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Neurologic Clinics

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https://www.readbyqxmd.com/read/29157406/contemporary-topics-in-multiple-sclerosis
#1
EDITORIAL
Darin T Okuda
No abstract text is available yet for this article.
February 2018: Neurologic Clinics
https://www.readbyqxmd.com/read/29157405/common-clinical-and-imaging-conditions-misdiagnosed-as-multiple-sclerosis-a-current-approach-to-the-differential-diagnosis-of-multiple-sclerosis
#2
REVIEW
Aksel Siva
Multiple Sclerosis is increasing, so is the number of misdiagnosed cases as MS. One major source of misdiagnosis is misinterpretation of nonspecific clinical and imaging findings and misapplication of MS diagnostic criteria resulting in an overdiagnosis of MS! Since nonspecific white matter abnormalities on brain MRI and other imaging findings that may mimic MS, as well as MS-nonspecific lesions that are seen in people with MS, neurologists should be aware of all possibilities and should be able to interpret the clinical and MRI findings well and by their selves! The differential diagnosis of MS includes MS variants and inflammatory astrocytopathies and other atypical inflammatory-demyelinating syndromes, as well as a number of systemic diseases with CNS involvement...
February 2018: Neurologic Clinics
https://www.readbyqxmd.com/read/29157404/anomalies-characteristic-of-central-nervous-system-demyelination-radiologically-isolated-syndrome
#3
REVIEW
Christine Lebrun, Orhun H Kantarci, Aksel Siva, Daniel Pelletier, Darin T Okuda
Radiologically isolated syndrome (RIS) was defined in 2009 for asymptomatic patients who presented incidentally identified white matter anomalies within the central nervous system suggestive of multiple sclerosis (MS). Approximately one-third of RIS subjects will have a seminal clinical demyelinating event within 5 years of the identification of their abnormal MRI. Clinical evolution mirrors relapsing remitting or progressive forms of MS. Pejorative factors for clinical conversion are male gender, age younger than 35 years, and spinal cord lesions...
February 2018: Neurologic Clinics
https://www.readbyqxmd.com/read/29157403/spinal-cord-mri-in-multiple-sclerosis
#4
REVIEW
Alexandra Muccilli, Estelle Seyman, Jiwon Oh
Spinal cord (SC) MRI in multiple sclerosis (MS) has significant usefulness in clinical and investigational settings. Conventional MRI of the SC is used in clinical practice, because it has both diagnostic and prognostic value. A number of advanced, quantitative SC MRI measures that assess the structural and functional integrity of the SC have been evaluated in investigational settings. These techniques have collectively demonstrated usefulness in providing insight into microstructural and functional changes relevant to disability in MS...
February 2018: Neurologic Clinics
https://www.readbyqxmd.com/read/29157402/effective-utilization-of-mri%C3%A2-in-the-diagnosis-and-management-of-multiple-sclerosis
#5
REVIEW
Antonio Giorgio, Nicola De Stefano
MRI is the most important tool for diagnosis and management of patients with multiple sclerosis (MS). MRI shows high sensitivity for detection of white matter lesions in the central nervous system and specificity for lesion dissemination in space and time. MRI is also used for tracking disease activity, prognostic evaluation, and monitoring the efficacy and safety of disease-modifying treatments. Nonconventional MRI measures (eg, brain atrophy) and quantitative measures of advanced MRI can capture features of MS beyond WM lesions but are not currently implemented in clinical practice...
February 2018: Neurologic Clinics
https://www.readbyqxmd.com/read/29157401/multiple-sclerosis-in-the-contemporary-age-understanding-the-millennial-patient-with-multiple-sclerosis-to-create-next-generation-care
#6
REVIEW
Madison R Hansen, Darin T Okuda
The average age of onset of multiple sclerosis (MS) is between 20 and 40 years of age. Therefore, most new patients diagnosed with MS within the next 10 to 15 years will be from the millennial generation, representing those born between 1982 and 2000. Certain preferences and trends of this contemporary generation will present new challenges to the MS physician and effective MS care. By first understanding these challenges, relevant and successful solutions can be created to craft a system of care that best benefits the millennial patient with MS...
February 2018: Neurologic Clinics
https://www.readbyqxmd.com/read/29157400/advanced-symptom-management-in-multiple-sclerosis
#7
REVIEW
Elizabeth Crabtree-Hartman
Meaningful symptom management can have a profound impact on quality of life. It can challenge time parameters during clinic, and therefore thought should be given to strategies that can improve efficiency and thereby make the undertaking more tenable. For any given symptom, the building blocks of care, such as vitamin D status, exercise/physical therapy, nutrition, and stress management, and ensuring disease-modifying therapy coverage, should be maximized. For each symptom, there are pharmacologic and nonpharmacologic interventions...
