Prescription Medication Misuse
Semin Neurol 2018; 38: 654-664 DOI: 10.1055/s-0038-1673691In the United States, there is a prescription medication misuse crisis including increases in unintentional drug overdose deaths, medications obtained on the illicit market (i.e., diversion), and in the number of individuals seeking treatment for addiction to prescription medications. Neurologists manage patients suffering from conditions (e.g., pain, seizures, spasticity) where the prescriptions of medications with misuse potential are indicated. It is therefore imperative that neurologists understand which medications are liable to misuse and institute strategies ...
Source: Seminars in Neurology - December 6, 2018 Category: Neurology Authors: Hill, Jeoffrey Alford, Daniel P. Tags: Review Article Source Type: research

Neuropathic Pain
Semin Neurol 2018; 38: 644-653 DOI: 10.1055/s-0038-1673679Neuropathic pain management is challenging, and typically requires a multifaceted approach. There are several treatment options, both pharmacologic and nonpharmacologic. Of the available pharmacologic agents, those with the strongest supporting evidence include tricyclic antidepressants, serotonin–norepinephrine reuptake inhibitors, and certain antiseizure agents. There is emerging evidence for the use of cannabinoids, but conclusive studies are not available. Nonpharmacologic therapies that have been utilized in the management of neuropathic pain include acup...
Source: Seminars in Neurology - December 6, 2018 Category: Neurology Authors: Macone, Amanda Otis, James A. D. Tags: Review Article Source Type: research

Myofascial Pain
Semin Neurol 2018; 38: 640-643 DOI: 10.1055/s-0038-1673674Myofascial pain syndromes arise from acute and chronic musculoskeletal pain and often have a referred neuropathic component. It affects more than three quarters of the world's population and is one of the most important and overlooked causes of disability. The origins of pain are thought to reside anywhere between the motor end plate and the fibrous outer covering of the muscle, with involvement of microvasculature and neurotransmitters at the cellular level. Diagnosis is made by clinical examination for the presence of myofascial trigger points, though some ancilla...
Source: Seminars in Neurology - December 6, 2018 Category: Neurology Authors: Weller, Jason L. Comeau, Douglas Otis, James A.D. Tags: Review Article Source Type: research

Radicular Pain Syndromes: Cervical, Lumbar, and Spinal Stenosis
Semin Neurol 2018; 38: 634-639 DOI: 10.1055/s-0038-1673680Back pain is a top primary and urgent care complaint; radicular pain can be caused by herniation of the nucleus pulposus (intervertebral disc), spinal stenosis, or degenerative changes to the vertebrae. The focus of this clinical review will be the clinical approach and treatment of lumbar radicular pain, cervical radicular pain, and spinal stenosis. Usually localized through neurological history, exam, and imaging, specific signs and symptoms for lumbar radicular, spinal stenosis, and cervical radicular pain can help determine etiology. Once radicular back pain has...
Source: Seminars in Neurology - December 6, 2018 Category: Neurology Authors: Patel, Ekta A. Perloff, Michael D. Tags: Review Article Source Type: research

Headache in Pregnancy, the Puerperium, and menopause
Semin Neurol 2018; 38: 627-633 DOI: 10.1055/s-0038-1673681Headache is a neurologic disorder that displays gender dichotomy. It is well established that there is a strong link between migraine headache and sex hormones, specifically estrogen, which influences the severity of migraines during the menstrual cycle, pregnancy, and menopause. Furthermore, the epidemiology of headaches during pregnancy and the postpartum period is very distinct from that in males or nonpregnant females, in part due to the hemodynamic and hematologic changes that occur during pregnancy. These changes put women at higher risk for cerebral venous th...
Source: Seminars in Neurology - December 6, 2018 Category: Neurology Authors: Sader, Elie Rayhill, Melissa Tags: Review Article Source Type: research

Posttraumatic Headache
Semin Neurol 2018; 38: 619-626 DOI: 10.1055/s-0038-1673692Posttraumatic headaches are among the most challenging complaints after mild traumatic brain injury (mTBI). They are a debilitating problem experienced by patients after TBI of all severities. Up to 90% of mild TBI patients experience headache, particularly if female and with a premorbid history of primary headache. Tension headache has classically been the most common subtype, but in military populations migraine has dominated. Posttraumatic headache encompasses a spectrum of headache types that overlap heavily with common primary headache disorders, but also auton...
Source: Seminars in Neurology - December 6, 2018 Category: Neurology Authors: Dwyer, Brigid Tags: Review Article Source Type: research

