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 5, 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 - August 1, 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 29, 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 28, 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 15, 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 7, 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 29, 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 27, 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 16, 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 3, 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 28, 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 11, 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 30, 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 18, 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 2, 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 18, 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 18, 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 17, 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 17, 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 3, 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 20, 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 13, 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 8, 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 6, 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 5, 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 3, 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 30, 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 30, 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 5, 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 3, 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 3, 2019 Category: Neurology Source Type: research

Correction to: Treatment of Excessive Daytime Sleepiness in Patients with Narcolepsy
The correct spelling of the author should be listed as Laura P érez-Carbonell, MD as shown above. (Source: Current Treatment Options in Neurology)
Source: Current Treatment Options in Neurology - November 28, 2019 Category: Neurology Source Type: research

Pain Management in Multiple Sclerosis: a Review of Available Treatment Options
AbstractPurpose of reviewMultiple Sclerosis (MS) is a chronic autoimmune disease with no curative treatment available. While recent years have ushered in many effective new disease-modifying therapies for MS, they have not obviated the need for symptomatic treatments for MS-related pain. In this review, we discuss available approaches to control pain, which is one of the most common complaints MS patients have.Recent findingsThe most recent research in this topic is directed towards non-pharmacologic interventions including water exercises, yoga and cannabis. More trials are being conducted on neuromodulation for MS-relate...
Source: Current Treatment Options in Neurology - November 27, 2019 Category: Neurology Source Type: research

The Influence of Therapeutics on Prognostication After Cardiac Arrest
AbstractPurpose of reviewThe goal of this review is to highlight the influence of therapeutic maneuvers on neuro-prognostication measures administered to comatose survivors of cardiac arrest. We focus on the effect of sedation regimens in the setting of targeted temperature management (TTM), one of the principle interventions known to improve neurological recovery after cardiac arrest. Further, we discuss the critical need for novel markers, as well as refinement of existing markers, among patients receiving extracorporeal membrane oxygenation (ECMO) in the setting of failed conventional resuscitation, known as extracorpor...
Source: Current Treatment Options in Neurology - November 25, 2019 Category: Neurology Source Type: research

The Landscape of Hematopoietic Stem Cell Transplant and Gene Therapy for X-Linked Adrenoleukodystrophy
AbstractPurpose of reviewTo present an updated appraisal of hematopoietic stem cell transplant (HSCT) and gene therapy for X-linked adrenoleukodystrophy (ALD) in the setting of a novel, presymptomatic approach to disease.Recent findingsOutcomes in HSCT for ALD have been optimized over time due to early patient detection, improved myeloablative conditioning regimens, and adjunctive treatment for patients with advanced cerebral disease. Gene therapy has arrested disease progression in a cohort of boys with childhood cerebral ALD. New therapeutic strategies have provided the clinical basis for the implementation of Newborn Sc...
Source: Current Treatment Options in Neurology - November 25, 2019 Category: Neurology Source Type: research

Delirium Management in the ICU
AbstractPurpose of reviewDelirium occurs frequently in critically ill patients and is associated with adverse outcomes in both the short and long term. In this review, we aim to highlight recent study findings on the prevention and treatment of delirium, provide additional recommendations based on expert guidelines, and indicate knowledge gaps deserving of future study.Recent findingsMulticomponent non-pharmacologic interventions have been shown to be efficacious in non-ICU populations, and multicomponent strategies such as the ABCDEF bundle have been adopted in the ICU with several studies showing a potential benefit in d...
Source: Current Treatment Options in Neurology - November 14, 2019 Category: Neurology Source Type: research

Transcranial Magnetic Stimulation for the Treatment of Pediatric Neurological Disorders
AbstractPurpose of reviewRepetitive transcranial magnetic stimulation (rTMS) is a form of noninvasive brain stimulation that is used for the treatment of migraine and major depression in adults and is now being evaluated for use in other disorders. The purpose of this review is to summarize the physiology underlying TMS, the safety and tolerability in pediatric patients, and the evidence for TMS efficacy in the treatment of pediatric neurologic disorders.Recent findingsStudies investigating rTMS for adolescent depression, hemiparesis due to pediatric stroke, autism, and tics/Tourette syndrome have demonstrated some therape...
Source: Current Treatment Options in Neurology - November 13, 2019 Category: Neurology Source Type: research

