The Regulation of Cerebral Spinal Fluid Flow and Its Relevance to the Glymphatic System
AbstractPurpose of ReviewThe glymphatic system is a relatively new concept that has been associated with regulation of cerebrospinal fluid (CSF), as well as brain waste clearance. Novel techniques to study glymphatic dysfunction have in turn prompted a reassessment of brain physiology and underlying elements of neurological disease. This review incorporates a contemporary imaging perspective focused on understanding the regulation of CSF flow, thus expanding the putative clinical relevance of this system and the relationships between CSF flow and glymphatic function.Recent FindingsMR imaging studies, especially those that ...
Source: Current Neurology and Neuroscience Reports - October 19, 2020 Category: Neuroscience Source Type: research

Psychosis in Alzheimer ’s Disease
AbstractPurpose of ReviewTo review the incidence, treatment and genetics of psychosis in people with mild cognitive impairment (MCI) and Alzheimer ’s disease (AD).Recent FindingsPsychosis in Alzheimer ’s disease (AD) has an incidence of ~ 10% per year. There is limited evidence regarding psychological interventions. Pharmacological management has focused on atypical antipsychotics, balancing modest benefits with evidence of long-term harms. The 5HT2A inverse agonist pimavanserin appears to co nfer benefit in PD psychosis with initial evidence of benefit in AD. Cholinesterase inhibitors give modest benefi...
Source: Current Neurology and Neuroscience Reports - October 13, 2020 Category: Neuroscience Source Type: research

Porphyric Neuropathy: Pathophysiology, Diagnosis, and Updated Management
AbstractPurpose of ReviewTo review the peripheral neurological complications of the acute hepatic porphyrias, as well as the latest advances in their pathophysiology and management.Recent FindingsThe diagnosis of porphyric neuropathy remains challenging as varying neuropathic patterns are encountered depending on disease stage, including a non-length-dependent distribution pattern. The major pathophysiologic mechanism is δ-aminolevulinic acid (ALA)–induced neurotoxicity. The less restrictive blood-nerve barrier in the autonomic ganglia and myenteric plexus may explain the frequency of dysautonomic manifestation...
Source: Current Neurology and Neuroscience Reports - October 6, 2020 Category: Neuroscience Source Type: research

Sleep-Wake Control by Melanin-Concentrating Hormone (MCH) Neurons: a Review of Recent Findings
AbstractPurpose of the ReviewMelanin-concentrating hormone (MCH) –expressing neurons located in the lateral hypothalamus are considered as an integral component of sleep-wake circuitry. However, the precise role of MCH neurons in sleep-wake regulation has remained unclear, despite several years of research employing a wide range of techniques. We review recent data on this aspect, which are mostly inconsistent, and propose a novel role for MCH neurons in sleep regulation.Recent FindingsWhile almost all studies using “gain-of-function” approaches show an increase in rapid eye movement sleep (or paradoxical...
Source: Current Neurology and Neuroscience Reports - October 1, 2020 Category: Neuroscience Source Type: research

Recent Advances in Blood-Based Biomarkers of Remote Combat-Related Traumatic Brain Injury
AbstractPurpose of ReviewTraumatic brain injury (TBI) is highly prevalent among service members and Veterans (SMVs) and associated with changes in blood-based biomarkers. This manuscript reviews candidate biomarkers months/years following military-associated TBI.Recent FindingsSeveral blood-based biomarkers have been investigated for diagnostic or prognostic use to inform care years after military-associated TBI. The most promising include increased levels of plasma/serum and exosomal proteins reflecting neuronal, axonal and/or vascular injury, and inflammation, as well as altered microRNA expression and auto-antibodies of...
Source: Current Neurology and Neuroscience Reports - September 27, 2020 Category: Neuroscience Source Type: research

Post-Traumatic Headache in Children and Adolescents: a Narrative Review with a Focus on Management
This article aims to review pediatric PTH, its epidemiology and pathophysiology with a focus on management and future directions.Recent FindingsUsing MEDLINE, EMBASE, 52 articles on PTH in children and adolescents from 2016 to 2020 were identified. Over the last 4  years, our understanding of traumatic brain injury pathophysiology has grown, expanding the potential for more therapeutic targets. Despite this achievement, and recently published consensus guidelines, the review demonstrated a lack of published controlled trials to help guide management of pedia tric PTH.SummaryThe last 4  years have provided new ins...
Source: Current Neurology and Neuroscience Reports - September 18, 2020 Category: Neuroscience Source Type: research

