Prevalence, Mechanisms, and Management of Ischemic Stroke in Heart Failure Patients
Semin Neurol DOI: 10.1055/s-0041-1726329Heart failure (HF) and stroke, two of the major causes of death worldwide, are closely associated. Although atrial fibrillation (AF), which occurs in more than half of patients with HF, is a major risk factor for stroke, there is a great deal of evidence that HF itself increases the risk of stroke independent of AF. The main mechanism of stroke appears to be thromboembolism. However, previous studies have failed to demonstrate the benefit of warfarin in patients with HF without AF, as the benefit of stroke prevention was counteracted by the increased incidence of major bleeding. Rece...
Source: Seminars in Neurology - April 13, 2021 Category: Neurology Authors: Seol, Hyeyoung Kim, Jong S. Tags: Review Article Source Type: research

Neurological Complications in Patients with Heart Transplantation
This article provides a review of the diagnosis and management of neurological complications after cardiac transplantation. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Seminars in Neurology)
Source: Seminars in Neurology - April 13, 2021 Category: Neurology Authors: Sakusic, Amra Rabinstein, Alejandro A. Tags: Review Article Source Type: research

Cerebrovascular Complication and Valve Surgery in Infective Endocarditis
Semin Neurol DOI: 10.1055/s-0041-1726327Infective endocarditis (IE) with neurologic complications is common in patients with active IE. The most common and feared neurological complication of left-sided IE is cerebrovascular, from septic emboli causing ischemic stroke, intracranial hemorrhage (ICH), or an infectious intracranial aneurysm with or without rupture. In patients with cerebrovascular complications, valve replacement surgery is often delayed for concern of further neurological worsening. However, in circumstances when an indication for valve surgery to treat IE is present, the benefits of early surgical treatment...
Source: Seminars in Neurology - April 13, 2021 Category: Neurology Authors: Rice, Cory J. Kovi, Shivakrishna Wisco, Dolora R. Tags: Review Article Source Type: research

Atrial Fibrillation and Ischemic Stroke: A Clinical Review
Semin Neurol DOI: 10.1055/s-0041-1726332Atrial fibrillation (AF) is an important risk factor for ischemic stroke resulting in a fivefold increased stroke risk and a twofold increased mortality. Our understanding of stroke mechanisms in AF has evolved since the concept of atrial cardiopathy was introduced as an underlying pathological change, with both AF and thromboembolism being common manifestations and outcomes. Despite the strong association with stroke, there is no evidence that screening for AF in asymptomatic patients improves clinical outcomes; however, there is strong evidence that patients with embolic stroke of ...
Source: Seminars in Neurology - April 13, 2021 Category: Neurology Authors: Migdady, Ibrahim Russman, Andrew Buletko, Andrew B. Tags: Review Article Source Type: research

Cerebrovascular Disease and Cognitive Outcome in Patients with Cardiac Disease
Semin Neurol DOI: 10.1055/s-0041-1726330The pace of understanding cognitive decline and dementia has rapidly accelerated over the past decade, with constantly evolving insights into the vascular contributions to cognitive impairment and dementia (VCID). Notably, more overlap has been discovered in the pathophysiology between what was previously understood to be Alzheimer's disease and VCID, leading to a heightened emphasis on disease prevention through early and aggressive control of vascular risk factors. One particularly vulnerable population may be those with cardiac disease, as they are at risk for cerebrovascular dise...
Source: Seminars in Neurology - April 13, 2021 Category: Neurology Authors: Johansen, Michelle C. Gottesman, Rebecca F. Tags: Review Article Source Type: research

Antithrombotic Therapy for Stroke Patients with Cardiovascular Disease
Semin Neurol DOI: 10.1055/s-0041-1726331Prevention of ischemic stroke relies on the use of antithrombotic medications comprising antiplatelet agents and anticoagulation. Stroke risk is particularly high in patients with cardiovascular disease. This review will focus on the role of antithrombotic therapies in the context of different types of cardiovascular disease. We will discuss oral antiplatelet medications and both IV and parental anticoagulants. Different kinds of cardiovascular disease contribute to stroke via distinct pathophysiological mechanisms, and the optimal treatment for each varies accordingly. We will explo...
Source: Seminars in Neurology - April 13, 2021 Category: Neurology Authors: Gusdon, Aaron M. Farrokh, Salia Grotta, James C. Tags: Review Article Source Type: research