Migraine and Tension-Type Headache
Semin Neurol 2018; 38: 608-618 DOI: 10.1055/s-0038-1673683Migraine and tension-type headache (TTH) are common primary disorders that carry significant morbidity and socioeconomic effect. In this article, we will review the epidemiology, presentation, and diagnosis of these disorders. First-line acute treatment for migraine consists of analgesics, triptans, and antiemetics, while nonsteroidal anti-inflammatory drugs are the mainstay treatment for TTH. Patients with frequent or chronic headaches warrant prophylactic therapy. For migraine, various classes of preventives can be used (β-blockers, tricyclics, antiepileptics...
Source: Seminars in Neurology - December 6, 2018 Category: Neurology Authors: Kahriman, Azmin Zhu, Shuhan Tags: Review Article Source Type: research

Cluster Headache and Other Trigeminal Autonomic Cephalalgias
Semin Neurol 2018; 38: 603-607 DOI: 10.1055/s-0038-1673682The trigeminal autonomic cephalalgias are a group of distinct primary headache disorders that share common characteristics of strict unilateral headache often accompanied by unilateral cranial autonomic features. Cluster headache is the most well-known example, but other than neurologists, practitioners often have limited familiarity with these disorders and treatment options. Delays in diagnosis are typical and treatment options remain suboptimal, associated with limited scientific research into these brain disorders. Improved familiarity with core clinical feature...
Source: Seminars in Neurology - December 6, 2018 Category: Neurology Authors: McGeeney, Brian E. Tags: Review Article Source Type: research

Headache and Pain
Semin Neurol 2018; 38: 601-602 DOI: 10.1055/s-0038-1676295 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Neurology)
Source: Seminars in Neurology - December 6, 2018 Category: Neurology Authors: Zhu, Shuhan Otis, James Tags: Preface Source Type: research

Shuhan Zhu, MD and James Otis, MD, FAAN
Semin Neurol 2018; 38: 599-600 DOI: 10.1055/s-0038-1676294 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Neurology)
Source: Seminars in Neurology - December 6, 2018 Category: Neurology Authors: Greer, David M. Tags: Introduction to the Guest Editors Source Type: research

Ethical Issues Pertaining to Conflicts of Interest Between Neurologists and the Pharmaceutical and Medical Device Industries
Semin Neurol 2018; 38: 589-598 DOI: 10.1055/s-0038-1668081A conflict of interest (COI) exists when a physician's professional responsibilities are compromised by personal or financial relationships. COIs between physicians and the pharmaceutical or medical device industry (Industry) are common. Collaborations with Industry have many potential benefits, but also raise potential ethical pitfalls. Industry-related COIs have widespread influence on medical education, research, and clinical practice, and therefore have profound implications for the integrity of the field of medicine. Full disclosure is an important step toward ...
Source: Seminars in Neurology - October 15, 2018 Category: Neurology Authors: Robbins, Nathaniel M. Tags: Review Article Source Type: research

Ensuring Justice in Access to Investigational Neurological Drugs
Semin Neurol 2018; 38: 583-588 DOI: 10.1055/s-0038-1668076Patients who suffer from life-threatening illnesses or are stricken with conditions that could result in serious morbidity who have exhausted all appropriate treatments may choose to try, through the Food and Drug Administration's expanded access program, an investigational drug or device in development. The program has succeeded for decades in allowing patients to access potentially helpful but still experimental agents. Nevertheless, the administration of investigational drugs outside of clinical trials raises several ethical issues. Of particular concern are the ...
Source: Seminars in Neurology - October 15, 2018 Category: Neurology Authors: Kearns, Lisa Bateman-House, Alison Caplan, Arthur Tags: Review Article Source Type: research