February 2018: Neurologic Clinics
https://www.readbyqxmd.com/read/29157399/the-dynamics-of-the-gut-microbiome-in-multiple-sclerosis-in-relation-to-disease
#8
REVIEW
Ellen M Mowry, Justin D Glenn
Multiple sclerosis (MS) is a neuroinflammatory autoimmune disease of unknown etiology, although genetic components and environmental triggers are thought to collude to commence pathogenesis. Numerous investigations are now demonstrating the role of the gut microbiota in neuroinflammation and how alterations in its content may be associated with MS disease. This article explores the studies using MS rodent models to determine the roles of gut bacteria in neuroinflammatory disease, evaluate the evidence linking gut bacterial dysbiosis and MS, and give insight into potential MS therapies targeting the gut microbiota currently under investigation...
February 2018: Neurologic Clinics
https://www.readbyqxmd.com/read/29157398/new-advances-in-disease-modifying-therapies-for-relapsing-and-progressive-forms-of-multiple-sclerosis
#9
REVIEW
Angela Vidal-Jordana
Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system in which inflammation, demyelination, and axonal loss occurs from early stages of the disease. It mainly affects people between 20 and 40 years old, with a female predominance. Treatment options have been increasingly growing in the past years and newer drugs, some with novel mechanisms of action, are being developed for treating patients with MS. There is an increasing interest in developing new drugs that will promote neuroprotection and/or myelin repair through different mechanisms of action that may target the most degenerative component of the disease...
February 2018: Neurologic Clinics
https://www.readbyqxmd.com/read/29157397/progressive-forms-of-multiple-sclerosis-distinct-entity-or-age-dependent-phenomena
#10
REVIEW
Burcu Zeydan, Orhun H Kantarci
In multiple sclerosis (MS), disease course is defined by a subclinical or clinical relapsing remitting phase, a progressive phase, and the overlapping phase in-between. Each phase can have intermittently active or inactive periods. Subclinical activity in radiologically isolated syndrome evolving to primary-progressive MS is mostly indistinguishable from relapsing-remitting MS evolving to secondary-progressive MS. The onset of progressive-phase MS is age-dependent but time and pre-progressive phase agnostic...
February 2018: Neurologic Clinics
https://www.readbyqxmd.com/read/29157396/ethnic-considerations-and-multiple-sclerosis-disease-variability-in-the-united-states
#11
REVIEW
Erica Rivas-Rodríguez, Lilyana Amezcua
Minorities in the United States such as African Americans and Hispanics may have more severe disease than non-Hispanic whites. Factors contributing to these disparities are reviewed. The variations in disability from non-Hispanic whites may be the result of differences in clinical presentation, genetic underpinnings, and sociocultural factors. Creating awareness and increasing participation in research studies may improve our understanding.
February 2018: Neurologic Clinics
https://www.readbyqxmd.com/read/29157395/pediatric-multiple-sclerosis-from-recognition-to-practical-clinical-management
#12
REVIEW
Cynthia X Wang, Benjamin M Greenberg
Pediatric-onset multiple sclerosis (MS) is a rare but increasingly recognized condition that both parallels and diverges from adult-onset MS. Exposure to key risk determinants for MS disease pathogenesis may occur during childhood. The diagnosis of pediatric MS can be challenging due to potential for atypical presentations and a broad differential diagnosis. MS disease-modifying therapies have not been rigorously studied in children and raise difficult questions on how to manage a chronic inflammatory neurologic disease in a population of patients with developing central nervous and immune systems...
February 2018: Neurologic Clinics
https://www.readbyqxmd.com/read/29157394/new-insights-into-multiple-sclerosis-clinical-course-from-the-topographical-model-and-functional-reserve
#13
REVIEW
Stephen C Krieger, James Sumowski
Clinical course in multiple sclerosis (MS) is difficult to predict on group and individual levels. We discuss the topographical model of MS as a new approach to characterizing the clinical course, with the potential to personalize disability progression based on each individual patient's pattern of disease burden (eg, lesion location) and reserve. The dynamic clinical threshold depicted in this visual model may help clinicians to educate patients about clinical phenotype and disease burden, and foster an understanding of the difference between relapses and pseudoexacerbations...