Advocacy in Headache Medicine: Tips at the Bedside, the Institutional Level, and Beyond
We describe the pervasiveness of headache diseases across the globe and the need for healthcare advocacy, define healthcare advocacy, and identify how providers can incorporate healthcare advocacy into clinical practice and beyond.Recent FindingsNearly 3 billion people across the globe experience migraine or tension-type headache, yet headache diseases receive a fraction of the funding that is allocated to other diseases. Despite its prevalence, those with headache diseases, especially migraine, experience external and internal stigma. As physicians, our job extends past the direct needs of the patient and must also focus ...
Source: Current Neurology and Neuroscience Reports - September 16, 2020 Category: Neuroscience Source Type: research

Retinal Diseases that Can Masquerade as Neurological Causes of Vision Loss
AbstractPurpose of ReviewThis review aims to discuss retinal diseases that may masquerade as neurological causes of vision loss and highlights modern ophthalmic ancillary testing that can help to establish these diagnoses.Recent FindingsRetinal diseases with signs and symptoms overlapping with neurological causes of vision loss include central serous chorioretinopathy, retinal ischemia, acute macular neuroretinopathy, Acute zonal occult outer retinopathy (AZOOR) complex diseases, paraneoplastic retinopathy, retinal dystrophy, and toxic retinopathy. Diagnosis is facilitated by electrophysiologic studies and multimodal ophth...
Source: Current Neurology and Neuroscience Reports - September 14, 2020 Category: Neuroscience Source Type: research

A Practical Approach to Imaging of the Supplementary Motor Area and Its Subcortical Connections
AbstractPurpose of ReviewFirst, an anatomical and functional review of these cortical areas and subcortical connections with T-fMRI and tractography techniques; second, to demonstrate the value of this approach in neurosurgical planning in a series of patients with tumors close to the SMA.Recent FindingsImplications in language and cognitive networks with a clear hemispheric lateralization of these SMA/pre-SMA. The recommendation of the use of the advanced neuroimaging studies for surgical planning and preservation of these areas.SummaryThe SMA/pre-SMA and their subcortical connections are functional areas to be taken into...
Source: Current Neurology and Neuroscience Reports - September 14, 2020 Category: Neuroscience Source Type: research

Congenital Zika Virus Infection: a Review with Emphasis on the Spectrum of Brain Abnormalities
AbstractPurpose of ReviewIn 2016, the World Health Organization declared the Zika virus (ZIKV) outbreak a Public Health Emergency of International Concern following a cluster of associated neurological disorders and neonatal malformations. Our aim is to review the clinical and neuroimaging findings seen in congenital Zika syndrome.Recent FindingsZIKV injures neural progenitor cells in the hippocampus, a brain region important for learning, memory, cognition, and emotion/stress response. Positron emission tomography has revealed global neuroinflammation in ZIKV infection in animal models.SummaryCongenital Zika syndrome is a...
Source: Current Neurology and Neuroscience Reports - September 2, 2020 Category: Neuroscience Source Type: research

Gerstmann Syndrome
This article reviews recent research on the clinical aspects of this syndrome.Recent FindingsDuring the last years, just some few new reports of Gerstmann syndrome are found in neurological and neuropsychological literature. Most of the reports are single-case reports. An association between Gerstmann syndrome and the so-called semantic aphasia has been pointed out. Two different explanations to this unusual syndrome have been recently proposed: (1) the pathological process is located in the left parietal white matter disconnecting separate cortical networks and (2) it represents a disturbance in the ability to verbally me...
Source: Current Neurology and Neuroscience Reports - August 26, 2020 Category: Neuroscience Source Type: research

Neuromuscular Complications of Statin Therapy
This article identifies the risk factors and provides a review of neuromuscular side effects associated with statin use, their diagnosis and treatment. (Source: Current Neurology and Neuroscience Reports)
Source: Current Neurology and Neuroscience Reports - August 24, 2020 Category: Neuroscience Source Type: research