Contentious Ethical and Legal Aspects of Determination of Brain Death
Semin Neurol 2018; 38: 576-582 DOI: 10.1055/s-0038-1668075Although the concept of death by neurologic criteria is accepted throughout much of the world and death can legally be determined by neurologic criteria throughout the United States, the process is fraught with contentious ethical and legal controversies. I explore historic and contemporary ethical and legal disputes about determination of death by neurologic criteria including the need for consent from patients' surrogates prior to determination of death, the role of religion in determination of death, management of objections to determination of death by neurologi...
Source: Seminars in Neurology - October 15, 2018 Category: Neurology Authors: Lewis, Ariane Tags: Review Article Source Type: research

Neuropalliative Care: A Practical Guide for the Neurologist
Semin Neurol 2018; 38: 569-575 DOI: 10.1055/s-0038-1668074Neuropalliative care is a new and growing field within neurology that focuses on improving the quality of life of patients with serious neurologic illnesses. While specialty-level palliative care training is available to interested neurologists, all neurologists can strive to provide primary palliative care for their patients. In this review, we will describe the scope of neuropalliative care, define patient populations who may benefit from palliative care, and explore the communication and symptom management skills essential to palliative care delivery. [...] Thiem...
Source: Seminars in Neurology - October 15, 2018 Category: Neurology Authors: Brizzi, K. Creutzfeldt, C. J. Tags: Review Article Source Type: research

Futility and Patients Who Insist on Medically Ineffective Therapy
Semin Neurol 2018; 38: 561-568 DOI: 10.1055/s-0038-1667386As medical decisions fall under more scrutiny and society demands increasing transparency of care, it is likely that more opportunities for conflicts will emerge. Similarly, with increasing demand and a static supply, the issue of who receives treatment and for how long naturally will arise. This mismatch leads to discussions of resource utilization and limitation of care in light of patients' values and rights. Clinicians should always be forthcoming with the uncertainty of prognostication while also articulating the severity of a patient's disease in relation to t...
Source: Seminars in Neurology - October 15, 2018 Category: Neurology Authors: Cifrese, Laura Rincon, Fred Tags: Review Article Source Type: research

Using Neuroimaging to Detect Covert Awareness and Determine Prognosis of Comatose Patients: Informing Surrogate Decision Makers of Individual Patient Results
Semin Neurol 2018; 38: 555-560 DOI: 10.1055/s-0038-1667385Robust prognostic indicators of neurological recovery are urgently needed for acutely comatose patients. Functional neuroimaging is a highly sensitive tool for uncovering covert cognition and awareness in behaviorally nonresponsive patients with prolonged disorders of consciousness, and may be applicable to acutely comatose patients. Establishing a link between early detection of covert awareness in acutely comatose patients and eventual recovery of function could have significant implications for patient prognosis, treatment, and end-of-life decisions. Because func...
Source: Seminars in Neurology - October 15, 2018 Category: Neurology Authors: Graham, Mackenzie Doherty, Colin P. Naci, Lorina Tags: Review Article Source Type: research

Disorders of Consciousness: Ethical Issues of Diagnosis, Treatment, and Prognostication
Semin Neurol 2018; 38: 548-554 DOI: 10.1055/s-0038-1667384Consciousness defines our humanity more than any other biologic phenomena that a clinician might be called upon to examine, diagnose, or treat. When family comes to the bedside of a patient, they hope to find them talking, thinking, and feeling. The complexity of consciousness allows an expansive gradation of dysfunction such that we must consider numerous potential insults, possible interventions, and often an unknown likelihood of recovery. As value-laden questions are more often in the hands of surrogate decision makers, the neurologist is given the herculean tas...
Source: Seminars in Neurology - October 15, 2018 Category: Neurology Authors: Septien, Spencer Rubin, Michael A. Tags: Review Article Source Type: research

Informed Consent for the Human Research Subject with a Neurologic Disorder
This article provides a framework for investigators likely to encounter subjects with some degree of neurological impairment, whose capacity to consent requires scrupulous assessment prior to enrollment in research trials. We consider several researches and disease contexts—from emergency epilepsy research to long-term dementia research—and clarify the ethical and legal principles governing consent for participation in each. We additionally explore empirical research on consent capacity and survey several areas of emerging ethical import that will require the attention of investigators in decades to come. [...]...
Source: Seminars in Neurology - October 15, 2018 Category: Neurology Authors: Vaishnav, Neil H. Chiong, Winston Tags: Review Article Source Type: research

