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

Current Status of Antiepileptic Drugs as Preventive Migraine Therapy
This article specifically provides the following: (1) a review of the mechanism of action, efficacy, and tolerability of topiramate and divalproex sodium/sodium valproate, the most widely used AEDs for migraine prevention, (2) a discussion on emerging evidence regarding the efficacy of zonisamide and levetiracetam, and (3) comments on gabapentin, pregabalin, carbamazepine, oxcarbazepine, and lamotrigine, AEDs which have insufficient evidence for use in migraine prevention.Recent findingsThe potential role for new extended-release formulations of topiramate in migraine prevention is discussed.SummaryThere is substantial evi...
Source: Current Treatment Options in Neurology - March 18, 2019 Category: Neurology Source Type: research

When to Consider Prophylactic Antimigraine Therapy in Children with Migraine
This article reviews current guidelines and practices to provide a better clinical approach in the management of migraines in children and adolescents.Recent findingsCurrently, the only FDA-approved medical treatment option for preventive therapy in chronic migraine in adolescents is topiramate. However, the Childhood and Adolescent Migraine Prevention Study (CHAMP) did not endorse superiority of topiramate or amitriptyline over placebo.SummaryAt this time, there is no clear consensus on when to start preventive therapy in children and adolescents with migraines. The decision is multifactorial and should be initiated after...
Source: Current Treatment Options in Neurology - March 14, 2019 Category: Neurology Source Type: research

Invited Commentary on Preventive Anti-Migraine Therapy (PAMT)
AbstractMigraine is a chronic paroxysmal neurological disorder characterized by multiphase attacks of head pain and a myriad of neurological symptoms. Chronic migraine causes a great personal and societal burden. Many patients are poorly responsive to, or non-compliant with, conventional migraine preventive therapies. For this reason, physicians are constantly looking for effective migraine prevention strategies. The recent introduction of an innovative pharmacological class useful for migraine prevention, namely monoclonal antibodies towards calcitonin gene-related peptide or its receptors, opens a new, immense therapeuti...
Source: Current Treatment Options in Neurology - March 14, 2019 Category: Neurology Source Type: research

Treatment of Central Nervous System Complications of Renal Dialysis and Transplantation
AbstractPurpose of reviewMost clinical neurologists will have come across individuals receiving renal replacement therapy who have developed a neurological complication, and neurologists working in, or close to, hospitals with a Renal Unit will be very aware of the range of central nervous system (CNS) complications that may develop in these patients. These can often be difficult to differentiate from disorders relating to renal failure or systemic conditions leading to kidney disease and can in fact arise from the interaction between underlying disease and the side effects of treatment. Patients with renal disease frequen...
Source: Current Treatment Options in Neurology - March 11, 2019 Category: Neurology Source Type: research

New Therapeutic Options for Fragile X Syndrome
AbstractPurpose of reviewThe purpose of this review is to provide an overview of current research and clinical practice guidelines in fragile X syndrome (FXS) with regard to therapeutic approaches in the management of this condition. The authors summarize and discuss findings from relevant preclinical studies and results from clinical trials in human subjects with FXS. Additionally, we provide an outline of the basic framework for understanding and providing educational and psychosocial supports for these individuals.Recent findingsCurrent treatments in FXS are largely symptom based and focused on managing associated psych...
Source: Current Treatment Options in Neurology - February 27, 2019 Category: Neurology Source Type: research

Diagnosis and Management of Autoimmune Dementia
AbstractPurpose of reviewTo describe the clinical, laboratory, and MRI features that characterize cognitive decline in the setting of central nervous system (CNS) autoimmunity, and provide an overview of current treatment modalities.Recent findingsThe field of autoimmune neurology is rapidly expanding due to the increasing number of newly discovered autoantibodies directed against specific CNS targets. The clinical syndromes associated with these autoantibodies are heterogeneous but frequently share common, recognizable clinical, and MRI characteristics. While the detection of certain autoantibodies strongly suggest the pr...
Source: Current Treatment Options in Neurology - February 27, 2019 Category: Neurology Source Type: research

