Stopping disease-modifying therapy in relapsing and progressive multiple sclerosis
Purpose of review To assess the reasons for considering discontinuation of disease-modifying therapies (DMTs)in patients with multiple sclerosis (MS). Relevant aspects of the natural history, pathology, and immunology are analyzed. Recent findings A number of retrospective observational studies in aggregate indicate that stopping DMTs may be attempted in older individuals with stable disease. Prognostic factors have been identified informing about the risk of recurrence of disease activity after DMT discontinuation. Summary Several clinical scenarios provide a rationale to stop DMTs in people with MS. Cum...
Source: Current Opinion in Neurology - July 20, 2021 Category: Neurology Tags: SPECIAL COMMENTARY Source Type: research

The state of telemedicine for persons with Parkinson's disease
Purpose of review The COVID-pandemic has facilitated the implementation of telemedicine in both clinical practice and research. We highlight recent developments in three promising areas of telemedicine: teleconsultation, telemonitoring, and teletreatment. We illustrate this using Parkinson's disease as a model for other chronic neurological disorders. Recent findings Teleconsultations can reliably administer parts of the neurological examination remotely, but are typically not useful for establishing a reliable diagnosis. For follow-ups, teleconsultations can provide enhanced comfort and convenience to patients,...
Source: Current Opinion in Neurology - July 20, 2021 Category: Neurology Tags: MOVEMENT DISORDERS: Edited by Per Svenningsson Source Type: research

Ataxin-2 gene: a powerful modulator of neurological disorders
Purpose of review To provide an update on the role of Ataxin-2 gene (ATXN2) in health and neurological diseases. Recent findings There is a growing complexity emerging on the role of ATXN2 and its variants in association with SCA2 and several other neurological diseases. Polymorphisms and intermediate alleles in ATXN2 establish this gene as a powerful modulator of neurological diseases including lethal neurodegenerative conditions such as motor neuron disease, spinocerebellar ataxia 3 (SCA3), and peripheral nerve disease such as familial amyloidosis polyneuropathy. This role is in fact far wider than the previou...
Source: Current Opinion in Neurology - July 20, 2021 Category: Neurology Tags: MOVEMENT DISORDERS: Edited by Per Svenningsson Source Type: research

Update on alpha-synuclein-based biomarker approaches in the skin, submandibular gland, gastrointestinal tract, and biofluids
Purpose of review There is a need for objective diagnostic and prognostic biomarkers in Parkinson's disease (PD), partly given the expected increase in clinical trials aimed at demonstrating a disease-modifying effect in early disease. Alpha-synuclein (α-syn) plays a decisive role in the pathogenesis of PD. Here, we review recent publications exploring established and novel methodologies to detect α-syn species in tissues and biofluids. Recent findings Using immunohistochemistry (IHC), recent studies have focused on the detection of phosphorylated α-syn (p-α-syn) in cutaneous nerve fibers...
Source: Current Opinion in Neurology - July 20, 2021 Category: Neurology Tags: MOVEMENT DISORDERS: Edited by Per Svenningsson Source Type: research

Autoimmune movement disorders with neuronal antibodies – an update
Purpose of review The rapid developments in neuroimmunology reflect also on the field of movement disorders, where there is an ever expanding spectrum of new antibodies. This review focuses on the new neuronal antibodies, their clinical spectrum and recent pathophysiological insights. It gives an update on previous work about neuronal antibody-related movement disorders. Recent findings Phosphodiesterase 10A antibodies are a new marker of paraneoplastic chorea. Seizure-related 6 homolog like 2 antibodies are a differential diagnosis in atypical parkinsonism with cerebellar ataxia and cognitive impairment. mGluR5...
Source: Current Opinion in Neurology - July 20, 2021 Category: Neurology Tags: MOVEMENT DISORDERS: Edited by Per Svenningsson Source Type: research

