Imaging Predictors of Vasospasm and Delayed Cerebral Ischaemia After Subarachnoid Haemorrhage
AbstractPurpose of ReviewAcute spontaneous subarachnoid haemorrhage (SAH) is a severe disease, frequently complicated by vasospasm and delayed cerebral ischaemia (DCI), which have a negative impact on prognosis. Imaging studies are essential in the diagnosis of SAH. In this article, we review the available imaging techniques for prediction, monitoring and diagnosis of these complications of SAH.Recent FindingsNon-contrast computed tomography (CT) and transcranial Doppler (TCD) have been so far the mainly used techniques to evaluate SAH patients during the acute stage of disease and to screen for vasospasm and DCI. However,...
Source: Current Treatment Options in Neurology - November 24, 2020 Category: Neurology Source Type: research

Recent Advances in the Management of Cluster Headache
AbstractPurpose of reviewAmong the spectrum of pain conditions, cluster headache represents one of the most severe. Targeted therapies for cluster headache are evolving thus improving the available therapeutic armamentarium. A better understanding of the currently available therapies, as well as new and emerging options, may aide physicians to manage affected sufferers better by evolving treatment guidance.Recent findingsWhile classic first-line medications are useful in some patients with cluster headache, they are often accompanied by significant side effects that limit their use. Recently, novel treatments with better t...
Source: Current Treatment Options in Neurology - November 23, 2020 Category: Neurology Source Type: research

New Avenues in Radiotherapy of Glioblastoma: from Bench to Bedside
AbstractPurpose of ReviewThis review presents the new updates in treatment by radiotherapy of patients with glioblastoma. Despite the standard treatment, patients with glioblastoma present a relapse quasi-systematic observed in radiation fields with recurrent tumors resistant to therapy. We will highlight new targets involved in radioresistance, discovered in vitro, and that could have an impact in new treatments for glioblastoma, which remains a lethal tumor.Recent FindingsSo far, clinical studies did not show any efficacy for patients except the one involving tumor-treating fields. For the last decade, it has been discov...
Source: Current Treatment Options in Neurology - November 20, 2020 Category: Neurology Source Type: research

Stroke Treatment in the Setting of Systemic Disease
AbstractWhile the possible stroke risks for more prevalent conditions, such as cardiac disease or cancer, are important to recognize, there are other equally devastating systemic diseases that can affect younger adults and, if not cautious, may be misdiagnosed if stroke is the initial presentation.Purpose of reviewWe aim to discuss treatments of three rarer, but important systemic diseases associated with an increased incidence of ischemic stroke, specifically sickle cell anemia, human immunodeficiency virus (HIV), and Takayasu ’s arteritis.Recent findingsGiven that individuals with these diseases are now living long...
Source: Current Treatment Options in Neurology - November 13, 2020 Category: Neurology Source Type: research

Advances in Targeted Therapies for Pediatric Brain Tumors
AbstractPurpose of ReviewOver the last years, our understanding of the molecular biology of pediatric brain tumors has vastly improved. This has led to more narrowly defined subgroups of these tumors and has created new potential targets for molecularly driven therapies. This review presents an overview of the latest advances and challenges of implementing targeted therapies into the clinical management of pediatric brain tumors, with a focus on gliomas, craniopharyngiomas, and medulloblastomas.Recent FindingsPediatric low-grade gliomas (pLGG) show generally a low mutational burden with the mitogen-activated protein kinase...
Source: Current Treatment Options in Neurology - November 12, 2020 Category: Neurology Source Type: research

Treatment of SUNCT/SUNA, Paroxysmal Hemicrania, and Hemicrania Continua: An Update Including Single-Arm Meta-analyses
AbstractPurpose of ReviewThis review presents a critical appraisal of the treatment strategies for short-lasting unilateral neuralgiform headache attacks (SUNHA), paroxysmal hemicrania (PH), and hemicrania continua (HC). We assess the available, though sparse, evidence on both medical and surgical treatments. In addition, we present estimated pooled analyses of the most common treatments and emphasize recent promising findings.Recent FindingsThe majority of literature available on the treatment of these rare trigeminal autonomic cephalalgias are small open-label observational studies and case reports. Pooled analyses revea...
Source: Current Treatment Options in Neurology - November 11, 2020 Category: Neurology Source Type: research

