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Current Opinion in Neurology

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https://www.readbyqxmd.com/read/29324507/determining-when-to-stop-antiepileptic-drug-treatment
#1
Steven C Schachter
PURPOSE OF REVIEW: As the number of patients diagnosed with epilepsy continues to rise and the pharmacological and device-based treatment options for epilepsy increase, determining when to stop antiepileptic drug (AED) treatment continues to be an important issue for patient management and counseling. RECENT FINDINGS: This review focuses on outcomes following AED withdrawal in seizure-free adults with epilepsy. Practical considerations are also discussed because, despite the importance of this topic, relatively little progress has been made in the past year regarding the identification of patients whose risk for recurrent seizures after AED withdrawal is no higher than that of the general population...
January 10, 2018: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29303866/pet-and-ictal-spect-can-be-helpful-for-localizing-epileptic-foci
#2
Tim J von Oertzen
PURPOSE OF REVIEW: Functional neuroimaging with PET and SPECT is a commonly used tool in presurgical evaluation. The following article reviews the literature of PET and SPECT in presurgical assessment of epilepsies published in the last year. RECENT FINDINGS: FDG-PET adds concomitant information in temporal and extratemporal lobe epilepsy in adults and children. The pattern of hypometabolism in FDG-PET is a good additional predictor or seizure outcome in TLE with mesial temporal sclerosis or negative MRI...
January 4, 2018: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29278550/intelligent-use-of-antiepileptic-drugs-is-beneficial-to-patients
#3
Jocelyn Y Cheng, Jacqueline A French
PURPOSE OF REVIEW: To describe the most important issues a clinician must consider whenever selecting and administering antiepileptic drugs (AEDs). There is no available algorithm that identifies how to individualize selection of AEDs. Proper selection and administration can make an enormous difference in both effectiveness and tolerability. RECENT FINDINGS: Many principles of AED selection remain unchanged. Selection of AEDs must be based on understanding of epilepsy syndrome and seizure type, comorbidities, risk of adverse events, as well as on patient characteristics such as age and sex...
December 22, 2017: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29278549/new-developments-in-understanding-focal-cortical-malformations
#4
Albert J Becker, Heinz Beck
PURPOSE OF REVIEW: Focal cortical dysplasias (FCDs) represent common cortical malformations that are frequently associated with epilepsy. They have so far not been well understood in terms of their molecular pathogenesis, and with respect to mechanisms of seizure emergence. RECENT FINDINGS: Several recent studies have succeeded in making significant advances in understanding the molecular genetics, in particular FCD type II. A second major advance has been the development of novel rodent models of FCDs that replicate a somatic mutation seen in humans, lead to a focal lesion, and recapitulate many phenotypic features of human FCDs...
December 22, 2017: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29278548/the-current-place-of-epilepsy-surgery
#5
Jerome Engel
PURPOSE OF REVIEW: Three randomized controlled trials demonstrate that surgical treatment is safe and effective for drug-resistant epilepsy (DRE), yet fewer than 1% of patients are referred for surgery. This is a review of recent trends in surgical referral for DRE, and advances in the field. Reasons for continued underutilization are discussed. RECENT FINDINGS: Recent series indicate no increase in surgical referral for DRE over the past two decades. One study suggests that decreased referrals to major epilepsy centers can be accounted for by increased referrals to low-volume nonacademic hospitals where results are poorer, and complication rates higher...
December 22, 2017: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29256931/the-first-seizure-as-an-indicator-of-epilepsy
#6
Albrecht Kunze, Markus Reuber
PURPOSE OF REVIEW: Optimal treatment of a possible first seizure depends on the determination if the paroxysmal event was an epileptic seizure and was on an accurate assessment of the recurrence risk. This review summarizes evidence from the last 5 years addressing the following questions: Is it an epileptic seizure? Is it a first seizure? When does a first seizure indicate epilepsy? RECENT FINDINGS: The acts of taking and interpreting the history from patients and witnesses continue to be the most important tools in the diagnosis of first seizures...
December 18, 2017: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29189299/global-orientation-in-space-and-the-lateralization-of-brain-functions
#7
Marianne Dieterich, Thomas Brandt
PURPOSE OF REVIEW: The functional role of the vestibular system for multisensory orientation and sensorimotor control is reviewed with a special focus on hemispherical lateralization and its consequences for neurological disorders of higher cortical function. RECENT FINDINGS: The peripheral and central vestibular systems are bilaterally organized with ipsilateral and contralateral ascending pathways and two multisensory cortical networks in the right and left hemisphere...
