Atrial Fibrillation for the Neurologist: Preventing both Ischemic and Hemorrhagic Strokes
AbstractPurpose of ReviewThis review aims to help neurologists managing atrial fibrillation (AF) patients who had an ischemic stroke and/or with intracranial hemorrhage (ICH) markers, therefore at high embolic/hemorrhagic risks.Recent FindingsImplantable loop recorders have substantially improved the accuracy of AF detection. Recent research yielded a set of powerful neuroimaging markers that can stratify ICH risk. Direct oral anticoagulants (DOAC) are easier to use with a lower ICH risk than warfarin in a general AF population. Finally, the FDA-approved left atrial appendage closure (LAAC) with the WATCHMAN device provide...
Source: Current Neurology and Neuroscience Reports - February 6, 2018 Category: Neuroscience Source Type: research

Neurological Complications of Acute and Chronic Sinusitis
AbstractPurpose of ReviewAcute and chronic sinusitis can give rise to a wide array of intracranial and orbital complications. These complications include brain abscess, subdural empyema, epidural abscess, meningitis, venous sinus thrombosis, frontal bone osteomyelitis, and orbital cellulitis and abscess. Despite numerous medical advances, these complications carry a risk of mortality and significant morbidity.Recent FindingsRecent studies have shown improvement in both the mortality and the morbidity associated with the neurologic complications of acute and chronic sinusitis. However, there are still a large portion of pat...
Source: Current Neurology and Neuroscience Reports - February 5, 2018 Category: Neuroscience Source Type: research

Genomic Alterations in Sporadic Pituitary Tumors
AbstractPurpose of ReviewPituitary tumors are undergoing a transformation in histopathologic and molecular classification, coincident with the continued refinement of increasingly powerful methods of genomic annotation and discovery. We highlight novel genomic alterations identified in pituitary adenomas and craniopharyngiomas and discuss their clinical implications.Recent FindingsSporadic pituitary adenomas are associated with relatively few recurrent somatic mutations. Recurrent mutations occur largely in subsets of hormone-producing tumors, includingGNAS andGPR101 in somatotroph adenomas andUSP8 in corticotroph adenomas...
Source: Current Neurology and Neuroscience Reports - February 2, 2018 Category: Neuroscience Source Type: research

Neurological Adverse Events Associated with Immune Checkpoint Inhibitors: Diagnosis and Management
AbstractPurpose of ReviewImmune checkpoint inhibitors represent a major step forward in the field of oncologic immunotherapy these last years and have significantly increased survival of cancer patients in an ever-growing number of indications. These agents block specific immune checkpoint molecules (programmed cell death protein 1 and its ligand as well as cytotoxic T-lymphocyte-associated antigen 4) that normally downregulate the immune response. These new agents show a specific range of adverse effects induced by abnormal immunologic activation.Recent FindingsMany different neurologic adverse events have been described,...
Source: Current Neurology and Neuroscience Reports - February 1, 2018 Category: Neuroscience Source Type: research

Sleep Disturbance and Cognitive Dysfunction in Multiple Sclerosis: a Systematic Review
AbstractPurpose of ReviewThe present review summarizes recent research on the association between sleep disturbance and cognitive dysfunction in MS. Assessment methodology, domain-specific associations between sleep disturbance and cognitive dysfunction, and implications for future research and treatment are discussed.Recent FindingsAll 12 studies included in this review found significant associations between sleep disturbance and cognitive dysfunction; however, results varied considerably depending on the assessment method used and the cognitive domain assessed. Self-reported sleep disturbance generally predicted self-rep...
Source: Current Neurology and Neuroscience Reports - January 29, 2018 Category: Neuroscience Source Type: research

The Potential of Stem Cells in Treatment of Traumatic Brain Injury
AbstractPurpose of ReviewTraumatic brain injury (TBI) is a global public health concern, with limited treatment options available. Despite improving survival rate after TBI, treatment is lacking for brain functional recovery and structural repair in clinic. Recent studies have suggested that the mature brain harbors neural stem cells which have regenerative capacity following brain insults. Much progress has been made in preclinical TBI model studies in understanding the behaviors, functions, and regulatory mechanisms of neural stem cells in the injured brain. Different strategies targeting these cell population have been ...
Source: Current Neurology and Neuroscience Reports - January 25, 2018 Category: Neuroscience Source Type: research