Pharmacotherapy for Small Fiber Neuropathy
AbstractPurpose of reviewSmall fiber neuropathy (SFN) is a condition that affects small nerve fibers leading to a variety of symptoms, including pain, discomfort, tingling, and sensory loss. The development of new drugs is commonly complicated by variable medication pharmacokinetics and patients ’ response to treatment due to comorbidities. In this review, we discuss currently used drugs, including the evidence about their efficacy. We also mention the medications with a questionable response in SFN treatment and those that are potential emerging therapies.Recent findingsSFN treatment is aimed towards addressing the ...
Source: Current Treatment Options in Neurology - November 9, 2020 Category: Neurology Source Type: research

Vascular Events, Vascular Disease and Vascular Risk Factors —Strongly Intertwined with COVID-19
AbstractPurpose of reviewTo elucidate the intertwining of vascular events, vascular disease and vascular risk factors and COVID-19.Recent findingsStrokes are a leading cause of disability and death worldwide. Vascular risk factors are important drivers of strokes. There are unmodifiable vascular risk factors such as age and ethnicity and modifiable vascular risk factors. According to the INTERSTROKE study, the 10 most frequent modifiable vascular risk factors are arterial hypertension, physical inactivity, overweight, dyslipidaemia, smoking, unhealthy diet, cardiac pathologies, diabetes mellitus, stress/depression and over...
Source: Current Treatment Options in Neurology - October 8, 2020 Category: Neurology Source Type: research

COVID-19 Era Stroke Service: Virtually Normal
ConclusionsZoom conferences are a promising technology for stroke services. Further studies are needed to further elucidate their benefits and drawbacks. (Source: Current Treatment Options in Neurology)
Source: Current Treatment Options in Neurology - October 8, 2020 Category: Neurology Source Type: research

Secondary Causes of Myositis
AbstractPurpose of reviewThe purpose of this paper is to comprehensively evaluate secondary causes of inflammatory myopathies (myositis) and to review treatment options.Recent findingsThis review highlights recent advancements in our understanding of known causes of myositis, including newer drugs that may cause myositis such as checkpoint inhibitors and viruses such as influenza, HIV, and SARS-CoV2. We also discuss treatment for malignancy-associated myositis and overlap myositis, thought to be a separate entity from other rheumatologic diseases.SummaryInfections, drugs, rheumatologic diseases, and malignancies are import...
Source: Current Treatment Options in Neurology - October 5, 2020 Category: Neurology Source Type: research

Unraveling the Possible Routes of SARS-COV-2 Invasion into the Central Nervous System
We present data regarding the family of Coronaviruses (CoVs) and the central nervous system (CNS), and describe parallels between SARS-CoV-2 and other members of the family, which have been investigated in more depth and combine these findings with the recent advancements regarding SARS-CoV-2.SummarySARS-CoV-2 like other CoVs is neuroinvasive, neurotropic and neurovirulent. Two main pathways of CNS penetration seem to be the strongest candidates, the hematogenous and the neuronal. Τhe olfactory route in particular appears to play a significant role in neuroinvasion of coronaviruses and SARS-CoV-2, as well. However, exi...
Source: Current Treatment Options in Neurology - September 24, 2020 Category: Neurology Source Type: research

A Literature Systematic Review with Meta-Analysis of Symptoms Prevalence in Covid-19: the Relevance of Olfactory Symptoms in Infection Not Requiring Hospitalization
AbstractPurpose of reviewTo investigate the association between the olfactory dysfunction and the more typical symptoms (fever, cough, dyspnoea) within the Sars-CoV-2 infection (COVID-19) in hospitalized and non-hospitalized patients.Recent findingsPubMed, Scopus and Web of Science databases were reviewed from May 5, 2020, to June 1, 2020. Inclusion criteria included English, French, German, Spanish or Italian language studies containing original data related to COVID19, anosmia, fever, cough, and dyspnoea, in both hospital and non-hospital settings. Two investigators independently reviewed all manuscripts and performed qu...
Source: Current Treatment Options in Neurology - August 27, 2020 Category: Neurology Source Type: research