Treatment of Excessive Daytime Sleepiness in Patients with Narcolepsy
AbstractPurpose of reviewThe aim of this review is to discuss and summarize the main therapeutic strategies for the management of excessive daytime sleepiness (EDS) in patients with narcolepsy. An overview of novel therapies and potential future options are covered as well.Recent findingsFirst line treatments for EDS in narcolepsy patients include modafinil/armodafinil and sodium oxybate. Other options with a stimulant effect, such as methylphenidate and amphetamines are considered if the former do not control the symptoms. More recently, pitolisant (H3 receptor inverse agonist) was approved by the European Medicines Agenc...
Source: Current Treatment Options in Neurology - November 12, 2019 Category: Neurology Source Type: research

Therapies for Restless Legs in Parkinson ’s Disease
AbstractPurpose of reviewThe aim of this article was to review the options and particularities of the treatment of restless legs syndrome (RLS) in Parkinson ’s disease (PD).Recent findingsRLS is more frequent in PD than in the general population. Even if these two disorders share some specificity (dopa-sensitivity), they also differ in many features (iron load, genetic profile, dopaminergic cell count), resulting in different adaptations of the treatment. Only one study has specifically explored and demonstrated the efficacy of a treatment (rotigotine) in RLS with PD, constraining us to treat RLS with PD by analogy a...
Source: Current Treatment Options in Neurology - November 9, 2019 Category: Neurology Source Type: research

Brain Metastases as a First Site of Recurrence in Patients Receiving Chemotherapy with Controlled Systemic Cancer: a Critical but Under-Recognized Clinical Scenario
AbstractPurpose of reviewAs the treatment of many malignancies has improved, brain metastases (BM) have been observed as a site of the first recurrence in patients with controlled systemic cancers. This suggests that while the administered chemotherapy is effective against systemic cancer, drug concentrations in the central nervous system (CNS) are likely too low to be effective. These findings are in accord with data suggesting that more than 98% of FDA-approved drugs on the market today are unable to cross the blood-brain barrier (BBB).Recent findingsThis retrospective literature review was conducted to estimate the prop...
Source: Current Treatment Options in Neurology - November 9, 2019 Category: Neurology Source Type: research

Functional Electrical Stimulation Cycling Exercise for People with Multiple Sclerosis
AbstractPurpose of reviewThere has been substantial interest in the role of exercise for managing impairments, limitations, and disability progression among persons with multiple sclerosis (MS). Despite established benefits of exercise training for persons who have mild-to-moderate MS, the ability to deliver exercise to persons who experience higher disability remains challenging. One promising approach for exercise in this population is functional electrical stimulation (FES) cycling. This review provides a summary of the current evidence for FES cycling as an exercise training modality in persons with MS with respect to ...
Source: Current Treatment Options in Neurology - November 8, 2019 Category: Neurology Source Type: research

Outcomes and Cost-Effectiveness of Autologous Hematopoietic Cell Transplant for Multiple Sclerosis
We present the reader with a brief review on the AHCT procedure, its immunomodulatory mechanism of action in MS, the most recent evidence in support of its use in patients with relapsing-remitting multiple sclerosis (RRMS), as well as its cost considerations.Recent findingsThe first meta-analysis of clinical trials of AHCT for patients with MS demonstrated durable 5-year progression-free survival rates and low treatment-related mortality. Recently, the first randomized controlled phase III clinical trial demonstrated AHCT to be superior to best available therapy for a subset of patients with RRMS. This led to the American ...
Source: Current Treatment Options in Neurology - October 17, 2019 Category: Neurology Source Type: research

Correction to: The Charles Bonnet Syndrome: a Systematic Review of Diagnostic Criteria
Shortly after publication, the authors became aware of several typographical errors in Table 1 which were introduced during the copy-editing process. (Source: Current Treatment Options in Neurology)
Source: Current Treatment Options in Neurology - October 4, 2019 Category: Neurology Source Type: research

Newer Treatment Approaches in Pediatric-Onset Multiple Sclerosis
AbstractPurpose of reviewWith the recognition that pediatric-onset multiple sclerosis (POMS) is characterized by more prominent disease activity, earlier age at onset of disability milestones, and more prominent cognitive impairment compared with physical disability earlier in the disease course compared with adult-onset multiple sclerosis (AOMS), there has been increasing interest in identifying optimal and safe treatment approaches to achieve better disease control in this group. Injectable therapies have been traditionally used as first line in this population, although not formally approved. This review focuses on curr...
Source: Current Treatment Options in Neurology - September 27, 2019 Category: Neurology Source Type: research

