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

Complementary and Alternative Medicine for Painful Peripheral Neuropathy
AbstractPurpose of reviewThe purpose of our manuscript is to review the current evidence supporting the use of complementary and alternative medicine (CAM) in neuromuscular disease, specifically in painful peripheral neuropathy (PPN). We outline the therapeutic challenges of this debilitating condition and describe the best evidence for incorporating such therapies into clinical practice. The most studied modalities include lifestyle modifications with diet and exercise, supplements, and acupuncture. CAM therapies such as yoga, meditation, electrical stimulation, neuromodulatory devices, and cannabis are mentioned as emerg...
Source: Current Treatment Options in Neurology - September 2, 2019 Category: Neurology Source Type: research

Correction to: Chimeric Antigen Receptor T Cell-Related Neurotoxicity: Mechanisms, Clinical Presentation, and Approach to Treatment
The correct spelling of the co-author should be listed as Sarah Nagle, MD. (Source: Current Treatment Options in Neurology)
Source: Current Treatment Options in Neurology - August 9, 2019 Category: Neurology Source Type: research

Update on Trigeminal Neuralgia
AbstractPurpose of reviewTo review current treatments for trigeminal neuralgia, with an emphasis on determining which patients may benefit from neurosurgical procedures.Recent findingsA detailed history is the most helpful tool for diagnosing trigeminal neuralgia (TN) and predicting response to neurosurgical treatments. Patients with classic trigeminal neuralgia will describe severe, unilateral, intermittent facial pain that is triggered by innocuous sensory stimuli. In most cases, pain is caused by compression of the trigeminal nerve by a blood vessel near the brainstem. Magnetic resonance imaging is necessary to rule out...
Source: Current Treatment Options in Neurology - July 31, 2019 Category: Neurology Source Type: research

The Charles Bonnet Syndrome: a Systematic Review of Diagnostic Criteria
AbstractPurposeTo perform a systematic review of diagnostic criteria for the Charles Bonnet syndrome (CBS).Recent findingsAcross 33 studies that specified diagnostic criteria for CBS, hallucinations and vision loss were a common requirement, but there was considerable heterogeneity regarding hallucination properties (i.e., formed vs. unformed) and the severity of vision loss. The exclusion of confounding neuropsychiatric disorders was also common, but specific disorders and their method of ascertainment were variable.SummaryThere is considerable diagnostic heterogeneity for CBS in the literature. These differences have imp...
Source: Current Treatment Options in Neurology - July 25, 2019 Category: Neurology Source Type: research

Chimeric Antigen Receptor T Cell-Related Neurotoxicity: Mechanisms, Clinical Presentation, and Approach to Treatment
AbstractPurpose of reviewChimeric antigen receptor T cell (CAR-T) adoptive cell therapy is an effective treatment for patients with refractory B cell malignancies. As its use has grown, there has been an increase in the incidence of a serious, potentially fatal neurotoxicity known as immune effector cell-associated neurotoxicity syndrome (ICANS). This review discusses the clinical manifestations of this neurotoxicity syndrome, current grading systems, management strategies, and proposed biologic mechanisms leading to neurotoxicity.Recent findingsCurrent research suggests that patients with a higher disease burden and highe...
Source: Current Treatment Options in Neurology - July 20, 2019 Category: Neurology Source Type: research

Treatment of Primary Central Nervous System Lymphoma in Immunocompetent Patients
AbstractPurpose of reviewThis review focuses on the findings of recent randomized prospective trials evaluating new therapeutic options for primary central nervous system lymphoma (PCNSL) in first-line treatment and on the most promising novel agents.Recent findingsThe current standard treatment of newly diagnosed PCNSL has long been depending on high-dose methotrexate (HD-MTX) –based polychemotherapy followed by whole-brain radiotherapy (WBRT). Recent randomized trials have provided evidence that high-dose chemotherapy with autologous stem cell transplantation (ASCT) is a valuable alternative option to WBRT as conso...
Source: Current Treatment Options in Neurology - July 19, 2019 Category: Neurology Source Type: research

Diffuse Intrinsic Pontine Glioma: From Diagnosis to Next-Generation Clinical Trials
We present evidence supporting neurosurgical biopsy, early palliative care involvement, limitation of glucocorticoid use, and the leveraging of preclinical DIPG models as a pipeline to next-generation clinical trials.Recent findingsNew molecular understanding of pediatric high-grade gliomas has led to the reclassification of DIPG as one member of a family of diffuse gliomas occurring in the midline of the central nervous system that exhibit pathognomonic mutations in genes encoding histone 3 (H3 K27M). DIPG remains a clinically relevant term, though diagnostically the 80% of DIPG cases that exhibit the H3 K27M mutation hav...
Source: Current Treatment Options in Neurology - July 10, 2019 Category: Neurology Source Type: research