Cerebellar ataxia, neuropathy, vestibular areflexia syndrome: genetic and clinical insights
Purpose of review This review aims to summarise the present cerebellar ataxia, neuropathy, vestibular ataxia syndrome (CANVAS) literature, providing both clinical and genetic insights that might facilitate the timely clinical and genetic diagnosis of this disease. Recent findings Recent advancements in the range of the clinical features of CANVAS have aided the development of a broader, more well-defined clinical diagnostic criteria. Additionally, the identification of a biallelic repeat expansion in RFC1 as the cause of CANVAS and a common cause of late-onset ataxia has opened the door to the potential discover...
Source: Current Opinion in Neurology - July 20, 2021 Category: Neurology Tags: MOVEMENT DISORDERS: Edited by Per Svenningsson Source Type: research

Impulse control disorders and related behaviors in Parkinson's disease: risk factors, clinical and genetic aspects, and management
Purpose of review To review recent findings and research directions on impulse control disorders and related behaviors (ICDRBs) in Parkinson's disease (PD). Recent findings Longitudinal studies found that prevalence increases during PD progression, incident ICDRBs being around 10% per year in patients treated with dopaminergic therapies. Screening tools and severity scales already developed have been validated and are available in several countries and languages. The main clinical risk factors include young age, male gender, type, doses and duration of dopaminergic therapy, PD motor severity and dyskinesia, depr...
Source: Current Opinion in Neurology - July 20, 2021 Category: Neurology Tags: MOVEMENT DISORDERS: Edited by Per Svenningsson Source Type: research

Fragile X-associated tremor/ataxia syndrome: pathophysiology and management
Purpose of review The purpose of this paper is to review the prevalence, pathophysiology, and management of fragile X-associated tremor/ataxia syndrome (FXTAS). Recent findings The pathophysiology of FXTAS involves ribonucleic acid (RNA) toxicity due to elevated levels of the premutation-expanded CGG (eoxycytidylate-deoxyguanylate-deoxyguanylate)-repeat FMR1 mRNA, which can sequester a variety of proteins important for neuronal function. A recent analysis of the inclusions in FXTAS demonstrates elevated levels of several proteins, including small ubiquitin-related modifiers 1/2 (SUMO1/2), that target molecules f...
Source: Current Opinion in Neurology - July 20, 2021 Category: Neurology Tags: MOVEMENT DISORDERS: Edited by Per Svenningsson Source Type: research

Editorial: Update on movement disorders
No abstract available (Source: Current Opinion in Neurology)
Source: Current Opinion in Neurology - July 20, 2021 Category: Neurology Tags: MOVEMENT DISORDERS: Edited by Per Svenningsson Source Type: research

Update on neuroimaging in non-Alzheimer's disease dementia: a focus on the Lewy body disease spectrum
Purpose of review An accurate differential diagnosis between Alzheimer's disease (AD) and non-AD dementia is of paramount importance to study disease mechanisms, define prognosis, and select patients for disease-specific treatments. The purpose of the present review is to describe the most recent neuroimaging studies in Lewy body disease spectrum (LBDS), focusing on differences with AD. Recent findings Different neuroimaging methods are used to investigate patterns of alterations, which can be helpful to distinguish LBDS from AD. Positron emission tomography radiotracers and advanced MRI structural and functiona...
Source: Current Opinion in Neurology - July 20, 2021 Category: Neurology Tags: NEUROIMAGING: Edited by Massimo Filippi Source Type: research

Update on neuroimaging in Alzheimer's disease
Purpose of review The purpose of this review was to discuss the contribution of the most recent neuroimaging studies to our understanding of the mechanisms underlying Alzheimer's disease. Recent findings Studies have applied cross-sectional and longitudinal positron emission tomography (PET), structural and resting-state functional magnetic resonance imaging to primarily investigate (1) how Alzheimer's disease pathological hallmarks like tau and amyloid-beta build up and spread across the brain at different disease stage and in different disease phenotypes and (2) how the spreading of these proteins is related t...
Source: Current Opinion in Neurology - July 20, 2021 Category: Neurology Tags: NEUROIMAGING: Edited by Massimo Filippi Source Type: research

