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Current Treatment Options in Neurology

Stephen Keddie, Thomas Parker, Helen J Lachmann, Lionel Ginsberg
PURPOSE OF REVIEW: The purpose of this review is to highlight the molecular and clinical characteristics of the cryopyrin-associated periodic fever syndrome (CAPS) and its management. CAPS is an autosomal dominantly inherited autoinflammatory disorder associated with mutations in the NLRP3 gene, which ultimately lead to excessive production of interleukin-1β (IL-1β) and systemic inflammation. Typical systemic features include fever, urticarial rash and arthralgia, and ultimately amyloidosis...
September 3, 2018: Current Treatment Options in Neurology
Anthony J Brune, Eric R Eggenberger
PURPOSE OF REVIEW: The purpose of this review is to summarize current understanding regarding disorders of gaze with comitant ocular misalignment at distance or near and a full range of extraocular movement. Emphasis is placed on clinical features that may be used to differentiate underlying neurologic disease from the more common benign causes. The approach to the diagnostic evaluation and treatment is discussed. RECENT FINDINGS: Randomized controlled trials and Cochrane review suggest the superiority of formal office-based vision therapy in treating convergence insufficiency in children...
August 23, 2018: Current Treatment Options in Neurology
Nisali Gunawardane, Madeline Fields
PURPOSE OF REVIEW: Acute symptomatic and provoked seizures by definition occur in close proximity to an event and are considered to be situational. The treatment implications and likelihood of recurrence of acute symptomatic and provoked seizures differ from unprovoked seizures. In this article, the authors review the literature on acute symptomatic and provoked seizures with regard to therapeutic approach and risk of recurrence. RECENT FINDINGS: In the acute period, patients who suffer from acute symptomatic and provoked seizures have higher rates of morbidity and mortality...
August 23, 2018: Current Treatment Options in Neurology
Lance Watkins, Rohit Shankar
PURPOSE OF REVIEW: Recent reports have highlighted an increase in the number of epilepsy-related deaths. Sudden unexpected death in epilepsy (SUDEP) is thought to be the number one cause of death in chronic epilepsy. This review provides a summary of the current evidence of how to communicate, stratify, and mitigate known risk factors for SUDEP. RECENT FINDINGS: There is now a clearer understanding of the possible pathological mechanisms that contribute to SUDEP...
August 22, 2018: Current Treatment Options in Neurology
Mollie McDermott, Cemal B Sozener
PURPOSE OF REVIEW: We discuss the evidence and guidelines for acute blood pressure (BP) management for patients presenting with acute ischemic stroke or spontaneous cerebral hemorrhage. RECENT FINDINGS: Observational data suggest that the extremes of BP should be avoided in patients presenting with acute ischemic stroke. There is no convincing evidence that active BP reduction results in improved outcomes for ischemic stroke patients. Current guidelines recommend that BP be maintained ≤ 185/110 mmHg in patients who are candidates for intravenous tissue plasminogen activator (IV tPA) or mechanical thrombectomy and that BP be maintained ≤ 180/105 mmHg for at least 24 h in patients who have received IV tPA or have undergone mechanical thrombectomy...
August 18, 2018: Current Treatment Options in Neurology
Kaustubh Limaye, Edgar A Samaniego, Harold P Adams
PURPOSE OF REVIEW: Primary central nervous system angiitis (PCNSA) is a rare disease. Varying clinical pictures coupled with lack of sensitive and specific diagnostic tests lead to challenges in management of these patients. This unfortunately may lead to both under- or over-diagnosis and unnecessary treatment. It is important to recognize the different conditions that may mimic the clinical and radiologic presentation. We present a contemporary literature review that should update physicians who encounter this patient population...
August 4, 2018: Current Treatment Options in Neurology
Namita A Goyal, Tahseen Mozaffar
PURPOSE OF REVIEW: The purpose of this review is to update the audience on the recent progress in the treatment of idiopathic inflammatory myopathies, highlighting a myriad of treatment trials aimed at slowing down progression of muscle weakness and/or skin involvement in idiopathic inflammatory myopathies. RECENT FINDINGS: Myositis continues to be an active area of clinical and translational research. Through the work of a number of investigators, we now have a much better understanding of the pathogenesis underlying the various myositides...