Treatment of Neurological Manifestations of Gluten Sensitivity and Coeliac Disease
AbstractPurpose of reviewThe aim of this paper was to overview the current literature in order to establish the available treatment options for the neurological manifestations of gluten-related disorders (serologically confirmed gluten sensitivity and coeliac disease).Recent findingsA range of debilitating neurological manifestations is increasingly being recognized in patients with gluten sensitivity with and without enteropathy even in the absence of gastrointestinal symptoms. Ataxia is the commonest neurological manifestation, followed by peripheral neuropathy. Epilepsy, headache, encephalopathy, various movement disord...
Source: Current Treatment Options in Neurology - February 26, 2019 Category: Neurology Source Type: research

The Comprehensive Management of Cerebellar Ataxia in Adults
We present the management of ataxia in adults, beginning with establish ing an accurate diagnosis, followed by treatment of the multiple symptoms seen in cerebellar disorders, with a view to maximizing quality of life and effectively living with the consequences of ataxia. We discuss the importance of a multidisciplinary approach to the management of ataxia, including m edical and non-medical management and the evidence base that supports these interventions. We address the pharmacological treatment of ataxia, tremor, and other associated movement disorders; ophthalmological symptoms; bowel, bladder, and sexual symptoms; o...
Source: Current Treatment Options in Neurology - February 21, 2019 Category: Neurology Source Type: research

Status Epilepticus in the Neonate: Updates in Treatment Strategies
AbstractPurpose of reviewThe purpose of this review is to report recent advances in treatment of neonatal seizures, with a specific focus on new literature since a 2013 systematic review performed by this author (Slaughter) and others. There is a paucity of data with regard to well-defined status epilepticus (SE) in neonates, so treatment of recurrent seizures was also included in this inquiry. We aimed to summarize the efficacy and safety profiles of current therapeutic options as well as describe trends in medication selection in the neonatal intensive care unit (NICU) setting.Recent findingsPhenobarbital remains first-l...
Source: Current Treatment Options in Neurology - February 18, 2019 Category: Neurology Source Type: research

Stereotactic Radiosurgery for Multiple Brain Metastases
AbstractPurpose of reviewTo give an overview on the current evidence for stereotactic radiosurgery of brain metastases with a special focus on multiple brain metastases.Recent findingsWhile the use of stereotactic radiosurgery in patients with limited brain metastases has been clearly defined, its role in patients with multiple lesions (>  4) is still a matter of controversy. Whole-brain radiation therapy (WBRT) has been the standard treatment approach for patients with multiple brain lesions and is still the most commonly used treatment approach worldwide. Although distant brain failure is improved by WBRT, the ...
Source: Current Treatment Options in Neurology - February 13, 2019 Category: Neurology Source Type: research

Risk Factors for Sudden Unexpected Death in Epilepsy (SUDEP) and Their Mitigation
AbstractPurpose of reviewPeople with epilepsy have an increased risk of mortality when compared to the general population. Sudden unexpected death in epilepsy (SUDEP) is the most common cause of epilepsy-related death in children and adults. The purpose of this review is to discuss SUDEP, with an emphasis on SUDEP risk factors, their mitigation and prevention.Recent findingsSUDEP affects approximately 1 in 1000 people with epilepsy each year. Recent studies suggest that the incidence in children is similar to that of adults. The most important risk factor for SUDEP is the presence and frequency of generalized tonic-clonic ...
Source: Current Treatment Options in Neurology - February 13, 2019 Category: Neurology Source Type: research