Long-term Survivors of Childhood Brain Tumors: Impact on General Health and Quality of Life
AbstractPurpose of ReviewWe review and summarize the key issues affecting general health and quality of life (QOL) of pediatric long-term survivors of brain tumors.Recent FindingsLong-term survivors of brain tumors are at risk of considerable late morbidity and mortality. Lengthening survival in brain tumors has highlighted the deep impact of tumor and its treatment on the physical, psychological, functional, and social health and QOL of these survivors. Evolution in tumor therapy including surgery, radiotherapy, and systemic therapies, etc., has the potential to mitigate this impact to some extent.SummarySensitization of ...
Source: Current Neurology and Neuroscience Reports - November 8, 2017 Category: Neuroscience Source Type: research

Restorative Strategies in Movement Disorders: the Contribution of Imaging
AbstractPurpose of ReviewThe purpose of this review was to review the imaging, particularly positron emission tomography (PET), findings in neurorestoration studies in movement disorders, with specific focus on neural transplantation in Parkinson ’s disease (PD) and Huntington’s disease (HD).Recent FindingsPET findings in PD transplantation studies have shown that graft survival as reflected by increases in dopaminergic PET markers does not necessarily correlate with clinical improvement. PD patients with more denervated ventral striatum and more imbalanced serotonin-to-dopamine ratio in the grafted neurons ten...
Source: Current Neurology and Neuroscience Reports - November 2, 2017 Category: Neuroscience Source Type: research

Emerging Monogenic Complex Hyperkinetic Disorders
AbstractPurpose of ReviewHyperkinetic movement disorders can manifest alone or as part of complex phenotypes. In the era of next-generation sequencing (NGS), the list of monogenic complex movement disorders is rapidly growing. This review will explore the main features of these newly identified conditions.Recent FindingsMutations inADCY5 andPDE10A have been identified as important causes of childhood-onset dyskinesias andKMT2B mutations as one of the most frequent causes of complex dystonia in children. The delineation of the phenotypic spectrum associated with mutations inATP1A3,FOXG1,GNAO1,GRIN1,FRRS1L, andTBC1D24 is rev...
Source: Current Neurology and Neuroscience Reports - October 30, 2017 Category: Neuroscience Source Type: research

Emerging Technologies in Flow Diverters and Stents for Cerebrovascular Diseases
AbstractPurpose of ReviewStents and flow diverters have revolutionized the treatment of cerebrovascular disease. Guglielmi coils, flexible microcatheters, and first-generation intracranial stents, such as Neuroform (Stryker Neurovascular) and Enterprise stents (Codman/DePuy-Synthes), have paved the way for the development of the Pipeline Embolization Device (PED) (ev3/Covidien/Medtronic) and other endovascular approaches.Recent FindingsThis review discusses the historical development of flow diverter technologies from the PED to similar devices, such as the Surpass stent (Stryker Neurovascular), the Flow-Redirection Endolu...
Source: Current Neurology and Neuroscience Reports - October 28, 2017 Category: Neuroscience Source Type: research

Physiopathology of Migraine: What Have We Learned from Functional Imaging?
AbstractPurpose of ReviewThis review aims to provide an overview of the most recent and significant functional neuroimaging studies which have clarified the complex mechanisms underlying migraine pathophysiology.Recent FindingsThe recent data allow us to overcome the concept of a migraine generator suggesting that functional networks abnormalities may lead to changes in different brain area activities and consequent reduced migraine thresholds susceptibility, likely associated with higher migraine severity and burden.SummaryAlthough functional magnetic resonance imaging studies have allowed recognition of several migraine ...
Source: Current Neurology and Neuroscience Reports - October 23, 2017 Category: Neuroscience Source Type: research

Microbiota-Brain-Gut Axis and Neurodegenerative Diseases
AbstractPurpose of ReviewThe purposes of this review were as follows: first, to provide an overview of the gut microbiota and its interactions with the gut and the central nervous system (the microbiota-gut-brain axis) in health, second, to review the relevance of this axis to the pathogenesis of neurodegenerative diseases, such as Parkinson ’s disease, and, finally, to assess the potential for microbiota-targeted therapies.Recent FindingsWork on animal models has established the microbiota-gut-brain axis as a real phenomenon; to date, the evidence for its operation in man has been limited and has been confronted by ...
Source: Current Neurology and Neuroscience Reports - October 17, 2017 Category: Neuroscience Source Type: research