July 23, 2018: Current Treatment Options in Neurology
David Whitney, Danish Bhatti, Diego Torres-Russotto
PURPOSE OF REVIEW: Orthostatic tremor (OT) is a rare disorder characterized by tremor and a feeling of unsteadiness while standing that resolve upon walking or sitting. A pathognomonic 13-18 Hz tremor is seen on surface EMG while standing. Though its clinical features have been better defined over time, much of its pathophysiology remains unknown and treatment options are limited. We review here recent developments in both of these areas. RECENT FINDINGS: Several recent studies have furthered our understanding of the central oscillatory network involved in OT...
July 21, 2018: Current Treatment Options in Neurology
Constantine Farmakidis, Mamatha Pasnoor, Richard J Barohn, Mazen M Dimachkie
PURPOSE OF REVIEW: Congenital myasthenia syndromes are clinically and genetically heterogeneous but treatable conditions. Careful selection of drug therapy is paramount as the same drug can be effective, ineffective, and even harmful in different congenital myasthenia syndromes. The purpose of this article is to review current treatment options for these conditions. RECENT FINDINGS: Next-generation sequencing has accelerated the discovery of new genes and facilitated the description of novel congenital myasthenic syndromes...
July 21, 2018: Current Treatment Options in Neurology
Elena I Fomchenko, Emily J Gilmore, Charles C Matouk, Jason L Gerrard, Kevin N Sheth
PURPOSE OF REVIEW: Management of patients with subdural hematomas starts with Emergency Neurological Life Support guidelines. Patients with acute or chronic subdural hematomas (SDHs) associated with rapidly deteriorating neurologic exam, unilaterally or bilaterally dilated nonreactive pupils, and extensor posturing are considered imminently surgical; likewise, SDHs more than 10 mm in size or those associated with more than 5-mm midline shift are deemed operative. RECENT FINDINGS: While twist drill craniostomy and placement of subdural evacuating vport system (SEPS) are quick, bedside procedures completed under local anesthesia and appropriate for patients with chronic SDH or patients that cannot tolerate anesthesia, these techniques are not optimal for patients with acute SDH or chronic SDH with septations...
July 18, 2018: Current Treatment Options in Neurology
Roberta Rudà, Francesco Bruno, Riccardo Soffietti
PURPOSE OF REVIEW: The management of low-grade gliomas (grade II WHO) is still controversial, due to the rarity of these tumors and continuous advances in molecular diagnosis and new technologies for treatment. This article reviews the current understanding of management of grade II gliomas in light of the recent clinical and translational studies. RECENT FINDINGS: The role of an extensive surgery at onset is now fully recognized. Recent clinical trials in the USA and Europe have demonstrated the importance of chemotherapy either in association with radiotherapy or as initial treatment to delay the risk of cognitive defects following radiation...
July 4, 2018: Current Treatment Options in Neurology
Anna Heidbreder, Konstanze Philipp
PURPOSE OF REVIEW: This review aims to give an overview about the current knowledge of this novel neurological disorder associated to IgLON-5 antibodies and its treatment. RECENT FINDINGS: Anti-IgLON5 disease was first formally described in 2014. This newly discovered disorder recaps a complex neurological disorder with sleep, movement, and neuroimmunological and neurodegenerative aspects. The clinical manifestation of the anti-IgLON5 disease is very heterogeneous mostly including a sleep disorder with non-rapid eye movement (REM) sleep parasomnia and REM behavior disorder besides obstructive sleep apnea syndrome and stridor...
June 23, 2018: Current Treatment Options in Neurology
Tarun Girotra, Forrest Lowe, Wuwei Feng, Bruce Ovbiagele
PURPOSE OF REVIEW: This narrative review critically evaluated the published studies regarding the systematic use of antiplatelet agents for secondary stroke prevention. RECENT FINDINGS: Stroke is a leading cause of morbidity and mortality around the world. Multimodal prevention is the most viable strategy for reducing the societal burden of stroke recurrence. For secondary stroke prevention, antiplatelet therapy is at the core of effective long-term vascular risk reduction among survivors of an ischemic stroke or transient ischemic attack (TIA)...
