Autoimmune Encephalitides and Rapidly Progressive Dementias
This article focuses on the growing field of autoimmune encephalitis (AE) as it pertains to the differential diagnostic considerations in a work-up for RPD. Understanding clues in the history and examination is the first step in identifying patients with a potential autoimmune cause for RPD. While testing for infectious and toxic-metabolic etiologies is commonly preformed, it is necessary to consider early ancillary testing for AE in appropriate cases of RPD. Autoantibody testing in the spinal fluid and serum, brain imaging, and electroencephalography all form the first line of investigations for AE. Treatment options and ...
Source: Seminars in Neurology - March 29, 2019 Category: Neurology Authors: Wesley, Sarah F. Ferguson, Damien Tags: Review Article Source Type: research

Parkinson's Disease Dementia and Lewy Body Disease
Semin Neurol 2019; 39: 274-282 DOI: 10.1055/s-0039-1678579Dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PD-D) are Lewy body-related neurodegenerative disorders sharing common clinical and neuropathological findings. The clinical features of both conditions include cognitive impairment, behavioral symptoms, autonomic dysfunction, sleep disorders, and parkinsonism. The cognitive profile of both disorders is characterized by particularly severe deficits in executive and visuospatial functions as well as attention. Clinical differentiation between DLB and PD-D is based on an arbitrary distinction between th...
Source: Seminars in Neurology - March 29, 2019 Category: Neurology Authors: Sezgin, Mine Bilgic, Basar Tinaz, Sule Emre, Murat Tags: Review Article Source Type: research

Rare Tauopathies
Semin Neurol 2019; 39: 264-273 DOI: 10.1055/s-0039-1678584Tauopathies are rare neurodegenerative disorders related to microtubule-associated protein tau, which functions to stabilize microtubules. Pathological changes caused by overexpression or hyperphosphorylation of tau lead to the disengagement of tau from microtubules and accumulation of toxic intracellular inclusions. Tau pathology is the underlying mechanism for several sporadic and genetic disorders. These are collectively known as tauopathies. Each tauopathy is differentiated from others by its neuropathological features such as the presence of specific isoforms o...
Source: Seminars in Neurology - March 29, 2019 Category: Neurology Authors: Ali, Farwa Josephs, Keith Tags: Review Article Source Type: research

Frontotemporal Dementia: A Clinical Review
Semin Neurol 2019; 39: 251-263 DOI: 10.1055/s-0039-1683379Frontotemporal dementias are a clinically, neuroanatomically, and pathologically diverse group of diseases that collectively constitute an important cause of young-onset dementia. Clinically, frontotemporal dementias characteristically strike capacities that define us as individuals, presenting broadly as disorders of social behavior or language. Neurobiologically, these diseases can be regarded as “molecular nexopathies,” a paradigm for selective targeting and destruction of brain networks by pathogenic proteins. Mutations in three major genes collectiv...
Source: Seminars in Neurology - March 29, 2019 Category: Neurology Authors: Sivasathiaseelan, Harri Marshall, Charles R. Agustus, Jennifer L. Benhamou, Elia Bond, Rebecca L. van Leeuwen, Janneke E. P. Hardy, Chris J. D. Rohrer, Jonathan D. Warren, Jason D. Tags: Review Article Source Type: research

Vascular Cognitive Disorder
Semin Neurol 2019; 39: 241-250 DOI: 10.1055/s-0039-1678582The term vascular cognitive disorder (VCD) refers to a heterogeneous group of disorders in which the primary feature is cognitive impairment attributable to cerebrovascular disease (CVD). This includes not only vascular dementia (VaD) but also cognitive impairment of insufficient severity to meet diagnostic criteria for dementia. VCD is recognized as the second most common cause of dementia after Alzheimer's disease (AD), but prevalence rates vary widely according to the diagnostic criteria employed. There have been recent attempts to standardize diagnostic criteria...
Source: Seminars in Neurology - March 29, 2019 Category: Neurology Authors: Paradise, Matt B. Sachdev, Perminder S. Tags: Review Article Source Type: research

Current and Future Treatments in Alzheimer's Disease
Semin Neurol 2019; 39: 227-240 DOI: 10.1055/s-0039-1678581The foundation of current Alzheimer's disease (AD) treatment involves pharmacological and nonpharmacological management and care planning predicated on patient-centered psychoeducation, shared goal-setting, and decision-making forged by a strong triadic relationship between clinician and the patient-caregiver dyad. Food and Drug Administration (FDA) approved AD medications, cholinesterase-inhibitors (ChEIs), and the N-methyl-d-aspartate (NMDA) antagonist memantine, when utilized as part of a comprehensive care plan, while generally considered symptomatic medications...
Source: Seminars in Neurology - March 29, 2019 Category: Neurology Authors: Atri, Alireza Tags: Review Article Source Type: research

