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Chronic Demyelination and Axonal Degeneration in Multiple Sclerosis: Pathogenesis and Therapeutic Implications
AbstractPurpose of ReviewMultiple sclerosis (MS) is the most common demyelinating disease of the central nervous system (CNS). Inflammatory attacks in MS lead to both demyelination and axonal damage. However, due to incomplete remyelination most MS lesions remain chronically demyelinated. In parallel, there is axonal degeneration in the CNS of MS patients, contributing to progressive disability. There are currently no approved therapies that adequately restore myelin or protect axons from degeneration. In this review, we will discuss the pathophysiology of axonal loss and chronic demyelination in MS and how understanding t...
Source: Current Neurology and Neuroscience Reports - April 9, 2021 Category: Neuroscience Source Type: research

Cerebrovascular Complications Associated with Marijuana Use
AbstractPurpose of reviewIn the last few years, the attitude toward marijuana in many parts of the world has shifted from illicit to legalized for medical use and to decriminalized. In parallel, there has been a gradual increase in the consumption of this product in the general population, particularly among adolescents and young adults. Marijuana is generally perceived as a harmless drug. However, data obtained in observational studies and preclinical models have established associations between cannabis use and cardiovascular events. In addition, there is emerging evidence linking marijuana use to cerebrovascular complic...
Source: Current Neurology and Neuroscience Reports - April 7, 2021 Category: Neuroscience Source Type: research

Functional Connectome in Parkinson ’s Disease and Parkinsonism
AbstractPurpose of ReviewThere has been an exponential growth in functional connectomics research in neurodegenerative disorders. This review summarizes the recent findings and limitations of the field in Parkinson ’s disease (PD) and atypical parkinsonian syndromes.Recent FindingsIncreasingly more sophisticated methods ranging from seed-based to network and whole-brain dynamic functional connectivity have been used. Results regarding the disruption in the functional connectome vary considerably based on disease severity and phenotypes, and treatment status in PD. Non-motor symptoms of PD also link to the dysfunction in ...
Source: Current Neurology and Neuroscience Reports - April 4, 2021 Category: Neuroscience Source Type: research

Sleep Disorders in Patients with Essential Tremor
AbstractPurpose of the ReviewPatients diagnosed with essential tremor (ET) report frequent sleep complaints. This review focuses on the main findings of studies addressing sleep features in patients diagnosed with ET, updating previously reported information.Recent Findings and SummaryBad quality of sleep and excessive daytime somnolence are very frequent in patients with ET, although the effects of the drugs used for the therapy of ET could contribute to these complaints. REM sleep behavior disorder, restless legs, insomnia, and nocturia are frequent complaints as well. There is a lack of studies addressing polysomnograph...
Source: Current Neurology and Neuroscience Reports - March 22, 2021 Category: Neuroscience Source Type: research

Computed Tomography Imaging Predictors of Intracerebral Hemorrhage Expansion
AbstractPurpose of ReviewHematoma expansion (HE) is strongly associated with poor clinical outcome and is a compelling target for improving outcome after intracerebral hemorrhage (ICH). Non-contrast computed tomography (NCCT) is widely used in clinical practice due to its faster acquisition at the presence of acute stroke. Recently, imaging markers on NCCT are increasingly used for predicting HE. We comprehensively review the current evidence on HE prediction using NCCT and provide a summary for assessment of these markers in future research studies.Recent FindingsPredictors of HE on NCCT have been described in reports of ...
Source: Current Neurology and Neuroscience Reports - March 12, 2021 Category: Neuroscience Source Type: research

Neurological Complications of Endocrine Emergencies
AbstractPurpose of ReviewEndocrine disorders are the result of insufficient or excessive hormonal production. The clinical course is long, and the manifestations are nonspecific due to the systemic effect of hormones across many organs and systems including the nervous system. This is a narrative review of the recent evidence of the diagnosis and treatment approach of these medical and neurological emergencies.Recent FindingsWith the possible exception of diabetic ketoacidosis, hyperosmolar hyperglycemic state, and hypoglycemia, endocrinological emergencies are complex, uncommon yet life-threatening conditions with protean...
Source: Current Neurology and Neuroscience Reports - March 11, 2021 Category: Neuroscience Source Type: research

Neurocritical Care of Mechanical Circulatory Support Devices
AbstractPurpose of ReviewMechanical circulatory support (MCS) devices have demonstrated improved survival outcomes in otherwise refractory cardiopulmonary failure but are associated with significant neurologic morbidity and mortality. This review aims to characterize MCS-associated brain injury and discuss the neurocritical care of this population.Recent FindingsWe found no practice guidelines or specific management strategies for the neurocritical care of patients with MCS devices. Acute brain injury was commonly observed in short-term and durable MCS devices. There is emerging evidence that a standardized neurological mo...
Source: Current Neurology and Neuroscience Reports - March 10, 2021 Category: Neuroscience Source Type: research

