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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

An Update on the Treatment of Chorea
AbstractPurpose of reviewThere are many causes for chorea, including genetic, autoimmune, pharmacological, and structural lesions. Where appropriate, treatment is based on reversing the underlying cause of chorea; many cases are self-limited, resolving when the primary disorder is treated. This review focuses on the management of chorea due to untreatable causes.Recent findingsThere are a limited number of double-blind randomized control trials assessing the efficacy of specific chorea treatments. Most therapeutic recommendations are based on small open-label studies, case reports, and expert opinion. This is in part due t...
Source: Current Treatment Options in Neurology - September 25, 2018 Category: Neurology Source Type: research

Cryopyrin-Associated Periodic Fever Syndrome and the Nervous System
AbstractPurpose of reviewThe purpose of this review is to highlight the molecular and clinical characteristics of the cryopyrin-associated periodic fever syndrome (CAPS) and its management. CAPS is an autosomal dominantly inherited autoinflammatory disorder associated with mutations in theNLRP3 gene, which ultimately lead to excessive production of interleukin-1 β (IL-1β) and systemic inflammation. Typical systemic features include fever, urticarial rash and arthralgia, and ultimately amyloidosis. There are also multiple neurological manifestations including, but not restricted to, headache, sensorineural hearing loss, a...
Source: Current Treatment Options in Neurology - September 3, 2018 Category: Neurology Source Type: research

Acute Symptomatic Seizures and Provoked Seizures: to Treat or Not to Treat?
AbstractPurpose of reviewAcute symptomatic and provoked seizures by definition occur in close proximity to an event and are considered to be situational. The treatment implications and likelihood of recurrence of acute symptomatic and provoked seizures differ from unprovoked seizures. In this article, the authors review the literature on acute symptomatic and provoked seizures with regard to therapeutic approach and risk of recurrence.Recent findingsIn the acute period, patients who suffer from acute symptomatic and provoked seizures have higher rates of morbidity and mortality. Patients with acute symptomatic seizures in ...
Source: Current Treatment Options in Neurology - August 23, 2018 Category: Neurology Source Type: research

Disorders of Vergence Eye Movements
AbstractPurpose of reviewThe purpose of this review is to summarize current understanding regarding disorders of gaze with comitant ocular misalignment at distance or near and a full range of extraocular movement. Emphasis is placed on clinical features that may be used to differentiate underlying neurologic disease from the more common benign causes. The approach to the diagnostic evaluation and treatment is discussed.Recent findingsRandomized controlled trials and Cochrane review suggest the superiority of formal office-based vision therapy in treating convergence insufficiency in children. Divergence insufficiency in ol...
Source: Current Treatment Options in Neurology - August 23, 2018 Category: Neurology Source Type: research

Reducing the Risk of Sudden Unexpected Death in Epilepsy (SUDEP)
AbstractPurpose of ReviewRecent reports have highlighted an increase in the number of epilepsy-related deaths. Sudden unexpected death in epilepsy (SUDEP) is thought to be the number one cause of death in chronic epilepsy. This review provides a summary of the current evidence of how to communicate, stratify, and mitigate known risk factors for SUDEP.Recent FindingsThere is now a clearer understanding of the possible pathological mechanisms that contribute to SUDEP. SUDEP is the culmination of multifactorial predisposing and precipitating factors and has been linked to particular candidate genes. A number of static and mod...
Source: Current Treatment Options in Neurology - August 22, 2018 Category: Neurology Source Type: research

Acute Blood Pressure Management in Acute Ischemic Stroke and Spontaneous Cerebral Hemorrhage
AbstractPurpose of reviewWe discuss the evidence and guidelines for acute blood pressure (BP) management for patients presenting with acute ischemic stroke or spontaneous cerebral hemorrhage.Recent findingsObservational data suggest that the extremes of BP should be avoided in patients presenting with acute ischemic stroke. There is no convincing evidence that active BP reduction results in improved outcomes for ischemic stroke patients. Current guidelines recommend that BP be maintained ≤ 185/110 mmHg in patients who are candidates for intravenous tissue plasminogen activator (IV tPA) or mechanical thrombectomy and t...
Source: Current Treatment Options in Neurology - August 18, 2018 Category: Neurology Source Type: research