Genetics of Epileptic Networks: from Focal to Generalized Genetic Epilepsies
AbstractPurpose of ReviewSeizures can arise in neocortical, thalamocortical, limbic or brainstem networks. Here, we review recent genetic mechanisms implicated in focal and genetic generalized epilepsies (GGEs).Recent FindingsPathogenic variation in GAP activity toward RAGs 1 (GATOR1) complex genes (i.e.,DEPDC5,NPRL2 andNPRL3) mainly result in focal epilepsies. They are associated with high rates of sudden unexpected death in epilepsy and malformations of cortical development (MCD), where “two-hits” in GATOR1-related pathways are also found in MCDs. Large-scale sequencing studies continue to reveal new genetic ...
Source: Current Neurology and Neuroscience Reports - August 12, 2020 Category: Neuroscience Source Type: research

Management of Menstrual Migraine
This article will review the current literature regarding the pathophysiology, epidemiology, and treatment of menstrual migraine. (Source: Current Neurology and Neuroscience Reports)
Source: Current Neurology and Neuroscience Reports - August 7, 2020 Category: Neuroscience Source Type: research

Infusion Therapies for Parkinson ’s Disease
AbstractPurpose of ReviewAdvanced Parkinson ’s disease (APD) is marked by significant motor and non-motor complications affecting the patient’s quality of life. Optimization of standard oral therapies (SOT) at some point fails to provide adequate relief. Among the available device-aided therapies, infusion therapies (IT) work on the ratio nale that continuous striatal dopaminergic stimulation can significantly reduce the motor fluctuations and smoothen the treatment response. This review serves to familiarize readers with available IT for APD with a focus on motor and non-motor effects, and safety.Recent Findin...
Source: Current Neurology and Neuroscience Reports - July 31, 2020 Category: Neuroscience Source Type: research

Approach to an Intracranial Mass in Patients With HIV
AbstractPurpose of ReviewSpace-occupying lesions represent a diagnostic challenge among people with the human immunodeficiency virus, acquired immunodeficiency syndrome (HIV/AIDS). To determine the best diagnostic approach to the wide array of possible etiologies and provide a thorough interpretation of neuroimaging in order to narrow a hierarchical differential diagnosis among these patients. Given that there is no pathognomonic neuroimaging pattern in this clinical setting, we searched results from brain biopsies to best determine the etiology of commonly found lesions.Recent FindingsMultimodal brain MRI and MRI spectros...
Source: Current Neurology and Neuroscience Reports - July 29, 2020 Category: Neuroscience Source Type: research

Detecting Seizures and Epileptiform Abnormalities in Acute Brain Injury
AbstractPurpose of ReviewAcute brain injury (ABI) is a broad category of pathologies, including traumatic brain injury, and is commonly complicated by seizures. Electroencephalogram (EEG) studies are used to detect seizures or other epileptiform patterns. This review seeks to clarify EEG findings relevant to ABI, explore practical barriers limiting EEG implementation, discuss strategies to leverage EEG monitoring in various clinical settings, and suggest an approach to utilize EEG for triage.Recent FindingsCurrent literature suggests there is an increased morbidity and mortality risk associated with seizures or patterns on...
Source: Current Neurology and Neuroscience Reports - July 26, 2020 Category: Neuroscience Source Type: research

Primary Age-Related Tauopathy (PART): Addressing the Spectrum of Neuronal Tauopathic Changes in the Aging Brain
AbstractPurpose of ReviewPrimary age-related tauopathy (PART) was recently proposed as a pathologic diagnosis for brains that harbor neurofibrillary tangles (Braak stage ≤ 4) with little, if any, amyloid burden. We sought to review the clinicopathologic findings related to PART.Recent FindingsMost adult human brains show at least focal tauopathic changes, and the majority of individuals with PART do not progress to dementia. Older age and cognitive impairment correlate with increased Braak stage, and multivariate analyses suggest that the rate of cognitive decline is less than matched patients with Alzheimer dise...
Source: Current Neurology and Neuroscience Reports - July 13, 2020 Category: Neuroscience Source Type: research

Depression and Anxiety in the Epilepsies: from Bench to Bedside
AbstractPurpose of ReviewDepression and anxiety substantially contribute to interictal disability in patients with epilepsy (PWE). This review summarizes current studies that shed light on mechanisms of comorbidity.Recent FindingsMounting epidemiological data implicate shared risk factors for anxiety/depression and seizure propensity, but these remain largely elusive and probably vary by epilepsy type. Within PWE, these symptoms appear to be associated with unique genetic, neuropathological, and connectivity profiles. Temporal lobe epilepsy has received enormous emphasis particularly in preclinical studies of comorbidity, ...
Source: Current Neurology and Neuroscience Reports - July 13, 2020 Category: Neuroscience Source Type: research