A Comprehensive Review of Risk Factor, Mechanism, and Management of Left Ventricular Assist Device –Associated Stroke
Semin Neurol DOI: 10.1055/s-0041-1726328The use of left ventricular assist devices (LVADs) has been increasing in the last decade, along with the number of patients with advanced heart failure refractory to medical therapy. Ischemic stroke and intracranial hemorrhage remain the leading causes of morbidity and mortality in LVAD patients. Despite the common occurrence and the significant outcome impact, underlying mechanisms and management strategies of stroke in LVAD patients are controversial. In this article, we review our current knowledge on pathophysiology and risk factors of LVAD-associated stroke, outline the diagnos...
Source: Seminars in Neurology - April 13, 2021 Category: Neurology Authors: Cho, Sung-Min Tahsili-Fahadan, Pouya Kilic, Ahmet Choi, Chun Woo Starling, Randall C. Uchino, Ken Tags: Review Article Source Type: research

Brain Injury in Extracorporeal Membrane Oxygenation: A Multidisciplinary Approach
Semin Neurol DOI: 10.1055/s-0041-1726284Extracorporeal membrane oxygenation (ECMO) represents an established technique to provide temporary cardiac and/or pulmonary support. ECMO, in veno-venous, veno-arterial or in extracorporeal carbon dioxide removal modality, is associated with a high rate of brain injuries. These complications have been reported in 7 to 15% of adults and 20% of neonates, and are associated with poor survival. Thromboembolic events, loss of cerebral autoregulation, alteration of the blood–brain barrier, and hemorrhage related to anticoagulation represent the main causes of severe brain injury dur...
Source: Seminars in Neurology - April 13, 2021 Category: Neurology Authors: Chiarini, Giovanni Cho, Sung-Min Whitman, Glenn Rasulo, Frank Lorusso, Roberto Tags: Review Article Source Type: research

Delirium in Cardiac and Cardiovascular Surgical Intensive Care Units
Semin Neurol DOI: 10.1055/s-0041-1726283Delirium is a common occurrence in cardiac and cardiovascular surgical intensive care units. Due to multiple confounding factors, this diagnosis remains challenging for medical professionals. Multiple theories exist regarding the pathophysiology of delirium, which include disruption of neurotransmitters as well as inflammation. Delirium has been associated with prolonged hospitalizations and an increase in mortality. Although there are widely used screening tools for delirium, none have been validated in this particular patient population. Limited treatments exist for delirium, so: b...
Source: Seminars in Neurology - April 13, 2021 Category: Neurology Authors: Breit, Hannah Bleck, Thomas P. Koffman, Lauren Tags: Review Article Source Type: research

Acute Ischemic Stroke Associated with Myocardial Infarction: Challenges and Management
Semin Neurol DOI: 10.1055/s-0041-1726333Acute ischemic stroke (AIS) and acute myocardial infarction (AMI) may co-occur simultaneously or in close temporal succession, with occurrence of one ischemic vascular event increasing a patient's risk for the other. Both employ time-sensitive treatments, and both benefit from expert consultation. Patients are at increased risk of stroke for up to 3 months following AMI, and aggressive treatment of AMI, including use of reperfusion therapy, decreases the risk of AIS. For patients presenting with AIS in the setting of a recent MI, treatment with alteplase, an intravenous tissue plasmi...
Source: Seminars in Neurology - April 13, 2021 Category: Neurology Authors: Boyanpally, Anusha Cutting, Shawna Furie, Karen Tags: Review Article Source Type: research

Neurorehabilitation
Semin Neurol 2021; 41: 109-110 DOI: 10.1055/s-0041-1726458 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Neurology)
Source: Seminars in Neurology - April 8, 2021 Category: Neurology Authors: Dwyer, Brigid Katz, Douglas I. Tags: Preface Source Type: research

Brigid Dwyer, MD, and Douglas I. Katz, MD
Semin Neurol 2021; 41: 107-108 DOI: 10.1055/s-0041-1726457 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Neurology)
Source: Seminars in Neurology - April 8, 2021 Category: Neurology Authors: Greer, David M. Tags: Introduction to the Guest Editors Source Type: research