Update on neuroimaging for categorization of Parkinson's disease and atypical parkinsonism
The objective of this review is to present the work of the last three years in the field of imaging for diagnostic categorization of parkinsonian syndromes focusing on progressive supranuclear palsy (PSP) and multiple system atrophy (MSA). Recent findings Two main complementary approaches are being pursued. The first seeks to develop and validate manual qualitative or semi-quantitative imaging markers that can be easily used in clinical practice. The second is based on quantitative measurements of magnetic resonance imaging abnormalities integrated in a multimodal approach and in automatic categorization machine lea...
Source: Current Opinion in Neurology - July 20, 2021 Category: Neurology Tags: NEUROIMAGING: Edited by Massimo Filippi Source Type: research

Central vein sign and iron rim in multiple sclerosis: ready for clinical use?
Purpose of review To summarize recent evidence from the application of susceptibility-based MRI sequences to investigate the ‘central vein sign’ (CVS) and ‘iron rim’ as biomarkers to improve the diagnostic work-up of multiple sclerosis (MS) and predict disease severity. Recent findings The CVS is a specific biomarker for MS being detectable from the earliest phase of the disease. A threshold of 40% of lesions with the CVS can be optimal to distinguish MS from non-MS patients. Iron rim lesions, reflecting chronic active lesions, develop in relapsing-remitting MS patients and persist in pro...
Source: Current Opinion in Neurology - July 20, 2021 Category: Neurology Tags: NEUROIMAGING: Edited by Massimo Filippi Source Type: research

Update on neuroimaging in brain tumours
Purpose of review To highlight some of the recent advances in magnetic resonance imaging (MRI), in terms of acquisition, analysis, and interpretation for primary diagnosis, treatment planning, and surveillance of patients with a brain tumour. Recent findings The rapidly emerging field of radiomics associates large numbers of imaging features with clinical characteristics. In the context of glioma, attempts are made to correlate such imaging features with the tumour genotype, using so-called radiogenomics. The T2-fluid attenuated inversion recovery (FLAIR) mismatch sign is an easy to apply imaging feature for ide...
Source: Current Opinion in Neurology - July 20, 2021 Category: Neurology Tags: NEUROIMAGING: Edited by Massimo Filippi Source Type: research

Update on neuroimaging in disorders of consciousness
Purpose of review Neuroimaging has acquired a prominent place in the assessment of disorders of consciousness (DoC). Rapidly evolving technologies combined with state-of-the-art data analyses open new horizons to probe brain activity, but selecting appropriate imaging modalities from the plethora of available techniques can be challenging for clinicians. This update reviews selected advances in neuroimaging that demonstrate clinical relevance and translational potential in the assessment of severely brain-injured patients with DoC. Recent findings Magnetic resonance imaging and high-density electroencephalograph...
Source: Current Opinion in Neurology - July 20, 2021 Category: Neurology Tags: NEUROIMAGING: Edited by Massimo Filippi Source Type: research

Unveiling the neuroimaging-genetic intersections in the human brain
Purpose of review The prevalence of new public datasets of brain-wide and single-cell transcriptome data has created new opportunities to link neuroimaging findings with genetic data. The aim of this study is to present the different methodological approaches that have been used to combine this data. Recent findings Drawing from various sources of open access data, several studies have been able to correlate neuroimaging maps with spatial distribution of brain expression. These efforts have enabled researchers to identify functional annotations of related genes, identify specific cell types related to brain phen...
Source: Current Opinion in Neurology - July 20, 2021 Category: Neurology Tags: NEUROIMAGING: Edited by Massimo Filippi Source Type: research