Alzheimer's Disease Including Focal Presentations
Semin Neurol 2019; 39: 213-226 DOI: 10.1055/s-0039-1681041Alzheimer's disease (AD) is the commonest neurodegenerative disease and the most frequent cause of dementia. It affects 30 million people worldwide. Current research criteria focus on biomarkers' status for amyloid and tau using positron emission tomography and cerebrospinal fluid analysis, independent of clinical status. Current epidemiological data, which mostly rely on biomarker-undetermined AD cases, have highlighted ApoE4 and age as the main risk factors. Rare autosomal dominant mutations also account for a small fraction of early-onset AD. The main clinical ph...
Source: Seminars in Neurology - March 29, 2019 Category: Neurology Authors: Villain, Nicolas Dubois, Bruno Tags: Review Article Source Type: research

Interpretation of Biomarker Data in Diagnosis of Primary Dementias
Semin Neurol 2019; 39: 200-212 DOI: 10.1055/s-0039-1683380In the last few years, an improved understanding of dementia biomarkers has significantly increased the diagnostic accuracy for dementias. The National Institutes of Health Biomarkers Definitions Working Group defines a biomarker as “a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention.” In the field of dementia, a biomarker is a biological measure pointing to a specific dementing pathology. Dementia biomarkers may also se...
Source: Seminars in Neurology - March 29, 2019 Category: Neurology Authors: Salardini, Arash Tags: Review Article Source Type: research

Neuroimaging in Dementias
Semin Neurol 2019; 39: 188-199 DOI: 10.1055/s-0039-1678580Dementia is a global health issue, the burden of which will worsen with an increasingly aging population. Alzheimer's disease (AD) is the most common dementia, with 50 to 60% of all dementias attributable to AD alone, while the rest are mostly due to frontotemporal lobar dementia, dementia with Lewy bodies, Parkinson's disease dementia, and vascular dementia. Diagnosis of dementias is made clinically with the aid of other testing modalities including neuroimaging. While the role of imaging has traditionally been to exclude reversible causes of dementia, positron emi...
Source: Seminars in Neurology - March 29, 2019 Category: Neurology Authors: Mahalingam, Sowmya Chen, Ming-Kai Tags: Review Article Source Type: research

A Multifactor Approach to Mild Cognitive Impairment
Semin Neurol 2019; 39: 179-187 DOI: 10.1055/s-0039-1678585Mild cognitive impairment (MCI) represents an intermediate stage between normal cognition and dementia. Individuals with MCI are at increased risk of conversion to dementia, and the rate of progression of MCI to dementia is dependent on age, gender, and education. MCI may be diagnosed using neuropsychological criteria using cut-offs representing decrements in cognition, or using criteria to assess for a decline in functional status. The ability to determine the status of dementia-related biomarkers has allowed for better staging and prognostication in different form...
Source: Seminars in Neurology - March 29, 2019 Category: Neurology Authors: Qarni, Taha Salardini, Arash Tags: Review Article Source Type: research

A Comprehensive Update on Treatment of Dementia
Semin Neurol 2019; 39: 167-178 DOI: 10.1055/s-0039-1683408Treatment of dementias represents an important but relatively neglected part of neurological care of the elderly population. Individual therapeutic interventions may make only small changes to the quality of life of individuals afflicted with dementia, but when used in combination these interventions synergize and can make a significant difference. Additionally, given the societal scale of the problem of dementia care, the overall impact, in economic and sociological terms, of such therapies is of consequence. Presently there are no disease-modifying treatments for ...
Source: Seminars in Neurology - March 29, 2019 Category: Neurology Authors: Tisher, Annya Salardini, Arash Tags: Review Article Source Type: research

An Overview of Primary Dementias as Clinicopathological Entities
Semin Neurol 2019; 39: 153-166 DOI: 10.1055/s-0039-1683445Dementia is a state of cognitive dysfunction which leads to functional decline. It is a syndrome caused by several medical and neurological causes, but most cases of dementia are due to “primary dementias.” Primary dementias are neurological diseases whose manifestations are predominantly cognitive. Most primary dementias are caused by neurodegenerative proteinopathies where an accumulation of misfolded proteins leads to neuronal loss, neuroinflammation and glial reaction. Each proteinopathy is characterized by the type of protein implicated in its patho...
Source: Seminars in Neurology - March 29, 2019 Category: Neurology Authors: Salardini, Arash Tags: Review Article Source Type: research

Dementia
Semin Neurol 2019; 39: 151-152 DOI: 10.1055/s-0039-1685173 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 - March 29, 2019 Category: Neurology Authors: Salardini, Arash Tags: Preface Source Type: research

