Issue Overview
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: ISSUE OVERVIEW Source Type: research

Key Points for Issue
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: KEY POINTS FOR ISSUE Source Type: research

List of Abbreviations
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: LIST OF ABBREVIATIONS Source Type: research

Learning Objectives
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: LEARNING OBJECTIVES AND CORE COMPETENCIES Source Type: research

Erratum
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: Erratum Source Type: research

Postreading Self-Assessment and CME Test—Preferred Responses
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: SELF-ASSESSMENT AND CME Source Type: research

Postreading Self-Assessment and CME Test
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: SELF-ASSESSMENT AND CME Source Type: research

Instructions for Completing CME and Tally Sheet
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: SELF-ASSESSMENT AND CME Source Type: research

Rising Drug Costs for Neurologic Diseases
The cost of prescription drugs in the United States is rising like never before and has led to an inflection point where clinicians must consider the potential financial damage to the patient and to society related to the more expensive drugs available. Many of the highest-priced drugs are approved as orphan drugs, a legally defined status providing additional benefits to pharmaceutical companies that is intended to incentivize therapeutic development for rare diseases. The Orphan Drug Act has been a great success since it was enacted in 1983, resulting in the development of many innovative, life-changing, and even lifesav...
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: PRACTICE ISSUES Source Type: research

Test Utilization and Value in the Evaluation of Peripheral Neuropathies
This article describes two cases to illustrate the appropriate diagnostic workup of those with typical or atypical neuropathy. (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: PRACTICE ISSUES Source Type: research