Data-driven approaches to neuroimaging biomarkers for neurological and psychiatric disorders: emerging approaches and examples
Purpose of review The ‘holy grail’ of clinical applications of neuroimaging to neurological and psychiatric disorders via personalized biomarkers has remained mostly elusive, despite considerable effort. However, there are many reasons to continue to be hopeful, as the field has made remarkable advances over the past few years, fueled by a variety of converging technical and data developments. Recent findings We discuss a number of advances that are accelerating the push for neuroimaging biomarkers including the advent of the ‘neuroscience big data’ era, biomarker data competitions, the d...
Source: Current Opinion in Neurology - July 20, 2021 Category: Neurology Tags: NEUROIMAGING: Edited by Massimo Filippi Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Neurology)
Source: Current Opinion in Neurology - July 20, 2021 Category: Neurology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Central nervous system infections and antimicrobial resistance: an evolving challenge
Purpose of review Antimicrobial resistance is an increasing threat to patients also in nosocomial central nervous system (CNS) infections. The present review focusses on optimizing intravenous treatment in order to achieve sufficient concentrations of antibiotics in the different compartments of the CNS when the causative pathogens have reduced sensitivity to antibiotics or/and the impairment of the blood–cerebrospinal fluid (CSF) and blood–brain barrier is mild. Recent findings Experience has been gathered with treatment protocols for several established antibiotics using increased doses or continuo...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: CNS INFLAMMATORY DISORDERS: INFECTIOUS DISEASES: Edited by Erich Schmutzhard Source Type: research

Invasive neuromonitoring and neurological intensive care unit management in life-threatening central nervous system infections
Purpose of review Patients with infectious diseases of the central nervous system (CNS) commonly require treatment in the intensive care unit (ICU). In a subset of patients with a life-threatening course, a more aggressive and invasive management is required. Treatment relies on the expertise of the intensivists as most recommendations are currently not based on a high level of evidence. Recent findings Published data suggest that an invasive brain-focused management should be considered in life-threatening CNS infections. Brain resuscitation by adequate control of intracranial pressure (ICP) and optimization of...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: CNS INFLAMMATORY DISORDERS: INFECTIOUS DISEASES: Edited by Erich Schmutzhard Source Type: research

Vector-borne protozoal infections of the CNS: cerebral malaria, sleeping sickness and Chagas disease
Purpose of review Malaria, Chagas Disease and Human African Trypanosomiasis are vector-borne protozoan illnesses, frequently associated with neurological manifestations. Intriguing but ignored, limited mainly to resource-limited, tropical settings, these disorders are now coming to light because of globalisation and improved diagnosis and treatment. Enhanced understanding of these illnesses has prompted this review. Recent findings Methods of diagnosis have currently transitioned from blood smear examinations to immunological assays and molecular methods. Tools to assess neurological involvement, such as magneti...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: CNS INFLAMMATORY DISORDERS: INFECTIOUS DISEASES: Edited by Erich Schmutzhard Source Type: research

Toxin-associated infectious diseases: tetanus, botulism and diphtheria
Purpose of review The incidence rates of the toxin-related infectious diseases, tetanus, diphtheria and botulism declined dramatically over the past decades mainly because of the implementation of immunization programs also in low-and-middle-income countries (LAMICs) and by improving hygiene conditions. But still, single cases occur, and they need fastest possible recognition and management. Recent findings Over the past 20 years, the incidence of neonatal tetanus has declined by more than 90%. This success was achieved by immunizing women in reproductive age in areas of high risk as sub-Saharan Africa and par...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: CNS INFLAMMATORY DISORDERS: INFECTIOUS DISEASES: Edited by Erich Schmutzhard Source Type: research

Neuro-COVID-19 is more than anosmia: clinical presentation, neurodiagnostics, therapies, and prognosis
Purpose of review To provide an overview on current knowledge of neurological symptoms and complications of COVID-19, and to suggest management concepts. Recent findings Headache, dizziness, excessive tiredness, myalgia, anosmia/hyposmia, and ageusia/dysgeusia are common nonspecific neurological manifestations during early COVID-19 disease found in the majority of patients. Less frequent but more severe and specific neurological manifestations include Guillain--Barré syndrome, encephalopathy, encephalitis/meningitis, epileptic seizures, and cerebrovascular events. Beyond standard neurological examination,...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: CNS INFLAMMATORY DISORDERS: INFECTIOUS DISEASES: Edited by Erich Schmutzhard Source Type: research