Treatment Updates in Postural Tachycardia Syndrome
AbstractPurpose of reviewPostural tachycardia syndrome is a common condition characterized by the presence of orthostatic intolerance in conjunction with excessive postural tachycardia. This review will focus on treatment updates in postural tachycardia syndrome and will include a discussion of rehabilitative, vasopressor, heart rate modulation, volume expansion, and immunomodulatory treatment strategies.Recent findingsA recent study added to existing literature the benefits of exercise retraining in postural tachycardia syndrome (POTS) patients who were able to successfully complete a 3-month exercise regimen. Another rec...
Source: Current Treatment Options in Neurology - August 24, 2020 Category: Neurology Source Type: research

Treatment Updates for Neuromuscular Channelopathies
This article aims to review the current and upcoming treatment options of primary muscle channelopathies including the non-dystrophic myotonias and periodic paralyses.Recent findingsThe efficacy of mexiletine in the treatment of myotonia is now supported by two randomised placebo-controlled trials, one of which utilised a novel aggregated n-of-1 design. This has resulted in licencing of the drug via orphan drug status. There is also good evidence that mexiletine is well tolerated and safe in this patient group without the need for intensive monitoring. A range of alternative antimyotonic treatment options include lamotrigi...
Source: Current Treatment Options in Neurology - August 21, 2020 Category: Neurology Source Type: research

Neurologic Manifestations of Systemic Disease: Seizure
AbstractPurpose of reviewThe goal of this paper is to review the pathophysiology and briefly discuss the management of acute symptomatic seizures secondary to various systemic conditions.Recent findingsSeizures are a common first neurological manifestation of systemic conditions and can assist in early recognition and diagnosis of these conditions. This paper reviews acute symptomatic seizures secondary to vascular disease, malignancy, underlying autoimmune etiologies, infection, toxic metabolic conditions, and nutritional causes.SummaryAcute symptomatic seizures and systemic conditions have a bidirectional relationship &m...
Source: Current Treatment Options in Neurology - August 10, 2020 Category: Neurology Source Type: research

COVID-19 and Sleep in Medical Staff: Reflections, Clinical Evidences, and Perspectives
AbstractPurpose of the reviewThere is evidence that, before the coronavirus pandemic 2019 (COVID-19), healthcare workers did not experience good sleep quality with relevant consequences on health. By contrast, little is known about the sleep quality of medical staff during the COVID-19 pandemic. In this review, we aimed to contribute with a review of the literature, sharing our clinical experience supported by actigraphic evaluation and by proposing future strategies.Recent findingsSleep disorders, in particular insomnia, have been commonly reported in frontline medical workers, in hospitals during the COVID-19 pandemic an...
Source: Current Treatment Options in Neurology - August 5, 2020 Category: Neurology Source Type: research

Neurologic Manifestations of Systemic Disease: Sleep Disorders
AbstractPurpose of reviewSleep is intimately involved in overall health and wellbeing. We provide a comprehensive report on the interplay between systemic diseases and sleep to optimize the outcomes of systemic disorders.Recent findingsSpanning the categories of endocrinologic disorders, metabolic/toxic disturbances, renal, cardiovascular, pulmonary, gastrointestinal, infectious diseases, autoimmune disorders, malignancy, and critical illness, the review highlights the prevalent coexisting pathology of sleep across the spectrum of systemic disorders. Although it is rare that treating a sleep symptom can cure disease, atten...
Source: Current Treatment Options in Neurology - August 5, 2020 Category: Neurology Source Type: research

Management of Primary Lateral Sclerosis
AbstractPurpose of reviewPrimary lateral sclerosis is a progressive neurodegenerative process that primarily affects upper motor neuron and presents with progressive stiffness and spasticity in all muscle groups. Given its rarity, diagnosis can be difficult and there has been limited research into what the best treatment is. This review will work to summarize the current available knowledge on the management of primary lateral sclerosis (PLS) including medications, nonpharmacologic interventions, diet, and exercise.Recent findingsThere have been no controlled studies of therapies in PLS. Management decisions are based on e...
Source: Current Treatment Options in Neurology - August 5, 2020 Category: Neurology Source Type: research

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Source: Current Treatment Options in Neurology - August 5, 2020 Category: Neurology Source Type: research