Genetic Variation and Impact on Outcome in Traumatic Brain Injury: an Overview of Recent Discoveries
AbstractPurpose of ReviewTraumatic brain injury (TBI) has a significant burden of disease worldwide and outcomes vary widely. Current prognostic tools fail to fully account for this variability despite incorporating clinical, radiographic, and biochemical data. This variance could possibly be explained by genotypic differences in the patient population. In this review, we explore single nucleotide polymorphism (SNP) TBI outcome association studies.Recent FindingsIn recent years, SNP association studies in TBI have focused on global, neurocognitive/neuropsychiatric, and physiologic outcomes. While the APOE gene has been the...
Source: Current Neurology and Neuroscience Reports - March 10, 2021 Category: Neuroscience Source Type: research

Management Strategies for Comorbid Supine Hypertension in Patients with Neurogenic Orthostatic Hypotension
This article reviews the pathophysiology and clinical characteristics of nOH and nSH, and describes the management of patients with both nOH and nSH.Recent FindingsPressor medications required to treat the symptoms of nOH also increase the risk of nSH. Because nOH and nSH are hemodynamically opposed, therapies to treat one condition may exacerbate the other. The management of patients with nOH who also have nSH can be challenging and requires an individualized approach to balance the short- and long-term risks associated with these conditions.SummaryApproaches to manage neurogenic BP dysregulation include nonpharmacologic ...
Source: Current Neurology and Neuroscience Reports - March 9, 2021 Category: Neuroscience Source Type: research

The Role of Genetic Testing for Parkinson ’s Disease
AbstractPurpose of ReviewTo describe current practices and attitudes about genetic testing for Parkinson ’s disease (PD) among neurologists, highlight the changing scene of genetic testing for PD, and provide guidance on facilitating PD genetic testing in a clinical practice.Recent FindingsSince the 1990s, researchers have discovered several major gene variants contributing to PD etiology. A large body of literature now exists supporting the frequency of these variants in different populations and their effects on phenotype and clinical course. Recently, clinical trials have emerged with therapies targeting genetic forms...
Source: Current Neurology and Neuroscience Reports - March 8, 2021 Category: Neuroscience Source Type: research

Digital Technology in Movement Disorders: Updates, Applications, and Challenges
This article reviews recent literature on the application of digital technology in movement disorders, with a focus on Parkinson ’s disease (PD) and Huntington’s disease.Recent FindingsRecent research has demonstrated the ability for digital technology to discriminate between individuals with and without PD, identify those at high risk for PD, quantify specific motor features, predict clinical events in PD, inform clinical management, and generate novel insights.SummaryDigital technology has enormous potential to transform clinical research and care in movement disorders. However, more work is needed to better validate...
Source: Current Neurology and Neuroscience Reports - March 3, 2021 Category: Neuroscience Source Type: research

Challenges and Controversies in the Genetic Diagnosis of Hereditary Spastic Paraplegia
AbstractPurpose of ReviewThe hereditary spastic paraplegias (HSPs) are a group of disorders characterised by progressive lower limb weakness and spasticity. We address the challenges and controversies involved in the genetic diagnosis of HSP.Recent FindingsThere is a large and rapidly expanding list of genes implicated in HSP, making it difficult to keep gene testing panels updated. There is also a high degree of phenotypic overlap between HSP and other disorders, leading to problems in choosing the right panel to analyse. We discuss genetic testing strategies for overcoming these diagnostic hurdles, including the use of t...
Source: Current Neurology and Neuroscience Reports - February 28, 2021 Category: Neuroscience Source Type: research

Telehealth in Multiple Sclerosis Clinical Care and Research
AbstractPurpose of ReviewThe COVID-19 pandemic has provided us with a unique opportunity to experiment with telehealth and evaluate its benefits and limitations. This review discusses the impact of telehealth on multiple sclerosis (MS) care and research in adults and children.Recent FindingsTelehealth visits for MS patients have been shown to reduce missed workdays and costs for patients. Brief telephone-based counseling may be associated with better adherence to disease-modifying therapy, although results of multiple home-based tele-rehabilitation for people with MS have been equivocal. Overall, patients and providers hav...
Source: Current Neurology and Neuroscience Reports - February 28, 2021 Category: Neuroscience Source Type: research

Genetic ataxias: update on classification and diagnostic approaches
AbstractAtaxia encompasses a large group of rare disorders characterized by irregular movements, decreased coordination, imbalance, kinetic tremor, wide-based stance, and dysarthria. Evaluating ataxia can be challenging considering the volume of disorders and their complex pathologies involving diverse genetic and clinical factors. This is a comprehensive review of the genetic ataxia literature, presenting updated guidelines for differential diagnosis. Age, time course, and family history provide initial guidance for evaluation of ataxia. As genetic testing is increasingly utilized, new genes are discovered and phenotypes ...
Source: Current Neurology and Neuroscience Reports - February 26, 2021 Category: Neuroscience Source Type: research

Frameworks for Parkinson ’s Disease Rehabilitation Addressing When, What, and How
AbstractPurpose of ReviewThis review summarizes the evidence on rehabilitation for people with Parkinson ’s disease, including when to refer, what rehabilitation professionals should address, and how to deliver rehabilitation care.Recent FindingsClinical practice guidelines support physical therapy, occupational therapy, and speech-language pathology for Parkinson ’s disease. However, integrating guidelines into practice may be difficult. Implementation studies take into account patient and clinician perspectives. Synthesizing guidelines with implementation research can improve local delivery.SummaryThere is moderate t...
Source: Current Neurology and Neuroscience Reports - February 22, 2021 Category: Neuroscience Source Type: research