Treatment and Outcomes in Nutritional Optic Neuropathy
AbstractPurpose of reviewNutritional optic neuropathy is a potential cause of severe visual loss; however, appropriate and timely management can result in excellent visual outcomes. The purpose of this review is to outline our current understanding of the treatment and outcomes for nutritional optic neuropathy.Recent findingsCurrent understanding of nutritional optic neuropathy has been greatly aided by some well-reported and investigated epidemics of the condition, most notably the Cuban epidemic optic neuropathy of the early 1990s. More recently, there is an emerging literature surrounding nutritional deficiencies that c...
Source: Current Treatment Options in Neurology - February 7, 2019 Category: Neurology Source Type: research

Sleep Abnormalities in Multiple Sclerosis
AbstractPurpose of reviewThis review summarizes the most well-documented sleep disorders seen in patients with multiple sclerosis (MS), with a special focus on the impact on quality of life.Recent findingsSleep abnormalities in patients with MS are a multifactorial and relatively complex issue affecting approximately 60% of the patients while the pathophysiology of these symptoms is not fully understood. Circadian rhythm disorders and increased levels of pro-inflammatory cytokines have been recognized as potential players in affecting sleep homeostasis in MS patients. Medication-related side effects such as in immunotherap...
Source: Current Treatment Options in Neurology - January 31, 2019 Category: Neurology Source Type: research

Advances in Management of Psychosis in Neurodegenerative Diseases
AbstractPurpose of the reviewPsychosis is broadly defined as a disengagement from reality. It describes syndromes that impair both thought content and thought process. Psychosis negatively impacts an individual ’s quality of life, in addition to the families caring for them. Psychosis with different types of hallucinations and delusions occurs in the context of delirium. Neuropsychiatric symptoms (NPS) are almost universal in the course of common neurodegenerative disorders (NDD) like Alzheimer’s disea se (AD) or Parkinson’s disease (PD).In this paper, the authors took an effort to characterize AD and PD ...
Source: Current Treatment Options in Neurology - January 23, 2019 Category: Neurology Source Type: research

Treatment Approaches for MOG-Ab-Associated Demyelination in Children
AbstractPurpose of reviewThe purpose of this review is to summarize current understanding regarding the treatment of myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-associated demyelination in children. Emphasis is placed on the unique obstacles we face when predicting the risk of relapse and the important implications of such challenges when planning treatment protocols.Recent findingsMOG-Abs are consistently identified in a range of acquired demyelinating syndromes (ADS) in adults and children with a clinical phenotype distinct of MS and AQP4-Ab neuromyelitis optica spectrum disorder. Although initially thought to ...
Source: Current Treatment Options in Neurology - January 22, 2019 Category: Neurology Source Type: research

Diagnostic Criteria, Differential Diagnosis, and Treatment of Minor Motor Activity and Less Well-Known Movement Disorders of Sleep
AbstractPurpose of reviewSleep-related movement disorders (SRMD) include several different motor activities during sleep. Few of them are well known and well classified, whereas others are minor motor disorders of sleep which are neither thoroughly characterized and classified nor have been extensively investigated to clarify their pathogenesis and clinical relevance. This review will focus on those minor sleep-related movement disorders.Recent findingsBefore diagnosing periodic limb movement (PLM) disorder in patients with PLM during polysomnography, other disorders associated with PLM need to be excluded, namely restless...
Source: Current Treatment Options in Neurology - January 19, 2019 Category: Neurology Source Type: research

Restless Legs Syndrome and Other Movement Disorders of Sleep —Treatment Update
AbstractPurpose of reviewThe purpose of this review article is to summarize and discuss the recent advances in the treatment of restless legs syndrome (RLS), as well as REM sleep behavior disorder (RBD), and periodic leg movement disorder (PLMD).Recent findingsTraditionally, dopaminergic therapy has been considered the sole option for first-line treatment of RLS due to their impressive acute efficacy. Dopamine agonists such as oral pramipexole and ropinirole, as well as transdermal rotigotine are all effective treatment options. However, augmentation of the RLS symptoms is a major limitation of oral dopaminergic therapy. R...
Source: Current Treatment Options in Neurology - November 9, 2018 Category: Neurology Source Type: research