Correction to: Dietary Interventions and Multiple Sclerosis
AbstractThe original version of this article contains an error in the second sentence of the second paragraph of thePaleolithic Diet section. (Source: Current Neurology and Neuroscience Reports)
Source: Current Neurology and Neuroscience Reports - October 17, 2017 Category: Neuroscience Source Type: research

Integrated Health Care Management of Moderate to Severe TBI in Older Patients —A Narrative Review
AbstractPurpose of ReviewTraumatic brain injuries are common, especially within the elderly population, which is typically defined as age 65 and older. This narrative review aims at summarizing and critically evaluating important aspects of their health care management in covering the entire pathway from prehospital care to rehabilitation and beyond.Recent FindingsThe number of older patients with traumatic brain injury (TBI) is increasing, and there seem to be differences in all aspects of care along their pathway when compared to younger patients. Despite a higher mortality and a generally less favorable outcome, the cur...
Source: Current Neurology and Neuroscience Reports - October 7, 2017 Category: Neuroscience Source Type: research

Treatment Advances in Spinal Muscular Atrophy
AbstractPurpose of ReviewSpinal muscular atrophy (SMA) is a genetic disorder of motor neurons in the anterior horns of the spinal cord and brainstem that results in muscle atrophy and weakness. SMA is an autosomal recessive disease linked to deletions of theSMN1 gene on chromosome 5q. Humans have a duplicate gene (SMN2) whose product can mitigate disease severity, leading to the variability in severity and age of onset of disease, and is therefore a target for drug development.Recent FindingsAdvances in preclinical and clinical trials have paved the way for novel therapeutic options for SMA patients, including many current...
Source: Current Neurology and Neuroscience Reports - October 6, 2017 Category: Neuroscience Source Type: research

PET Molecular Imaging Research of Levodopa-Induced Dyskinesias in Parkinson ’s Disease
AbstractPurpose of ReviewTo review the current status of positron emission tomography (PET) molecular imaging research of levodopa-induced dyskinesias (LIDs) in Parkinson ’s disease (PD).Recent FindingsRecent PET studies have provided robust evidence that LIDs in PD are associated with elevated and fluctuating striatal dopamine synaptic levels, which is a consequence of the imbalance between dopaminergic and serotonergic terminals, with the latter playing a key role in mishandling presynaptic dopamine release. Long-term exposure to levodopa is no longer believed to solely induce LIDs, as studies have highlighted that...
Source: Current Neurology and Neuroscience Reports - October 3, 2017 Category: Neuroscience Source Type: research

Neurobehavioral Effects and Biomarkers of Sleep Loss in Healthy Adults
This article reviews the neurobehavioral deficits resulting from sleep loss in adults, various countermeasures to mitigate these effects, and biomarkers to identify individual differences in neurobehavioral responses.Recent FindingsTotal sleep deprivation and chronic sleep restriction increase the homeostatic sleep drive and diminish waking neurobehavioral functioning, producing deficits in attention, memory and cognitive speed, increases in sleepiness and fatigue, and unstable wakefulness. Recovery sleep, extension of sleep, and use of caffeine and/or naps are all effective countermeasures to mitigate these responses. Can...
Source: Current Neurology and Neuroscience Reports - September 25, 2017 Category: Neuroscience Source Type: research

Infections in Patients Receiving Multiple Sclerosis Disease-Modifying Therapies
AbstractPurpose of ReviewThis paper will systemically review the risk of infections associated with current disease-modifying treatments and will discuss pre-treatment testing recommendations, infection monitoring strategies, and patient education.Recent FindingsAside from glatiramer acetate and interferon-beta therapies, all other multiple sclerosis treatments to various degrees impair immune surveillance and may predispose patients to the development of both community-acquired and opportunistic infections. Some of these infections are rarely seen in neurologic practice, and neurologists should be aware of how to monitor ...
Source: Current Neurology and Neuroscience Reports - September 22, 2017 Category: Neuroscience Source Type: research

Tuberculous Meningitis in Children and Adults: New Insights for an Ancient Foe
AbstractPurpose of ReviewTuberculous meningitis is the most devastating manifestation of infection withMycobacterium tuberculosis and represents a medical emergency. Approximately one half of tuberculous meningitis patients die or suffer severe neurologic disability. The goal of this review will be to review the pathogenic, clinical, and radiologic features of tuberculous meningitis and to highlight recent advancements in translational and clinical science.Recent FindingsPharmacologic therapy includes combination anti-tuberculosis drug regimens and adjunctive corticosteroids. It is becoming clear that a successful treatmen...
Source: Current Neurology and Neuroscience Reports - September 20, 2017 Category: Neuroscience Source Type: research

