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Editor ’s Note: a Brief History of Preventative Antimigraine Therapy (PAMT)
(Source: Current Treatment Options in Neurology)
Source: Current Treatment Options in Neurology - March 20, 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 17, 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 17, 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 13, 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 13, 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 10, 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 overa...
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