Involving Minors in Medical Decision Making: Understanding Ethical Issues in Assent and Refusal of Care by Minors
Semin Neurol 2018; 38: 533-538 DOI: 10.1055/s-0038-1668078When caring for minors, the clinician–patient relationship becomes more ethically complex by the inclusion of parents in the clinician–parent–patient triad. As they age, children become more capable of participating in the decision-making process. This involvement may lead them to either accept or refuse proposed care, both of which are ethically acceptable positions when the minor's capacity to participate in decision making is carefully considered in the context of their age, development, and overall health. Certain conditions may be more likely ...
Source: Seminars in Neurology - October 15, 2018 Category: Neurology Authors: Lang, Abigail Paquette, Erin Talati Tags: Review Article Source Type: research

Physician-Hastened-Death in Patients with Progressive Neurodegenerative or Neuromuscular Disorders
Semin Neurol 2018; 38: 522-532 DOI: 10.1055/s-0038-1668080Physician-hastened-death remains a controversial topic for patients and those who care for them. It is a particularly relevant topic for neurologists who currently, or will in the future, reside in jurisdictions where physician-hastened-death is legal. In this article, I attempt to provide a comprehensive and contemporary discussion of hastened-death issues in a measured and respectful fashion. My goal is to provide clinicians with the information necessary to mold their own judgment and conscience in preparation for a time in which one or more of their patients req...
Source: Seminars in Neurology - October 15, 2018 Category: Neurology Authors: Russell, James A. Tags: Review Article Source Type: research

Ethical Issues in Vascular Neurology
This article addresses ethical concerns pertinent to each phase. First, we discuss ethical issues regarding consent for thrombolysis and endovascular treatment for acute ischemic stroke, including a review of considerations regarding the provision of acute stroke treatment advice over the telephone. Next, we discuss capacity for consent and prognostication after ischemic stroke and intracranial hemorrhage, with a focus on the problems of the self-fulfilling prophecy. Finally, we discuss residual disability and patients' return to driving. Consideration of these ethical dimensions of cerebrovascular disease will assist neur...
Source: Seminars in Neurology - October 15, 2018 Category: Neurology Authors: Wheeler, Natalie C. Murali, Sadhana Sattin, Justin A. Tags: Review Article Source Type: research

Ethical Considerations in Neurogenetic Testing
Semin Neurol 2018; 38: 505-514 DOI: 10.1055/s-0038-1667382Recent advances in the genetics of neurologic diseases coupled with improvements in sensitivity and specificity are making genetic testing an increasingly important part of diagnosis and management for neurologists. However, the complex nature of genetic testing, the nuances of multiple result types, and the short- and long-term consequences of genetic diagnoses raise important ethical issues for the clinician. Neurologists must balance the ethical principles of beneficence and nonmaleficence, on the one hand, with patient autonomy on the other hand, when ordering s...
Source: Seminars in Neurology - October 15, 2018 Category: Neurology Authors: Su, Xiaowei W. Simmons, Zachary Tags: Review Article Source Type: research

Medical Ethics Education for Neurology Residents: Where Do We Go from Here?
Semin Neurol 2018; 38: 497-504 DOI: 10.1055/s-0038-1667381Neurologists regularly confront complex clinical scenarios that require the application of ethical principles to achieve a respectful and fair resolution. In this article, we describe the types of ethically precarious scenarios neurologists encounter, the current status of standards for ethics and communication training for neurology residents, and the present practice of ethics training in neurology residency programs. We make recommendations for optimizing bioethics training for neurology residents and suggest methods for assessing the efficacy of these training i...
Source: Seminars in Neurology - October 15, 2018 Category: Neurology Authors: Traner, Christopher B. Tolchin, Dorothy W. Tolchin, Benjamin Tags: Review Article Source Type: research

Ethics in Neurology
Semin Neurol 2018; 38: 495-496 DOI: 10.1055/s-0038-1673410 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Neurology)
Source: Seminars in Neurology - October 15, 2018 Category: Neurology Authors: Lewis, Ariane Bernat, James L. Tags: Preface Source Type: research

Ariane Lewis, MD and James L. Bernat, MD
Semin Neurol 2018; 38: 493-494 DOI: 10.1055/s-0038-1673409 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Neurology)
Source: Seminars in Neurology - October 15, 2018 Category: Neurology Authors: Greer, David M. Tags: Introduction to the Guest Editors Source Type: research