Arash Salardini, MBBS, BSc
Semin Neurol 2019; 39: 149-150 DOI: 10.1055/s-0039-1685174 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 - March 29, 2019 Category: Neurology Authors: Greer, David M. Tags: Introduction to the Guest Editor Source Type: research

Wilderness Neurology
Semin Neurol 2019; 39: 137-148 DOI: 10.1055/s-0038-1676994The study of wilderness medicine is within the scope of medical care in the austere environment and addresses medicine as practiced in the setting of delayed access to definitive medical care, hostile environment, limited equipment, and inherent risks to the patient and/or rescuers. Part of this topic includes the care of patients with neurologic illness and/or injury.We will address the five most important skills of a wilderness medicine professional: decision making, prevention, preparation, protocol development, and education by applying the principles to select ...
Source: Seminars in Neurology - February 11, 2019 Category: Neurology Authors: Schlein, Sarah M. Marcolini, Paul G. Marcolini, Evie G. Tags: Review Article Source Type: research

Movement Disorders Emergencies
Semin Neurol 2019; 39: 125-136 DOI: 10.1055/s-0038-1677050Many acute and potentially life-threatening medical conditions have hyperkinetic or hypokinetic movement disorders as their hallmark. Here we review the clinical phenomenology, and diagnostic principles of neuroleptic malignant syndrome, malignant catatonia, serotonin syndrome, Parkinsonism hyperpyrexia, acute parkinsonism, acute chorea-ballism, drug-induced dystonia, and status dystonicus. In the absence of definitive lab tests and imaging, only a high index of clinical suspicion, awareness of at-risk populations, and variations in clinical presentation can help wi...
Source: Seminars in Neurology - February 11, 2019 Category: Neurology Authors: Rajan, Suraj Kaas, Bonnie Moukheiber, Emile Tags: Review Article Source Type: research

Acute Manifestations of Neuromuscular Disease
This article reviews neuromuscular emergencies by localization in the peripheral nervous system of the underlying disorder, as well as the identification and management of neuromuscular respiratory failure. [...] 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 - February 11, 2019 Category: Neurology Authors: Edmundson, Christyn Bird, Shawn J. Tags: Review Article Source Type: research

Functional (Psychogenic) Neurological Disorders: Assessment and Acute Management in the Emergency Department
Semin Neurol 2019; 39: 102-114 DOI: 10.1055/s-0038-1676844Functional neurological disorders (FND) are complex and prevalent neuropsychiatric conditions. Importantly, some patients with FND develop acute onset symptoms requiring emergency department (ED) evaluations. Historically, FND was a “rule-out” diagnosis, making assessment and management in the ED difficult. While the rapid triage of potential neurological emergencies remains the initial task, advancements have altered the approach to FND. FND is now a “rule-in” diagnosis based on validated neurological examination signs and semiological featu...
Source: Seminars in Neurology - February 11, 2019 Category: Neurology Authors: Anderson, Jordan R. Nakhate, Vihang Stephen, Christopher D. Perez, David L. Tags: Review Article Source Type: research

Emergency Evaluation and Management of Encephalitis and Myelitis in Adults
Semin Neurol 2019; 39: 082-101 DOI: 10.1055/s-0038-1676845Infection of the central nervous system is often a life-threatening emergency. In many cases, the clinician faces an unknown pathogen and must rely upon clinical acumen and a thorough, systematic diagnostic investigation to establish a diagnosis and initiate appropriate treatment. Because patients typically present with a syndrome, such as temporal lobe encephalitis, rather than a known pathogen (e.g., herpes simplex virus 1 encephalitis), we describe diagnostic considerations in the context of their neuroanatomic tropisms and patterns of disease. This paradigm refl...
Source: Seminars in Neurology - February 11, 2019 Category: Neurology Authors: Bradshaw, Michael J. Venkatesan, Arun Tags: Review Article Source Type: research

Emergency Management of Epilepsy and Seizures
Semin Neurol 2019; 39: 073-081 DOI: 10.1055/s-0038-1677008Seizure- and epilepsy-related complications are a common cause of emergency medical evaluation, accounting for 5% of 911 calls and 1% of emergency department visits. Emergency physicians and neurologists must be able to recognize and treat seizure- and epilepsy-related emergencies. This review describes the emergency evaluation and management of new onset seizures, breakthrough seizures in patients with known epilepsy, status epilepticus, acute symptomatic seizures, and acute adverse effects of antiepileptic drugs. [...] Thieme Medical Publishers 333 Seventh Avenue,...
Source: Seminars in Neurology - February 11, 2019 Category: Neurology Authors: Bank, Anna M. Bazil, Carl W. Tags: Review Article Source Type: research

