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A Review of the Current Literature and Updates on Embolic Stroke of Undetermined Source (ESUS)
AbstractPurpose of ReviewThe initial ESUS construct presumed that atrial fibrillation (AF) would be detected in a substantial percentage of patients, but subsequent studies have determined that the rate of AF detection is much lower than anticipated, thereby highlighting other potential causes of ESUS. To date, there is no clear consensus supporting PFO closure or anticoagulation in ESUS patients. In this review, we discuss the recent studies on potential causes of ESUS and related work-up as well as report the recent trials on the treatment of ESUS.Recent FindingsSome of the potential causes of ESUS are undetected AF, pat...
Source: Current Treatment Options in Neurology - August 6, 2022 Category: Neurology Source Type: research

Quality Improvement in Neurocritical Care: a Review of the Current Landscape and Best Practices
AbstractPurpose of ReviewThe field of neurocritical care (NCC) has grown such that there is now a substantial body of literature on quality improvement specific to NCC. This review will discuss the development of this literature over time and highlight current best practices with practical tips for providers.Recent FindingsThere is tremendous variability in patient care models for NCC patients, despite evidence showing that certain structural elements are associated with better outcomes. There now also exist evidence-based recommendations for neurocritical care unit (NCCU) structure and processes, as well as NCC-specific p...
Source: Current Treatment Options in Neurology - August 6, 2022 Category: Neurology Source Type: research

Pompe Disease: a Clinical, Diagnostic, and Therapeutic Overview
AbstractPurpose of ReviewThis review summarizes the clinical presentation and provides an update on the current strategies for diagnosis of Pompe disease. We will review the available treatment options. We examine newly approved treatments as well as upcoming therapies in this condition. We also provide commentary on the unmet needs in clinical management and research for this disease.Recent FindingsIn March 2015, Pompe disease was added to the Recommended Uniform Screening Panel (RUSP) and since then a number of states have added Pompe disease to their slate of diseases for their Newborn Screening (NBS) program. Data emer...
Source: Current Treatment Options in Neurology - August 4, 2022 Category: Neurology Source Type: research

Tenecteplase or Alteplase: What Is the Thrombolytic Agent of the Future?
AbstractPurpose of reviewAlteplase has been the thrombolytic of choice for acute ischaemic stroke for more than two decades. A thrombolytic which is easier to administer and with improved or comparable safety and efficacy is desirable. Tenecteplase has emerged as a potential successor, and its off-license use in acute ischaemic stroke has increased in recent years. We aimed to examine the evidence base for each drug and discuss their use in varying patient populations in acute ischaemic stroke.Recent findingsSeveral trials comparing tenecteplase and alteplase have reported very recently with the results of the ACT trial st...
Source: Current Treatment Options in Neurology - July 30, 2022 Category: Neurology Source Type: research

Optimizing Sleep and Circadian Health in the NeuroICU
This article introduces fundamental concepts in circadian biology and the neuroscience of sleep, reviews recent studies characterizing circadian rhythm and sleep disruption among critically ill patients and potentially links to functional outcomes, and draws upon existing literature to propose therapeutic strategies to mitigate those harms. Particular attention is given to patients with critical neurologic conditions and the unique environment of the neuro-intensive care unit.Recent FindingsCircadian rhythm disruption is widespread among critically ill patients and sleep time is reduced and abnormally fragmented. There is ...
Source: Current Treatment Options in Neurology - July 15, 2022 Category: Neurology Source Type: research

Diagnosis, Treatment, and Prevention of Stroke in Transgender Adults
AbstractPurpose of ReviewTo identify the current state of science on stroke in transgender adults and highlight gaps in need of further research. We will review current research on cerebrovascular risk and disease, hormone therapy, and stroke in transgender individuals. Finally, we will provide a framework for healthcare providers to prevent and reduce disparities through inclusive care practices.Recent FindingsTransgender people experience unique stroke risk factors, secondary to both psychosocial stress and health-related behaviors. These include higher rates of HIV, tobacco use, stimulant use, and hepatitis C. The use o...
Source: Current Treatment Options in Neurology - July 11, 2022 Category: Neurology Source Type: research

Central Positional Nystagmus
AbstractPurpose of reviewCentral positional nystagmus (CPN) is attributed to disease affecting the central vestibulo-cerebellar pathways. It can be associated with prominent vertigo, oscillopsia, and dysautonomia. Its treatment highly depends on the etiology, and response is fairly heterogenous. This review presents a critical appraisal of CPN therapies.Recent findingsAnecdotal reports have stated efficacy of 3,4-diaminopyridine, 4-aminopyridine, and clonazepam in downbeating CPN secondary to structural lesions. In tumors, CPN may improve after tumoral resection and radiotherapy. In multiple sclerosis, intravenous steroids...
Source: Current Treatment Options in Neurology - July 11, 2022 Category: Neurology Source Type: research