Secondary Cerebrovascular Prevention in Light of the COVID-19 Pandemic
Conclusion:We recommend:(1) As in normal times, during the COVID-19 pandemic wave, patients need to seek urgent medical attention in case of any acute cerebrovascular event. This will assure they receive needed rapid cerebrovascular secondary prevention in addition to acute intravenous and endovascular reperfusion strategies.(2) As in normal times, during the COVID-19 pandemic wave, it is of utmost importance that patients adhere to their individual recommendations for secondary prevention.(3) Optimal secondary but also primary cerebrovascular prevention might reduce the burden of COVID-19 now and during potential subseque...
Source: Current Treatment Options in Neurology - August 4, 2020 Category: Neurology Source Type: research

Immune-Related Neuromuscular Complications of Checkpoint Inhibitors
AbstractPurpose of ReviewImmune checkpoint inhibition for treatment of metastatic cancers is recognized to cause diverse immune-mediated neurological syndromes. This review will discuss current knowledge about the frequency and varied presentation of these syndromes affecting the peripheral nervous system as well as detail important diagnostic and management considerations.Recent FindingsImmune-related adverse events affect the peripheral nervous system more often than the central nervous system, and rates are likely underestimated. Most data regarding neurological immune –related adverse events are retrospective, an...
Source: Current Treatment Options in Neurology - July 31, 2020 Category: Neurology Source Type: research

Inflammatory Manifestations of Systemic Diseases in the Central Nervous System
AbstractPurpose of ReviewThis review presents the current recommended therapeutic interventions for inflammatory disease in the central nervous system (CNS) secondary to systemic diseases of immune dysregulation. Treatment recommendations for CNS inflammation associated with rheumatologic conditions, immune-related adverse effects from immune checkpoint inhibitors (ICIs), and demyelinating disease from tumor necrosis factor- α (anti-TNFs) are explored. Additional therapeutic options for inflammation related to postviral syndromes and genetic immunodeficiencies are also discussed.Recent FindingsIn addition to treatmen...
Source: Current Treatment Options in Neurology - July 28, 2020 Category: Neurology Source Type: research

Neurologic Manifestations of Systemic Disease: Peripheral Nervous System
AbstractPurpose of ReviewThe impact that systemic disease has on the peripheral nervous system is vast. Polyneuropathies due to these disorders fall into broad categories including metabolic diseases, nutritional deficiencies, rheumatological diseases, infectious diseases, and malignancy-associated disorders. This review focuses on the treatment of these systemic disease –associated polyneuropathies.Recent FindingsMany of the specific polyneuropathies covered in this review are relatively rare and understudied. As such treatment recommendations are based on expert opinion, small case series, and case reports. Even mo...
Source: Current Treatment Options in Neurology - July 27, 2020 Category: Neurology Source Type: research

Myasthenia Gravis Treatment Updates
AbstractPurpose of reviewThis review presents an update of current treatment strategies for patients with myasthenia gravis (MG) depending on their clinical and immunological characteristics.Recent findingsNowadays, the available treatment options for MG are: (1) inhibitors of the acetylcholinesterase, useful as symptomatic treatment; (2) immunosuppressive drugs, the main treatment, initiated and escalated following international guidelines; (3) immunomodulatory drugs (intravenous immunoglobulin and plasma exchange), predominantly used in acute worsening or MG crisis; and (4) thymectomy, performed in patients with thymoma,...
Source: Current Treatment Options in Neurology - July 14, 2020 Category: Neurology Source Type: research

Pseudoprogression in Gliomas: the Use of Advanced MRI for Treatment Decisions
AbstractPurpose of reviewThe definitions of pseudoprogression (PsP) have greatly varied with time, with a reported incidence ranging from 10 to 30%. PsP is mainly a radiological definition, as a new or enlarging area of contrast agent enhancement, without argument of true tumor progression (TP), which will resolve or stabilize without any change in treatment. Because anatomical magnetic resonance imaging (MRI) is unsatisfactory in differentiating PsP from TP, advanced MR techniques are needed, adding sensitivity and specificity to obtain a more solid diagnosis.Recent findingsBecause of its high reported diagnostic accuracy...
Source: Current Treatment Options in Neurology - July 6, 2020 Category: Neurology Source Type: research

