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Accessing Investigational Products Outside of a Trial: Considerations for Neuromuscular Providers
AbstractPurpose of ReviewPeople with fatal neuromuscular diseases such as ALS want to access investigational products. Trials are our preferred pathway for this, but most people with these diseases will not be able to participate due to restrictive inclusion criteria, travel burdens, or design features they will not accept. This leaves FDA Expanded Access Programs (EAPs), the Right To Try (RTT) pathway, and self-purchase of alternative and off-label treatments (AOTs).Recent FindingsA recent survey highlighted physician barriers to the above pathways, including lack of knowledge and concerns about time burdens and risks. Em...
Source: Current Treatment Options in Neurology - November 13, 2021 Category: Neurology Source Type: research

Dual Antiplatelet Therapy in Ischemic Stroke Prevention: Which Two Could Be Better than One?
AbstractPurpose of reviewRecurrent stroke after ischemic stroke (IS) or high-risk transient ischemic attack (TIA) increases morbidity and mortality. Secondary stroke prevention strategies include modification of behavioral and vascular risk factors and antithrombotic use, including single or dual antiplatelet therapy (DAPT). In this review, we focus on DAPT indications, combinations, and treatment duration.Recent findingsStudies showed that for patients with mild to moderate non-cardioembolic strokes or those with symptomatic intracranial or mild extracranial stenosis ( ≤ 30% diameter reduction), short-term DAPT (21–...
Source: Current Treatment Options in Neurology - November 5, 2021 Category: Neurology Source Type: research

Reducing Sudden Unexpected Death in Epilepsy: Considering Risk Factors, Pathophysiology and Strategies
We describe and discuss risk factors and possible pathophysiological mechanisms to elucidate possible preventative strategies to avert SUDEP.Recent FindingsSudden death accounts for a significant proportion of premature mortality in people with epilepsy compared to the general population. Unmodifiable risk factors include a history of neurologic insult, younger age of seizure-onset, longer epilepsy duration, a history of convulsions, symptomatic epilepsy, intellectual disability, and non-ambulatory status. Modifiable risk factors include the presence of convulsive seizures, increased seizure frequency, timely and appropria...
Source: Current Treatment Options in Neurology - November 3, 2021 Category: Neurology Source Type: research

Gut Microbiome as Potential Therapeutics in Multiple Sclerosis
AbstractPurpose of ReviewThe gut microbiome is an emerging arena to investigate multiple sclerosis (MS) pathogenesis and potential therapeutics. In this review, we summarize the available data and postulate the feasibilities of potential MS therapeutic approaches that modulate the gut microbiome.Recent FindingsGrowing evidence indicates dysbiosis in the gut bacterial ecosystem in MS. Diet and other interventions produce biologically significant changes in the gut bacterial communities and functions, can potentially regulate the immune system, and benefit people with MS. While well-conducted investigations of the therapeuti...
Source: Current Treatment Options in Neurology - October 29, 2021 Category: Neurology Source Type: research

Seizure Management in the Intensive Care Unit
AbstractPurpose of this reviewThis review presents current therapy for seizures in the intensive care unit. The reader is provided with recent evidence regarding the use of EEG in determining treatment for acute seizures. Proposed treatment approaches for seizures and status epilepticus are provided. Controversies and complexity of selecting treatments are discussed.Recent findingsCritical Care EEG Monitoring Research Consortium analyzed the association of periodic and rhythmic electroencephalographic patterns with seizures and found that lateralized and generalized periodic discharges and lateralized rhythmic delta were a...
Source: Current Treatment Options in Neurology - October 21, 2021 Category: Neurology Source Type: research

Treatment of Vascular Myelopathies
This article reviews the treatment of vascular myelopathies of various causes, with an emphasis on the treatment and prevention of the most common non-traumatic etiologies: ischemia secondary to open and endovascular interventions for treatment of thoracoabdominal aortic aneurysms and spontaneous (non-periprocedural) spinal cord ischemia and infarction.Recent findingsAcute vascular myelopathies can present as sudden or rapid onset of paraplegia or quadriplegia. In such cases, spine MRI allows rapid and reliable exclusion of compressive or hemorrhagic lesions and may identify acute spinal cord ischemia; thus, it should be t...
Source: Current Treatment Options in Neurology - October 14, 2021 Category: Neurology Source Type: research

Management/Treatment of Lambert-Eaton Myasthenic Syndrome
This article reviews the current treatment strategies for patients with Lambert-Eaton myasthenic syndrome (LEMS) including potassium channel blockers, immunosuppressant therapies, and management of dysautonomia.Recent findingsSince the first report in 1983, 3,4-diaminopyridine (amifampridine) has been used as a symptomatic treatment for LEMS. The biggest recent development in LEMS treatment is the approval of two amifampridine drugs in 2018 by the Food and Drug Administration (FDA). Amifampridine phosphate (Firdapse ®) is a salt form that was approved for adult patients with LEMS. Amifampridine (Ruzurgi®) was approved fo...
Source: Current Treatment Options in Neurology - September 30, 2021 Category: Neurology Source Type: research