The Struggling Trainee: Principles of Effective Remediation
Semin Neurol 2018; 38: 486-492 DOI: 10.1055/s-0038-1667137Struggling trainees exist in all residency programs across all fields. Remediation, the act of improving deficiencies in struggling trainees, is necessary to promote the graduation of competent physicians. Deficiencies may be primarily cognitive or behavioral, and occasionally physical limitations do arise during residency. Remediation is challenging for all parties involved, and there is a paucity of literature to help guide the most effective process. In this review, we outline key principles of effective remediation of a struggling trainee in the modern era of me...
Source: Seminars in Neurology - August 20, 2018 Category: Neurology Authors: Kurzweil, Arielle M. Galetta, Steven L. Tags: Review Article Source Type: research

Continuing Medical Education in Neurology
Semin Neurol 2018; 38: 479-485 DOI: 10.1055/s-0038-1666978Continuing medical education (CME) is designed to keep physicians up-to-date on ever-changing practices and guidelines to provide patients with high quality care. CME is especially important in the field of neurology due to rapidly evolving knowledge and medical advances, and is a required element of maintenance of certification. CME itself has evolved from a passive, didactic approach to a learner-centered approach which utilizes new technologies, online learning, and simulations. CME improves knowledge, skills, and, to a lesser extent, patient outcomes, with multi...
Source: Seminars in Neurology - August 20, 2018 Category: Neurology Authors: Khazanova, Darya Safdieh, Joseph E. Tags: Review Article Source Type: research

Assessment in Neurologic Education
This article provides an overview of modern principles of medical education as they can be applied to neurologic education, complemented by practical recommendations for neurologic educators to develop or improve assessment systems within their own training programs. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Seminars in Neurology)
Source: Seminars in Neurology - August 20, 2018 Category: Neurology Authors: Jones, Lyell K. Tags: Review Article Source Type: research

A Future for Simulation in Acute Neurology
Semin Neurol 2018; 38: 465-470 DOI: 10.1055/s-0038-1666986Acute neurologic (and potentially disability prone) conditions are rarely taught and, if so, at the bedside and usually after the fact. Simulation training offers a realistic environment to teach rapid-fire decision making, how to take charge, and how best to approach a deteriorating, acutely ill neurologic patient.Simulating acute neurology is a newly emerging educational program. Proven principles of simulation, which may include teaching technical skills, can be applied to acute neurology (and neurointensive care). Communication skills pertaining to catastrophic ...
Source: Seminars in Neurology - August 20, 2018 Category: Neurology Authors: Wijdicks, Eelco F. M. Hocker, Sara E. Tags: Review Article Source Type: research

New Media, Technology and Neurology Education
Semin Neurol 2018; 38: 457-464 DOI: 10.1055/s-0038-1666985The use of technology in neurology education has revolutionized many aspects of medical teaching, addressing some important challenges of modern education such as information overload and the unique needs of millennial learners. However, it also has inherent problems, such as depersonalization and high development costs. Due to the heterogeneity of different applications, it is difficult to establish general principles to guide front line educators, but it may be possible to describe “minimum” best practice elements. In this article, we examine commonali...
Source: Seminars in Neurology - August 20, 2018 Category: Neurology Authors: Lau, K.H. Vincent Lakhan, Shaheen E. Achike, Francis Tags: Review Article Source Type: research

Planning Education for Long-Term Retention: The Cognitive Science and Implementation of Retrieval Practice
Semin Neurol 2018; 38: 449-456 DOI: 10.1055/s-0038-1666983Educational systems are rarely designed for long-term retention of information. Strong evidence has emerged from cognitive psychology and applied education studies that repeated retrieval of information significantly improves retention compared to repeated studying. This effect likely emerges from the processes of memory consolidation and reconsolidation. Consolidation and reconsolidation are the means by which memories are organized into associational networks or schemas that are created and recreated as memories are formed and recalled. As educators implement retr...
Source: Seminars in Neurology - August 20, 2018 Category: Neurology Authors: Larsen, Douglas P. Tags: Review Article Source Type: research