Present Uses, Future Applications, and Technical Underpinnings of Electrical Impedance Myography
AbstractPurpose of ReviewIn this article, we provide an overview of electrical impedance myography (EIM), including its technical and theoretical basis, a summary of its varied applications, and ongoing developments.Recent FindingsEIM has been used as a disease severity biomarker in a variety of disorders affecting the muscle, ranging from amyotrophic lateral sclerosis (ALS) to muscular dystrophies to disuse atrophy due to the weightlessness of space. In ALS, studies have demonstrated that major reductions in sample size in clinical trials can be achieved. Similarly, in the Duchenne muscular dystrophy, the technique tracks...
Source: Current Neurology and Neuroscience Reports - September 20, 2017 Category: Neuroscience Source Type: research

Sleep Disturbance After TBI
AbstractPurpose of ReviewPresent relevant literature to update knowledge on sleep science, identify common sleep disturbances seen in TBI, discuss evidence for available treatment options, and illuminate future areas for research.Recent FindingsSleep disturbances, including insomnia, circadian rhythm disturbances, and sleep apnea, are prevalent for all severities of traumatic brain injury (TBI), can be chronic, and affect both rehabilitation and recovery from the TBI.SummaryNew knowledge of basic sleep mechanisms and neurochemistry has exploded in the last decade. In addition to known effects on mood and cognition from sle...
Source: Current Neurology and Neuroscience Reports - September 20, 2017 Category: Neuroscience Source Type: research

Risk-Based Bioequivalence Recommendations for Antiepileptic Drugs
AbstractPurpose of ReviewThis review summarizes the current FDA practice in developing risk- and evidence-based product-specific bioequivalence guidances for antiepileptic drugs (AEDs).Recent FindingsFDA ’s product-specific guidance (PSG) for AEDs takes into account the therapeutic index of each AED product. Several PSGs for AEDs recommend fully replicated studies and a reference-scaled average bioequivalence (RS-ABE) approach that permit the simultaneous equivalence comparison of the mean and wit hin-subject variability of the test and reference products.SummaryThe PSGs for AEDs published by FDA reflect the agency &...
Source: Current Neurology and Neuroscience Reports - September 19, 2017 Category: Neuroscience Source Type: research

Aphasia As a Predictor of Stroke Outcome
AbstractPurpose of ReviewAphasia is a common feature of stroke, affecting 21 –38% of acute stroke patients and an estimated 1 million stroke survivors. Although stroke, as a syndrome, is the leading cause of disability in the USA, less is known about the independent impact of aphasia on stroke outcomes.Recent FindingsDuring the acute stroke period, aphasia has been found to increase length of stay, inpatient complications, overall neurological disability, mortality, and to alter discharge disposition. Outcomes during the sub-acute and chronic stroke periods show that aphasia is associated with lower Functional Indepe...
Source: Current Neurology and Neuroscience Reports - September 19, 2017 Category: Neuroscience Source Type: research

TBI Rehabilomics Research: an Exemplar of a Biomarker-Based Approach to Precision Care for Populations with Disability
AbstractPurpose of reviewThe purpose of this review is to summarize how “-omics” technologies can inform rehabilitation-relevant outcomes for a range of populations with neurologically related disability by including outcome metrics linked to the World Health Organization’s International Classification of Functioning, Disability, and Health (WHO-ICF) domains of im pairments in body function, activity limitations, and participation restrictions.Recent findingsTo date, nearly every area of medicine uses biomarkers in some capacity to aid in understanding how personal biology informs clinical care. “-O...
Source: Current Neurology and Neuroscience Reports - September 19, 2017 Category: Neuroscience Source Type: research

DVT Prevention in Stroke
AbstractPurpose of ReviewThe purpose of this review is to discuss the prevention of venous thromboembolism (VTE) in stroke patients. We discuss use of oral anticoagulation and other interventions for the prevention of VTE. A new class of medications, non-vitamin K antagonist oral anticoagulants (NOACs), have been successfully trialed for the prevention of VTE. We review the data and guidance statements for VTE prevention.Recent FindingsWarfarin and vitamin K antagonist drugs have been the mainstay of VTE prevention for decades. More recently, NOACs have become available for both stroke and systemic embolism prevention in n...
Source: Current Neurology and Neuroscience Reports - September 18, 2017 Category: Neuroscience Source Type: research