Neuropathogenesis of acute coronavirus disease 2019
Purpose of review Over the course of the coronavirus disease (COVID-19) pandemic, it has become increasingly clear that there is a high prevalence of neurological complications in people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Recent findings Studies of central nervous system (CNS) tissue in brain model systems and from adults with acute SARS-CoV-2 infection have begun to uncover potential mechanisms for neurological damage during COVID-19. These studies suggest that direct viral invasion of the CNS occurs in a subset of cases but does not frequently cause overt viral meningoe...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: CNS INFLAMMATORY DISORDERS: INFECTIOUS DISEASES: Edited by Erich Schmutzhard Source Type: research

Emerging infectious encephalitides
Purpose of review The COVID-19 pandemic has cast increased attention on emerging infections. Clinicians and public health experts should be aware of emerging infectious causes of encephalitis, mechanisms by which they are transmitted, and clinical manifestations of disease. Recent findings A number of arthropod-borne viral infections -- transmitted chiefly by mosquitoes and ticks -- have emerged in recent years to cause outbreaks of encephalitis. Examples include Powassan virus in North America, Chikungunya virus in Central and South America, and tick-borne encephalitis virus in Europe. Many of these viruses exh...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: CNS INFLAMMATORY DISORDERS: INFECTIOUS DISEASES: Edited by Erich Schmutzhard Source Type: research

Neurosyphilis and Lyme neuroborreliosis
Purpose of review Neurosyphilis (NS) and Lyme neuroborreliosis (LNB) are spirochetal diseases with distinct clinical manifestations. The diagnosis of NS remains challenging due to imperfect diagnostic criteria and testing modalities. With LNB, misconceptions about diagnosis and treatment lead to considerable morbidity and drug related adverse effects. Recent findings Although studies continue investigating alternate approaches and new diagnostic tests for NS, few data exist to change current approaches to diagnosis, management or follow up. In the diagnosis of LNB, the chemokine CXCL13 shows promising diagnostic...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: CNS INFLAMMATORY DISORDERS: INFECTIOUS DISEASES: Edited by Erich Schmutzhard Source Type: research

Central nervous system tuberculosis
Purpose of review Central nervous system (CNS) tuberculosis is the most devastating form of tuberculosis (TB), with mortality and or neurological sequelae in over half of individuals. We reviewed original research and systematic reviews published since 1 January 2019 for new developments in CNS TB pathophysiology, diagnosis, management and prognosis. Recent findings Insight in the pathophysiology is increasing steadily since the landmark studies in 1933, focussing on granuloma type classification, the relevance of the M. tuberculosis bacterial burden and the wide range of immunological responses. Although Xpert/...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: CNS INFLAMMATORY DISORDERS: INFECTIOUS DISEASES: Edited by Erich Schmutzhard Source Type: research

Acute bacterial meningitis
Purpose of review Community-acquired bacterial meningitis is a continually changing disease. This review summarises both dynamic epidemiology and emerging data on pathogenesis. Updated clinical guidelines are discussed, new agents undergoing clinical trials intended to reduce secondary brain damage are presented. Recent findings Conjugate vaccines are effective against serotype/serogroup-specific meningitis but vaccine escape variants are rising in prevalence. Meningitis occurs when bacteria evade mucosal and circulating immune responses and invade the brain: directly, or across the blood–brain barrier. Ti...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: CNS INFLAMMATORY DISORDERS: INFECTIOUS DISEASES: Edited by Erich Schmutzhard Source Type: research

Editorial: Infections of the nervous system: a continuing challenge and a plea to join forces for neurology, (neuro-)intensive care, epidemiology, internal medicine, pediatrics, family medicine, public health and the global health system
No abstract available (Source: Current Opinion in Neurology)
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: CNS INFLAMMATORY DISORDERS: INFECTIOUS DISEASES: Edited by Erich Schmutzhard Source Type: research

Medication overuse headache
This article reviews the recent ideas regarding the development of this disorder and its effective management. Recent findings It has been proposed that all acute migraine medications can lead to MOH, with differences in the propensity of different agents to cause the problem. Early data suggests that gepants, which are small-molecule calcitonin gene-related peptide antagonists used for the acute treatment of migraine, may be an exception. Recent studies show that practitioners and the general public are still largely unaware of the problem of medication overuse and its damaging effects. Summary MOH is an acc...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: HEADACHE: Edited by Mark W. Green Source Type: research