Brain –Computer Interfaces in Neurorecovery and Neurorehabilitation
Semin Neurol DOI: 10.1055/s-0041-1725137Recent advances in brain–computer interface technology to restore and rehabilitate neurologic function aim to enable persons with disabling neurologic conditions to communicate, interact with the environment, and achieve other key activities of daily living and personal goals. Here we evaluate the principles, benefits, challenges, and future directions of brain–computer interfaces in the context of neurorehabilitation. We then explore the clinical translation of these technologies and propose an approach to facilitate implementation of brain–computer interfaces for ...
Source: Seminars in Neurology - March 19, 2021 Category: Neurology Authors: Young, Michael J. Lin, David J. Hochberg, Leigh R. Tags: Review Article Source Type: research

Evidence for Early and Regular Physical Therapy and Exercise in Parkinson's Disease
Semin Neurol DOI: 10.1055/s-0041-1725133Advances in medical management of Parkinson's disease (PD) have resulted in living longer with disability. Although disability worsens over the course of the disease, there are signs of disability even in the early stages. Several studies reveal an early decline in gait and balance and a high prevalence of nonmotor signs in the prodromal period that contribute to early disability. There is a growing body of evidence revealing the benefits of physical therapy and exercise to mitigate motor and nonmotor signs while improving physical function and reducing disability. The presence of ea...
Source: Seminars in Neurology - March 19, 2021 Category: Neurology Authors: Ellis, Terry D. Col ón-Semenza, Cristina DeAngelis, Tamara R. Thomas, Cathi A. Hilaire, Marie-H élène Saint Earhart, Gammon M. Dibble, Leland E. Tags: Review Article Source Type: research

Retention of Physical Gains in the Community Following Physical Training for Multiple Sclerosis: A Systematic Review and Implications
Semin Neurol DOI: 10.1055/s-0041-1725139Multiple sclerosis (MS) is a progressive neurological illness whose typically young adult onset results in a nearly entire lifetime of worsening disability. But despite being an unrelenting neurodegenerative disease, numerous clinical trials over the past 40 years for MS have vigorously attempted to improve or at least stabilize declining physical function. Although the vast majority of the studies assessed training effects only within controlled laboratory or clinic settings, in recent years a growing interest has emerged to test whether newer therapies can instead benefit real-life...
Source: Seminars in Neurology - March 9, 2021 Category: Neurology Authors: Mark, Victor W. Tags: Review Article Source Type: research

Learning and Stroke Recovery: Parallelism of Biological Substrates
Semin Neurol DOI: 10.1055/s-0041-1725136Stroke is a debilitating disease. Current effective therapies for stroke recovery are limited to neurorehabilitation. Most stroke recovery occurs in a limited and early time window. Many of the mechanisms of spontaneous recovery after stroke parallel mechanisms of normal learning and memory. While various efforts are in place to identify potential drug targets, an emerging approach is to understand biological correlates between learning and stroke recovery. This review assesses parallels between biological changes at the molecular, structural, and functional levels during learning an...
Source: Seminars in Neurology - March 9, 2021 Category: Neurology Authors: Joy, Mary Teena Carmichael, S Thomas Tags: Review Article Source Type: research

Rehabilitation of Concussion and Persistent Postconcussive Symptoms
This article presents a structured method for the diagnosis of concussion and PPCS in the outpatient setting, which includes a history, physical examination, and additional tests as clinically indicated to help identify underlying symptom generators. Treatment for concussion and PPCS should be individualized, based on predominant signs and symptoms, and can include subsymptom threshold aerobic exercise, cervical physical therapy, vestibulo-ocular rehabilitation, behavioral and cognitive psychotherapy, and some symptom-specific pharmacological therapies. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, ...
Source: Seminars in Neurology - March 4, 2021 Category: Neurology Authors: Wilber, Charles G. Leddy, John J. Bezherano, Itai Bromley, Lacey Edwards, Amanda E. Willer, Barry S. Haider, Mohammad N. Tags: Review Article Source Type: research

Hereditary Myelopathies
Semin Neurol DOI: 10.1055/s-0041-1725153Hereditary myelopathies are an important and likely underappreciated component of neurogenetic disease. While previously distinctions have been made by age of onset, the growing power and availability of high-quality neuroimaging and next-generation sequencing are increasingly expanding classical phenotypes and diminishing the utility of age-based classifications. Increasingly, cases of “atypical” disease presentations are challenging past assumptions regarding the age of onset and survival in many disorders and identifying allelic syndromes in others. Despite this, there...
Source: Seminars in Neurology - March 4, 2021 Category: Neurology Authors: Walker, Melissa A. Tags: Review Article Source Type: research