Bedside Teaching in Neurology
Semin Neurol 2018; 38: 441-448 DOI: 10.1055/s-0038-1666984The patient's bedside offers an ideal venue for teaching the art of clinical neurology and modeling humanism and professionalism. However, bedside teaching is underutilized in modern medical education, despite evidence that learners desire more. Logistical challenges and lack of teacher confidence are commonly cited reasons, but both can be mitigated with a deliberate approach and sufficient experience. Well-executed bedside teaching can provide lasting lessons for learners while enhancing the patient experience, without affecting the efficiency or quality care deli...
Source: Seminars in Neurology - August 20, 2018 Category: Neurology Authors: Dewey, Jeffrey J. Cho, Tracey A. Tags: Review Article Source Type: research

Teaching the Neurological Examination in a Rapidly Evolving Clinical Climate
Semin Neurol 2018; 38: 428-440 DOI: 10.1055/s-0038-1667135The neurological examination remains the essence of neurology. It allows symptoms to be assessed, diagnoses to be made, and dynamic functions to be followed. Skill in the neurological examination has faced increasing challenges from the encroachment of diagnostic imaging, but has maintained its clinical utility. It has also encountered the battle for the precious time within a medical curriculum. This review considers how the neurological examination can best be taught into the future. It does so by considering factors related to the examination, the learner, the te...
Source: Seminars in Neurology - August 20, 2018 Category: Neurology Authors: Hillis, James M. Milligan, Tracey A. Tags: Review Article Source Type: research

The Future of the Lecture in Neurology Education
Semin Neurol 2018; 38: 418-427 DOI: 10.1055/s-0038-1667042The lecture has been a core pedagogical method since the early days of formal medical education. Although approaches to formal lectures have evolved over the years, there has been ongoing debate about the role that lectures should play in modern medical education. Arguably, traditional lectures do not align well with modern learning theory, and do not take full advantage of our current knowledge of how people learn. In many modern medical curricula, lectures have been replaced by self-study activities, including video-based lectures, computer-based learning modules,...
Source: Seminars in Neurology - August 20, 2018 Category: Neurology Authors: Schaefer, Sara M. Dominguez, Moises Moeller, Jeremy J. Tags: Review Article Source Type: research

Promoting Careers in Neurology: Mentorship of Medical Students
Semin Neurol 2018; 38: 413-417 DOI: 10.1055/s-0038-1666988Research in neurological disorders is expanding at a phenomenal pace, and the need for neurologists is increasing as the population ages. This results in a critical requirement for medical students entering the neurology pipeline. Mentoring, whether formal or informal, ensures that students are inspired and supported to enter the field of neurology. Students should also receive structured mentoring throughout their longitudinal curriculum. Informal mentoring programs enable expanded opportunities for collaborations in education, research, and outreach. Faculty, resi...
Source: Seminars in Neurology - August 20, 2018 Category: Neurology Authors: Zuzuarregui, Jos é-Rafael Wu, Connie Hohler, Anna DePold Tags: Review Article Source Type: research

Managing Neurophobia: How Can We Meet the Current and Future Needs of Our Students?
Semin Neurol 2018; 38: 407-412 DOI: 10.1055/s-0038-1666987Neurophobia was defined more than two decades ago as a “fear of neural sciences and clinical neurology” among medical students. Despite recognition of the ailment and research into underlying causes, medical students and neurological educators continue to struggle with neurophobia today. At our institution, we have been successful at mitigating neurophobia. Here, we define the underlying drivers of neurophobia, based on the relevant literature. We also describe our strategies for battling neurophobia in the preclinical and clinical years by (1) establish...
Source: Seminars in Neurology - August 20, 2018 Category: Neurology Authors: Tarolli, Christopher G. J ózefowicz, Ralph F. Tags: Review Article Source Type: research

Neurology Education
Semin Neurol 2018; 38: 405-406 DOI: 10.1055/s-0038-1668169 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Neurology)
Source: Seminars in Neurology - August 20, 2018 Category: Neurology Authors: Moeller, Jeremy J. Tags: Preface Source Type: research

Jeremy J. Moeller, MD, MSc, FRCPC
Semin Neurol 2018; 38: 403-404 DOI: 10.1055/s-0038-1668167 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Neurology)
Source: Seminars in Neurology - August 20, 2018 Category: Neurology Authors: Greer, David M. Tags: Introduction to the Guest Editor Source Type: research