Peripheral Neuropathies Associated With Monoclonal Gammopathies
This article discusses how to approach patients with monoclonal gammopathy and peripheral neuropathy, highlighting clinical and laboratory clues that may aid in establishing a diagnosis in a timely manner. RECENT FINDINGS From a hematologic standpoint, a monoclonal gammopathy may be of undetermined significance or can be associated with an underlying myeloma, lymphoplasmacytic lymphoma, or amyloidosis. Each of these conditions can cause peripheral neuropathy, with varying clinical and electrodiagnostic profiles. Treatment usually consists of treating the underlying hematologic disorder. IgM-associated peripheral neuropa...
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Spinal Muscular Atrophy
This article provides an overview of the pathophysiology and clinical presentations of spinal muscular atrophy (SMA) and reviews therapeutic developments, including US Food and Drug Administration (FDA)–approved gene-targeted therapies and mainstays of supportive SMA care. RECENT FINDINGS Over the past decades, an understanding of the role of SMN protein in the development and maintenance of the motor unit and the intricate genetics underlying SMA has led to striking developments in therapeutics with three FDA-approved treatments for SMA, one targeting SMN1 gene replacement (onasemnogene abeparvovec-xioi) and two ...
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Amyotrophic Lateral Sclerosis and Other Motor Neuron Diseases
This article reviews the clinical features, diagnostic approach, and treatments available for amyotrophic lateral sclerosis (ALS) and other motor neuron diseases. The article also provides an update on the genetics and pathophysiology of ALS. RECENT FINDINGS ALS remains a clinical diagnosis without a unique biomarker. The areas of greatest progress include a large expansion in the number of genes associated with familial and sporadic ALS. The discovery of these genes, along with other work, has provided a deeper understanding of the mechanisms of motor neuron failure in ALS. Areas of particular interest include the role...
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Management of Neuropathic Pain in Polyneuropathy
This article reviews recent literature on complementary and pharmacologic therapies for the management of painful polyneuropathies. Exercise has emerged as an important therapeutic tool and may also improve the underlying polyneuropathy in the setting of obesity, metabolic syndrome, and diabetes. SUMMARY The approach to management of painful polyneuropathies is multifactorial, using both pharmacologic and nonpharmacologic measures to improve pain severity and patient quality of life. (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Peripheral Neuropathies Due to Vitamin and Mineral Deficiencies, Toxins, and Medications
This article provides a comprehensive approach and list of items that must be considered in the setting of new-onset neuropathy. RECENT FINDINGS Although many of the neuropathies described in this article have decreased in prevalence in developed countries because of public health interventions and occupational/environmental regulations, new causes for this class of neuropathy continue to be uncovered. SUMMARY The peripheral nervous system is susceptible to a broad array of metabolic and toxic abnormalities, which most often lead to a length-dependent sensory-predominant axonal peripheral neuropathy. A careful histor...
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Peripheral Neuropathies Associated With Vasculitis and Autoimmune Connective Tissue Disease
This article discusses peripheral neuropathies associated with vasculitis (isolated or in the setting of systemic vasculitis) and autoimmune connective tissue disease and provides a brief overview of their diagnostic evaluation and management. RECENT FINDINGS The classification of systemic vasculitic neuropathy and nonsystemic vasculitic neuropathy continues to evolve. Classification according to the presence of antineutrophil cytoplasmic antibodies and their subtypes facilitates prognostication and management. Recent research on antineutrophil cytoplasmic antibody–associated vasculitis has added to our understand...
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Charcot-Marie-Tooth Disease and Other Hereditary Neuropathies
This article provides an overview of Charcot-Marie-Tooth disease (CMT) and other inherited neuropathies. These disorders encompass a broad spectrum with variable motor, sensory, autonomic, and other organ system involvement. Considerable overlap exists, both phenotypically and genetically, among these separate categories, all eventually exhibiting axonal injury and neurologic impairment. Depending on the specific neural and non-neural localizations, patients experience varying morbidity and mortality. Neurologic evaluations, including neurophysiologic testing, can help diagnose and predict patient disabilities. Diagnosis i...
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Chronic Inflammatory Demyelinating Polyradiculoneuropathy and Its Variants
This article highlights the clinical presentation, pathophysiology, diagnostic evaluation, and treatment approach of these polyneuropathies. RECENT FINDINGS The spectrum of CIDP is expanding with the recent characterization of neuropathies associated with nodal and paranodal antibodies. These neuropathies are distinguished by their unique presentations and are often refractory to IV immunoglobulin (IVIg) therapy. Subcutaneous immunoglobulins have recently been approved as a treatment option for CIDP and join corticosteroids, IVIg, and plasma exchange as first-line treatment. SUMMARY CIDP is characterized by progressi...
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Guillain-Barré Syndrome
This article reviews the clinical features, diagnosis and differential diagnosis, prognosis, pathogenesis, and current and upcoming treatments of Guillain-Barré syndrome (GBS). RECENT FINDINGS GBS is an acute inflammatory neuropathic illness with striking clinical manifestations and significant morbidity. A substantial proportion of patients with GBS do not respond to current immunomodulatory therapies (ie, plasma exchange and IV immunoglobulin [IVIg]), highlighting the need for new therapies. Prognostic models that can accurately predict functional recovery and the need for artificial ventilation have emerged. T...
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Diabetes and Metabolic Disorders and the Peripheral Nervous System
This article provides an up-to-date review of the manifestations of neuropathy seen in the setting of diabetes and other metabolic disorders. RECENT FINDINGS Although a number of metabolic disorders cause or are associated with peripheral neuropathy, the neuropathies associated with glucose dysregulation make up the vast majority of cases. Recent investigations have determined major differences in the neuropathies associated with type 1 and type 2 diabetes. Neuropathy in type 1 diabetes is closely linked to glycemic control, whereas neuropathy in type 2 diabetes is linked to dyslipidemia, central obesity, hypertension, ...
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

A Structured Approach to the Diagnosis of Peripheral Nervous System Disorders
This article describes the nature and pattern of sensory and motor deficits associated with lesions of specific spinal nerve roots, plexus, or peripheral nerves. It also describes the patterns of sensory and motor deficits that suggest multifocal or generalized disorders of the motor neurons, sensory neurons, and peripheral nerves. RECENT FINDINGS The pattern of sensory and motor deficits may be used to distinguish lesions of the peripheral nervous system from those of the central nervous system. The spinal roots, nerve plexus, and peripheral nerves supply specific muscles and receive sensory input from distinctive cuta...
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Disorders of Peripheral Nerves, From Beginning to End
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: EDITOR’S PREFACE Source Type: research

Contributors
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: CONTRIBUTORS Source Type: research

Table of Contents
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2020 Category: Neurology Tags: Table of Contents Source Type: research

Issue Overview
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: ISSUE OVERVIEW Source Type: research

Key Points for Issue
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: KEY POINTS FOR ISSUE Source Type: research