June 23, 2018: Current Treatment Options in Neurology
Joseph Savitt, Michaela Mathews
PURPOSE OF REVIEW: This article discusses visual disorders in both Parkinson disease (PD) and other Parkinsonian disorders. It is organized largely by the anatomical site of pathology and emphasizes practical treatments. Targeted treatment options include medications, surgery, occupational, and physical therapies as well as optical aids. RECENT FINDINGS: The causes of visual complaints in Parkinson disease and other similar disorders are being more clearly identified...
June 23, 2018: Current Treatment Options in Neurology
Megan Crone, Jean K Mah
PURPOSE OF REVIEW: The purpose of this review is to summarize the current and emerging therapies for Duchenne muscular dystrophy (DMD). RECENT FINDINGS: Coinciding with new standardized care guidelines, there are a growing number of therapeutic options to treat males with DMD. Treatment of the underlying pathobiology, such as micro-dystrophin gene replacement, exon skipping, stop codon read-through agents, and utrophin modulators showed variable success in animal and human studies...
June 23, 2018: Current Treatment Options in Neurology
Elena I Fomchenko, Emily J Gilmore, Charles C Matouk, Jason L Gerrard, Kevin N Sheth
PURPOSE OF REVIEW: Subdural hematomas (SDH) represent common neurosurgical problem associated with significant morbidity, mortality, and high recurrence rates. SDH incidence increases with age; numbers of patients affected by SDH continue to rise with our aging population and increasing number of people taking antiplatelet agents or anticoagulation. Medical and surgical SDH management remains a subject of investigation. RECENT FINDINGS: Initial management of patients with concern for altered mental status with or without trauma starts with Emergency Neurological Life Support (ENLS) guidelines, with a focus on maintaining ICP < 22 mmHg, CPP > 60 mmHg, MAP 80-110 mmHg, and PaO2 > 60 mmHg, followed by rapid sequence intubation if necessary, and expedited acquisition of imaging to identify a space-occupying lesion...
June 23, 2018: Current Treatment Options in Neurology
Ava Y Lin, Leo H Wang
PURPOSE OF REVIEW: To construct a framework to understand the different molecular interventions for muscular dystrophy. RECENT FINDINGS: The recent approval of antisense oligonucleotides treatment for Duchenne muscular dystrophy and spinal muscular atrophy and current clinical trials using recombinant adeno-associated virus for the treatment of those diseases suggests that we are at a tipping point where we are able to treat and potentially cure muscular dystrophies...
June 21, 2018: Current Treatment Options in Neurology
Raffaele Manni, Gianpaolo Toscano, Michele Terzaghi
PURPOSE OF REVIEW: The purpose of this review was to discuss the currently available pharmacologic and non-pharmacologic treatment options for parasomnias. RECENT FINDINGS: Recent pathophysiological findings about sleep structure in parasomnias helped understanding several drug mechanisms of action. Serotoninergic theory accounts for the effect of serotoninergic drugs. Study about spectral analysis of sleep showed the effect of clonazepam on spectral bands. Cannabinoids proved to be effective in some of parasomnias, as in many other neurological disorders...
June 5, 2018: Current Treatment Options in Neurology
Mark A Ferrante
PURPOSE OF REVIEW: The purpose of this review is to discuss the therapeutic options available in the treatment of traumatic injuries involving peripheral nerves. RECENT FINDINGS: For nerve gap repair, synthetic nerve tubes are limited to gaps below 3 cm in length and to small-diameter nerve repairs, whereas the dependency on proliferating host Schwann cell limits the size of acellularized autografts. Thus, in most situations, nerve autografts remain superior for nerve gap correction...
June 1, 2018: Current Treatment Options in Neurology
Sivashakthi Kanagalingam, Prem S Subramanian
PURPOSE OF REVIEW: This review presents a critical appraisal of current therapeutic strategies for patients with idiopathic intracranial hypertension (IIH). We present the reader with the most recent evidence to support medical and surgical interventions in patients with IIH and provide recommendations about treatment initiation and escalation. We also indicate areas where knowledge gaps exist regarding therapeutic efficacy and superiority of one intervention over another. RECENT FINDINGS: A double-masked, randomized prospective study of medical management of patients with mild IIH (Idiopathic Intracranial Hypertension Treatment Trial-IIHTT) has established that acetazolamide therapy has additional efficacy when compared to weight loss alone...
May 28, 2018: Current Treatment Options in Neurology
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