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Neurologic Manifestations of the Antiphospholipid Syndrome — an Update
AbstractPurpose of ReviewIn recent years, the spectrum of neurological manifestations of antiphospholipid syndrome (APS) has been growing. We provide a critical review of the literature with special emphasis on presentation, proposed mechanisms of disease, and treatment of neurological involvement in APS.Recent FindingsAlthough stroke is the most common cause of neurological manifestations in patients with APS, other neurological disorders have been increasingly associated with the disease, including cognitive dysfunction, headache, and epilepsy. Direct oral anticoagulants have failed to show non-inferiority compared to vi...
Source: Current Neurology and Neuroscience Reports - June 14, 2021 Category: Neuroscience Source Type: research

The History of Amnesia —a Review
AbstractPurpose of ReviewThis review traces amnesia ’s history from its earliest eighteenth century classification as a medical disorder to the present. Sophisticated depictions in the nineteenth century literature containing elaborate compilations of causal factors, including neurologic, consider pathogenesis, course, duration, durability, and tem poral features.Recent FindingsSevere amnesia, especially anterograde involving new learning, found archetypal expression in the twentieth century, in the case of H.M. The “pure” amnesia confirmed an independent memory disorder distinct from other cognitive disturbances, wi...
Source: Current Neurology and Neuroscience Reports - June 10, 2021 Category: Neuroscience Source Type: research

Critical Appraisal of Amyloid Lowering Agents in AD
AbstractPurpose of ReviewAccording to the amyloid cascade hypothesis, removing amyloid beta (A β) should cure Alzheimer’s disease (AD). In the past three decades, many agents have been tested to try to lower Aβ production, prevent Aβ aggregation, and dissolve Aβ deposits. However, the paucity in definitive preventative or curative properties of these agents in clinical trials has result ed in more avant-garde approaches to therapeutic investigations. Immunotherapy has become an area of focus for research on disease-modifying therapies for neurodegenerative diseases. In this review, we highlight the current clinical d...
Source: Current Neurology and Neuroscience Reports - June 10, 2021 Category: Neuroscience Source Type: research

Approach to Pediatric Intractable Migraine
AbstractPurpose of ReviewIntractable migraine in children and adolescents is a significant cause of disability and decreased quality of life (QoL) in this population. Challenges include lack of unifying definition for intractable migraine, and limited data on best-practice management in this age group, with most current treatment pathways extrapolated from adult studies or expert consensus.Recent FindingsA comprehensive approach in the evaluation and management of intractable migraine in this age group encompasses excluding secondary causes of headache; making an accurate diagnosis; identifying and appropriately managing m...
Source: Current Neurology and Neuroscience Reports - June 4, 2021 Category: Neuroscience Source Type: research

Central Nervous System Infections in Immunocompromised Patients
This article reviews current epidemiologic trends, clinical presentations, and diagnostic strategies for central nervous system (CNS) infections in human immunodeficiency virus-negative (HIV) patients immunocompromised by their underlying disease or by receipt of immunosuppressive or immunomodulating therapies. Three patient groups are considered: (1) cancer patients; (2) hematopoietic or solid organ transplantation recipients; and (3) patients with autoimmune or inflammatory conditions requiring therapies that alter the host immune response.Recent FindingsClinical presentations, associated neuroimaging, and cerebrospinal ...
Source: Current Neurology and Neuroscience Reports - May 26, 2021 Category: Neuroscience Source Type: research

Infection Mitigation Strategies for Multiple Sclerosis Patients on Oral and Monoclonal Disease-Modifying Therapies
AbstractPurpose of ReviewThe newer, higher-efficacy disease-modifying therapies (DMTs) for multiple sclerosis (MS) —orals and monoclonals—have more profound immunomodulatory and immunosuppressive properties than the older, injectable therapies and require risk mitigation strategies to reduce the risk of serious infections. This review will provide a systematic framework for infectious risk mitigation strateg ies relevant to these therapies.Recent FindingsWe classify risk mitigation strategies according to the following framework: (1) screening and patient selection, (2) vaccinations, (3) antibiotic prophylaxis, (4) lab...
Source: Current Neurology and Neuroscience Reports - May 19, 2021 Category: Neuroscience Source Type: research

Retinal Migraine: Evaluation and Management
AbstractPurpose of ReviewThis review aims to summarize the last 15 years of literature and case reports detailing retinal migraine —an uncommon and somewhat poorly understood migraine variant.Recent FindingsIn the last 15 years, only 12 cases of retinal migraine have been outlined. Similar to other migraine statistics, retinal migraine appears to affect women more so than men and presents with unilateral headache which tends to be ipsilateral to the side of vision loss. The pathophysiology may relate to vasoconstriction of retinal vessels, as evidenced by ictal fundus photography in the past few years.SummaryRetinal migr...
Source: Current Neurology and Neuroscience Reports - May 11, 2021 Category: Neuroscience Source Type: research

Nutraceuticals and Behavioral Therapy for Headache
AbstractPurpose of ReviewHeadache affects and disables at least 1 billion people worldwide. Patients and providers seek new therapies to relieve headache without the side effects and financial burden of current treatments. This narrative review highlights recent treatment advances in integrative headache medicine: nutraceuticals and behavioral therapies.Recent FindingsGrowing use of complementary and alternative medicine (CAM) therapies for headache (riboflavin, coenzyme Q10, magnesium, vitamin D, melatonin) alongside mainstream treatments is increasing with improving evidence of quality, safety, and tolerability. Increasi...
Source: Current Neurology and Neuroscience Reports - May 10, 2021 Category: Neuroscience Source Type: research