Gastrointestinal Dysfunction in Parkinson ’s Disease
AbstractPurpose of reviewDuring the past 25  years, there has been an explosion of information regarding the occurrence of gastrointestinal dysfunction in Parkinson’s disease. In this review, the clinical features of gastrointestinal dysfunction in Parkinson’s disease will be described and information regarding the potential role of the enteric nervous system and the gut microbiome in the genesis of Parkinson’s disease will be addressed.Recent findingsRecognition is growing regarding the role that gastroparesis and small intestinal dysfunction may play in Parkinson ’s disease, especially with r...
Source: Current Treatment Options in Neurology - October 25, 2018 Category: Neurology Source Type: research

Cognitive Deficits in Multiple Sclerosis: Recent Advances in Treatment and Neurorehabilitation
This article highlights recent progress in research on treatment and neurorehabilitation of cognitive impairment in multiple sclerosis (MS) including pharmacological interventions, physical exercise, and neuropsychological rehabilitation, both in conventional and technology-assisted settings.Recent findingsThe most consistent evidence in terms of improvement or preservation of circumscribed cognitive scores in MS patients comes from moderately sampled randomized clinical trials on multimodal approaches that combine conventional or computerized neuropsychological training with psychoeducation or cognitive behavioral therapy...
Source: Current Treatment Options in Neurology - October 22, 2018 Category: Neurology Source Type: research

Current Treatment Strategies and Future Treatment Options for Dravet Syndrome
AbstractPurpose of reviewDravet syndrome is a rare but severe genetic epilepsy that has unique treatment challenges. This is a review of current and future potential treatment options.Recent findingsTreatment for Dravet syndrome should encompass many aspects of the syndrome such as gait, behavior, and nutrition, as well as focus on seizure control. Many sodium channel blockers should be avoided as they are likely to exacerbate seizures. Current options for treatment include valproic acid, clobazam, stiripentol, and ketogenic diet. Testing is underway for several new treatment options with unique mechanisms of action and th...
Source: Current Treatment Options in Neurology - October 13, 2018 Category: Neurology Source Type: research

Neurotoxicity of Anesthesia in Children: Prevention and Treatment
AbstractPurpose of reviewThe purpose of this review is to summarize the current evidence regarding the impact of the exposure to anesthetic and sedative agents on neurodevelopment during the period of rapid brain growth in the first 3  years of life. Though much of the definitive data demonstrating anesthesia-induced neurotoxicity has come from studies in young animals, the focus of this review is on emerging human data.Recent findingsIn 2016, the first prospective trials investigating the neurodevelopmental impact of early anesthetic exposure (GAS and PANDA studies) were published, both showing no significant impact ...
Source: Current Treatment Options in Neurology - October 13, 2018 Category: Neurology Source Type: research

Treatment of Persistent Postural-Perceptual Dizziness (PPPD) and Related Disorders
This article will review different treatment strategies for this common functional neurological disorder and provide practical recommendations for tailored therapy.Recent findingsAn emerging understanding of the underlying pathophysiology that considers vestibular, postural, cognitive, and emotional aspects can enable patients to profit from vestibular rehabilitation, as well as cognitive-behavioral therapy (CBT). Crucially, approaches from CBT should inform and augment physiotherapeutic techniques, and, on the other hand, vestibular exercises or relaxation techniques can be integrated into CBT programs. Antidepressant med...
Source: Current Treatment Options in Neurology - October 13, 2018 Category: Neurology Source Type: research