Principles of Neural Repair and Their Application to Stroke Recovery Trials
Semin Neurol DOI: 10.1055/s-0041-1725140Neural repair is the underlying therapeutic strategy for many treatments currently under investigation to improve recovery after stroke. Repair-based therapies are distinct from acute stroke strategies: instead of salvaging threatened brain tissue, the goal is to improve behavioral outcomes on the basis of experience-dependent brain plasticity. Furthermore, timing, concomitant behavioral experiences, modality specific outcome measures, and careful patient selection are fundamental concepts for stroke recovery trials that can be deduced from principles of neural repair. Here we discus...
Source: Seminars in Neurology - March 4, 2021 Category: Neurology Authors: Lin, David J. Cramer, Steven C. Tags: Review Article Source Type: research

Clinical Neurorehabilitation: Using Principles of Neurological Diagnosis, Prognosis, and Neuroplasticity in Assessment and Treatment Planning
This article discusses a clinical neurological paradigm, using rigorous clinical assessment of neuropathological and clinical diagnosis, along with prognostication of natural history and recovery. In the context of the role of neuroplasticity in recovery, this paradigm can add significant value to rehabilitation team management and planning. It contributes to enhanced understanding of neurological impairments and syndromes as they relate to functional disability, aiding in targeting deficits and setting treatment goals. Rehabilitation strategies and goals should be informed by natural history and prognosis, and viewed in t...
Source: Seminars in Neurology - March 4, 2021 Category: Neurology Authors: Katz, Douglas I. Dwyer, Brigid Tags: Review Article Source Type: research

Motor Recovery: How Rehabilitation Techniques and Technologies Can Enhance Recovery and Neuroplasticity
Semin Neurol DOI: 10.1055/s-0041-1725138There are now a large number of technological and methodological approaches to the rehabilitation of motor function after stroke. It is important to employ these approaches in a manner that is tailored to specific patient impairments and desired functional outcomes, while avoiding the hype of overly broad or unsubstantiated claims for efficacy. Here we review the evidence for poststroke plasticity, including therapy-related plasticity and functional imaging data. Early demonstrations of remapping in somatomotor and somatosensory representations have been succeeded by findings of whit...
Source: Seminars in Neurology - March 4, 2021 Category: Neurology Authors: Braun, Robynne G. Wittenberg, George F. Tags: Review Article Source Type: research

Assessment and Treatment of Concussion in the Pediatric Population
Semin Neurol DOI: 10.1055/s-0041-1725135Traumatic brain injury (TBI) is common in children. The evaluation and management of children with TBI is based on the research performed in adults. There is a relative paucity of research in the literature involving children and many of the practice recommendations for this age are based on expert opinion in the absence of good research studies in both sports and non–sports-related injuries. The pediatric population is heterogeneous and the approach might be specific for infants, preschoolers, school age children, and adolescents. Children may also suffer from neurodevelopment...
Source: Seminars in Neurology - March 3, 2021 Category: Neurology Authors: Lugo, Giancarlo J. Beletanga, Maria Goldstein, Laura Rana, Mandeep Jonas, Rinat Torres, Alcy R. Tags: Review Article Source Type: research

Acute Stroke
Semin Neurol 2021; 41: 003-003 DOI: 10.1055/s-0041-1722922 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Neurology)
Source: Seminars in Neurology - February 22, 2021 Category: Neurology Authors: Sangha, Navdeep Ishida, Koto Tags: Preface Source Type: research

Navdeep Sangha, MD, and Koto Ishida, MD
Semin Neurol 2021; 41: 001-002 DOI: 10.1055/s-0041-1722921 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Neurology)
Source: Seminars in Neurology - February 22, 2021 Category: Neurology Authors: Greer, David M. Tags: Introduction to the Guest Editors Source Type: research

Surgical Interventions for Supratentorial Intracranial Hemorrhage: The Past, Present, and Future
Semin Neurol DOI: 10.1055/s-0040-1722639Spontaneous supratentorial intracranial hemorrhage is extremely disabling and is associated with high mortality. Primary treatment for patients with this disease process is maximal medical management with blood pressure control and correction of clotting disorders due to comorbid conditions or medications. Over the past decade, significant strides have been made in understanding the benefits of surgical intervention in the treatment of intracranial hemorrhage through multiple clinical trials. In this article, we review the evolution of surgical treatments beginning with the STICH tri...
Source: Seminars in Neurology - January 28, 2021 Category: Neurology Authors: Patel, Smruti K. Saleh, Mohamed S. Body, Alaina Zuccarello, Mario Tags: Review Article Source Type: research