Thrombolysis Before Thrombectomy in Acute Large Vessel Occlusion: a Risk/Benefit Assessment and Review of the Evidence
AbstractPurpose of ReviewRecent evidence has shown an overwhelming benefit of mechanical thrombectomy for acute anterior circulation large vessel occlusion (LVO). Whether there is any additional benefit of IV tPA treatment prior to thrombectomy over thrombectomy alone is unproven in randomized trials. In this review, we summarize the available evidence for and against pre-thrombectomy treatment with IV tPA.Recent FindingsIn clinical trials demonstrating efficacy of thrombectomy, the majority of included patients were eligible for (and treated with) IV tPA. Systemic thrombolysis prior to thrombectomy is fraught with potenti...
Source: Current Treatment Options in Neurology - June 28, 2020 Category: Neurology Source Type: research

Management of Symptomatic Intracranial Atherosclerotic Stenosis
AbstractPurpose of reviewThis review addresses the current evidence of epidemiologic and therapeutic strategies in patients with intracranial atherosclerotic stenosis (ICAS).Recent findingsThere is a considerable number of patients with ICAS worldwide, especially in Asia. Modern neuroimaging techniques have improved assessment lately and they are providing insight into ICAS-related mechanisms causing cerebrovascular ischaemic events. Several studies have investigated vascular risk factors for ICAS, primarily in Asians. Vascular risk factors not only facilitate the occurrence of ICAS, but their optimal management is linked ...
Source: Current Treatment Options in Neurology - June 26, 2020 Category: Neurology Source Type: research

Management of Cognitive Impairment After Stroke
AbstractPurpose of ReviewIn this review, we present the reader with the latest diagnostic and therapeutic approaches in the management of patients with post-stroke cognitive impairment (PSCI). We discuss the most commonly utilized and validated neuropsychological assessments and neuroimaging diagnostic assessment tools. We also provide a critical appraisal of the pharmacological treatment approaches of  PSCI, in addition to highlighting the latest emerging non-pharmacological and technological advances in cognitive rehabilitation techniques.Recent FindingsAdvanced MRI techniques and newer PET tracers are being ut...
Source: Current Treatment Options in Neurology - June 15, 2020 Category: Neurology Source Type: research

Is there Still a Time Window in the Treatment of Acute Stroke?
AbstractPurpose of reviewIt has become evident that strict time-based criteria are not optimal in selecting patients for acute stroke intervention, leaving the majority of patients untreated due to missing universal time-based criteria. We discuss the pathophysiologic basis for a shift of focus from time to the imaging evidence of salvageable tissue, as well as clinical and imaging tools.Recent findingsThere is strong evidence for the benefit of thrombectomy in patients with a sustained salvageable tissue presenting within 24  h. Although evidence of benefit is limited in patients presenting longer than 24 h, tho...
Source: Current Treatment Options in Neurology - June 2, 2020 Category: Neurology Source Type: research

Infectious Encephalitis in the Neurocritical Care Unit
AbstractPurpose of reviewInfectious encephalitis is a rapidly progressive encephalopathy caused by a variety of pathogens, most commonly viruses. It is associated with significant mortality and morbidity, often requiring evaluation and treatment in the intensive care unit. This review article discusses the diagnosis of the infectious etiologies, the assessment for differential diagnoses, and the initiation of therapies, and most importantly, it entails the rapid and efficient management of the associated complications.Recent findingsNovel emerging technologies (e.g., metagenomic next-generation sequencing) have the potenti...
Source: Current Treatment Options in Neurology - May 27, 2020 Category: Neurology Source Type: research

Telemedicine for the Care of Neuromuscular Disorders
AbstractPurpose of reviewPatients with neuromuscular disorders have complex, multimodal needs. Weakness, fatigue, distance, and resources often limit access to health care. This review aims to summarize the progress to date on synchronous (real-time) telemedicine visits and asynchronous (store-and-forward) telehealth data collection in order to identify ways in which these can fill gaps in health care for these patients.Recent findingsMost of the research on telemedicine for neuromuscular disorders has been done with amyotrophic lateral sclerosis (ALS). Synchronous videoconferencing has been shown to be feasible and accept...
Source: Current Treatment Options in Neurology - May 10, 2020 Category: Neurology Source Type: research

