is a neuropsychiatric condition in which pain is initiated or caused by a primary lesion or dysfunction in the nervous system. Understanding the complexity of neuropathic pain becomes the cornerstone for appropriate diagnosis and management. Diagnosis must take into account comorbid conditions. Successful management depends on realistic patient and physician expectations and an individualized, multidisciplinary approach

Migraine and other headache conditions are relatively common during pregnancy. Physicians and other primary health care providers should not assume that because a patient presents with headache alone, such symptoms can be taken lightly. Most patients do not develop new-onset headache during pregnancy, and all patients who do develop such a condition must be evaluated thoroughly. Similarly, patients who develop any change in their headache condition must undergo a careful evaluation. Fig. 3.1 is an algorithm to aid in evaluating pregnant patients with headache. Postpartum headaches also must be evaluated and treated appropriately. In most cases of headache during pregnancy and postpartum, the patient is suffering with a benign medical condition. Even so, quality of life is an important consideration in preserving the patient's physical and emotional well-being (102, 103). A stepwise approach to symptomatic treatment should be provided for all patients. A high index of suspicion for nonbenign causes of headache will assist in decreasing morbidity and mortality to the mother and fetus

Growth failure is a recognized feature of the Prader-Willi syndrome (PWS). Despite evidence that hypothalamic dysfunction accompanies the syndrome, the etiology of this growth failure remains controversial because most patients with PWS are obese. In order to contribute to resolution of this controversy, we performed a retrospective analysis of 16 obese and non-obese PWS children. GH deficiency was diagnosed in 12 of the 16 subjects and occurred independently of weight status. All of the non-obese subjects were GH deficient. Of the 4 GH-sufficient children, 2 were moderately obese and 2 were morbidly obese. One of these children had clinical evidence of GH deficiency including a low IGF-1 level. Only one of the children had evidence of GH deficiency and a normal IGF-1 level, a pattern that could be attributable to obesity. We conclude that most short children with PWS have growth hormone deficiency and that this deficiency probably results from hypothalamic dysfunction