Facial pain beyond trigeminal neuralgia
Purpose of review Trigeminal neuralgia is a well-known facial pain syndrome with several treatment options. In contrast, non-neuralgiform idiopathic facial pain syndromes are relatively rare, reflected by the fact that, until 2020, no internationally accepted diagnostic classification existed. Like trigeminal neuralgia, these non-dental facial pain syndromes need to be managed by neurologists and pain specialists, but the lack of pathophysiological understanding has resulted in an underrepresented and undertreated patient group. Recent findings This work provides a brief overview of the most common primary facia...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: HEADACHE: Edited by Mark W. Green Source Type: research

Targets for migraine treatment: beyond calcitonin gene-related peptide
Purpose of review Despite the development of several medications for the acute and preventive treatment of migraine, there are still many patients in whom lack of efficacy, tolerability, interactions or contraindications make other options necessary. CGRP-based drugs have opened the door to a new era of migraine-targeted treatments. Beyond CGRP, there are other promising targets covered here. Recent findings For the acute treatment of migraine, 5-HT1F receptor agonists, ditans, are now available. Unlike triptans, 5-HT1B/1D receptor agonists, cardiovascular disease is not a contraindication for the use of ditans....
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: HEADACHE: Edited by Mark W. Green Source Type: research

Evaluating thunderclap headache
Purpose of review Thunderclap headache (TCH) is an abrupt-onset of severe headache that needs to be thoroughly investigated because the most common secondary cause is subarachnoid hemorrhage (SAH). There has been no consensus guideline regarding the diagnostic workup. This review aims to provide an update on the evaluation of TCH. Recent findings The most important update in the 2019 American College of Emergency Physicians guideline for evaluation of acute headache in the emergency department is that negative noncontrast brain computed tomography (CT) findings within 6 h from ictus essentially excludes SAH. A...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: HEADACHE: Edited by Mark W. Green Source Type: research

Can you have a migraine aura without knowing it?
Purpose of review This review covers several aspects our understanding of episodic manifestations and unusual symptoms that may be associated with migraine aura. Recent findings The episodic manifestation of migraine aura is typically visual in nature, although five other types are currently recognized: sensory, speech and/or language, motor, brainstem, and retinal. Other transitory perceptions or experiences such as emotional, olfactory, or auditory have been reported as possible migraine auras. As underlined by the much higher reported prevalence of aura manifestation in individuals with professional knowledge...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: HEADACHE: Edited by Mark W. Green Source Type: research

Sinus, disabling tension-type, and temporomandibular joint headaches
Purpose of review Clinicians frequently face questions from headache patients regarding the roles played by sinus issues, muscle tension, and temporomandibular joint (TMJ) problems. This review highlights new concepts regarding the diagnosis and management of these headache conditions and their differentiation from migraine. Recent findings Recent research has clarified the roles played by pathology in the paranasal sinuses and TMJ in patients reporting headache. Additional information from physiologic studies in patients with tension-type headache (TTH) has improved the understanding of this condition. Summa...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: HEADACHE: Edited by Mark W. Green Source Type: research

Updates on management of headache in women and transgender women
Purpose of review Gender differences exist in headache disorders. A greater understanding of the role of hormones in headache can help the clinician better approach and manage common primary headache disorders. Recent findings Recent studies highlight differences in how migraine and cluster headache present in women and men. Updates to the ongoing debate of how to manage the use of hormones in women with migraine, especially with aura, have been well reviewed in the last 18 months. A new meta-analysis evaluates gender differences in response to triptans. Summary This review will focus on recent updates ...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: HEADACHE: Edited by Mark W. Green Source Type: research

