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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 25, 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 25, 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 25, 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 25, 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 1, 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 8, 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 30, 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 24, 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 19, 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 consolida...
Source: Current Treatment Options in Neurology - July 18, 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 9, 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 latter i...
Source: Current Treatment Options in Neurology - July 9, 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 neuro...
Source: Current Treatment Options in Neurology - July 4, 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 models: mult...
Source: Current Treatment Options in Neurology - June 30, 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 27, 2019 Category: Neurology Source Type: research