February 2018: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29189298/laboratory-examinations-for-the-vestibular-system
#8
Raymond van de Berg, Sally Rosengren, Herman Kingma
PURPOSE OF REVIEW: In the last decades, researchers suggested that clinical assessment of labyrinthine function in detail became easy thanks to video head impulse tests (VHITs), vestibular evoked myogenic potential test (VEMP) and video-oculography (VOG). It has been argued that they can replace electronystagmography, the caloric and rotatory chair tests. This review addresses the latest evaluations of these tests and the opportunities they offer, but also the limitations in clinical practice...
February 2018: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29140815/neuroimaging-diagnostic-and-monitoring-approaches-in-ophthalmology
#9
Bart K Chwalisz, Marc A Bouffard, Sashank Prasad, Dean M Cestari
PURPOSE OF REVIEW: We review new applications of optical coherence tomography (OCT) technology in neuro-ophthalmology. We also describe new technologies for visualizing the extracranial vessels in the diagnosis of giant cell arteritis (GCA). RECENT FINDINGS: Newer OCT modalities are expanding the evaluation of the optic disc, and are being applied to a number of neurologic conditions such as demyelinating and neurodegenerative disease. Swept-source OCT and enhanced-depth imaging OCT are refining the fine-grained analysis of the optic nerve head in the diagnosis of papilledema and optic nerve drusen...
February 2018: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29140814/visual-snow-syndrome-what-we-know-so-far
#10
Francesca Puledda, Christoph Schankin, Kathleen Digre, Peter J Goadsby
PURPOSE OF REVIEW: We provide an overview of the neurological condition known as visual snow syndrome. Patients affected by this chronic disorder suffer with a pan-field visual disturbance described as tiny flickering dots, which resemble the static noise of an untuned television. RECENT FINDINGS: The term 'visual snow' has only appeared in the medical literature very recently. The clinical features of the syndrome have now been reasonably described and the pathophysiology has begun to be explored...
February 2018: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29120921/pregnancy-and-ischemic-stroke-a-practical-guide-to-management
#11
Mayte E van Alebeek, Roel de Heus, Anil M Tuladhar, Frank-Erik de Leeuw
PURPOSE OF REVIEW: Ischemic stroke during pregnancy or the puerperium is a devastating disease during a crucial period in life and warrants a specific approach. To date, current practice is mainly based on expert opinion because of a lack of randomized controlled trials and high-quality observational studies. The present review is intended as a practical guide to (acute) management of ischemic stroke during pregnancy and puerperium. RECENT FINDINGS: Recent findings showed that the incidence of stroke during pregnancy is rising...
February 2018: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29120920/the-growing-clinical-spectrum-of-cerebral-amyloid-angiopathy
#12
Marieke J H Wermer, Steven M Greenberg
PURPOSE OF REVIEW: Cerebral amyloid angiopathy (CAA) is diagnosed primarily as a cause of lobar intracerebral hemorrhages (ICH) in elderly patients. With improving MRI techniques, however, the role of CAA in causing other symptoms has become clear. Recognizing the full clinical spectrum of CAA is important for diagnosis and treatment. In this review we summarize recent insights in clinical CAA features, MRI biomarkers, and management. RECENT FINDINGS: The rate of ICH recurrence in CAA is among the highest of all stroke subtypes...
February 2018: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29120919/nystagmus
#13
Alexander A Tarnutzer, Dominik Straumann
PURPOSE OF REVIEW: The clinical and laboratory assessment of nystagmus in patients with neurologic disorders can provide crucial elements for a state-of-the-art differential diagnosis. An increasing number of publications in the fields of neuro-otology and neuro-ophthalmology have nystagmus in the center of interest, which makes frequent updates on the diagnostic and therapeutic relevance of these contributions indispensable. This review covers important clinical studies and studies in basic research relevant for the neurologist published from January 2016 to August 2017...