Drug interactions and risks associated with the use of triptans, ditans and monoclonal antibodies in migraine
Purpose of review The aim of this study was to review current evidence concerning potential risks and interactions associated with concomitant use of drugs indicated for the abortive treatment of migraine, namely triptans and ditans, and more recently developed drugs used for the preventive treatment. The latter drug class encompasses monoclonal antibodies (mAbs), which target either calcitonin gene-related peptide (CGRP) or its receptor. Recent findings To date, no pharmacokinetic interactions between these drug classes have been reported. However, patients who suffer from triptan- (or ditan-) induced medicatio...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: HEADACHE: Edited by Mark W. Green Source Type: research

Editorial: A 2021 update on migraine
No abstract available (Source: Current Opinion in Neurology)
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: HEADACHE: Edited by Mark W. Green Source Type: research

Vaccinations in multiple sclerosis patients receiving disease-modifying drugs
Purpose of review This review focuses on new evidence supporting the global immunization strategy for multiple sclerosis (MS) patients receiving disease-modifying drugs (DMDs), including the recently available vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Recent findings New data strengthen the evidence against a causal link between MS and vaccination. Recent consensus statements agree on the need to start vaccination early. Timings for vaccine administration should be adjusted to ensure safety and optimize vaccine responses, given the potential interference of DMDs. Pa...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: MULTIPLE SCLEROSIS: Edited by Per S. Sørensen Source Type: research

Predicting disability worsening in relapsing and progressive multiple sclerosis
Purpose of review Multiple sclerosis (MS) is a clinically heterogeneous disease, which complicates expectant management as well as treatment decisions. This review provides an overview of both well established and emerging predictors of disability worsening, including clinical factors, imaging factors, biomarkers and treatment strategies. Recent findings In addition to well known clinical predictors (age, male sex, clinical presentation, relapse behaviour), smoking, obesity, vascular and psychiatric comorbidities are associated with subsequent disability worsening in persons with MS. A number of imaging features...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: MULTIPLE SCLEROSIS: Edited by Per S. Sørensen Source Type: research

Use of disease-modifying drugs during pregnancy and breastfeeding
Purpose of review The fact that multiple sclerosis (MS) predominantly affects women has been recognized for many years. As the age at diagnosis is decreasing, and treatment options are becoming more complex, increasing numbers of women are facing decisions about the use of disease modifying therapy (DMT) in and around pregnancy. Recent findings New data are rapidly becoming available, particularly regarding the safety of therapies in both pregnancy and breastfeeding. Effective treatment and suppression of relapses is key to ensuring good outcomes in the longer term for the woman, however this must be balanced ag...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: MULTIPLE SCLEROSIS: Edited by Per S. Sørensen Source Type: research

Targeting B cells in multiple sclerosis
Purpose of review Treatments targeting B cells are increasingly used for patients with multiple sclerosis (MS). We review the mechanisms of action, clinical effectiveness and safety of treatment, with emphasis on recently published studies. Recent findings Several monoclonal antibodies targeting the surface molecule CD20 on B cells are approved or being developed for treatment of MS. Overall, they seem comparable in terms of strongly suppressing radiological disease activity and relapse biology. Novel approaches include anti-CD19 antibody therapy and treatment with oral drugs targeting Bruton's tyrosine kinase (...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: MULTIPLE SCLEROSIS: Edited by Per S. Sørensen Source Type: research

Highly effective disease-modifying treatment as initial MS therapy
Purpose of review Using highly effective (HE) compounds right from the beginning of disease-modifying immunotherapy (DMT) in people with multiple sclerosis (pwMS) has gained popularity among clinicians and pwMS alike. We discuss the most recent evidence supporting this approach, and whether any of the associated risks should stop us adopting it as a default strategy. Recent findings With the addition of injectable ofatumumab, and the two oral sphingosine one phosphate modulators siponimod and ozanimod, ten HE DMTs are now available for pwMS, though variation in licensing status and cost may limit their use in so...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: MULTIPLE SCLEROSIS: Edited by Per S. Sørensen Source Type: research