February 2018: Neurologic Clinics
https://www.readbyqxmd.com/read/29157393/new-concepts-related-to-disease-appreciation-in-multiple-sclerosis
#14
REVIEW
Christina J Azevedo, Amirhossein Jaberzadeh, Daniel Pelletier
In the past several decades, MRI has become an indispensable tool in the field of multiple sclerosis (MS) for clinicians and researchers. However, the MS field still faces several challenges. This review focuses on 2 current areas of difficulty: 1) discriminating MS from other diseases when the clinical history and imaging features are atypical or nonspecific, and 2) the lack of quantitative imaging metrics with which to follow MS patients over time in clinical practice. This review highlights promising MRI and postprocessing techniques that have potential applications in these areas...
February 2018: Neurologic Clinics
https://www.readbyqxmd.com/read/29157392/multiple-sclerosis-mechanisms-of-disease-and-strategies-for-myelin-and-axonal-repair
#15
REVIEW
Hernan Nicolas Lemus, Arthur E Warrington, Moses Rodriguez
Multiple sclerosis is an inflammatory demyelinating disease of the central nervous system with a variety of presentations and unclear pathogenesis. Multiple sclerosis has been associated with the term autoimmunity as a surrogate for pathogenesis. Multiple sclerosis is an organ-specific disease with immune-mediated myelin destruction. Understanding the complex etiology of multiple sclerosis and the importance of axon integrity is critical for clinicians who treat the disease. This review discusses the immune and autoimmune aspects of multiple sclerosis based on the current published data and novel evidence of strategies that promote remyelination and protect axons...
February 2018: Neurologic Clinics
https://www.readbyqxmd.com/read/28962817/the-evolution-of-neurocritical-care
#16
EDITORIAL
Alejandro A Rabinstein
No abstract text is available yet for this article.
November 2017: Neurologic Clinics
https://www.readbyqxmd.com/read/28962816/shared-decision-making-in-neurocritical-care
#17
REVIEW
Muhammad Waqas Khan, Susanne Muehlschlegel
Shared decision making is a collaborative decision-making process between health care providers and patients or their surrogates, taking into account the best scientific evidence available while considering the patient's values, goals, and preferences. Decision aids are tools enabling SDM. This article discusses shared decision making in general and in the intensive care unit in particular and facilitators and barriers for the creation and implementation of International Patient Decision Aids Standards Collaboration-compliant decision aids for the intensive care unit and neuro-intensive care unit...
November 2017: Neurologic Clinics
https://www.readbyqxmd.com/read/28962815/neurologic-complications-of-solid-organ-transplantation
#18
REVIEW
Michael Pizzi, Lauren Ng
Among patients receiving solid organ transplants, approximately one-third will develop neurologic symptoms. Most of these neurologic symptoms will occur within 30 days of their transplantation. These neurologic symptoms include neurotoxicity of immunosuppressive agents, seizures, encephalopathy, cerebrovascular events, opportunistic infections, posttransplant lymphoproliferative disorder, and central pontine myelinosis. Some neurologic complications are seen more frequently in specific organ transplant recipients...
November 2017: Neurologic Clinics
https://www.readbyqxmd.com/read/28962814/nosocomial-infections-in-the-neurointensive-care-unit
#19
REVIEW
Katharina Maria Busl
Infectious complications in the neurointensive care unit (neuro-ICU) are common, including pneumonia, urinary tract infection, bloodstream infection, and intracranial infection. The neuro-ICU population poses a specific challenge in the diagnosis of infections, because of the high incidence of fever in acutely brain-injured patients. Furthermore, susceptibility to infections is likely enhanced by brain-injury (induced immune modulation). This article reviews the concept of brain injury-induced immune modulation, and summarizes available data and knowledge on nosocomial meningitis and ventriculitis, and systemic infectious complications in patients with traumatic brain injury, ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and status epilepticus...
November 2017: Neurologic Clinics
https://www.readbyqxmd.com/read/28962813/acute-cardiac-complications-in-critical-brain-disease
#20
REVIEW
Juan G Ripoll, Joseph L Blackshear, José L Díaz-Gómez
Acute cardiac complications in critical brain disease should be understood as a clinical condition representing an intense brain-heart crosstalk and might mimic ischemic heart disease. Two main entities (neurogenic stunned myocardium [NSM] and stress cardiomyopathy) have been better characterized in the neurocritically ill patients and they portend worse clinical outcomes in these cases. The pathophysiology of NSM remains elusive. However, significant progress has been made on the early identification of neurocardiac compromise following acute critical brain disease...
November 2017: Neurologic Clinics
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