Management of Spontaneous Intracerebral Hemorrhage
AbstractPurpose of ReviewWe review the current evidence for medical and surgical treatments of spontaneous intracerebral hemorrhage (ICH).Recent FindingsTherapy with hemostatic agents (e.g. factor VIIa and tranexamic acid) if started early after bleeding onset may reduce hematoma expansion, but their clinical effectiveness has not been shown. Rapid anticoagulation reversal with prothrombin concentrates (PCC) plus vitamin K is the first choice in vitamin K antagonist-related ICH. In ICH related to dabigatran, anticoagulation can be rapidly reversed with idarucizumab. PCC are recommended for ICH related to FXa inhibitors, wh...
Source: Current Neurology and Neuroscience Reports - September 8, 2017 Category: Neuroscience Source Type: research

Sensory Neuronopathies
AbstractPurpose of ReviewThe sensory neuronopathies are sensory-predominant polyneuropathies that result from damage to the dorsal root and trigeminal sensory ganglia. This review explores the various causes of acquired sensory neuronopathies, the approach to diagnosis, and treatment.Recent FindingsDiagnostic criteria have recently been published and validated to allow differentiation of sensory neuronopathies from other polyneuropathies. On the basis of serial electrodiagnostic studies, the treatment window for the acquired sensory neuronopathies has been identified as approximately 8 months. If treatment is initiated wit...
Source: Current Neurology and Neuroscience Reports - August 23, 2017 Category: Neuroscience Source Type: research

Genetics of Alzheimer ’s Disease: the Importance of Polygenic and Epistatic Components
AbstractPurpose of ReviewWe aimed to summarize the recent advances in genetic findings of Alzheimer ’s disease (AD), focusing on traditional single-marker and gene approaches and non-traditional ones, i.e., polygenic and epistatic components.Recent FindingsGenetic studies have progressed over the last few decades from linkage to genome-wide association studies (GWAS), and most recently studies utilizing high-throughput sequencing. So far, GWASs have identified several common variants characterized by small effect sizes (besidesAPOE- ε4). Sequencing has facilitated the study of rare variants with larger effect...
Source: Current Neurology and Neuroscience Reports - August 21, 2017 Category: Neuroscience Source Type: research

Carotid Artery Stenosis: Medical Therapy, Surgery, and Stenting
AbstractPurpose of ReviewThe purpose of the study was to update the recent information pertaining to carotid artery stenosis risk stratification and treatment.Recent FindingsCurrent decision-making related to carotid artery stenosis is based on clinical trials that are outdated. Medical therapy has improved considerably in the past two decades, and this has reduced the stroke rate for both symptomatic and asymptomatic carotid stenoses. In recent community-based studies, the stroke risk with asymptomatic stenosis has been
Source: Current Neurology and Neuroscience Reports - August 19, 2017 Category: Neuroscience Source Type: research

Imaging the Etiology of Apathy, Anxiety, and Depression in Parkinson ’s Disease: Implication for Treatment
AbstractApathy, depression, and anxiety are among the most important non-motor signs of Parkinson ’s disease (PD). This may be encountered at early stages of illness and represent a major source of burden. Understanding their pathophysiology is a major prerequisite for efficient therapeutic strategies. Anatomical and metabolic imaging studies have enabled a breakthrough by demonstrating that w idespread abnormalities within the limbic circuits notably the orbitofrontal and anterior cingulate cortices, amygdala, thalamus, and ventral striatum are involved in the pathophysiology of depression, anxiety, and apathy in PD...
Source: Current Neurology and Neuroscience Reports - August 18, 2017 Category: Neuroscience Source Type: research

Optical Coherence Tomography to Differentiate Papilledema from Pseudopapilledema
AbstractPurpose of ReviewMild papilledema may be difficult to distinguish by clinical observation from pseudopapilledema. An accurate diagnosis is critical to avoid invasive workup and unwarranted treatment. In this review, we focus on the development and subsequent role of optical coherence tomography (OCT) in detecting and differentiating optic nerve head drusen (ONHD) from papilledema and other causes of acquired swelling of the optic disc.Recent FindingsNewer OCT technologies which permit deeper penetration to improve detection of ONHD were also reviewed. Enhanced depth imaging (EDI) spectral-domain OCT and swept-sourc...
Source: Current Neurology and Neuroscience Reports - August 17, 2017 Category: Neuroscience Source Type: research