Correction to: Neurological and Medical Complications in Brain Tumor Patients
The order of the authors was inadvertently inverted; Dr. Alyahya is the intended first author. (Source: Current Neurology and Neuroscience Reports)
Source: Current Neurology and Neuroscience Reports - July 13, 2020 Category: Neuroscience Source Type: research

Clinical Characteristics of Cataplectic Attacks in Type 1 Narcolepsy
This article reviews recent research on the clinical characteristics of cataplexy.Recent FindingsLongitudinal research in adults suggests that there may be a remission of cataplectic severity after symptom stabilization. First-line treatment options for cataplexy include sodium oxybate and pitolisant, with many drugs such as AXS-12, FT218, and JZP258 under investigation. Patients with cataplexy reported greater limitations of daily activities such as driving and exercise compared to patients without cataplexy.SummaryCataplexy remains a challenge for children and adults with narcolepsy and can interfere with daily activitie...
Source: Current Neurology and Neuroscience Reports - July 10, 2020 Category: Neuroscience Source Type: research

When Drugs Do Not Work: Alternatives to Antiseizure Medications
AbstractPurpose of ReviewDespite the increase in the number of novel antiseizure medications over the past 20  years, approximately one-third of patients will not have adequate seizure control on medications. For these patients, additional options need to be considered, including dietary, device, and surgical treatments. In addition, many complementary therapies can be considered as adjunctive treatment, w ith the intent of improving quality of life for persons with epilepsy and potentially allowing for improvement in seizure control.Recent FindingsThis review outlines established and developing treatments for drug-re...
Source: Current Neurology and Neuroscience Reports - July 8, 2020 Category: Neuroscience Source Type: research

Thrombolysis beyond 4.5  h in Acute Ischemic Stroke
AbstractPurpose of ReviewThe purpose of this article is to review the current approaches using neuroimaging techniques to expand eligibility for intravenous thrombolytic therapy in acute ischemic stroke patients with stroke of unknown symptom onset.Recent FindingsIn recent years, several randomized, placebo-controlled trials have shown neuroimaging-guided approaches to be feasible in determining eligibility for alteplase beyond 4.5  h from last known well, and efficacious for reducing disability. DWI-FLAIR mismatch on MRI is an effective tool to identify stroke lesions less than 4.5 h in onset in patients with st...
Source: Current Neurology and Neuroscience Reports - June 29, 2020 Category: Neuroscience Source Type: research

Cardiac Imaging After Ischemic Stroke or Transient Ischemic Attack
This article summarizes the latest research on this topic and provides an approach to clinical practice to use cardiac imaging after stroke.Recent FindingsEchocardiography remains the primary imaging method for cardiac work-up after stroke. Recent echocardiography studies further demonstrated promising results regarding the prediction of non-permanent atrial fibrillation after ischemic stroke. Cardiac magnetic resonance imaging and computed tomography have been tested for their diagnostic value, in particular in patients with cryptogenic stroke, and can be considered as second line methods, providing complementary informat...
Source: Current Neurology and Neuroscience Reports - June 29, 2020 Category: Neuroscience Source Type: research

Neurological and Medical Complications in Brain Tumor Patients
AbstractPurpose of ReviewPatients with brain tumors are susceptible to multiple complications that can affect their survival or quality of life. The scope of these complications is widening due to prolonged overall survival and improved therapies. In this review, we discuss the most common complications in this patient population focusing on the recent literature. We specifically concentrated on tumor-related epilepsy, vasogenic edema, infectious, vascular, chemotherapeutic, radiation, endocrine, and cognitive complications.Recent FindingsMolecular biomarkers play a role in epileptogenicity in brain tumor patients, and ant...
Source: Current Neurology and Neuroscience Reports - June 28, 2020 Category: Neuroscience Source Type: research