Diagnosis and Management of Autonomic Dysfunction in Dementia Syndromes
AbstractPurpose of reviewAutonomic dysfunction is common in dementia, particularly in the Lewy body dementias. This review considers the evidence for autonomic dysfunction in dementia, common symptoms and potential management options.Recent findingsAutonomic dysfunction has been shown in Alzheimer ’s disease and Lewy body dementias. Common symptoms include orthostatic dizziness, syncope, falls, urinary tract symptoms and constipation. Non-pharmacological management of orthostatic hypotension should include bolus water drinking. Pharmacological management may include the use of midodrine or droxidopa although the latt...
Source: Current Treatment Options in Neurology - July 10, 2019 Category: Neurology Source Type: research

Treatment Strategies for Neuroretinitis: Current Options and Emerging Therapies
AbstractPurpose of reviewTo explore and critically appraise the published data on the current and emerging treatment modalities for neuroretinitis.Recent findingsThe optimum treatment strategy for neuroretinitis due toBartonella henselae in immunocompetent individuals is not clear and a matter of debate. The role of systemic corticosteroids in infectious neuroretinitis and the optimum immunosuppressive regimen for use in recurrent idiopathic neuroretinitis also remains ill defined.SummaryThere is no class 1 evidence to support a specific treatment strategy for neuroretinitis. For uncomplicatedB. henselae–associated n...
Source: Current Treatment Options in Neurology - July 5, 2019 Category: Neurology Source Type: research

Interprofessional Care for Neuromuscular Disease
AbstractPurpose of reviewThis review aims to delineate interprofessional care models for neuromuscular disease. Evidence regarding both the benefits and barriers to interprofessional neuromuscular care in both inpatient and outpatient settings is presented. Finally, opportunities to improve both access to and quality of care provided by interprofessional team clinics will be discussed.Recent findingsAlthough the term “multidisciplinary” is often misapplied to denote any interprofessional team-based care setting, there are important differences in team structure and dynamics in each of the three most common mode...
Source: Current Treatment Options in Neurology - July 1, 2019 Category: Neurology Source Type: research

Monitoring of Neurocognitive Function in the Care of Patients with Brain Tumors
AbstractPurpose of reviewA detailed characterization of the nature of neurocognitive impairment in patients with brain tumors is provided, as well as considerations for clinical practice regarding neuropsychological assessment throughout the disease course.Recent findingsNeurocognitive impairment is common in patients with brain tumors and may result from the tumor itself, as a consequence of treatment, including surgery, chemotherapy, and radiation, or in association with supportive care medications (e.g., anticonvulsant and pain medications). Serial surveillance of neurocognitive functioning in this population can facili...
Source: Current Treatment Options in Neurology - June 28, 2019 Category: Neurology Source Type: research

Approaches to Remyelination Therapies in Multiple Sclerosis
AbstractPurpose of reviewWhile there are a growing number of therapies targeting relapse prevention in multiple sclerosis (MS), there are no approved therapies promoting remyelination. Understanding endogenous myelin formation, remyelination strategies, pre-clinical models, and clinical outcomes is essential to the interpretation of current and future clinical trials of remyelinating agents.Recent findingsSeveral recent clinical trials of remyelination therapies, including opicinumab, clemastine, and GSK239512, showed negative or modest results. These results could highlight challenges translating pre-clinical studies into...
Source: Current Treatment Options in Neurology - June 28, 2019 Category: Neurology Source Type: research

Understanding Atrial Cardiopathy: an Under-Recognized Contributor to Cardioembolic Stroke
AbstractPurpose of reviewIschemic stroke is the fifth leading cause of death in the world with cardioembolic stroke (CES) causing a disproportional amount of the morbidity and mortality associated with stroke. Atrial fibrillation (AF) is the leading cause of CES, and as the population ages, the incidence of CES is anticipated to rise. The importance of proper diagnosis and treatment of patients with embolic-appearing stroke is significant due to the burden of disease and the severity of the illness.Recent findingsThe past decade has seen an explosion of treatment options for patients with CES related to AF as well as bette...
Source: Current Treatment Options in Neurology - June 25, 2019 Category: Neurology Source Type: research

Treatment of Post-Stroke Depression
We present the reader with the most recent evidence to support pharmacological, psychosocial, and neuromodulation interventions in PSD. We also discuss the relevance of using antidepressants and psychotherapy to prevent PSD and discuss evidence that antidepressant treatment may reduce mortality after stroke.Recent findingsNeuroinflammation and decrease neurogenesis and plasticity may play an important role in the mechanism of PSD. The strongest predictors of PSD are stroke severity, early physical disability, and severity of loss of functioning. Nevertheless, populations at risk for PSD are yet to be identified. Recent met...
Source: Current Treatment Options in Neurology - June 25, 2019 Category: Neurology Source Type: research