Neurological Complications of Therapeutic Monoclonal Antibodies: Trends from Oncology to Rheumatology
AbstractPurpose of ReviewThis review is to describe the scope of neurological complications associated with monoclonal antibody-based therapies, applied across medical specialties, to demonstrate the common and rare neurological syndromes that may be encountered in clinical practice according to the therapeutic agent being receive, and to explain appropriate work-up, diagnosis, and management of drug complications, as supported by the literature.Recent FindingsThe number of commercially available, evidence-based therapeutic monoclonal antibodies continues to expand. In oncology, immune checkpoint inhibitors are particularl...
Source: Current Neurology and Neuroscience Reports - August 17, 2017 Category: Neuroscience Source Type: research

Molecular Imaging and Updated Diagnostic Criteria in Lewy Body Dementias
AbstractPurpose of ReviewThe aims of the study were to review recent advances in molecular imaging in the Lewy body dementias (LBD) and determine if these may support the clinical but contested temporal profile distinction between Parkinson disease (PD) with dementia (PDD) versus dementia with Lewy bodies (DLB).Recent FindingsThere do not appear to be major regional cerebral metabolic or neurotransmitter distinctions between PDD and DLB. However, recent studies highlight the relative discriminating roles of Alzheimer proteinopathies. PDD patients have lower cortical β-amyloid deposition than DLB. Preliminary tau PET s...
Source: Current Neurology and Neuroscience Reports - August 14, 2017 Category: Neuroscience Source Type: research

Emerging Diagnostic and Therapeutic Strategies for Tauopathies
This article reviews new and emerging diagnostic therapies for tauopathies including novel imaging techniques and biomarkers and also reviews recent tau therapeutics.Recent FindingsBuilding evidence from animal and cell models suggests that prion-like misfolding and propagation of pathogenic tau proteins between brain cells are central to the neurodegenerative process. These rapidly growing developments build rationale and motivation for the development of therapeutics targeting this mechanism through altering phosphorylation and other post-translational modifications of the tau protein, blocking aggregation and spread usi...
Source: Current Neurology and Neuroscience Reports - August 7, 2017 Category: Neuroscience Source Type: research

Psychogenic Non-Epileptic Seizures
AbstractPurpose of ReviewIn this review, we elucidate the evaluation process involved in the diagnosis of psychogenic non-epileptic seizures (PNES). Minimum clinical criteria required to attain this diagnosis via a staged approach are delineated. The psychological underpinnings and management of PNES from the neurologists ’ perspective are also explored.Recent FindingsHelpful clues can be deduced from history-taking, seizure semiology, ictal/peri-ictal physical exam, and ictal/inter-ictal EEG data. No single clinical data point is definitively diagnostic of PNES. Instead, the level of certainty for PNES diagnosis is ...
Source: Current Neurology and Neuroscience Reports - August 2, 2017 Category: Neuroscience Source Type: research

Brain Tumor-Related Epilepsy: a Current Review of the Etiologic Basis and Diagnostic and Treatment Approaches
This article is an overview of the epidemiology, etiology, and diagnostic and treatment approaches of tumor-related epilepsy primarily with regard to glial-based tumors, the most commonly considered brain tumor in this field.Recent FindingsOver the past many years, several novel etiologic mechanisms to explain how tumors induce seizures have been developed, which this article reviews, including the roles of glutamate-induced excitotoxicity, matrix metalloproteinases, isocitrate dehydrogenase, methylguanine methyltransferase, and functional network connectivity. As well, diagnostic and treatment approaches vary considerably...
Source: Current Neurology and Neuroscience Reports - July 28, 2017 Category: Neuroscience Source Type: research

Unresolved Issues in Thrombectomy
AbstractPurpose of ReviewTrials demonstrating marked benefit of mechanical thrombectomy (MT) for acute stroke caused by large vessel occlusion (LVO) in the anterior circulation have been the most significant advance in acute ischemic stroke in the past 20  years. However, despite this marked advance, there are still many hurdles to improving access to thrombectomy worldwide. Additionally, despite these advances, a substantial portion of patients with LVO still are left disabled.Recent FindingsThe major randomized trials focused on patients within 6  h from symptom onset, with occlusion of the ICA or proximal MCA,...
Source: Current Neurology and Neuroscience Reports - July 25, 2017 Category: Neuroscience Source Type: research

