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Current Treatment Options in Neurology

Aaro V Salminen, Juliane Winkelmann
PURPOSE OF REVIEW: The purpose of this review article is to summarize and discuss the recent advances in the treatment of restless legs syndrome (RLS), as well as REM sleep behavior disorder (RBD), and periodic leg movement disorder (PLMD). RECENT FINDINGS: Traditionally, dopaminergic therapy has been considered the sole option for first-line treatment of RLS due to their impressive acute efficacy. Dopamine agonists such as oral pramipexole and ropinirole, as well as transdermal rotigotine are all effective treatment options...
November 9, 2018: Current Treatment Options in Neurology
Ronald F Pfeiffer
PURPOSE OF REVIEW: During the past 25 years, there has been an explosion of information regarding the occurrence of gastrointestinal dysfunction in Parkinson's disease. In this review, the clinical features of gastrointestinal dysfunction in Parkinson's disease will be described and information regarding the potential role of the enteric nervous system and the gut microbiome in the genesis of Parkinson's disease will be addressed. RECENT FINDINGS: Recognition is growing regarding the role that gastroparesis and small intestinal dysfunction may play in Parkinson's disease, especially with regard to erratic responses to anti-Parkinson medication...
October 25, 2018: Current Treatment Options in Neurology
Arseny A Sokolov, Petr Grivaz, Riley Bove
PURPOSE OF REVIEW: This article highlights recent progress in research on treatment and neurorehabilitation of cognitive impairment in multiple sclerosis (MS) including pharmacological interventions, physical exercise, and neuropsychological rehabilitation, both in conventional and technology-assisted settings. RECENT FINDINGS: The most consistent evidence in terms of improvement or preservation of circumscribed cognitive scores in MS patients comes from moderately sampled randomized clinical trials on multimodal approaches that combine conventional or computerized neuropsychological training with psychoeducation or cognitive behavioral therapy...
October 22, 2018: Current Treatment Options in Neurology
Julie Ziobro, Krista Eschbach, Joseph E Sullivan, Kelly G Knupp
PURPOSE OF REVIEW: Dravet syndrome is a rare but severe genetic epilepsy that has unique treatment challenges. This is a review of current and future potential treatment options. RECENT FINDINGS: Treatment for Dravet syndrome should encompass many aspects of the syndrome such as gait, behavior, and nutrition, as well as focus on seizure control. Many sodium channel blockers should be avoided as they are likely to exacerbate seizures. Current options for treatment include valproic acid, clobazam, stiripentol, and ketogenic diet...
October 13, 2018: Current Treatment Options in Neurology
Amy E Vinson, Constance S Houck
PURPOSE OF REVIEW: The purpose of this review is to summarize the current evidence regarding the impact of the exposure to anesthetic and sedative agents on neurodevelopment during the period of rapid brain growth in the first 3 years of life. Though much of the definitive data demonstrating anesthesia-induced neurotoxicity has come from studies in young animals, the focus of this review is on emerging human data. RECENT FINDINGS: In 2016, the first prospective trials investigating the neurodevelopmental impact of early anesthetic exposure (GAS and PANDA studies) were published, both showing no significant impact on IQ from a single brief anesthetic...
October 13, 2018: Current Treatment Options in Neurology
Stoyan Popkirov, Jon Stone, Dagny Holle-Lee
PURPOSE OF REVIEW: Persistent postural-perceptual dizziness (PPPD) is a newly defined disorder of functional dizziness that in the International Classification of Diseases in its 11th revision (ICD-11) supersedes phobic postural vertigo and chronic subjective dizziness. Despite efforts to unify the diagnosis of functional (somatoform) dizziness, patients will present with a variety of triggers, perpetuating factors, and comorbidities, requiring individualized treatment. This article will review different treatment strategies for this common functional neurological disorder and provide practical recommendations for tailored therapy...
October 13, 2018: Current Treatment Options in Neurology
Michael I Nahhas, David C Hess
PURPOSE OF REVIEW: The purpose of this article is to provide a review of state-of-the-art cellular therapy in cerebrovascular diseases by discussing published and ongoing clinical trials. RECENT FINDINGS: In spite of the challenge in translating the success of cellular therapy in acute strokes from preclinical models to clinical trials, early phase clinical trial have recently shown promise in overcoming these challenges. Various stem cell types and doses are being studied, different routes of administration are under investigation, as well as defining the optimal time window to intervene...
October 9, 2018: Current Treatment Options in Neurology
Joseph T Daley, Jennifer L DeWolfe
PURPOSE OF REVIEW: There is a known interrelationship between sleep and epilepsy. This review highlights the recent findings regarding interactions between sleep and circadian rhythms and the manifestations of epilepsy and surgical treatments for refractory epilepsy. RECENT FINDINGS: CLOCK gene expression may be reduced within the epileptogenic focus in patients with refractory epilepsy. Interictal epileptiform discharges during NREM and especially REM sleep may lateralize to the epileptogenic hemisphere...
September 27, 2018: Current Treatment Options in Neurology
Bicky Thapa, Adam Lauko, Kunal Desai, Vyshak Alva Venur, Manmeet S Ahluwalia
PURPOSE OF REVIEW: Brain metastases are frequent complication of lung cancer and are associated with poor prognosis. Patients with brain metastases secondary to lung cancer have traditionally been managed with surgery and radiation with limited role for systemic chemotherapy. In the past decade, however, this paradigm has shifted largely due to the advent of targeted therapies and immunotherapies, both of which have demonstrated efficacy in the treatment of brain metastases and extracranial disease...
September 27, 2018: Current Treatment Options in Neurology
Valérie Cochen De Cock, Nadège Girardot-Tinant, France Woimant, Aurélia Poujois
PURPOSE OF REVIEW: The aim of this article was to review the different sleep disorders associated with Wilson's disease (WD), their mechanisms and their treatments. RECENT FINDINGS: Some of these disorders such as REM sleep behavior disorder or sleepiness can appear as a prodromal phase phenomenon in WD allowing an early treatment of the disease and sometimes a resolution of the sleep disorder. Sleep disorders in WD are frequent combining insomnia, daytime sleepiness, restless legs syndrome (RLS), cataplexy-like episodes, and REM sleep behavior disorder (RBD)...
September 27, 2018: Current Treatment Options in Neurology
Karla Alejandra Mora Rodríguez, Selim R Benbadis
PURPOSE OF REVIEW: The purpose of this review is to summarize and discuss available information on the management of epilepsy patients on renal replacement therapy. Older and newer antiepileptic drugs (AEDs) pharmacology will be reviewed, as well as the need to supplement dosages during or after hemodialysis, peritoneal dialysis, and continuous renal replacement treatment. RECENT FINDINGS: The great majority of anticonvulsants have been studied in patients with renal failure...
September 27, 2018: Current Treatment Options in Neurology
Erin Feinstein, Ruth Walker
PURPOSE OF REVIEW: There are many causes for chorea, including genetic, autoimmune, pharmacological, and structural lesions. Where appropriate, treatment is based on reversing the underlying cause of chorea; many cases are self-limited, resolving when the primary disorder is treated. This review focuses on the management of chorea due to untreatable causes. RECENT FINDINGS: There are a limited number of double-blind randomized control trials assessing the efficacy of specific chorea treatments...
September 25, 2018: 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
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