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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
Cheran Elangovan, Adeolu Morawo, Aiesha Ahmed
PURPOSE OF REVIEW: Peripheral nerve hyperexcitability (PNH) syndromes are divided into primary and secondary groups based on the presence or absence of demonstrable peripheral nerve disease. In this review, we systematically evaluate the evidence for current therapies and supportive managements based on autoimmune, paraneoplastic, and genetic components in pathophysiology reported in the literature. RECENT FINDINGS: Current therapy options are based on symptomatic management as well as focusing the underlying immune/genetic/paraneoplastic pathology by immunosuppressants, chemotherapy, and surgery...
May 28, 2018: Current Treatment Options in Neurology
Si Un Lee, Chang Wan Oh, O-Ki Kwon, Jae Seung Bang, Seung Pil Ban, Hyoung Soo Byoun, Tackeun Kim
PURPOSE OF REVIEW: Moyamoya disease (MMD) is being increasingly diagnosed with the development of radiological surveillance technology and increased accessibility to medical care. Accordingly, there have been several recent reports on treatment outcomes in MMD. In this review, we summarize recent advances in surgical treatment and outcomes of adult MMD, while addressing related controversies. RECENT FINDINGS: Recent studies suggest that revascularization surgery leads to significantly more favorable outcomes for stroke prevention, angiographic and hemodynamic changes, and clinical outcomes than does conservative treatment for adult patients with ischemic MMD...
May 28, 2018: Current Treatment Options in Neurology
Ina Terón, Melissa S Eng, Jeffrey M Katz
PURPOSE OF REVIEW: Treatment recommendations for pregnancy associated ischemic stroke are scarce. This may be due to the fact that, in general, obstetricians tend not to make recommendations for stroke patients and neurologists are not commonly involved in the care of pregnant women. Herein, we review the multiple etiologies of ischemic stroke during pregnancy, considerations for diagnostic testing, and acute treatment and prevention options, including associated risks specific to the pregnant and puerperal state...
May 21, 2018: Current Treatment Options in Neurology
Anson Wang, Santiago Ortega-Gutierrez, Nils H Petersen
PURPOSE OF REVIEW: The purpose of this review is to briefly describe the concept of cerebral autoregulation, to detail several bedside techniques for measuring and assessing autoregulation, and to outline the impact of impaired autoregulation on clinical and functional outcomes in acute brain injury. Furthermore, we will review several autoregulation studies in select forms of acute brain injuries, discuss the potential for its use in patient management in the ICU, and suggest further avenues for research...
May 17, 2018: Current Treatment Options in Neurology
Grace Y Gombolay, Tanuja Chitnis
PURPOSE OF REVIEW: Neuromyelitis optica spectrum disorders (NMOSDs) are a group of inflammatory and demyelinating disorders of the central nervous system that can occur in children and adults. The classic presentation of NMOSD is characterized by optic neuritis and transverse myelitis, but other presentations are also recognized, expanding the disease as NMO spectrum disorders. The purpose of this review is to discuss the clinical features, along with management and treatment options, including potential future therapeutic options, in pediatric NMOSD...
May 2, 2018: Current Treatment Options in Neurology
Vilija G Jokubaitis, Yuan Zhou, Helmut Butzkueven, Bruce V Taylor
PURPOSE OF REVIEW: This review will examine the current evidence that genetic and/or epigenetic variation may influence the multiple sclerosis (MS) clinical course, phenotype, and measures of MS severity including disability progression and relapse rate. RECENT FINDINGS: There is little evidence that MS clinical phenotype is under significant genetic control. There is increasing evidence that there may be genetic determinants of the rate of disability progression...
April 24, 2018: Current Treatment Options in Neurology
Valérie Cochen De Cock
PURPOSE OF REVIEW: The purpose of this review was to explore the different sleep disorders associated with MSA, their mechanisms, and their treatments. RECENT FINDINGS: Stridor is a red flag for the diagnosis of MSA. Recent findings show that its presence in early stage of the disease is associated with a reduction in life expectancy. Its management should be fast and adapted. Its treatment with continuous positive airway pressure or tracheostomy is efficacious...
April 20, 2018: Current Treatment Options in Neurology
Tim Sinnecker, Cristina Granziera, Jens Wuerfel, Regina Schlaeger
PURPOSE OF REVIEW: Volumetric analysis of brain imaging has emerged as a standard approach used in clinical research, e.g., in the field of multiple sclerosis (MS), but its application in individual disease course monitoring is still hampered by biological and technical limitations. This review summarizes novel developments in volumetric imaging on the road towards clinical application to eventually monitor treatment response in patients with MS. RECENT FINDINGS: In addition to the assessment of whole-brain volume changes, recent work was focused on the volumetry of specific compartments and substructures of the central nervous system (CNS) in MS...
April 20, 2018: Current Treatment Options in Neurology
Gamaleldin M Osman, Davi F Araújo, Carolina B Maciel
PURPOSE OF REVIEW: To present data available on the epidemiology and significance of rhythmic and periodic patterns that lie on the ictal interictal continuum and propose an algorithm for the clinical approach to patients exhibiting these patterns. RECENT FINDINGS: There is accumulating evidence on the prognostic implications of various rhythmic and periodic patterns in the critically ill population. These patterns are not only associated with increased seizure risk but have also been associated with worse outcome and increased long-term risk of epilepsy in recent studies...
April 18, 2018: Current Treatment Options in Neurology
Sylvia C Kurz, Patrick Y Wen
PURPOSE OF REVIEW: More effective therapies for glioblastoma are urgently needed. Immunotherapeutic strategies appear particularly promising and are therefore intensively studied. This article reviews the current understanding of the immunosuppressive glioblastoma microenvironment, discusses the rationale behind various immunotherapies, and outlines the findings of several recently published clinical studies. RECENT FINDINGS: The results of CheckMate-143 indicated that nivolumab is not superior to bevacizumab in patients with recurrent glioblastoma...
April 18, 2018: Current Treatment Options in Neurology
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