Advancements in the Treatment of Cerebrovascular Complications of Cancer
AbstractPurpose of reviewTo present the new guidelines and therapeutic options regarding cerebrovascular complications of cancer, mainly ischemic stroke, cerebral venous thrombosis (CVT), and leptomeningeal carcinomatosis (LMC).Recent findingsA temporal trend study (2019) revealed that clinicians are still reluctant to apply thrombolysis to cancer patients, although two new studies (2018) reported no increased mortality. Several clinical trials on direct oral anticoagulants (DOACs) showed their superiority or, at least, non-inferiority compared with low molecular weight heparins in the treatment of venous thromboembolism (...
Source: Current Treatment Options in Neurology - April 29, 2020 Category: Neurology Source Type: research

Harnessing Big Data in Neurocritical Care in the Era of Precision Medicine
AbstractPurpose of reviewTo survey the literature around “big data” and “artificial intelligence” use, its challenges, and examples in clinical and research domains within neurocritical care.Recent findingsInnovations in digital data storage and integration technology have motivated the active development of data-driven tools for neurocritical care practice. There has been progress towards harmonization of data dictionaries within the field to boost generalizability of studies. Numerous collaborative groups have cultivated datasets that will enable further study of disease detection, prediction, and...
Source: Current Treatment Options in Neurology - April 17, 2020 Category: Neurology Source Type: research

Cannabinoids for the Treatment of Epilepsy: a Review
AbstractPurpose of reviewTreatment-resistant epilepsy (TRE) is associated with severe morbidity and mortality and affects over 30% of epilepsy patients. Despite advances in epilepsy management over the last 30  years, this rate has largely remained unchanged. Through a largely patient driven movement and despite federal regulations, cannabidiol (CBD) emerged as a candidate drug for improving the management of treatment-resistant epilepsies. This review highlights the available research on CBD and its the rapeutic role in the treatment of TREs.Recent findingsRandomized controlled trials have established CBD as an add-o...
Source: Current Treatment Options in Neurology - April 1, 2020 Category: Neurology Source Type: research

Controversies in Brain Death Declaration: Legal and Ethical Implications in the ICU
This article provides a brief overview of the history and complexities of brain death determination. We examine a few legal cases that highlight some of the controversies surrounding the validity of brain death tests in light of varying state laws and institutional policy, the appropriateness of making religious accommodations, the dilemma of continuing organ-sustaining support in a pregnant brain-dead patient, and the issue of whether to obtain informed consent from surrogate decision makers before proceeding to testing.Recent findingsIn response to physician concerns about navigating these complex cases, especially with ...
Source: Current Treatment Options in Neurology - March 17, 2020 Category: Neurology Source Type: research

Therapy for Cataplexy
AbstractPurpose of the reviewCataplexy, an involuntary loss of muscle activity triggered by strong emotions is the most impressive symptom in narcolepsy. This review gives an overview of the current understanding of cataplexy and its available treatment options.Recent findingsWith the discovery of hypocretin/orexin, the understanding of the pathophysiology of cataplexy advanced in the past decades. In the recent years, with the development of new anticataplectic agents (e.g., Pitolisant) symptomatic treatment of cataplexy has further improved. Abrupt cessation of anticataplectic medication especially antidepressants increa...
Source: Current Treatment Options in Neurology - March 17, 2020 Category: Neurology Source Type: research

Iron Replacement Therapy in Restless Legs Syndrome
AbstractPurpose of reviewThe main purpose of this manuscript is to review the existing clinical evidence about when iron replacement therapy should be initiated for RLS/WED, and how it should be administered (oral vs. intravenous).Recent findingsOur knowledge of the pathophysiology of restless legs syndrome/Willis-Ekbom (RLS/WED) continues to grow, revealing the existence of brain iron deficiency as the most well-known biological alteration behind this disorder. Since iron replacement therapy in RLS/WED is one of the first-line available treatments, its indication should be considered periodically, at both the beginning an...
Source: Current Treatment Options in Neurology - March 16, 2020 Category: Neurology Source Type: research

Update on the Treatment of Tics in Tourette Syndrome and Other Chronic Tic Disorders
AbstractPurpose of reviewThis review presents a critical appraisal of current therapeutic strategies for tics in patients with Tourette syndrome (TS) and other chronic tic disorders. We discuss the most recent evidence to support behavioural/psychosocial, pharmacological and surgical interventions in patients with tics and summarize existing recommendations about treatment selection. We also indicate the main knowledge gaps regarding efficacy, safety and prioritization of interventions and provide a summary of the emerging therapeutic approaches.Recent findingsDuring the past few years, high-quality randomized controlled t...
Source: Current Treatment Options in Neurology - March 16, 2020 Category: Neurology Source Type: research