Treatment Options for Agitation in Dementia
AbstractPurpose of reviewThe goal of the current review is to provide an update on the management of agitation in persons with dementia with a focus on pharmacological management of persons with Alzheimer ’s disease.Recent findingsAs consistently effective and safe pharmacologic interventions are still lacking, identifying and addressing medical and environmental precipitants remain a priority. Acetylcholinesterase inhibitors and memantine should be initiated to enhance cognition, and if present, management of insomnia or sundowning with trazodone is indicated. If agitation persists, treatment with citalopram can be ...
Source: Current Treatment Options in Neurology - June 24, 2019 Category: Neurology Source Type: research

Sleep Disorders and Stroke: Does Treatment of Obstructive Sleep Apnea Decrease Risk of Ischemic Stroke?
AbstractPurpose of reviewThis review aims to support obstructive sleep apnea (OSA) as a risk factor for ischemic stroke, review treatment strategies for OSA, provide a comprehensive review of clinical data on OSA treatment and ischemic stroke risk, and to critically assess if treatment of OSA decreases the risk of ischemic stroke and if treatment improves outcomes and subsequent ischemic stroke risk in post-stroke patients.Recent findingsSeveral observational studies, randomized controlled trials (RCTs), and meta-analyses have examined the risk of ischemic stroke and cardiovascular events in patients with OSA and have also...
Source: Current Treatment Options in Neurology - June 24, 2019 Category: Neurology Source Type: research

Immune-Mediated Neuropathies
AbstractPurpose of reviewThe purpose of this review article is to discuss the pathogenesis of acute and chronic immune-mediated neuropathies along with the recent advances in their treatment.Recent findingsSince the first description of Guillain-Barre syndrome (GBS) more than a century ago, there have been numerous forms of immune-mediated neuropathies described expanding the spectrum. Understanding the role of the immune system in the pathogenesis of immune-mediated neuropathies has been an advancement towards the diagnosis and treatment.SummaryIt is postulated that immune-mediated neuropathies are a group of diseases res...
Source: Current Treatment Options in Neurology - June 21, 2019 Category: Neurology Source Type: research

Prevention and Treatment of Acute Stroke in the Nonagenarians and Beyond: Medical and Ethical Issues
AbstractPurpose of reviewAs one of the fastest growing portions of the population, nonagenarians will constitute a significant percentage of the stroke patient population in the near future. Nonagenarians are nevertheless not specifically targeted by most clinical guidelines. In this review, we aimed to summarise the available evidence guiding stroke prevention and treatment in this age group.Recent findingsSeveral recent observational studies have shown that the benefits of anticoagulation for the oldest old patients with atrial fibrillation may outweigh the bleeding risk. A sub-analysis of the IST-3 trial has shown for t...
Source: Current Treatment Options in Neurology - May 8, 2019 Category: Neurology Source Type: research

Lipoic Acid and Other Antioxidants as Therapies for Multiple Sclerosis
AbstractOxidative stress (OS), when oxidative forces outweigh endogenous and nutritional antioxidant defenses, contributes to the pathophysiology of multiple sclerosis (MS). Evidence of OS is found during acute relapses, in active inflammatory lesions, and in chronic, longstanding plaques. OS results in both ongoing inflammation and neurodegeneration. Antioxidant therapies are a rational strategy for people with MS with all phenotypes and disease durations.Purpose of reviewTo understand the function of OS in health and disease, to examine the contributions of OS to MS pathophysiology, and to review current evidence for the...
Source: Current Treatment Options in Neurology - May 6, 2019 Category: Neurology Source Type: research

Current Treatment Options in Neurology —SMA Therapeutics
AbstractPurpose of reviewIn this review, we discuss the clinical and genetic features of 5q spinal muscular atrophy and highlight approved and upcoming therapies.Recent findingsWe emphasize that multidisciplinary care has been a key component of the improved quality and length of life seen in these individuals in the past decade. We discuss the evidence leading to the approval of nusinersen and the evidence leading to the anticipated approval of onasemnogene abeparvovec-xioi. Additional clinical therapies that are on the horizon are discussed and the importance of continued multidisciplinary care even after treatment is em...
Source: Current Treatment Options in Neurology - April 29, 2019 Category: Neurology Source Type: research

Brachial Plexopathies: Update on Treatment
AbstractPurpose of reviewBrachial plexopathies (BPs) are a heterogeneous group of diseases which can profoundly affect person ’s function and quality of life. This review targets current approaches to treatment of different BP types.Recent findingsAlthough there are multiple BP etiologies, non-traumatic causes are particularly unrecognized by clinicians, leading to misdiagnoses and delay in appropriate therapies. Recent data suggests that idiopathic neuralgic amyotrophy may be 50-fold more common than previously thought, with poorer outcomes than reported unless rapid diagnosis is followed by a multidisciplinary appr...
Source: Current Treatment Options in Neurology - April 27, 2019 Category: Neurology Source Type: research