Stem Cell Therapy in Cerebrovascular Disease
AbstractPurpose of reviewThe purpose of this article is to provide a review of state-of-the-art cellular therapy in cerebrovascular diseases by discussing published and ongoing clinical trials.Recent findingsIn spite of the challenge in translating the success of cellular therapy in acute strokes from preclinical models to clinical trials, early phase clinical trial have recently shown promise in overcoming these challenges. Various stem cell types and doses are being studied, different routes of administration are under investigation, as well as defining the optimal time window to intervene. In addition, experimental meth...
Source: Current Treatment Options in Neurology - October 9, 2018 Category: Neurology Source Type: research

Sleep Abnormalities in Wilson ’s Disease
AbstractPurpose of reviewThe aim of this article was to review the different sleep disorders associated with Wilson ’s disease (WD), their mechanisms and their treatments.Recent findingsSome of these disorders such as REM sleep behavior disorder or sleepiness can appear as a prodromal phase phenomenon in WD allowing an early treatment of the disease and sometimes a resolution of the sleep disorder.SummarySleep disorders in WD are frequent combining insomnia, daytime sleepiness, restless legs syndrome (RLS), cataplexy-like episodes, and REM sleep behavior disorder (RBD). Sleep recordings confirm these disorders. Mecha...
Source: Current Treatment Options in Neurology - September 27, 2018 Category: Neurology Source Type: research

Novel Systemic Treatments for Brain Metastases From Lung Cancer
AbstractPurpose of reviewBrain metastases are frequent complication of lung cancer and are associated with poor prognosis. Patients with brain metastases secondary to lung cancer have traditionally been managed with surgery and radiation with limited role for systemic chemotherapy. In the past decade, however, this paradigm has shifted largely due to the advent of targeted therapies and immunotherapies, both of which have demonstrated efficacy in the treatment of brain metastases and extracranial disease.Recent findingsWhile patients with brain metastases secondary to lung cancer have historically been excluded from trials...
Source: Current Treatment Options in Neurology - September 27, 2018 Category: Neurology Source Type: research

Managing Antiepileptic Medication in Dialysis Patients
AbstractPurpose of reviewThe purpose of this review is to summarize and discuss available information on the management of epilepsy patients on renal replacement therapy. Older and newer antiepileptic drugs (AEDs) pharmacology will be reviewed, as well as the need to supplement dosages during or after hemodialysis, peritoneal dialysis, and continuous renal replacement treatment.Recent findingsThe great majority of anticonvulsants have been studied in patients with renal failure. Many of them have also been assessed during renal replacement therapy. For some, data are scant, and choice of management must be decided through ...
Source: Current Treatment Options in Neurology - September 27, 2018 Category: Neurology Source Type: research

Sleep, Circadian Rhythms, and Epilepsy
AbstractPurpose of reviewThere is a known interrelationship between sleep and epilepsy. This review highlights the recent findings regarding interactions between sleep and circadian rhythms and the manifestations of epilepsy and surgical treatments for refractory epilepsy.Recent findingsCLOCK gene expression may be reduced within the epileptogenic focus in patients with refractory epilepsy. Interictal epileptiform discharges during NREM and especially REM sleep may lateralize to the epileptogenic hemisphere. Intracranial video EEG monitoring and EEG from implanted responsive neurostimulator devices confirm scalp video EEG ...
Source: Current Treatment Options in Neurology - September 27, 2018 Category: Neurology Source Type: research

Sleep Abnormalities in Wilson ’s Disease
AbstractPurpose of reviewThe aim of this article was to review the different sleep disorders associated with Wilson ’s disease (WD), their mechanisms and their treatments.Recent findingsSome of these disorders such as REM sleep behavior disorder or sleepiness can appear as a prodromal phase phenomenon in WD allowing an early treatment of the disease and sometimes a resolution of the sleep disorder.SummarySleep disorders in WD are frequent combining insomnia, daytime sleepiness, restless legs syndrome (RLS), cataplexy-like episodes, and REM sleep behavior disorder (RBD). Sleep recordings confirm these disorders. Mecha...
Source: Current Treatment Options in Neurology - September 27, 2018 Category: Neurology Source Type: research