Cerebral Edema in Traumatic Brain Injury: a Historical Framework for Current Therapy
AbstractPurpose of reviewThe purposes of this narrative review are to (1) summarize a contemporary view of cerebral edema pathophysiology, (2) present a synopsis of current management strategies in the context of their historical roots (many of which date back multiple centuries), and (3) discuss contributions of key molecular pathways to overlapping edema endophenotypes. This may facilitate identification of important therapeutic targets.Recent findingsCerebral edema and resultant intracranial hypertension are major contributors to morbidity and mortality following traumatic brain injury. Although Starling forces are phys...
Source: Current Treatment Options in Neurology - March 2, 2020 Category: Neurology Source Type: research

Dizziness and Balance Problems in Children
AbstractPurpose of reviewDizziness and balance problems in children can be multifactorial. Awareness regarding these disorders is limited. This paper reviews the existing literature in this field to raise the awareness of the discipline that can generate significant morbidity in children. It looks in detail into epidemiology, the aetiology, the diagnostic algorithm and the management of dizziness and balance problems in children.Recent findingsAn accurate history followed by the latest diagnostic algorithm with  the latest vestibular test battery that are utilised in adults can be used in children that lead to th...
Source: Current Treatment Options in Neurology - February 19, 2020 Category: Neurology Source Type: research

Newer Immunotherapies for the Treatment of Acute Neuromuscular Disease in the Critical Care Unit
Opinion statementPurpose of reviewIn this review, we discuss current treatment options for commonly encountered neuromuscular disorders in intensive care units. We will discuss epidemiology, pathophysiology, and acute and chronic treatment options for myasthenia gravis, Guillain-Barr é syndrome, West Nile virus, Botulism, and amyotrophic lateral sclerosis.Recent findingsEculizumab is the newest immunomodulator therapy approved by the Food and Drug Administration in treatment of myasthenia gravis, shown to improve long-term functional outcomes. Edaravone is the newest therapy in management of amyotrophic lateral scle...
Source: Current Treatment Options in Neurology - February 12, 2020 Category: Neurology Source Type: research

Epilepsy in brain metastasis: an emerging entity
AbstractPurpose of reviewThe purpose of this review is to highlight advances in the management of seizures in brain metastases from solid tumors.Recent findingsThe highest risk for seizures is in patients with melanoma and lung cancer. There is lack of data on the efficacy of antiepileptic drugs (AEDs), but interactions between enzyme-inducing AEDs and anticancer agents must be avoided. Levetiracetam and valproic acid are the most appropriate drugs. Prophylaxis with AEDs for patients with brain metastases without a history of seizures is not recommended. Total resection of a brain metastasis allows complete seizure control...
Source: Current Treatment Options in Neurology - February 7, 2020 Category: Neurology Source Type: research

Mobile Stroke Units: Bringing Treatment to the Patient
AbstractPurpose of reviewMobile stroke units (MSUs) have revolutionized emergency stroke care by delivering pre-hospital thrombolysis faster than conventional ambulance transport and in-hospital treatment. This review discusses the history of MSUs technological development, current operations and research, cost-effectiveness, and future directions.Recent findingsMultiple prospective and retrospective studies have shown that MSUs deliver acute ischemic stroke treatment with intravenous recombinant tissue plasminogen activator (IV r-tPA) approximately 30  min faster than conventional care. The 90-day modified Rankin Sco...
Source: Current Treatment Options in Neurology - February 5, 2020 Category: Neurology Source Type: research

Therapy for Insomnia and Circadian Rhythm Disorder in Alzheimer Disease
AbstractPurpose of the reviewThere is strong evidence for a bidirectional association between sleep disorders and Alzheimer ’s disease (AD). In particular, insomnia may be a potentially modifiable risk factor for AD. The present review summarizes recent advances in treatment of sleep disorders in AD.Recent findingsSome studies investigated the efficacy and safety of hypnotic agents as ramelteon and mirtazapine to treat sleep disorders in AD but no significant therapeutic effects have been observed. Benzodiazepines are the most frequently used medication for treatment of insomnia but they may cause significant side ef...
Source: Current Treatment Options in Neurology - February 4, 2020 Category: Neurology Source Type: research