Impulse Control Disorders in REM Sleep Behavior Disorder
AbstractPurpose of reviewThis paper reviews clinical and pathophysiological features of both impulse control disorders (ICDs) and REM sleep behavior disorder (RBD) in Parkinson ’s disease (PD), as well as current evidences of their association. Then, we suggest recommendations to manage PD patients with RBD in order to prevent this potentially devastating psychiatric complication.Recent findingsICDs are psychiatric complications occurring in patients with Parkinson ’s disease (PD) treated with dopaminergic replacement therapies (DRT). Besides DRT, risk factors for ICDs are poorly known. We recently showed an as...
Source: Current Treatment Options in Neurology - April 8, 2019 Category: Neurology Source Type: research

Statins in Ischemic Stroke Prevention: What Have We Learned in the Post-SPARCL (The Stroke Prevention by Aggressive Reduction in Cholesterol Levels) Decade?
We describe the current status of lipid-lowering therapies for ischemic stroke prevention. The SPARCL trial published in 2006 has been a landmark study in vascular neurology. The trial demonstrated that high-dose atorvastatin prevents recurrent stroke, and led the AHA/ASA to recommend statin therapy for patients with stroke or TIA of atherosclerotic origin.Recent findingsRecently, the J-STARS study demonstrated that therapy with low-dose pravastatin reduced atherothrombotic infarction incidence among patients with prior ischemic stroke. Besides, several trials have shown improved stroke outcomes with non-statin lipid-lower...
Source: Current Treatment Options in Neurology - April 8, 2019 Category: Neurology Source Type: research

OnabotulinumtoxinA in Migraine and Other Headaches: Review and Update
AbstractPurpose of the reviewThe role of onabotulinumtoxinA in headache management was serendipitously found over a decade ago and approved for chronic migraine in 2010 based on pivotal studies. The purpose of this review is to highlight the impact on headache and other health parameters which is critically reviewed, as well as the putative mechanisms of action.Recent findingsOnabotulinumtoxinA is effective in migraine, not only headache frequency and pain intensity but also other health parameters including quality of life. Tolerability is high and benefit/cost analysis is favorable. It should be considered off-label in r...
Source: Current Treatment Options in Neurology - April 4, 2019 Category: Neurology Source Type: research

Beta-Blockers for Migraine Prevention: a Review Article
AbstractPurpose of reviewThis review seeks to establish the role of beta-blockers (B-adrenergic receptor antagonists) in the pathophysiology of migraine prophylaxis, compare the efficacy of this group of medications with other common prophylactic agents, and also explore the relative benefits of using individual beta-blockers compared with others.Recent findingsNew evidence supports beta-blockers having several mechanisms of action in migraine prophylaxis. Numerous trials reveal significant clinical differences between various beta-blockers in migraine prophylaxis and that commonly used doses of beta-blockers are not optim...
Source: Current Treatment Options in Neurology - March 23, 2019 Category: Neurology Source Type: research

Antidepressants for Preventive Treatment of Migraine
AbstractPurpose of reviewThis review describes the pharmacology of each antidepressant class as it applies to migraine prevention, summarizes the evidence base for each medication, and describes relevant side effects and clinical considerations. Use of antidepressants for migraine prevention in clinical practice is also discussed.Recent findingsAntidepressants are commonly used as migraine preventives. Amitriptyline has the best evidence for use in migraine prevention. Nortriptyline is an alternative in patients who may not tolerate amitriptyline. The sedating effect of TCAs can be beneficial for patients with comorbid ins...
Source: Current Treatment Options in Neurology - March 21, 2019 Category: Neurology Source Type: research

Editor ’s Note: a Brief History of Preventative Antimigraine Therapy (PAMT)
(Source: Current Treatment Options in Neurology)
Source: Current Treatment Options in Neurology - March 21, 2019 Category: Neurology Source Type: research

Other Preventive Anti-Migraine Treatments: ACE Inhibitors, ARBs, Calcium Channel Blockers, Serotonin Antagonists, and NMDA Receptor Antagonists
This article examines several of the classes of medications that are used for migraine preventive treatment, specifically, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, serotonin antagonists, alpha-adrenergic agonists, and N-methyl-d-aspartic acid receptor antagonists.Recent findingsThere have been randomized control trials investigating medications in these drug classes since the most recent guidelines for migraine prevention in adults were published by the American Academy of Neurology, American Headache Society, and the Canadian Headache Society. In these investigatio...
Source: Current Treatment Options in Neurology - March 18, 2019 Category: Neurology Source Type: research