Acute Stroke
Semin Neurol 2019; 39: 061-072 DOI: 10.1055/s-0038-1676992Stroke remains one of the leading determinants of death and severe disability worldwide. It is a medical emergency with a narrow window for recognition and administration of outcome-modifying treatment in the emergency department. Ischemic stroke accounts for the majority of cerebrovascular events and revascularization therapies such as intravenous thrombolysis and endovascular thrombectomy are the mainstays of treatment in carefully selected patients. Intracerebral hemorrhage is less common but remains the deadliest type of stroke. Blood pressure reduction and hemo...
Source: Seminars in Neurology - February 11, 2019 Category: Neurology Authors: Morotti, Andrea Poli, Loris Costa, Paolo Tags: Review Article Source Type: research

Acute Visual Disorders —What Should the Neurologist Know?
Semin Neurol 2019; 39: 053-060 DOI: 10.1055/s-0038-1677007Normal vision requires coordination of precisely controlled and coordinated eye movements and normal function of a large cortical and subcortical sensory network. Given the required precision of the system and wide anatomic distribution of the motor and sensory visual systems, vision can be disrupted by a variety of central and peripheral nervous system disorders. While many of these may be relatively benign or have no proven therapy, several may be isolated presentations or harbingers of more serious neurologic conditions. Both monocular and binocular vision losses...
Source: Seminars in Neurology - February 11, 2019 Category: Neurology Authors: Brune, Anthony J. Gold, Daniel R. Tags: Review Article Source Type: research

Evaluation and Management of Neck and Back Pain
Semin Neurol 2019; 39: 041-052 DOI: 10.1055/s-0038-1677044Neck and back pain are common reasons for seeking evaluation and treatment in the emergency department. Within both systems there exist several time-sensitive diagnoses that the emergency provider should be familiar with in order to prevent significant morbidity and mortality. In this article we provide a general overview of these complaints by discussing problems in a systems-based fashion as well as discussing the initial evaluation, work-up, and treatment options for these diagnoses. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Arti...
Source: Seminars in Neurology - February 11, 2019 Category: Neurology Authors: Martel, John W. Potter, Samuel B. Tags: Review Article Source Type: research

Acute Dizziness
Semin Neurol 2019; 39: 027-040 DOI: 10.1055/s-0038-1676857Dizziness is a common chief complaint with an extensive differential diagnosis that includes both benign and serious conditions. Physicians must distinguish the majority of patients who suffer from self-limiting conditions from those with serious illnesses that require acute treatment. The preferred approach to the diagnosis of an acutely dizzy patient emphasizes different aspects of the history to guide a focused physical examination, with the goal of differentiating benign peripheral vestibular conditions from dangerous posterior circulation strokes. Currently, mi...
Source: Seminars in Neurology - February 11, 2019 Category: Neurology Authors: Gurley, Kiersten L. Edlow, Jonathan A. Tags: Review Article Source Type: research

Evaluation and Management of the Emergency Department Headache
Semin Neurol 2019; 39: 020-026 DOI: 10.1055/s-0038-1677023The acute headache in the emergency department (ED) poses a diagnostic dilemma that may overwhelm providers attempting to weigh the cost of advanced workups against the risk of missing serious pathology. While the majority of headache concerns are benign primary headache disorders, identifying life-threatening secondary causes of headache—which may be broadly categorized into structural, infectious, and vascular causes—is the primary focus of evaluation in the ED. Secondary headaches are associated with a high morbidity and mortality, and require strict ...
Source: Seminars in Neurology - February 11, 2019 Category: Neurology Authors: Filler, Levi Akhter, Murtaza Nimlos, Perrin Tags: Review Article Source Type: research

Altered Mental Status in the Emergency Department
Semin Neurol 2019; 39: 005-019 DOI: 10.1055/s-0038-1677035Altered mental status is an umbrella term that covers a broad spectrum of disease processes that vary greatly in chronicity and severity. Causes can be a primary neurologic insult or a result of a systemic illness resulting in end-organ dysfunction of the brain. Acute changes in mental status are more likely than chronic changes to be immediately life-threatening and are therefore the focus of this review. Given the potential time-sensitive nature, acute changes in mental status must be addressed immediately and with urgency. We recommend a primary survey followed b...
Source: Seminars in Neurology - February 11, 2019 Category: Neurology Authors: Smith, Austin T. Han, Jin H. Tags: Review Article Source Type: research

Emergency Neurology
Semin Neurol 2019; 39: 003-004 DOI: 10.1055/s-0039-1678571 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 - February 11, 2019 Category: Neurology Authors: Goldstein, Joshua N. Ellenbogen, Jeffrey M. Tags: Preface Source Type: research

Joshua N. Goldstein, MD, PhD, and Jeffrey M. Ellenbogen, MMSc, MD
Semin Neurol 2019; 39: 001-002 DOI: 10.1055/s-0039-1678572 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 - February 11, 2019 Category: Neurology Authors: Greer, David M. Tags: Introduction to the Guest Editors Source Type: research

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