Treatment Considerations in the Radiologically Isolated Syndrome
AbstractPurpose of reviewThis review provides the reader with updated information needed to make an accurate diagnosis of radiologically isolated syndrome (RIS), discusses controversies and considerations related to therapeutic intervention in RIS, and summarizes ongoing clinical intervention trials.Recent findingsIndividuals with RIS lack clinical neurological symptoms but are at risk for the subsequent development of a first clinical neurological event consistent with a diagnosis of multiple sclerosis. There are two ongoing clinical intervention trials to determine whether disease-modifying treatments for multiple sclero...
Source: Current Treatment Options in Neurology - February 2, 2020 Category: Neurology Source Type: research

Therapy in Sleep-Related Hypermotor Epilepsy (SHE)
AbstractPurpose of reviewThe purpose of this review is to summarize and discuss current options and new advances in the treatment of sleep-related hypermotor epilepsy (SHE), focusing on pharmacological and surgical treatments.Recent findingsCarbamazepine (CBZ) has traditionally been regarded as the first-line treatment option in SHE patients. In patients showing an unsatisfactory response to monotherapy, topiramate (TPM), lacosamide (LCM) and acetazolamide (ACZ) could be reasonable add-on strategies. The increasing understanding of the role of neuronal nicotinic acetylcholine receptor (nAChR) in SHE pathophysiology has led...
Source: Current Treatment Options in Neurology - January 29, 2020 Category: Neurology Source Type: research

Immunotherapy in Narcolepsy
AbstractPurpose of reviewNarcolepsy type 1 (NT1) is a chronic and disabling sleep disorder due to the loss of hypocretinergic neurons in the lateral hypothalamus pathophysiologically linked to an autoimmune process. Current treatment is symptomatic, and no cure is available to date. Immunotherapy is considered a promising future therapeutic option, and this review discusses the rationale for immunotherapy in narcolepsy, current evidences of its effects, outcome measures, and future directions.Recent findingsA limited number of case reports and uncontrolled small case series have reported the effect of different immunothera...
Source: Current Treatment Options in Neurology - January 29, 2020 Category: Neurology Source Type: research

Benign Positional Paroxysmal Vertigo Treatment: a Practical Update
AbstractPurpose of the reviewTo define the best up-to-date practical approach to treat benign paroxysmal positional vertigo (BPPV).Recent findingsBoth posterior and horizontal canal BPPV canalith repositioning maneuvers (Semont, Epley, and Gufoni ’s maneuvers) are level 1 evidence treatment for evidence-based medicine. The choice of maneuver (since their efficacy is comparable) is up to the clinician’s preferences, failure of the previous maneuver, or movement restrictions of the patient. Maneuvers for controversial variants, such as ant erior canal and apogeotropic posterior canal BPPV, have weaker evidence of...
Source: Current Treatment Options in Neurology - December 4, 2019 Category: Neurology Source Type: research

Acute Transverse and Flaccid Myelitis in Children
AbstractPurpose of reviewThe etiologies of myelitis in children are broad, and our understanding of inflammatory myelopathies in the pediatric population continues to evolve. Acute flaccid myelitis (AFM), increasingly linked to enterovirus infections, has risen in incidence over recent years. As with other infectious myelopathies, AFM can be challenging to distinguish from inflammatory causes of acute transverse myelitis (ATM) at initial presentation. This review outlines an approach to the treatment of children presenting with myelopathy of suspected inflammatory etiology, with attention to how management may differ in th...
Source: Current Treatment Options in Neurology - December 2, 2019 Category: Neurology Source Type: research

Current Update on Treatment Strategies for Idiopathic Normal Pressure Hydrocephalus
The objective of this review is to present the current diagnostic and treatment approaches for iNPH and to discuss some of the postoperative modalities that complement positive surgical outcomes.Recent findingsAlthough historically reported patient outcomes following iNPH surgery were dismal and highly variable, recent advances in terms of better understanding of the iNPH disease process, better standardization of iNPH diagnostic and treatment processes arising from the adoption of clinical guidelines for diagnosis, treatment and in research methodologies, and availability of long-term follow-up data, have helped reduce th...
Source: Current Treatment Options in Neurology - December 2, 2019 Category: Neurology Source Type: research