February 2018: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29120918/tissue-is-more-important-than-time-insights-into-acute-ischemic-stroke-from-modern-brain-imaging
#14
Andrew Bivard, Mark Parsons
PURPOSE OF REVIEW: The clinical practice of acute ischemic stroke treatment has undergone a major change over the last 5 years, as multimodal imaging becomes more accessible, and evidence mounts that individualized treatment is possible. Multimodal imaging performed before treatment provides invaluable information to treating clinicians, which includes confirmation of the diagnosis, and provides guidance on the appropriateness and the likely outcome of intravenous or endovascular treatment for individual patients (and their families)...
February 2018: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29095749/genetics-of-vestibular-syndromes
#15
Pablo Roman-Naranjo, Alvaro Gallego-Martinez, Jose A Lopez Escamez
PURPOSE OF REVIEW: The increased availability of next generation sequencing has enabled a rapid progress in the discovery of genetic variants associated with vestibular disorders. We have summarized molecular genetics finding in vestibular syndromes during the last 18 months. RECENT FINDINGS: Genetic studies continue to shed light on the genetic background of vestibular disorders. Novel genes affecting brain development and otolith biogenesis have been associated with motion sickness...
February 2018: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29095748/central-control-of-eye-movements
#16
Jonathan J D Baird-Gunning, Christian J Lueck
PURPOSE OF REVIEW: Eye-movement research continues to provide an excellent tool for understanding the central control of motor function, both in health and disease. This article reviews recent findings in relation to saccadic eye movements, particularly antisaccades and microsaccades, with particular emphasis on the control of inaction, something which has recently become topical. RECENT FINDINGS: Microsaccades are under the control of the cerebral cortex, particularly the frontal and parietal eye fields...
February 2018: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29084065/recent-advances-in-the-management-of-symptomatic-vertebral-artery-stenosis
#17
Anna M Drazyk, Hugh S Markus
PURPOSE OF REVIEW: Vertebrobasilar stenosis accounts for 20% of posterior circulation strokes and is associated with high risk of early stroke recurrence. We review data from randomized controlled trials examining whether stenting may reduce this risk, including the recently published Vertebral Artery Ischaemia Stenting Trial (VIST). RECENT FINDINGS: VIST and VAST (Vertebral Artery Stenting Trial), having recruited both intracranial and extracranial vertebral stenosis and showed a low rate of perioperative stroke for extracranial (0 and 2%, respectively), but a higher rate for intracranial stenosis (15 and 22%, respectively)...
February 2018: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29084064/new-insights-into-cerebral-small-vessel-disease-and-vascular-cognitive-impairment-from-mri
#18
Eric E Smith, Andrew E Beaudin
PURPOSE OF REVIEW: We review recent MRI research that addresses two important challenges in cerebral small vessel disease (SVD) research: early diagnosis, and linking SVD with cognitive impairment. First, we review studies of MRI measurements of blood flow and blood-brain barrier integrity. Second, we review MRI studies identifying neuroimaging correlates of SVD-related cognitive dysfunction, focusing on brain connectivity and white matter microarchitecture. This research is placed in context through discussion of recent recommendations for management of incidentally discovered SVD, and neuroimaging biomarker use in clinical trials...
February 2018: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29084063/central-vertigo
#19
Jeong-Yoon Choi, Seung-Han Lee, Ji-Soo Kim
PURPOSE OF REVIEW: This review considers recent advances in central vertigo in terms of clinical and laboratory features and pathophysiology. RECENT FINDINGS: Strokes presenting dizziness-vertigo are more likely to be associated with a misdiagnosis in the emergency setting. The risk of future strokes after discharge is higher in patients diagnosed with peripheral vertigo than in control patients. Strokes and transient ischemic attacks account for one-quarter of acute transient vestibular syndrome...
February 2018: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29084062/antiplatelet-therapy-after-stroke-should-it-differ-in-the-acute-and-chronic-phase-after-stroke
#20
Xinyi Leng, Thomas W Leung, K S Lawrence Wong
PURPOSE OF REVIEW: Reviewing existing evidence regarding well tolerated and effective antiplatelet treatment in patients with acute or chronic, noncardioembolic ischemic stroke and transient ischemic attack (TIA). RECENT FINDINGS: For patients with high-risk stroke or TIA, for instance, minor stroke or high-risk TIA, or stroke of atherosclerotic origin with evidence suggesting risk of artery-to-artery embolism or with high-grade, symptomatic arterial stenosis, early initiated, short-term dual antiplatelet (e...
February 2018: Current Opinion in Neurology
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