List of Abbreviations
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: LIST OF ABBREVIATIONS Source Type: research

Learning Objectives
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: LEARNING OBJECTIVES AND CORE COMPETENCIES Source Type: research

Appendix B: Two-Week Sleep Diary
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: Appendix B Source Type: research

Appendix A: Epworth Sleepiness Scale
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: Appendix A Source Type: research

Postreading Self-Assessment and CME Test—Preferred Responses
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: SELF-ASSESSMENT AND CME Source Type: research

Postreading Self-Assessment and CME Test
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: SELF-ASSESSMENT AND CME Source Type: research

Instructions for Completing CME and Tally Sheet
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: SELF-ASSESSMENT AND CME Source Type: research

Optimizing Behavioral Sleep Strategies
Patients are increasingly looking to optimize sleep as a health and wellness strategy. Sleep health is often individualized based on three elements that correspond to overall physical and mental well-being: (1) sleep quality, which refers to the continuity and depth of sleep as well as a feeling of restoration upon awakening; (2) sleep quantity, which refers to the duration of sleep that is appropriate for a given age group; and (3) timing of the sleep window, which refers to the positioning of sleep that is aligned with an individual’s circadian rhythm for sleep or an ideal circadian zone. In the past, prescribing h...
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: PRACTICE ISSUES Source Type: research

Criminal Culpability for Acts Committed During a Possible Episode of REM Sleep Behavior Disorder
This article examines the complexities associated with RBD as a criminal defense strategy as well as the legal implications for physicians and their duty to patients and their families to mitigate risks associated with possible injuries related to RBD. (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: MEDICOLEGAL ISSUES Source Type: research