Neuropsychiatric Complications after Stroke
Semin Neurol DOI: 10.1055/s-0040-1722723Neuropsychiatric disturbances represent a common and uniquely challenging consequence of stroke. These disorders arise at the intersection of lesion-related brain dysfunction and psychological distress related to the event and its aftermath, making it difficult to identify what symptom is a direct physiological consequence of the stroke. Depression, anxiety, fatigue, apathy, emotionalism, and anger are the most common of these syndromes, and posttraumatic stress disorder related to the stroke event has become increasingly recognized as a relevant entity. Mania, obsessive–compul...
Source: Seminars in Neurology - January 28, 2021 Category: Neurology Authors: Nemani, Katlyn Gurin, Lindsey Tags: Review Article Source Type: research

Mobile Stroke Units: Current and Future Impact on Stroke Care
Semin Neurol DOI: 10.1055/s-0040-1722724Ischemic stroke is a leading cause of death and major disability that impacts societies across the world. Earlier thrombolysis of blocked arteries with intravenous tissue plasminogen activator (tPA) and/or endovascular clot extraction is associated with better clinical outcomes. Mobile stroke units (MSU) can deliver faster tPA treatment and rapidly transport stroke patients to centers with endovascular capabilities. Initial MSU trials in Germany indicated more rapid tPA treatment times using MSUs compared with standard emergency room treatment, a higher proportion of patients treated...
Source: Seminars in Neurology - January 28, 2021 Category: Neurology Authors: Bowry, Ritvij Grotta, James C. Tags: Review Article Source Type: research

Prehospital EMS Triage for Acute Stroke Care
Semin Neurol DOI: 10.1055/s-0040-1722725Acute stroke has had major advances over the last two decades due to the introduction of pharmacologic and endovascular revascularization, which can improve functional outcome. Stroke systems of care have been developed to provide faster, more efficient care for stroke patients. A major part of these care pathways is prehospital care, when patients are triaged to appropriate levels of care. It is essential that prehospital scales are used accurately and effectively by emergency medical services to assist them with the triage process. New technologies including mobile stroke units, te...
Source: Seminars in Neurology - January 27, 2021 Category: Neurology Authors: Noorian, Ali Reza Tags: Review Article Source Type: research

Stem Cell Treatment for Ischemic Stroke Recovery
This report reviews the different biological repair approaches using cell implants, discusses clinical trial design and surgical methods, and the current state of research. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Seminars in Neurology)
Source: Seminars in Neurology - January 27, 2021 Category: Neurology Authors: Kondziolka, Douglas Tags: Review Article Source Type: research

Alteplase and Adjuvant Therapies for Acute Ischemic Stroke
Semin Neurol DOI: 10.1055/s-0040-1722720Acute ischemic stroke (AIS) is a time sensitive medical emergency and a leading cause of morbidity and mortality worldwide. Intravenous (IV) recombinant tissue plasminogen activator (IV alteplase) is currently the only proven effective medication for the treatment of AIS with promising adjuvant medications currently under investigation. Recent advances in endovascular thrombectomy have broadened therapeutic options in specific patient populations, with modern treatment strategies utilizing advanced imaging modalities to extend the window for treatment. In all cases, rapid treatment r...
Source: Seminars in Neurology - January 20, 2021 Category: Neurology Authors: Gottula, Adam L. Barreto, Andrew D. Adeoye, Opeolu Tags: Review Article Source Type: research

Blood Pressure Management Before, During, and After Endovascular Thrombectomy for Acute Ischemic Stroke
Semin Neurol DOI: 10.1055/s-0040-1722721There is an absence of specific evidence or guideline recommendations on blood pressure management for large vessel occlusion stroke patients. Until randomized data are available, the periprocedural blood pressure management of patients undergoing endovascular thrombectomy can be viewed in two phases relative to the achievement of recanalization. In the hyperacute phase, prior to recanalization, hypotension should be avoided to maintain adequate penumbral perfusion. The American Heart Association guidelines should be followed for the upper end of prethrombectomy blood pressure: ≤1...
Source: Seminars in Neurology - January 20, 2021 Category: Neurology Authors: de Havenon, Adam Petersen, Nils Sultan-Qurraie, Ali Alexander, Matthew Yaghi, Shadi Park, Min Grandhi, Ramesh Mistry, Eva Tags: Review Article Source Type: research