New Therapeutic Strategies for Lewy Body Dementias
This article reviews current treatment strategies and recent advances for the Lewy body dementias (LBDs). Current available symptom treatment strategies are based on monoaminergic, cholinergic and glutaminergic neurotransmitter systems. Relatively robust evidence exists for cholinesterase inhibitors for cognitive impairment in LBD and in Parkinson ’s disease for antidepressants, clozapine and recently pimavanserin for psychosis. interpidine (RVT 101) and nelotanserin are currently under investigation. Non-pharmacological interventions, such as cognitive stimulation, physical exercises and neuromodulation strategies, ...
Source: Current Neurology and Neuroscience Reports - July 24, 2017 Category: Neuroscience Source Type: research

Non-Vitamin K Oral Anticoagulants (NOACs) and Their Reversal
AbstractPurpose of ReviewAn 80-year-old man presents with an acute right hemiparesis and National Institutes of Health Stroke Scale (NIHSS) of 25, 14  h after taking dabigatran. Activated partial thromboplastin time (aPTT) is 42.8 s. Arteriogram demonstrates left internal carotid artery thrombosis. What is the appropriate management of this patient with acute ischemic stroke while on a NOAC?Recent FindingsIdarucizumab is a reversal agent approved for dabigatran, and two more reversal agents, andexanet alfa and aripazine, are currently in development for NOACs.SummaryIn this article, we review currently available ...
Source: Current Neurology and Neuroscience Reports - July 22, 2017 Category: Neuroscience Source Type: research

New Genes Causing Hereditary Parkinson ’s Disease or Parkinsonism
This article reviews was to review genes where putative or confirmed pathogenic mutations causing Parkinson ’s disease or Parkinsonism have been identified since 2012, and summarizes the clinical and pathological picture of the associated disease subtypes.Recent FindingsNewly reported genes for dominant Parkinson ’s disease areDNAJC13,CHCHD2, andTMEM230. However, the evidence for a disease-causing role is not conclusive, and further genetic and functional studies are warranted.RIC3 mutations have been reported from one family but not yet encountered in other patients. New genes for autosomal recessive disease i...
Source: Current Neurology and Neuroscience Reports - July 21, 2017 Category: Neuroscience Source Type: research

Clippers
We describe the typical clinical, radiographic, and pathological features of CLIPPERS and emphasize consideration for alternative diagnoses when findings are not classic. A recommended diagnostic evaluation and initial treatment plan is provided. (Source: Current Neurology and Neuroscience Reports)
Source: Current Neurology and Neuroscience Reports - July 19, 2017 Category: Neuroscience Source Type: research

Secondary Stroke Prevention in Cryptogenic Stroke and Embolic Stroke of Undetermined Source (ESUS)
AbstractPurpose of the ReviewThe purpose of the study was to review the literature on cryptogenic stroke and embolic stroke of undetermined stroke (ESUS). Cryptogenic stroke according to TOAST criteria is a stroke which is not due to cardiogenic embolism, small vessel disease with lacunes or large vessel disease of brain supplying arteries. In the context of secondary stroke prevention studies, cryptogenic stroke is not operationally defined.Recent FindingsThe new concept of “embolic stroke of undetermined source” (ESUS) provides an operational definition. ESUS is diagnosed as a non-lacunar stroke on cerebral i...
Source: Current Neurology and Neuroscience Reports - July 13, 2017 Category: Neuroscience Source Type: research

Laser Interstitial Thermal Therapy for Epilepsy
AbstractMRI-guided laser interstitial thermal therapy (MgLiTT) uses a narrow diameter cannula to stereotactically target and heat deeper cerebral structures. This technique produces a precise lesion in the brain with great reliability because the localized tissue temperature change is monitored in real time. Because MgLiTT minimizes injury to surrounding brain, it appears to have a lower risk of affecting normal neurological function, and because it is done through a burr hole, there is less operative risk, less discomfort, and shorter hospitalizations. It is FDA approved for soft tissue ablation and is being increasingly ...
Source: Current Neurology and Neuroscience Reports - July 11, 2017 Category: Neuroscience Source Type: research

Monitoring the Brain After Cardiac Arrest: a New Era
AbstractPurpose of ReviewOf the approximately 350,000 out-of-hospital, and 750,000 after in-hospital cardiac arrest (CA) events in the US annually approximately 5-9% and 20% respectively may achieve return of spontaneous circulation (ROSC) after attempted cardiopulmonary resuscitation (CPR). Up to 2/3 of these initial survivors may go on die in the subsequent 24-72 hours after ROSC due to a combination of (1) on-going cerebral injury, (2) myocardial dysfunction and (3) massive systemic inflammatory response. In order to successfully manage patients more effectively, monitoring methods are needed to aid clinicians in the de...
Source: Current Neurology and Neuroscience Reports - July 1, 2017 Category: Neuroscience Source Type: research