Postintensive Care Syndrome in Pediatric Critical Care Survivors: Therapeutic Options to Improve Outcomes After Acquired Brain Injury
AbstractPurpose of reviewChildren surviving the pediatric intensive care unit (PICU) with neurologic illness or injury have long-term morbidities in physical, cognitive, emotional, and social functioning termed postintensive care syndrome (PICS). In this article, we review acute and longitudinal management strategies available to combat PICS in children with acquired brain injury.Recent findingsFew intervention studies in this vulnerable population target PICS morbidities. Small studies show promise for both inpatient- and outpatient-initiated therapies, mainly focusing on a single domain of PICS and evaluating heterogeneo...
Source: Current Treatment Options in Neurology - September 27, 2019 Category: Neurology Source Type: research

The Role of Surgery in Meningiomas
AbstractPurpose of reviewThis review presents the most recent evidences and recommendations in the pre-, intra-, and post-surgical management of patients harboring meningiomas. Due to the increasing relevance of multimodal approaches, in order to preserve patients ’ neurological function and quality of life (QoL), the role of observation and radiation treatments (as either primary or adjuvant therapy) has also been discussed.Recent findingsMultiple advances in neurosurgery, including the use of the microscope and endoscope, improved preoperative neuroimaging, intraoperative image-guided approaches, and intraoperative...
Source: Current Treatment Options in Neurology - September 27, 2019 Category: Neurology Source Type: research

Deep Brain Stimulation for Epilepsy: Biomarkers for Optimization
AbstractPurpose of reviewTwo large-scale controlled clinical trials have provided Class I evidence for the benefit of deep brain stimulation (DBS) as a therapy for refractory epilepsy. However, the efficacy has been variable, with some patients not achieving any improvement in their seizure control. This disparity could be the result of suboptimal stimulation parameters/electrodes or alternatively a difference in the type of seizures being treated. This review presents the most recent clinical results with a focus on two major targets for DBS, the anterior nucleus of the thalamus (ANT) and the hippocampus. We detail the et...
Source: Current Treatment Options in Neurology - September 26, 2019 Category: Neurology Source Type: research

Treatment of Extracranial Arterial Dissection: the Roles of Antiplatelet Agents, Anticoagulants, and Stenting
AbstractPurpose of reviewCervicocephalic arterial dissection (CeAD) is the most commonly identified cause of stroke in young healthy individuals. The management of acute ischemic stroke due to the diagnosed or suspected CeAD is well established and is appropriate for thrombolysis. There is a substantial risk of stroke recurrence in the early post-stroke period. The optimum method of stroke prevention in the subacute period remains debatable. In our review, we focused on the management of recurrent stroke in CeAD, the choice of various antithrombotic agents for stroke risk reduction with regard to specific pathogenetic mech...
Source: Current Treatment Options in Neurology - September 26, 2019 Category: Neurology Source Type: research

Basilar Artery Occlusion: Diagnosis and Acute Treatment
AbstractPurpose of reviewTo provide the latest updates in the diagnosis, management, and prognosis in patients with basilar artery occlusion (BAO).Recent findingsThe diagnosis of BAO requires a high index of suspicion among patients with sudden onset depressed level of consciousness, quadraparesis (or hemiparesis), and cranial nerve dysfunction. Computed topography with angiography is currently the diagnostic modality of choice for the diagnosis of BAO. Given the often catastrophic nature of BAO, intravenous thrombolysis combined with mechanical thrombectomy should be offered in eligible patients. Despite a lack of data fr...
Source: Current Treatment Options in Neurology - September 26, 2019 Category: Neurology Source Type: research

Pediatric Ocular Myasthenia Gravis
We present a review of current strategies in the treatment of pediatric ocular myasthenia gravis (OMG). A critical appraisal was performed of the current literature available on OMG and the treatment options available for all age populations. From this data, we present the evidence surrounding therapeutic options for pediatric OMG and discuss treatment outcomes in the pediatric population. We also present gaps in the literature with regard to pediatric OMG and possibilities for future research.Recent findingsWhile there is data on the use of steroid-sparing immunosuppressive agents for myasthenia gravis (MG), as a whole it...
Source: Current Treatment Options in Neurology - September 26, 2019 Category: Neurology Source Type: research