Neurologic Complications of Cranial Radiation Therapy and Strategies to Prevent or Reduce Radiation Toxicity
AbstractPurpose of ReviewRadiation therapy is an important treatment for patients with brain tumors but can have significant neurologic complications. This review highlights the broad spectrum of short-term and long-term neurologic complications that can occur in patients receiving cranial radiation therapy, and strategies to prevent and treat such complications.Recent FindingsDespite significant improvements in radiotherapy delivery, there are neurologic complications that can result from treatment. With increased recognition and understanding of these neurologic complications, novel strategies to prevent and mitigate the...
Source: Current Neurology and Neuroscience Reports - June 28, 2020 Category: Neuroscience Source Type: research

Acute Neurological Complications of Brain Tumors and Immune Therapies, a Guideline for the Neuro-hospitalist
AbstractPurpose of ReviewPatients with brain tumors presenting to the emergency room with acute neurologic complications may warrant urgent investigations and emergent management. As the neuro-hospitalist will likely encounter this complex patient population, an understanding of the acute neurologic issues will have value.Recent FindingsWe discuss updated information and management regarding various acute neurologic complications among neuro-oncology patients and neurologic complications of immunotherapy.SummaryUnderstanding of the acute neurologic complications associated with central nervous system tumors and with common...
Source: Current Neurology and Neuroscience Reports - June 28, 2020 Category: Neuroscience Source Type: research

Current Status of Dyslipidemia Treatment for Stroke Prevention
AbstractPurpose of ReviewElevated cholesterol is an established risk factor for ischemic stroke. The value of statins for stroke prevention has been clear for more than a decade.Recent FindingsHowever, the use of new medication combinations such as ezetimibe or proprotein convertase subtilisin –kexin type 9 inhibitors plus statins is increasing and the value for reducing stroke has been shown for these combination therapies. Recent data also support the strategy of lowering triglycerides for stroke prevention.SummaryA modern approach to dyslipidemia treatment and its relation to stroke prevention is summarized in thi...
Source: Current Neurology and Neuroscience Reports - June 21, 2020 Category: Neuroscience Source Type: research

Update on Pediatric Brain Tumors: the Molecular Era and Neuro-immunologic Beginnings
AbstractPurpose of ReviewTo provide an update on the current landscape of pediatric brain tumors and the impact of novel molecular insights on classification, diagnostics, and therapeutics.Recent FindingsScientific understanding of the genetic basis of central nervous system tumors has expanded rapidly over the last several years. The shift in classification of tumors to a molecularly based schema, accompanied by a growing number of early phase clinical trials of therapies aimed at inhibiting tumoral genetic and epigenetic programs, as well as those attempting to harness and magnify the immune response, has allowed a deepe...
Source: Current Neurology and Neuroscience Reports - June 19, 2020 Category: Neuroscience Source Type: research

Machine Learning for 3D Kinematic Analysis of Movements in Neurorehabilitation
AbstractPurpose of ReviewRecent advances in the machine learning field, especially in deep learning, provide the opportunity for automated, detailed, and unbiased analysis of motor behavior. Although there has not yet been wide use of these techniques in the motor rehabilitation field, they have great potential. In this review, I describe how the current state of machine learning can be applied to 3D kinematic analysis, and how this will have an impact on neurorehabilitation.Recent FindingsApplications of deep learning methods, in the form of convolutional neural networks, have been revolutionary for image analysis such as...
Source: Current Neurology and Neuroscience Reports - June 14, 2020 Category: Neuroscience Source Type: research

Sleep Disturbances in Patients with Autoimmune Encephalitis
AbstractPurpose of ReviewTo review sleep complaints reported in patients with autoimmune encephalitis, explore the relationship between sleep disturbances and subtypes of autoimmune encephalitis, and leverage knowledge concerning antibody-antigen specificity to inform the receptors, structures, and disseminated neural networks that contribute to sleep function in health and disease.Recent FindingsAutoimmune encephalitis is an inflammatory brain disorder characterized by the subacute onset of psychiatric symptoms, cognitive impairment, and focal neurologic deficits or seizures. Sleep disturbances are detected in a majority ...
Source: Current Neurology and Neuroscience Reports - June 9, 2020 Category: Neuroscience Source Type: research

Neurologic Toxicities of Cancer Immunotherapies: a Review
AbstractPurpose of ReviewThis review provides clinical characterization and approach to management of neurotoxicities associated with checkpoint inhibitor therapy and chimeric antigen receptor T cell (CAR T cell) therapy.Recent FindingsImmuno-oncology has revolutionized cancer treatment. The immunomodulatory effect of these treatments extends beyond the targeted cancers; however, with a range of immune-mediated toxicities being associated with these therapies. Both the peripheral and central nervous system are vulnerable to these toxicities, with several distinct clinical syndromes strongly associated with specific immunot...
Source: Current Neurology and Neuroscience Reports - June 7, 2020 Category: Neuroscience Source Type: research