Diagnostic and Therapeutic Approach to Autoimmune Neurologic Disorders
Semin Neurol 2018; 38: 392-402 DOI: 10.1055/s-0038-1660819The field of autoimmune neurology is evolving rapidly. The discovery of autoantibodies that target neural antigens has expanded swiftly in the last decade. Recognition of the clinical syndromes associated with autoimmune neurologic disorders, and our understanding of the pathophysiology, has progressed significantly. Radiographic, electrophysiological, and laboratory testing (particularly neural autoantibody testing) are fundamental in the diagnosis of autoimmune neurological disorders and in the exclusion of mimics. Furthermore, investigations may serve as a baseli...
Source: Seminars in Neurology - July 16, 2018 Category: Neurology Authors: L ópez-Chiriboga, A. Sebastian Flanagan, Eoin P. Tags: Review Article Source Type: research

Infection, Immunodeficiency, and Inflammatory Diseases in Autoimmune Neurology
This article will focus on the association of viral infections and dysregulation of the immune system as triggers of autoimmunity, in addition to various systemic inflammatory diseases that can cause neurological disease either with or without an established rheumatological disorder. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Seminars in Neurology)
Source: Seminars in Neurology - July 16, 2018 Category: Neurology Authors: Piquet, Amanda L. Clardy, Stacey L. Tags: Review Article Source Type: research

Imaging in Autoimmune Neurology
Semin Neurol 2018; 38: 371-378 DOI: 10.1055/s-0038-1660476Autoimmune disorders are becoming increasingly recognized within the broader field of neurology. The discovery of multiple, novel, neutrally targeted autoantibodies over the past decade and their translation into commercially available testing, in particular, has aided in the more rapid diagnosis of these disorders. When considering imaging in autoimmune neurologic disorders, it is important, when possible, to visualize the autoimmune process itself, as well as to make sure that the patient does not have an associated malignancy driving the overall process. Positron...
Source: Seminars in Neurology - July 16, 2018 Category: Neurology Authors: Linnoila, Jenny J. Tags: Review Article Source Type: research

Autoimmune Neurologic Diseases in Children
Semin Neurol 2018; 38: 355-370 DOI: 10.1055/s-0038-1660520Autoimmune diseases of the nervous system in children are composed of a heterogeneous group of rare disorders that can affect the central or peripheral nervous system at any level. Presentations may occur in children of any age and are typically acute or subacute in onset. Consideration of an autoimmune process as the etiology of neurologic diseases in children is important, as it may lead to early initiation of immunotherapy and an improvement in long-term neurologic outcomes. The developing nervous and immune systems in children create unique challenges in diagnos...
Source: Seminars in Neurology - July 16, 2018 Category: Neurology Authors: Sweeney, Michael Tags: Review Article Source Type: research

Pathogenic Mechanisms and Clinical Correlations in Autoimmune Myasthenic Syndromes
Semin Neurol 2018; 38: 344-354 DOI: 10.1055/s-0038-1660500Autoimmune myasthenic syndromes are antibody-mediated disorders of the neuromuscular junction. Common antigenic targets are the acetylcholine receptor or muscle specific kinase (MuSK) in myasthenia gravis (MG) and the voltage-gated calcium channel in Lambert-Eaton myasthenic syndrome. There is evidence that antibodies directed against other antigens such as low-density lipoprotein receptor-related protein 4 (LRP4) are also involved in MG. The mechanisms by which various antibodies exert their pathogenic effect depend on the IgG subclass and also the epitope location...
Source: Seminars in Neurology - July 16, 2018 Category: Neurology Authors: Cetin, Hakan Vincent, Angela Tags: Review Article Source Type: research

An Overview of Autoimmune and Paraneoplastic Encephalitides
Semin Neurol 2018; 38: 330-343 DOI: 10.1055/s-0038-1660821The understanding of the manifestations, mechanisms, and management of autoimmune encephalitis has expanded dramatically in recent decades. Immune-mediated encephalitides are comparable in incidence and prevalence to infectious etiologies, and are associated with significant morbidity, especially when there is a delay in recognition and treatment. As such, clinicians from many specialties must develop a functional understanding of these disorders. Herein we provide an overview of the autoimmune and paraneoplastic encephalitides, including those associated with eithe...
Source: Seminars in Neurology - July 16, 2018 Category: Neurology Authors: Bradshaw, Michael J. Linnoila, Jenny J. Tags: Review Article Source Type: research