Tenecteplase for Acute Ischemic Stroke Treatment
Semin Neurol DOI: 10.1055/s-0040-1722722The introduction of thrombolytic therapy in the 1990s has transformed acute ischemic stroke treatment. Thus far, intravenous recombinant tissue plasminogen activator (rt-PA) also known as alteplase is the only thrombolytic proven to be efficacious and approved by the United States Food and Drug Administration. But the thrombolytic agent tenecteplase (TNK) is emerging as a potential replacement for rt-PA. TNK has greater fibrin specificity, slower clearance, and higher resistance to plasminogen activator inhibitor-1 than rt-PA. Hence, TNK has the potential to provide superior lysis wi...
Source: Seminars in Neurology - January 20, 2021 Category: Neurology Authors: Baird, Alison E. Jackson, Richard Jin, Weijun Tags: Review Article Source Type: research

Poststroke Pain
Semin Neurol DOI: 10.1055/s-0040-1722641Pain is common but often underrecognized after stroke. Poststroke pain (PSP) hinders recovery, impairs quality of life, and is associated with the psychological state of patients with stroke. The most common subtypes of PSP include central PSP, complex regional pain syndrome, shoulder pain, spasticity-related pain, and headache. The pathophysiologies of these PSP subtypes are not yet clearly understood, and PSP is refractory to conventional treatment in many patients. However, recent studies have proposed potential pathophysiologies of PSP subtypes, which may help prioritize therapie...
Source: Seminars in Neurology - January 14, 2021 Category: Neurology Authors: Yang, Seoyon Chang, Min Cheol Tags: Review Article Source Type: research

Basilar Artery Occlusion and Emerging Treatments
Semin Neurol DOI: 10.1055/s-0040-1722638Basilar artery occlusion is a relatively uncommon but neurologically devastating condition. If revascularization is not achieved, the potential for death and disability is substantial. During the last several years, there have been positive endovascular stroke trials for the treatment of large vessel occlusion; however, all of them excluded patients with basilar artery occlusion. The current treatment of basilar artery occlusion is still founded on small observational studies or meta-analyses. As case selection for revascularization and treatment protocols often vary widely across in...
Source: Seminars in Neurology - January 14, 2021 Category: Neurology Authors: Liu, Zuolu Liebeskind, David S. Tags: Review Article Source Type: research

Cognitive Impairment in Patients with Stroke
Semin Neurol DOI: 10.1055/s-0040-1722217Despite substantial advances in stroke care, vascular cognitive impairment remains a prominent source of disability. Unlike sensorimotor impairments, cognition often continues to decline after stroke. An aging population will increase the prevalence of vascular cognitive impairment, with stroke playing an important role. Ten percent of patients presenting with stroke have pre-stroke dementia; an additional 10% will develop incident dementia with a first stroke, and 30% with a recurrent stroke. While stroke increases the risk of cognitive impairment, the presence of cognitive impairme...
Source: Seminars in Neurology - January 8, 2021 Category: Neurology Authors: D'Souza, Caitlin E. Greenway, Melanie R. F. Graff-Radford, Jonathan Meschia, James F. Tags: Review Article Source Type: research

Seizures and Status Epilepticus
Semin Neurol 2020; 40: 593-594 DOI: 10.1055/s-0040-1721086 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Neurology)
Source: Seminars in Neurology - November 24, 2020 Category: Neurology Authors: Pollandt, Sebastian Bleck, Thomas Tags: Preface Source Type: research

Sebastian Pollandt, MD, and Thomas Bleck, MD, MCCM
Semin Neurol 2020; 40: 591-592 DOI: 10.1055/s-0040-1721085 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Neurology)
Source: Seminars in Neurology - November 24, 2020 Category: Neurology Authors: Greer, David M. Tags: Introduction to the Guest Editors Source Type: research

Epilepsy —Work-Up and Management in Children
Semin Neurol DOI: 10.1055/s-0040-1718720Pediatric epilepsy is a highly variable condition due to age-related expression of syndromes that require specific diagnosis, evaluations, and treatments. Children with epilepsy differ from their adult counterparts in many important ways, mostly related to the age-related expression of specific epilepsy syndromes. This results in many important considerations related to the epilepsy diagnosis, classification, evaluations to determine an etiology, as well as treatment guidelines. A good understanding of these factors will help to establish an accurate epilepsy diagnosis, which in turn...
Source: Seminars in Neurology - November 11, 2020 Category: Neurology Authors: Tenney, Jeffrey R. Tags: Review Article Source Type: research