Advances in Management of Brain and Leptomeningeal Metastases
AbstractPurpose of ReviewThe management of brain and leptomeningeal metastases has changed significantly over the past decade.Recent FindingsHistorically, radiation therapy had been the mainstay of treatment. Several strategies to limit toxicities with radiation have been developed in the recent years. Increasingly systemic therapy options are being considered an important therapeutic option for CNS metastases. Numerous novel small molecule inhibitors and immunotherapy agents have intracranial activity to varying degrees, in addition to good extracranial disease control.SummaryOverall, the prognosis of select patients with...
Source: Current Neurology and Neuroscience Reports - June 5, 2020 Category: Neuroscience Source Type: research

Sleep and Sleep Disruption in Amyotrophic Lateral Sclerosis
AbstractPurpose of ReviewIn amyotrophic lateral sclerosis (ALS), sleep disruption is frequently present and substantially adds to disease burden. This review aims to summarize current knowledge on causes, pathophysiology, and treatment of sleep disturbances in ALS.Recent FindingsMotor neuron degeneration and muscle weakness may lead to muscle cramps, pain, spasticity, immobilization, restless legs, sleep-disordered breathing, and difficulties to clear secretions. Furthermore, existential fears and depression may promote insomnia. Sleep-disordered breathing, and nocturnal hypoventilation in particular, requires ventilatory ...
Source: Current Neurology and Neuroscience Reports - May 26, 2020 Category: Neuroscience Source Type: research

Impact of Age on Multiple Sclerosis Disease Activity and Progression
AbstractPurpose of ReviewThe purpose of this review is to discuss the interaction between aging, progressive disease course, disability worsening, and treatment strategies in multiple sclerosis (MS).Recent FindingsThe transition from the relapsing-remitting phase to the progressive phase in MS often happens in the fifth decade. In MS, structural central nervous system reserve decreases with aging and MS-associated mechanisms. While clinical and subclinical disease activity decreases with aging, the post-relapse recovery potential decreases with aging as well. Moreover, the efficacy of disease-modifying treatments declines ...
Source: Current Neurology and Neuroscience Reports - May 25, 2020 Category: Neuroscience Source Type: research

Caregiver Burden in Multiple Sclerosis: Recent Trends and Future Directions
AbstractPurpose of ReviewIn spite of recent advances in treatment, many people with multiple sclerosis (MS) require ongoing care and support. Informal caregivers can experience burden as a result of their role, with possible implications for quality of life (QOL). We review recent research examining MS caregiver experience to (1) understand current risk factors for caregiver burden and (2) identify possible strategies for increasing carer well-being.Recent FindingsMS caregiver experience is highly variable and can be predicted by a variety of care recipient, caregiver and contextual factors. Burden is not the only characte...
Source: Current Neurology and Neuroscience Reports - May 21, 2020 Category: Neuroscience Source Type: research

Lower Grade Gliomas
This article reviews recent research on the clinical and molecular aspects of the disease and innovative therapeutic modalities in the process.Recent FindingsNewly identified clinical and molecular features are currently used in the classification of LGG and applied in treatment-planning decisions. Advanced studies on the cellular level have an advanced understanding of the metabolic effects induced by IDH mutations, offering opportunities for specific targeted therapies that may improve patient outcomes. Such findings may lead to a paradigm shift in the treatment of these tumors.SummaryAlthough LGG are sensitive to radiat...
Source: Current Neurology and Neuroscience Reports - May 21, 2020 Category: Neuroscience Source Type: research

Cognitive Dysfunction in the Early Stages of Multiple Sclerosis —How Much and How Important?
This article summarizes the current knowledge about cognitive dysfunction in the early phase of MS, including biomarkers, MRI correlates, and its value as a prognostic marker.Recent FindingsNew sets of neuropsychological tests have been established to screen for cognitive dysfunction more easily and accurately. Moreover, structural changes detected by brain MRI and several biomarkers found in cerebrospinal fluid and blood serum have been recently correlated with decreased cognitive performance. Additionally, factors influencing cognition in MS, such as disease-modifying therapy, mood disorders, and lifestyle, are better de...
Source: Current Neurology and Neuroscience Reports - May 21, 2020 Category: Neuroscience Source Type: research