Immunosenescence: the Role of Aging in the Predisposition to Neuro-Infectious Complications Arising from the Treatment of Multiple Sclerosis
AbstractPurpose of ReviewThis review highlights some of the important changes in the immune system that occur in the process of normal aging. Immunosenescence as a concept is directly relevant to the world of neuro-inflammation, as it may be a contributing factor to the risks associated with some of the current immunosuppressive and immunomodulatory therapies used in treating multiple sclerosis (MS) and other inflammatory disorders.Recent FindingsProfound qualitative and quantitative changes occur in the adaptive and innate immunity compartments during aging. These changes may explain why patients of older age are at an in...
Source: Current Neurology and Neuroscience Reports - July 1, 2017 Category: Neuroscience Source Type: research

Dissection of Cervical and Cerebral Arteries
AbstractPurpose of ReviewWe aimed to summarize recent findings in cervical (CeAD) and intracranial artery dissection (IAD) research.Recent FindingsConsidered a disease of the young- and middle-aged, an analysis on the largest CeAD-population to date (n = 2391) revealed that about 1 of 14 CeAD-patients was aged ≥60 years. Distinct genetic variants were associated with CeAD. However, in clinical practice, genetic investigations are not helpful due to the small effect size. Despite the paucity of data from randomized-controlled trials in CeAD-s troke patients, both intravenous thrombolysis and endovascular t...
Source: Current Neurology and Neuroscience Reports - June 30, 2017 Category: Neuroscience Source Type: research

Controversies in Thrombolysis
AbstractPurpose of ReviewThe purpose of the review is to examine recent evidence on the effects of intravenous thrombolysis and identify the remaining uncertainties.Recent FindingsWe review the results of two large trials (the third International Stroke Trial (IST-3) and The Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED)) and the publications from the individual patient data analyses of the trials of alteplase conducted by the Stroke Thrombolysis Trialists Collaboration.SummaryDespite about a 2% risk of fatal intracerebral haemorrhage, on average, adult patients of all ages treated with 0.9 &nbs...
Source: Current Neurology and Neuroscience Reports - June 30, 2017 Category: Neuroscience Source Type: research

Current Controversies on Wernicke ’s Area and its Role in Language
AbstractPurpose of ReviewThe aim of the study is to assess historical anatomical and functional definitions of Wernicke ’s area in light of modern lesion and neuroimaging data.Recent Findings“Wernicke’s area” has become an anatomical label usually applied to the left posterior superior temporal gyrus and adjacent supramarginal gyrus. Recent evidence shows that this region is not critical for speech perception or for word comprehension. Rather, it supports retrieval of phonological forms (mental representations of phoneme sequences), which are used for speech output and short-term memory tasks. Focal...
Source: Current Neurology and Neuroscience Reports - June 27, 2017 Category: Neuroscience Source Type: research

Multiple Sclerosis in Latin Americans: Genetic Aspects
AbstractLatin Americans (LA) are a heterogeneous, multiethnic group of individuals who inhabit the continental countries in Latin America (LATAM), Caribbean islands and constitute the largest ethnic minority in the USA. Commonly used terminology and ethno racial classifications to define these groups may not be accurate. Risk for multiple sclerosis (MS) among LA is generally low to medium but frequencies are increasing in the American hemisphere. Genome-Wide Association Studies (GWAS) in LA show diverse variants and genetic proportions among Mestizos, the most representative ethnic population, who themselves are the produc...
Source: Current Neurology and Neuroscience Reports - June 21, 2017 Category: Neuroscience Source Type: research

The Use of Cannabinoids in Treating Dementia
AbstractPurpose of ReviewTo review and summarise the current evidence on the safety and efficacy of using cannabinoids to treat behavioural and neuropsychiatric symptoms of dementia.Recent FindingsTwo randomised controlled trials testing a synthetic form of tetrahydrocannabinol have shown that while well tolerated, there was no significant therapeutic effect, based on changes to scores on the neuropsychiatric inventory (NPI). Case reports and open label trials have indicated that there may be some therapeutic benefit of adding synthetic cannabinoids as an adjunctive therapy to reduce agitation, aberrant motor behaviour and...
Source: Current Neurology and Neuroscience Reports - June 19, 2017 Category: Neuroscience Source Type: research