Current Treatment Options for Patients with Myotonic Dystrophy Type 2
AbstractPurpose of the reviewMyotonic dystrophy types 1 and 2 are frequent forms of muscular dystrophies in adulthood. Their clinical differences need to be taken into account for the most appropriate treatment of patients. The aim of this article is to provide an overview on the current and upcoming therapeutic options for patients with myotonic dystrophy type 2 (DM2).Recent findingsAt the moment, no disease-modifying therapies are available for DM2; next-generation therapies may however be available in the near future. In the meanwhile, the symptomatic management of patients has greatly improved, thank to the production ...
Source: Current Treatment Options in Neurology - September 27, 2021 Category: Neurology Source Type: research

Race/Ethnicity Considerations in the Prevention and Treatment of Stroke
AbstractPurpose of reviewTo describe racial and ethnic considerations that exist for the prevention and treatment of ischemic and hemorrhagic stroke.Recent findingsMultiple studies have characterized stroke disparities. The Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS) found that Black individuals have nearly twice the rates of stroke compared to White individuals. Differences in the incidence of stroke risk factors, both inherited and acquired, contribute to these disparities. Black individuals have an earlier age of onset, a longer duration, and greater severity of hypertension compared to White individuals....
Source: Current Treatment Options in Neurology - September 27, 2021 Category: Neurology Source Type: research

Advanced Imaging in the Era of Tissue-Based Treatment for Acute Ischemic Stroke —a Practical Review
AbstractPurpose of the reviewAdvanced imaging is now used to identify acute ischemic stroke (AIS) patients for treatment with tissue plasminogen activator or mechanical thrombectomy, who are either out of the traditional treatment window or have an unknown last known well time. Current guidelines recommend adapting the complex inclusion criteria used in the clinical trials to provide optimal individual patient decisions in clinical practice. This review aims to facilitate such integration by organizing the available data in a practical clinical context.Recent findingsWe review two clinical vignettes of advanced imaging for...
Source: Current Treatment Options in Neurology - September 20, 2021 Category: Neurology Source Type: research

Clinical Trial Outcome Measurements in Lennox-Gastaut Syndrome and Their Application to the Development of Targeted Treatments
AbstractPurpose of ReviewLennox-Gastaut syndrome (LGS) is an epileptic encephalopathy that is challenging to treat, with  >80% of patients remaining refractory to therapy. Patient-oriented clinical outcome measures are essential for  treatment guidance and the development of new therapies. Here, we provide a comprehensive review of outcome measures used in clinical trials targeting patients with LGS, in order to inform future studies, develop, and implement targeted patient and caregiver-relevant outcome measures.Recent FindingsPublished clinical trials that include, or specifically target, individuals with LGS are ...
Source: Current Treatment Options in Neurology - September 9, 2021 Category: Neurology Source Type: research

Correction to: Ultrasound-Guided Therapies in the Neuro ICU
(Source: Current Treatment Options in Neurology)
Source: Current Treatment Options in Neurology - August 26, 2021 Category: Neurology Source Type: research

Surgical Management of Spontaneous Intracerebral Hemorrhage
AbstractPurpose of reviewThis review presents the current evidence and recommendations regarding surgical management of spontaneous intracerebral hemorrhage (ICH). In particular, we discuss the emerging minimally invasive surgical techniques and provide a surgical decision-making algorithm based on current evidence for the practicing clinician.Recent findingsHematoma evacuation is an attractive strategy to relieve mass effect, reduce intracranial pressure, and prevent secondary ongoing tissue injury and thereby reduce mortality and improve outcome. Enthusiasm for open surgical techniques such as craniotomy with clot evacua...
Source: Current Treatment Options in Neurology - August 2, 2021 Category: Neurology Source Type: research

Update on Nodopathies of the Peripheral Nerve
AbstractPurpose of reviewThe purpose of this paper is to provide an up-to-date review of the current knowledge on immune-mediated neuropathies secondary to antibodies against nodal and paranodal proteins.Recent findingsAntibodies against neurofascins and contactin have recently been linked to characteristic neuropathy presentations including a more acute/subacute presentation, involvement of cranial nerves, presence of tremor, and refractory to typical first-line treatments for immune-mediated neuropathies.SummaryNodopathies are a group of disorders associated with humoral autoimmunity to antigens of the node, paranode, an...
Source: Current Treatment Options in Neurology - June 24, 2021 Category: Neurology Source Type: research

The Importance and Opportunity for Healthy Aging Through Lifestyle, Behavior Medicine Among Older Adults With Multiple Sclerosis: the Case Based on Physical Activity
AbstractPurpose of reviewThere is a “graying” of the population of persons living with multiple sclerosis (MS), and the effects of normal aging occur on top of those associated with MS itself (i.e., aging with a long-term disabling disease). We develop the perspective that “Lifestyle Behavior Medicine for Healthy Aging with MS” may be an effective strategy for promoting healthy longevity in this immune-mediated, neurodegenerative disease of the central nervous system.Recent findingsThe perspective is based on recent evidence regarding (a) outcomes of aging with MS for declines in physical and cognitive functions; (...
Source: Current Treatment Options in Neurology - June 24, 2021 Category: Neurology Source Type: research