Autoimmune Movement Disorders
Semin Neurol 2018; 38: 316-329 DOI: 10.1055/s-0038-1660851Autoimmune movement disorders are rare but potentially treatable entities. They can present with an excess or paucity of movement and may have other associated neurological symptoms. These disorders were originally recognized by their classic clinical presentations and the cancers associated with them. Recent emphasis has been targeted on associated, and sometimes causative, antibodies. Although some disorders have stereotypical presentations, the spectrum of abnormalities reported in association with antibodies is widening. Determining whether antibodies are incide...
Source: Seminars in Neurology - July 16, 2018 Category: Neurology Authors: Fearon, Conor O'Toole, Orna Tags: Review Article Source Type: research

Autoimmune Dementia
Semin Neurol 2018; 38: 303-315 DOI: 10.1055/s-0038-1660480Dementia refers to an acquired syndrome of intraindividual cognitive decline that ultimately interferes with an individual's ability to manage their usual duties at work or home. As experience with the diagnosis and management of patients with autoimmune and paraneoplastic encephalitis (AE) has expanded, it has become increasingly apparent that dementia may arise as a subacute or chronic complication of immune-mediated injury to the central nervous system. Progressive memory and thinking problems may represent the first (or only) sign of an underlying autoimmune or ...
Source: Seminars in Neurology - July 16, 2018 Category: Neurology Authors: Long, Justin M. Day, Gregory S. Tags: Review Article Source Type: research

Autoimmune Epilepsy: The Evolving Science of Neural Autoimmunity and Its Impact on Epilepsy Management
Semin Neurol 2018; 38: 290-302 DOI: 10.1055/s-0038-1660860Autoimmune epilepsy is increasingly recognized as a distinct clinical entity, driven in large part by the recent discovery of neural autoantibodies in patients with isolated or predominant epilepsy presentations. Detection of neural autoantibodies in high-risk epilepsy patients supports an immune-mediated cause of seizures and, if applicable, directs the search for an underlying cancer when the paraneoplastic association of the associated antibody is compelling. Early diagnosis of autoimmune epilepsy is crucial, as prompt initiation of immunosuppressive treatment in...
Source: Seminars in Neurology - July 16, 2018 Category: Neurology Authors: Quek, Amy M.L. O'Toole, Orna Tags: Review Article Source Type: research

Autoimmune and Paraneoplastic Myelopathies
Semin Neurol 2018; 38: 278-289 DOI: 10.1055/s-0038-1660856Prompt recognition of an inflammatory myelopathy is critical, as a specific diagnosis and management plan allows for optimal patient outcomes. Many treatment options are now available for autoimmune and paraneoplastic myelopathies, but specific management strategies and expected prognosis vary widely depending on the underlying etiology. An understanding of the relevant clinical details, imaging findings, and other diagnostic information that can help achieve a specific myelopathy diagnosis and treatment plan is essential for all neurologists, given the variety of c...
Source: Seminars in Neurology - July 16, 2018 Category: Neurology Authors: Zalewski, Nicholas L. Flanagan, Eoin P. Tags: Review Article Source Type: research

Antibodies in Autoimmune Human Neurological Disease: Pathogenesis and Immunopathology
Semin Neurol 2018; 38: 267-277 DOI: 10.1055/s-0038-1660501Immune-mediated processes represent a rapidly expanding categorical etiology for neurological disease manifestations spanning all subspecialties of neurology. Neural autoantibodies can be grossly divided into two main groups based on localization of the antigen: intracellular and cell membrane/synaptic antibodies. Antibodies reactive with neuronal membrane antigens have been identified in serum and cerebrospinal fluid of patients developing neurological disease either independent of or associated with cancer comorbidity, whereas antibodies directed against intracell...
Source: Seminars in Neurology - July 16, 2018 Category: Neurology Authors: Williams, Jon P. Carlson, Noel G. Greenlee, John E. Tags: Review Article Source Type: research

Autoimmune Neurology
Semin Neurol 2018; 38: 265-266 DOI: 10.1055/s-0038-1667109 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Neurology)
Source: Seminars in Neurology - July 16, 2018 Category: Neurology Authors: Clardy, Stacey L. Tags: Preface Source Type: research