Updated Review of Leber Hereditary Optic Neuropathy
AbstractPurpose of ReviewWe aim to present a comprehensive review of Leber hereditary optic neuropathy (LHON), detailing currently established practices for diagnosis and management, as well as emerging research on novel therapies.Recent FindingsA randomized, placebo-controlled, double-masked trial demonstrated, in a post hoc analysis, that the anti-oxidant supplement idebenone may offer visual benefit in a subset of LHON patients early in the disease course. Several recent clinical trials have evaluated the safety and efficacy of gene therapy targeting the most common LHON mutation, m.11778/ND4. These trials unexpectedly ...
Source: Current Treatment Options in Neurology - July 1, 2022 Category: Neurology Source Type: research

Approach to the Management of Sodium Disorders in the Neuro Critical Care Unit
AbstractPurpose of ReviewTo present an overview of the current diagnostic and therapeutic approaches for patients with hyponatremia and hypernatremia in the neurocritical care unit (NCCU).Recent FindingsDysnatremias are associated with poor neurological outcomes and mortality in neurocritically ill patients. Volume status determination, although challenging, is critical in differentiating between the two most common etiologies of hyponatremia in the NCCU: SIADH and salt wasting. Central diabetes insipidus (CDI) is common in post trans-sphenoidal surgery patients and in severe brain injuries where it portends a poor prognos...
Source: Current Treatment Options in Neurology - June 22, 2022 Category: Neurology Source Type: research

Update on Paraneoplastic Neuromuscular Disorders
AbstractPurpose of ReviewTo review the clinical presentation and diagnosis of different paraneoplastic neuromuscular disorders and the available data on their treatment.Recent FindingsParaneoplastic neuromuscular disorders are rare, and their treatment needs a multidisciplinary approach. Given their rarity, there are no clinical trials specifically looking at these disorders and thus treatment is guided by management of autoimmune neuromuscular syndromes.SummaryParaneoplastic neuromuscular disorders can affect the entire axis of the peripheral nervous system including disorders of muscle, neuromuscular junction, peripheral...
Source: Current Treatment Options in Neurology - June 17, 2022 Category: Neurology Source Type: research

Pharmacologic and Acute Management of Spinal Cord Injury in Adults and Children
We present an approach to the SCI patient starting at presentation to acute rehabilitation and prognostication, with additional emphasis on the pediatric population when evidence is available.Recent FindingsFurther studies since the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS) demonstrated a potential functional outcome benefit with ultra-early surgical intervention  ≤ 8 h post-SCI. Subsequent analysis of the National Acute Spinal Cord Injury Study (NASCIS) II and NASCIS III trials have demonstrated potentially serious complications from intravenous methylprednisolone with limited benefit. Newer thera...
Source: Current Treatment Options in Neurology - June 10, 2022 Category: Neurology Source Type: research

Evaluation and Management of Delirium in Dementia
AbstractPurposeOur review aims to provide evidence-based information about diagnosis, evaluation, and management of delirium in the dementia population. In this review, we will define delirium and assess its impact on those individuals with dementia. We will summarize measures used to evaluate the underlying causes of delirium. Finally, we will discuss treatment and management options, including non-pharmacologic and pharmacologic therapies.Recent FindingsNew research into delirium has been sparse; however, there have been a couple of trials involving supplements such as melatonin. Other approaches, such as music therapy, ...
Source: Current Treatment Options in Neurology - May 18, 2022 Category: Neurology Source Type: research

Toxic Myopathies
AbstractPurpose of reviewThe goal of this paper is to review the clinical, electrophysiologic, and histopathologic features of toxic myopathy related to prescribed medications, highlighting new understanding. This paper is organized by treatment class to allow providers to easily prioritize learning about the potential myotoxic side effects of the medications they prescribe most frequently. Pathogenesis of toxicity is also discussed.Recent findingsMild muscle-related symptoms are common among statin users, but rarely statins can cause weakness due to either a toxic necrotizing myopathy or an immune-mediated necrotizing myo...
Source: Current Treatment Options in Neurology - May 4, 2022 Category: Neurology Source Type: research

Stroke Treatment in the Era of COVID-19: a Review
AbstractPurpose of ReviewTo describe a comprehensive review of the epidemiology, pathophysiology, and treatment of stroke in the era of COVID-19.Recent FindingsCOVID-19 is associated with myriad neurological disorders, including cerebrovascular disease. While ischemic stroke is the most common, COVID-19 is associated with an increased risk of intracranial hemorrhage, arterial dissection, posterior reversible encephalopathy syndrome, and cerebral venous sinus thrombosis. In this review, we discuss the epidemiology, pathophysiology, and treatment of stroke due to COVID-19. In addition, we describe how COVID-19 has changed th...
Source: Current Treatment Options in Neurology - April 25, 2022 Category: Neurology Source Type: research

Managing the Behavioral and Psychological Symptoms of Dementia
AbstractPurpose of ReviewAlzheimer ’s disease and related dementias are the source of significant distress, impairment, and caregiver burden in aging populations. A prominent reason for this impact is the Behavioral and Psychological Symptoms of Dementia (BPSD). Common BPSD include disruptive behaviors, such as agitation, aggressio n, severe anxiety, delusions, depression, apathy, and sleep disturbances. Specific dementias, such as behavioral variant frontotemporal dementia and dementia with Lewy bodies, are associated with socioemotional disturbances and visual hallucinations, respectively. The aim of this review is to ...
Source: Current Treatment Options in Neurology - April 25, 2022 Category: Neurology Source Type: research