Electroencephalogram Monitoring in Critical Care
Semin Neurol DOI: 10.1055/s-0040-1719073Seizures are common in critically ill patients. Electroencephalogram (EEG) is a tool that enables clinicians to provide continuous brain monitoring and to guide treatment decisions—brain telemetry. EEG monitoring has particular utility in the intensive care unit as most seizures in this setting are nonconvulsive. Despite the increased use of EEG monitoring in the critical care unit, it remains underutilized. In this review, we summarize the utility of EEG and different EEG modalities to monitor patients in the critical care setting. [...] Thieme Medical Publishers 333 Seventh A...
Source: Seminars in Neurology - November 11, 2020 Category: Neurology Authors: Rubinos, Clio Alkhachroum, Ayham Der-Nigoghossian, Caroline Claassen, Jan Tags: Review Article Source Type: research

Genetic Testing in Epilepsy
Semin Neurol DOI: 10.1055/s-0040-1719070Because of next-generation sequencing and the discovery of many new causative genes, genetic testing in epilepsy patients has become widespread. Pathologic variants resulting in epilepsy cause a variety of changes that can be broadly classified into syndromic disorders (i.e., chromosomal abnormalities), metabolic disorders, brain malformations, and abnormal cellular signaling. Here, we review the available genetic testing, reasons to pursue genetic testing, common genetic causes of epilepsy, the data behind what patients are found to have genetic epilepsies based on current testing, ...
Source: Seminars in Neurology - November 11, 2020 Category: Neurology Authors: Ritter, David M. Holland, Katherine Tags: Review Article Source Type: research

Epilepsy: Workup and Management in Adults
Semin Neurol DOI: 10.1055/s-0040-1719069When managing epilepsy, there is a temptation to focus care with respect to the last and the next seizure. However, epilepsy is a multifaceted chronic condition and should be treated as such. Epilepsy comes with many physical risks, psychological effects, and socioeconomic ramifications, demanding a long-term commitment from the treating physician. Patients with epilepsy, compared to other chronically ill patient populations, have a worse quality of life, family function, and less social support. The majority of patients are well controlled on antiseizure drugs. However, approximatel...
Source: Seminars in Neurology - November 11, 2020 Category: Neurology Authors: O'Dwyer, Rebecca Tags: Review Article Source Type: research

Status Epilepticus: Work-Up and Management in Adults
Semin Neurol DOI: 10.1055/s-0040-1719112Status epilepticus is one of the most common neurological emergencies and is likely to have increasing prevalence in coming years given an aging “baby boomer” population in the United States. Because status epilepticus is associated with significant morbidity and mortality, identification and treatment are paramount. Care should be taken to exclude nonorganic mimics and infectious and metabolic causes. Status epilepticus can be classified into stages with associated recommendations for escalation in therapy, increasing from push-dose benzodiazepines to continuous anesthet...
Source: Seminars in Neurology - November 11, 2020 Category: Neurology Authors: Meziane-Tani, Assia Foreman, Brandon Mizrahi, Moshe A. Tags: Review Article Source Type: research

Status Epilepticus: Definition, Classification, Pathophysiology, and Epidemiology
Semin Neurol DOI: 10.1055/s-0040-1718722Status epilepticus (SE) is the state of continuous or repetitive seizures, which can occur with or without convulsions. Evolving definitions of SE take into account the concept that neuronal injury may occur at different times in different types of SE.SE that does not respond to initial treatment may become refractory or even super-refractory. Nonconvulsive SE is increasingly recognized in comatose patients in critical care units, with the growing use of continuous electroencephalogram monitoring. SE is a neurologic emergency that carries a high risk of mortality and morbidity. [...]...
Source: Seminars in Neurology - November 11, 2020 Category: Neurology Authors: Johnson, Emily L. Kaplan, Peter W. Tags: Review Article Source Type: research