Sleep-Wake Disorders in Childhood
PURPOSE OF REVIEW The presentation of sleep issues in childhood differs from the presentation in adulthood and may be more subtle. Sleep issues may affect children differently than adults, and distinct treatment approaches are often used in children. RECENT FINDINGS Sodium oxybate was approved by the US Food and Drug Administration (FDA) in October 2018 for an expanded indication of treatment of sleepiness or cataplexy in patients with narcolepsy type 1 or narcolepsy type 2 aged 7 years or older, with side effect and safety profiles similar to those seen in adults. Restless sleep disorder is a recently proposed entity...
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Sleep in Patients With Neurologic Disease
This article provides a discussion of the current evidence and contemporary views on the relationship between sleep disorders and neurologic disease. RECENT FINDINGS Disrupted or disordered sleep can be associated with increased morbidity and mortality, the risk of cardiovascular events, increased seizure frequency, and altered immune responses. Studies have implicated disrupted sleep and circadian rhythm dysfunction with both amyloid-β (Aβ) deposition and tau deposition. A bidirectional relationship exists between disrupted sleep and the progression of Alzheimer disease pathology. Insomnia has been reported a...
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Insomnia
This article provides updated information regarding the diagnosis and treatment of chronic insomnia disorder. In addition to discussing the latest recommendations regarding pharmacotherapeutic options for insomnia, this article also discusses the increased use of nonpharmacologic treatment approaches, including cognitive-behavioral therapy intervention, integrative medicine, mindfulness and meditation, and other therapeutic options in clinical practice. RECENT FINDINGS Insomnia is one of the most common sleep disorders in patients with other neurologic disorders. The definition and criteria for insomnia were updated wit...
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Circadian Rhythm Sleep-Wake Disorders
This article provides an overview of circadian physiology and discusses common presentations and treatment strategies for the circadian rhythm sleep-wake disorders. RECENT FINDINGS Circadian rhythms are present throughout the body, and appreciation for the role that circadian dysregulation plays in overall health is increasing, with mounting associations between circadian disruption and cardiometabolic disease risk. SUMMARY It is important to recognize the ubiquitous role that circadian rhythms play throughout the brain and body. An understanding of circadian neurophysiology will provide insight into the means by whi...
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Restless Legs Syndrome and Other Common Sleep-Related Movement Disorders
This article focuses on RLS, highlighting the change in the paradigm of initial treatment, the role played by iron (pathophysiologic and therapeutic), and how to approach possible complications occurring with long-term treatment. SUMMARY RLS is one of the most common neurologic conditions, and it is common in clinical practice to find patients experiencing symptoms suggestive of RLS. Neurologists must be careful and thorough in the diagnosis, excluding RLS mimics. The decisions regarding which specific sleep-related movement disorder is present and how it should be treated are important because in certain cases, especia...
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Parasomnias Occurring in Non–Rapid Eye Movement Sleep
This article discusses the clinical manifestations, diagnosis and differential diagnosis, pathophysiology, and management of parasomnias occurring in non–rapid eye movement (REM) sleep. RECENT FINDINGS Disorders of arousal are characterized by dissociated sleep, with wake and sleep phenomena intermingling, and local sleep, in which different areas of the brain exist simultaneously in different states of wakefulness or sleep. The frequency of arousals from slow-wave sleep with delta or mixed-frequency activity has a high sensitivity but relatively low specificity for the diagnosis of arousal parasomnias. SUMMARY ...
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Rapid Eye Movement Sleep Behavior Disorder and Other Rapid Eye Movement Parasomnias
This article summarizes a century of sleep research to examine the maladies of dreaming, their pathophysiologic significance, and management. RECENT FINDINGS Under healthy physiologic conditions, REM sleep is characterized by vivid mentation combined with skeletal muscle paralysis. The loss of REM sleep atonia in RBD results in vivid, potentially injurious dream enactment to patients and bed partners. RBD is common, affecting at least 1% of the population and is primarily caused by α-synuclein pathology of REM sleep–related brainstem neurons. The majority of patients with RBD ultimately develop a neurodegene...
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Obstructive Sleep Apnea
PURPOSE OF REVIEW Obstructive sleep apnea (OSA) is often overlooked by clinicians; however, undiagnosed OSA can lead to negative outcomes for patients, including patients with underlying neurologic conditions. Clinicians should be aware of what questions to ask, what diagnostic tests to use, and what treatments to consider in patients with OSA. RECENT FINDINGS OSA influences many neurologic conditions, including stroke, epilepsy, headache, and neuromuscular conditions. Treatment of OSA is effective, especially with patient-tailored options, the correct education, and support. SUMMARY OSA is a serious medical condit...
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Central Disorders of Hypersomnolence
This article discusses the central disorders of hypersomnolence, a group of disorders resulting in pathologic daytime sleepiness, particularly narcolepsy type 1 and narcolepsy type 2, idiopathic hypersomnia, and Kleine-Levin syndrome. Disease features, diagnostic testing, epidemiology, pathophysiology, and treatment are reviewed. RECENT FINDINGS Increasing evidence implicates autoimmunity in narcolepsy type 1, including a strong association with human leukocyte antigen–DQB1*06:02, association with a polymorphism in the T-cell receptor alpha locus in genome-wide association, and the identification of autoreactive T...
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Evaluating the Sleepy and Sleepless Patient
This article explains the clinical approach to patients presenting with sleepiness or sleeplessness in a neurologic practice setting. Addressing the patient’s sleep symptoms may help improve symptoms of their other underlying primarily neurologic disorder. RECENT FINDINGS New diagnostic modalities at home such as home sleep apnea testing have improved access and diagnosis of sleep apnea. Consumer health tracking devices have also helped patients focus on their sleep duration and quality, prompting them to bring their concerns to their neurologist. SUMMARY Like many neurologic disorders, a detailed history and p...
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Neurobiology and Neuroprotective Benefits of Sleep
This article outlines the neurocircuitry underlying sleep-wake and circadian physiology with a focus on the fundamental roles that sleep and circadian health play in optimal neurologic function. RECENT FINDINGS The foundation of sleep and wake promotion is laid primarily by the “fast-acting” neurotransmitters: γ-aminobutyric acid (GABA) for sleep and glutamate for wake. External to these primary systems are a host of modulatory systems that are characterized by two flip-flop switches of mutually inhibitory neurotransmitter systems that facilitate transitions between wake and sleep as well as non–...
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Awakening to Sleep
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: EDITOR’S PREFACE Source Type: research

Contributors
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: CONTRIBUTORS Source Type: research

Table of Contents
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: Table of Contents Source Type: research

Issue Overview
No abstract available (Source: CONTINUUM: Lifelong Learning in Neurology)
Source: CONTINUUM: Lifelong Learning in Neurology - June 1, 2020 Category: Neurology Tags: ISSUE OVERVIEW Source Type: research