Novel Therapies for Glioblastoma
This article reviews the recent preclinical and clinical investigations that seek to expand the repertoire of effective medical and radiotherapy options for GBM.Recent FindingsRecent phase III trials evaluating checkpoint inhibition did not result in significant survival benefit. Select vaccine strategies have yielded promising results in early phase clinical studies and warrant further validation. Various targeted therapies are being explored but have yet to see breakthrough results. In addition, novel radiotherapy approaches are in development to maximize safe dose delivery.SummaryA multitude of preclinical and clinical ...
Source: Current Neurology and Neuroscience Reports - May 21, 2020 Category: Neuroscience Source Type: research

The Role of Arachnoid Granulations and the Glymphatic System in the Pathophysiology of Idiopathic Intracranial Hypertension
AbstractPurpose of ReviewIdiopathic intracranial hypertension (IIH) is a disorder characterized by long-standing elevated intracranial pressure (ICP). As the name applies, no uniform cause has been identified. IIH is typically characterized by headaches, pulsatile tinnitus, and visual deterioration.Recent FindingsAnomalies in cerebrospinal fluid (CSF) absorption are implicated in the pathophysiology of IIH. Non-invasive imaging of the brain parenchyma and the cerebral venous sinus has improved, and research has gained a better understanding of the role of cerebral venous sinus stenosis. Both have led to a better delineatio...
Source: Current Neurology and Neuroscience Reports - May 21, 2020 Category: Neuroscience Source Type: research

The Essentials of Molecular Testing in CNS Tumors: What to Order and How to Integrate Results
This article reviews various molecular tests and provides a concise overview of the most important molecular findings in the most commonly encountered CNS tumors.Recent FindingsMany molecular alterations in CNS tumors have been identified over recent years, some of which are incorporated into the 2016 World Health Organization (WHO) classification and the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy-Not Official WHO (cIMPACT-NOW) updates. Array-based methylation profiling has emerged over the past couple of years and will likely replace much of currently used ancillary testing for diagnosti...
Source: Current Neurology and Neuroscience Reports - May 21, 2020 Category: Neuroscience Source Type: research

Vestibular Lab Testing: Interpreting the Results in the Headache Patient with Dizziness
AbstractPurpose of ReviewTo provide an overview of vestibular lab testing and to familiarize the reader with common results observed in headache patients with dizziness.Recent FindingsThe latest research indicates variable levels of both peripheral and central vestibular dysfunction in headache populations with dizziness. Mechanisms may include vestibulocerebellar loss of inhibition, central vestibular network misfiring, and peripheral pathology aggravating central hypersensitization.SummaryHeadache patients are commonly affected by dizziness stemming from various etiologies. Although history is still the gold standard in ...
Source: Current Neurology and Neuroscience Reports - May 18, 2020 Category: Neuroscience Source Type: research

Migraine Aura: Updates in Pathophysiology and Management
AbstractPurpose of ReviewTo provide an updated review of the pathophysiology, diagnosis, and management of migraine with aura.Recent FindingsThalamic and other subcortical regions may play a role in the pathophysiology of migraine. There is inter-patient and intra-patient attack variability in the characteristics of typical aura especially visual aura symptoms. Migraine with brainstem aura may originate cortically. Migraine with retinal aura may be associated with structural and functional changes in the retina.SummaryAlthough cortical spreading depression (CSD) continues to be the predominant theory surrounding the pathop...
Source: Current Neurology and Neuroscience Reports - May 18, 2020 Category: Neuroscience Source Type: research

ED and Inpatient Management of Headache in Children and Adolescents
AbstractPurpose of ReviewPediatric migraine is common, and appropriate abortive treatment is important to limit impact on school performance and mental health. This review will describe the latest evidence for abortive treatment in the emergency department and inpatient settings.Recent FindingsIt is recognized that a protocol for emergency department treatment can increase efficacy and prevent admissions. These protocols commonly include a non-opioid analgesic and dopamine receptor antagonist. A novel approach to treatment with valproic acid is use of a continuous infusion. Administration of ketamine or propofol and periph...
Source: Current Neurology and Neuroscience Reports - May 13, 2020 Category: Neuroscience Source Type: research