Effects of the Menstrual Cycle on Neurological Disorders
AbstractPurpose of ReviewThe menstrual cycle involves recurrent fluctuations in hormone levels and temperature via neuroendocrine feedback loops. This paper reviews the impact of the menstrual cycle on several common neurological conditions, including migraine, seizures, multiple sclerosis, stroke, and Parkinson ’s disease.Recent FindingsThe ovarian steroid hormones, estrogen and progesterone, have protean effects on central nervous system functioning that can impact the likelihood, severity, and presentation of many neurological diseases. Hormonal therapies have been explored as a potential treatment for many neurologic...
Source: Current Neurology and Neuroscience Reports - May 10, 2021 Category: Neuroscience Source Type: research

Effects of Obstructive Sleep Apnea and CPAP on Cognitive Function
AbstractPurpose of ReviewObstructive sleep apnea (OSA) is characterized by repetitive episodes of complete or partial upper airway obstruction during sleep. Studies indicate that OSA is an independent risk factor for cognitive decline in older patients. The purpose of this paper is to critically review the recent literature on the cognitive effects of untreated OSA and the benefits of treatment across cognitive domains.Recent FindingsOSA ’s greatest impact appears to be on attention, vigilance, and information processing speed. Furthermore, the presence of OSA seems to have a significant impact on development and progres...
Source: Current Neurology and Neuroscience Reports - May 6, 2021 Category: Neuroscience Source Type: research

Sleep Disorders in Mitochondrial Diseases
AbstractPurpose of ReviewWe aim to summarize the sleep disorders reported in patients affected by primary mitochondrial dysfunctions and describe the association with their clinical and molecular characteristics.Recent FindingsSleep complaints are prevalent in mitochondrial disorders. Sleep-disordered breathing is the main sleep disorder reported in mitochondrial diseases. OSA and CSA are, respectively, more frequently associated with patients characterized by the prevalent involvement of the skeletal muscle and the predominant involvement of the central nervous system. Other sleep disorders, such as restless legs syndrome...
Source: Current Neurology and Neuroscience Reports - May 5, 2021 Category: Neuroscience Source Type: research

Cluster Headache: A Review and Update in Treatment
AbstractPurpose of ReviewThe treatment of cluster headache has evolved to include a handheld neuromodulation device and a monoclonal antibody in addition to more traditional agents.Recent FindingsGalcanezumab is an approved treatment for episodic cluster headache. The non-invasive vagal nerve stimulator has been shown to be effective as a treatment for episodic cluster headache. Dedicated pituitary imaging may not be necessary with a normal MRI of the brain.SummaryCluster headache is the most common trigeminal-autonomic cephalalgia, characterized by unilateral, frequent, debilitating attacks associated with ipsilateral aut...
Source: Current Neurology and Neuroscience Reports - May 5, 2021 Category: Neuroscience Source Type: research

Neurologic Complications of Poverty: the Associations Between Poverty as a Social Determinant of Health and Adverse Neurologic Outcomes
This study summarizes the recent literature on poverty as it contributes to neurological disease.Recent FindingsChildren growing up in poverty have increased risk for cognitive deficits and behavioral disorders as reported by Noble et al. (Dev Sci. 9(6):642 –54, 2006) and Farah et al. (Brain Res. 1110(1):166–74, 2006) as well as worse outcomes when it comes to epilepsy management and disease course as discussed by Camfield et al. (Epilepsia. 57(11):1826–33, 2016). In adulthood, as the number of social determinants of health increases, the inciden ce of stroke and severe stroke increases significantly as reported by R...
Source: Current Neurology and Neuroscience Reports - May 5, 2021 Category: Neuroscience Source Type: research

Economics of Multiple Sclerosis Disease-Modifying Therapies in the USA
AbstractPurpose of ReviewMultiple sclerosis (MS) is a prevalent and debilitating neuroinflammatory disease associated with a significant economic burden. Direct healthcare costs, which can average $70,000 a year, have risen rapidly over the last decade and are driven by the escalating cost of disease-modifying therapies (DMTs). Despite a growing number of DMTs, annual increases in price for most DMTs have commonly exceeded 10% over the last 15 years. The high cost of MS DMTs has created economic hardships for patients in terms of high out-of-pocket costs and insurance company-induced barriers. Although generic versions of ...
Source: Current Neurology and Neuroscience Reports - May 5, 2021 Category: Neuroscience Source Type: research

Telemedicine in Pediatric Headache: A Review and Practical Implementation
AbstractPurpose of ReviewThe purpose of this review was to summarize the current literature about telemedicine in pediatric headache and to provide practical guidance for its implementation.Recent FindingsThere are few studies dedicated to telemedicine in pediatric headache, and existing studies are small. Patients and families report high levels of satisfaction with telemedicine, and most are willing to continue telemedicine visits in the future. Telemedicine demonstrated similar reductions in headache frequency, severity, and duration as patients treated in-person. Remotely delivered psychologic interventions have some u...
Source: Current Neurology and Neuroscience Reports - April 12, 2021 Category: Neuroscience Source Type: research