Principles of Pharmacotherapy of Seizures and Status Epilepticus
Semin Neurol DOI: 10.1055/s-0040-1718721Status epilepticus is a neurological emergency with an outcome that is highly associated with the initial pharmacotherapy management that must be administered in a timely fashion. Beyond first-line therapy of status epilepticus, treatment is not guided by robust evidence. Optimal pharmacotherapy selection for individual patients is essential in the management of seizures and status epilepticus with careful evaluation of pharmacokinetic and pharmacodynamic factors. With the addition of newer antiseizure agents to the market, understanding their role in the management of status epilept...
Source: Seminars in Neurology - November 11, 2020 Category: Neurology Authors: Der-Nigoghossian, Caroline Tesoro, Eljim P. Strein, Micheal Brophy, Gretchen M. Tags: Review Article Source Type: research

Immunologic Treatments of Seizures and Status Epilepticus
Semin Neurol DOI: 10.1055/s-0040-1719111An autoimmune etiology for seizures, epilepsy, and status epilepticus is becoming increasingly recognized. The role of autoimmunity in epilepsy has been highlighted in the literature and the International League Against Epilepsy now recognizes autoimmune epilepsy as a distinct entity. An appropriate and thorough work-up of all new-onset seizures and status epilepticus is paramount in determining the likely efficacy of immunotherapeutic agents in treating seizures and status epilepticus. Criteria for the clinical diagnosis of autoimmune mediated epilepsy and encephalitis have been pub...
Source: Seminars in Neurology - November 11, 2020 Category: Neurology Authors: Culler, George W. VanHaerents, Stephen Tags: Review Article Source Type: research

Surgical Treatments of Epilepsy
This article reviews the two main categories of surgical epilepsy treatment—resective surgery and neuromodulation. Resective surgery includes temporal lobe resections, extratemporal resections, laser interstitial thermal therapy, and disconnection procedures. We discuss the three main types of neuromodulation—vagal nerve stimulation, responsive neurostimulation, and deep brain stimulation for epilepsy. The history and indications are explored for each type of treatment. Given the myriad types of resection and neuromodulation techniques, patient selection is reviewed in detail, with a discussion on which patient...
Source: Seminars in Neurology - November 11, 2020 Category: Neurology Authors: Ahmad, Shahjehan Khanna, Ryan Sani, Sepehr Tags: Review Article Source Type: research

Acute Seizures —Work-Up and Management in Children
This article will review updated definitions of seizures, including provoked versus unprovoked, as well as the International League Against Epilepsy operational definition of epilepsy. A variety of specific acute symptomatic seizures requiring special consideration are discussed, along with neonatal seizures and seizure mimics, which are common in pediatric populations. [...] 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 - November 5, 2020 Category: Neurology Authors: Romantseva, Lubov Lin, Nan Tags: Review Article Source Type: research

Acute Provoked Seizures —Work-Up and Management in Adults
Semin Neurol DOI: 10.1055/s-0040-1719075Acute provoked seizures, also known as acute symptomatic seizures, occur secondary to a neurological or systemic precipitant, commonly presenting as a first-time seizure. In this article, we will discuss etiology, emergent protocols, medical work-up, initial treatment, and management of these seizures. The definitions, classifications, and management of convulsive status epilepticus and nonconvulsive status epilepticus in an acute setting will also be reviewed. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents&n...
Source: Seminars in Neurology - November 5, 2020 Category: Neurology Authors: Moosavi, Rana Swisher, Christa B. Tags: Review Article Source Type: research

Ketogenic Diet Therapies for Seizures and Status Epilepticus
Semin Neurol DOI: 10.1055/s-0040-1719077Ketogenic diet therapies are high-fat, low-carbohydrate diets designed to mimic a fasting state. Although initially developed nearly one century ago for seizure management, most clinical trials for the management of drug-resistant epilepsy in children as well as adults have been conducted over the last 3 decades. Moreover, ketogenic diets offer promising new adjunctive strategies in the critical care setting for the resolution of acute status epilepticus when traditional antiseizure drugs and anesthetic agents fail. Here, we review the history of ketogenic diet development, the clini...
Source: Seminars in Neurology - November 5, 2020 Category: Neurology Authors: McDonald, Tanya J. W. Cervenka, Mackenzie C. Tags: Review Article Source Type: research

Epilepsy —Definition, Classification, Pathophysiology, and Epidemiology
This article begins by discussing the pathophysiology and epidemiology of epilepsy, and then covers the accepted contemporary definitions and classifications of seizures and epilepsies. [...] 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 - November 5, 2020 Category: Neurology Authors: Falco-Walter, Jessica Tags: Review Article Source Type: research