Update on Muscular Dystrophies with Focus on Novel Treatments and Biomarkers
This article reviews recent advances in the development of novel treatments and biomarkers in the realm of muscular dystrophies commonly encountered in pediatric population.Recent FindingsThe therapeutic landscape of muscular dystrophies has changed with the development of new approved treatments for Duchenne muscular dystrophy (DMD), the most common and severe muscular dystrophy. This has paved the way for the development of novel therapeutic strategies for not only DMD but also other muscular dystrophies.SummaryThis article reviews recent advances in the development of novel treatments and biomarkers in the realm of musc...
Source: Current Neurology and Neuroscience Reports - May 13, 2020 Category: Neuroscience Source Type: research

Therapeutic Hypothermia in Acute Ischemic Stroke —a Systematic Review and Meta-Analysis
AbstractPurpose of ReviewTherapeutic hypothermia (TH) in stroke demonstrates robust neuroprotection in animals but clinical applications remain controversial. We assessed current literature on the efficacy of TH in ischemic stroke.Recent FindingsWe conducted a meta-analysis comparing TH versus controls in studies published until June 2019. Controlled studies reporting on ≥ 10 adults with acute ischemic stroke were included. Primary outcome was functional independence (modified Rankin Scale [mRS] ≤ 2). Twelve studies (n = 351 TH,n = 427 controls) were included. Functional inde...
Source: Current Neurology and Neuroscience Reports - May 4, 2020 Category: Neuroscience Source Type: research

Perioperative Stroke
AbstractPurpose of ReviewThis review overviews perioperative stroke as it pertains to specific surgical procedures.Recent FindingsAs awareness of perioperative stroke increases, so does the opportunity to potentially improve outcomes for these patients by early stroke recognition and intervention.SummaryPerioperative stroke is defined to be any stroke that occurs within 30  days of the initial surgical procedure. The incidence of perioperative stroke varies and is dependent on the specific type of surgery performed. This chapter overviews the risks, mechanisms, and acute evaluation and management of perioperative stro...
Source: Current Neurology and Neuroscience Reports - April 26, 2020 Category: Neuroscience Source Type: research

Primary Exercise Headache
AbstractPurpose of ReviewPrimary exercise headache has gone through many descriptors in the past but generally is a headache that is precipitated by strenuous exercise without significant intracranial pathology. Its presentation can remain vague, often confused with other primary and secondary headache disorders and thus undertreated. This review aims to discuss primary exercise headache in the context of epidemiology, presentation, pathophysiology, differential diagnosis, and treatment.Recent FindingsTwo large epidemiological studies in Iran and Japan have further characterized a predilection for female patients, comorbid...
Source: Current Neurology and Neuroscience Reports - April 14, 2020 Category: Neuroscience Source Type: research

Pathophysiology of Conversion to Symptomatic Leber Hereditary Optic Neuropathy and Therapeutic Implications: a Review
AbstractPurposeLeber ’s hereditary optic neuropathy (LHON) is a genetic disease of the mitochondrial genome that mainly affects the retinal ganglion cells (RGC) of the inner retina resulting in central vision loss. New understandings in mitochondrial genetics are helping to elucidate the nuances of conversion and allo w for new therapeutic options.Recent FindingsAppreciation of the mitochondrial fission-fusion balance has allowed for increased understanding of the cascade of events that leads to clinical conversion in LOHN. Mathematical and computational models have helped to interpret the role of ROS in conversion, ...
Source: Current Neurology and Neuroscience Reports - April 14, 2020 Category: Neuroscience Source Type: research

Polypill Trials for Stroke Prevention —Main Results, Critical Appraisal, and Implications for US Population
AbstractPurpose of ReviewThe polypill, referring to a variety of combinations of low-cost cardiovascular and stroke preventive medications combined in a single tablet, has been evaluated as a population-based approach for cardiovascular disease prevention in several trials. This review summarizes the scope of the problem, main trial results, and their potential applicability to the US population.Recent FindingsInitial trials demonstrated the efficacy of the polypill approach. The most recent, the PolyIran study, showed the effectiveness of one form of a polypill for cardiovascular disease prevention, high medication adhere...
Source: Current Neurology and Neuroscience Reports - April 14, 2020 Category: Neuroscience Source Type: research