Early multiple sclerosis: diagnostic challenges in clinically and radiologically isolated syndrome patients
Purpose of review With the introduction of new diagnostic criteria, the sensibility for multiple sclerosis (MS) diagnosis increased and the number of cases with the clinically isolated syndrome (CIS) decreased. Nevertheless, a misdiagnosis might always be around the corner, and the exclusion of a ‘better explanation’ is mandatory. There is a pressing need to provide an update on the main prognostic factors that increase the risk of conversion from CIS or from radiologically isolated syndrome (RIS) to MS, and on the potential ‘red flags’ to consider during the diagnostic workup. Recent find...
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: MULTIPLE SCLEROSIS: Edited by Per S. Sørensen Source Type: research

Editorial: Challenges in the diagnosis and treatment of multiple sclerosis
No abstract available (Source: Current Opinion in Neurology)
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: MULTIPLE SCLEROSIS: Edited by Per S. Sørensen Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Neurology)
Source: Current Opinion in Neurology - May 11, 2021 Category: Neurology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Current advances in plasma and cerebrospinal fluid biomarkers in Alzheimer's disease
Purpose of review This review provides a concise overview of recent advances in cerebrospinal fluid (CSF) and blood-based biomarkers of Alzheimer's disease lesions. Recent findings Important recent advances for CSF Alzheimer's disease biomarkers include the introduction of fully automated assays, the development and implementation of certified reference materials for CSF Aβ42 and a unified protocol for handling of samples, which all support reliability and availability of CSF Alzheimer's disease biomarkers. Aβ deposition can be detected using Aβ42/Aβ40 ratio in both CSF and plasma, though a m...
Source: Current Opinion in Neurology - March 11, 2021 Category: Neurology Tags: DEGENERATIVE AND COGNITIVE DISEASES: Edited by Teresa Gomez-Isla Source Type: research

What have we learned from cognition in the oldest-old
Purpose of review People over 90 are the fastest growing segment of the population with the highest rates of dementia. This review highlights recent findings that provide insight to our understanding of dementia and cognition at all ages. Recent findings Risk factors for Alzheimer's disease (AD) and dementia differ by age, with some factors, like the development of hypertension, actually becoming protective in the oldest-old. At least half of all dementia in this age group is due to non AD pathologies, including microinfarcts, hippocampal sclerosis and TDP-43. The number of pathologic changes found in the brain ...
Source: Current Opinion in Neurology - March 11, 2021 Category: Neurology Tags: DEGENERATIVE AND COGNITIVE DISEASES: Edited by Teresa Gomez-Isla Source Type: research

Cerebral small vessel disease and vascular cognitive impairment: from diagnosis to management
We present recent developments in the field of small vessel disease (SVD)-related vascular cognitive impairment, including pathological mechanisms, updated diagnostic criteria, cognitive profile, neuroimaging markers and risk factors. We further address available management and therapeutic strategies. Recent findings Vascular and neurodegenerative pathologies often co-occur and share similar risk factors. The updated consensus criteria aim to standardize vascular cognitive impairment (VCI) diagnosis, relying strongly on cognitive profile and MRI findings. Aggressive blood pressure control and multidomain lifestyle i...
Source: Current Opinion in Neurology - March 11, 2021 Category: Neurology Tags: DEGENERATIVE AND COGNITIVE DISEASES: Edited by Teresa Gomez-Isla Source Type: research

What is ‘Alzheimer's disease’? The neuropathological heterogeneity of clinically defined Alzheimer's dementia
Purpose of review Beta-amyloid with paired helical filaments (PHF)-tau neurofibrillary tangles define hallmark Alzheimer's disease neuropathologic changes (AD-NC). Yet persons with Alzheimer's dementia, defined broadly as an amnestic multidomain progressive dementia, often exhibit postmortem evidence of other neuropathologies including other neurodegenerative (Lewy body disease and transactive response DNA-binding protein disease) and vascular-related brain lesions. Clinicopathologic and epidemiologic analyses demonstrate the significance of these substrates, as coinciding neuropathologies mitigate the threshold for di...
Source: Current Opinion in Neurology - March 11, 2021 Category: Neurology Tags: DEGENERATIVE AND COGNITIVE DISEASES: Edited by Teresa Gomez-Isla Source Type: research