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Current Treatment Options in Neurology

Luis Castilla-Guerra, María Del Carmen Fernandez-Moreno, David Leon-Jimenez, Miguel Angel Rico-Corral
PURPOSE OF REVIEW: We describe the current status of lipid-lowering therapies for ischemic stroke prevention. The SPARCL trial published in 2006 has been a landmark study in vascular neurology. The trial demonstrated that high-dose atorvastatin prevents recurrent stroke, and led the AHA/ASA to recommend statin therapy for patients with stroke or TIA of atherosclerotic origin. RECENT FINDINGS: Recently, the J-STARS study demonstrated that therapy with low-dose pravastatin reduced atherothrombotic infarction incidence among patients with prior ischemic stroke...
April 8, 2019: Current Treatment Options in Neurology
Maria Livia Fantini, Franck Durif, Ana Marques
PURPOSE OF REVIEW: This paper reviews clinical and pathophysiological features of both impulse control disorders (ICDs) and REM sleep behavior disorder (RBD) in Parkinson's disease (PD), as well as current evidences of their association. Then, we suggest recommendations to manage PD patients with RBD in order to prevent this potentially devastating psychiatric complication. RECENT FINDINGS: ICDs are psychiatric complications occurring in patients with Parkinson's disease (PD) treated with dopaminergic replacement therapies (DRT)...
April 8, 2019: Current Treatment Options in Neurology
Marc E Lenaerts, Tiffany H Green
PURPOSE OF THE REVIEW: The role of onabotulinumtoxinA in headache management was serendipitously found over a decade ago and approved for chronic migraine in 2010 based on pivotal studies. The purpose of this review is to highlight the impact on headache and other health parameters which is critically reviewed, as well as the putative mechanisms of action. RECENT FINDINGS: OnabotulinumtoxinA is effective in migraine, not only headache frequency and pain intensity but also other health parameters including quality of life...
April 4, 2019: Current Treatment Options in Neurology
Arash Danesh, P Christopher H Gottschalk
PURPOSE OF REVIEW: This review seeks to establish the role of beta-blockers (B-adrenergic receptor antagonists) in the pathophysiology of migraine prophylaxis, compare the efficacy of this group of medications with other common prophylactic agents, and also explore the relative benefits of using individual beta-blockers compared with others. RECENT FINDINGS: New evidence supports beta-blockers having several mechanisms of action in migraine prophylaxis. Numerous trials reveal significant clinical differences between various beta-blockers in migraine prophylaxis and that commonly used doses of beta-blockers are not optimal...
March 23, 2019: Current Treatment Options in Neurology
James R Couch
No abstract text is available yet for this article.
March 21, 2019: Current Treatment Options in Neurology
Rebecca Burch
PURPOSE OF REVIEW: This review describes the pharmacology of each antidepressant class as it applies to migraine prevention, summarizes the evidence base for each medication, and describes relevant side effects and clinical considerations. Use of antidepressants for migraine prevention in clinical practice is also discussed. RECENT FINDINGS: Antidepressants are commonly used as migraine preventives. Amitriptyline has the best evidence for use in migraine prevention...
March 21, 2019: Current Treatment Options in Neurology
Simy K Parikh, Stephen D Silberstein
BACKGROUND: Antiepileptic drugs (AEDs) are an important class of agents used in the treatment of migraine, a neurological disorder that imparts significant socioeconomic burden. It is important for neurologists to understand the rationale for AEDs in migraine-preventive treatment, as well as each agent's efficacy and tolerability profile, in order to best determine clinical care. PURPOSE OF THIS REVIEW: This article specifically provides the following: (1) a review of the mechanism of action, efficacy, and tolerability of topiramate and divalproex sodium/sodium valproate, the most widely used AEDs for migraine prevention, (2) a discussion on emerging evidence regarding the efficacy of zonisamide and levetiracetam, and (3) comments on gabapentin, pregabalin, carbamazepine, oxcarbazepine, and lamotrigine, AEDs which have insufficient evidence for use in migraine prevention...
March 18, 2019: Current Treatment Options in Neurology
Jill C Rau, David W Dodick
PURPOSE OF REVIEW: Migraine causes more years of life lived with disability than almost any other condition in the world and can significantly impact the lives of individuals with migraine, their families, and society. The use of medication for the prevention of migraine is an integral component to reducing disability caused by migraine. There are many different drug classes that have been investigated and shown efficacy in migraine prophylaxis. This article examines several of the classes of medications that are used for migraine preventive treatment, specifically, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, serotonin antagonists, alpha-adrenergic agonists, and N-methyl-D-aspartic acid receptor antagonists...
March 18, 2019: Current Treatment Options in Neurology
Sameer Jain, Stephen D Silberstein
Migraine is a chronic paroxysmal neurological disorder characterized by multiphase attacks of head pain and a myriad of neurological symptoms. Chronic migraine causes a great personal and societal burden. Many patients are poorly responsive to, or non-compliant with, conventional migraine preventive therapies. For this reason, physicians are constantly looking for effective migraine prevention strategies. The recent introduction of an innovative pharmacological class useful for migraine prevention, namely monoclonal antibodies towards calcitonin gene-related peptide or its receptors, opens a new, immense therapeutic scenario...
March 14, 2019: Current Treatment Options in Neurology
Mushtaq H Qureshi, Gregory J Esper, Ferhad F Bashir
PURPOSE OF REVIEW: Headache is not an uncommon complaint in children, and recognition of migraine is increasing in children and adolescents. Treatment options consist of abortive and preventive medications; however, when to start the preventive treatment is not clear in the pediatric population. This article reviews current guidelines and practices to provide a better clinical approach in the management of migraines in children and adolescents. RECENT FINDINGS: Currently, the only FDA-approved medical treatment option for preventive therapy in chronic migraine in adolescents is topiramate...
March 14, 2019: Current Treatment Options in Neurology
Samer Dahdaleh, Paresh Malhotra
PURPOSE OF REVIEW: Most clinical neurologists will have come across individuals receiving renal replacement therapy who have developed a neurological complication, and neurologists working in, or close to, hospitals with a Renal Unit will be very aware of the range of central nervous system (CNS) complications that may develop in these patients. These can often be difficult to differentiate from disorders relating to renal failure or systemic conditions leading to kidney disease and can in fact arise from the interaction between underlying disease and the side effects of treatment...
March 11, 2019: Current Treatment Options in Neurology
Isha Jalnapurkar, David M Cochran, Jean A Frazier
PURPOSE OF REVIEW: The purpose of this review is to provide an overview of current research and clinical practice guidelines in fragile X syndrome (FXS) with regard to therapeutic approaches in the management of this condition. The authors summarize and discuss findings from relevant preclinical studies and results from clinical trials in human subjects with FXS. Additionally, we provide an outline of the basic framework for understanding and providing educational and psychosocial supports for these individuals...
February 27, 2019: Current Treatment Options in Neurology
Elia Sechi, Eoin P Flanagan
PURPOSE OF REVIEW: To describe the clinical, laboratory, and MRI features that characterize cognitive decline in the setting of central nervous system (CNS) autoimmunity, and provide an overview of current treatment modalities. RECENT FINDINGS: The field of autoimmune neurology is rapidly expanding due to the increasing number of newly discovered autoantibodies directed against specific CNS targets. The clinical syndromes associated with these autoantibodies are heterogeneous but frequently share common, recognizable clinical, and MRI characteristics...
February 27, 2019: Current Treatment Options in Neurology
Panagiotis Zis, Marios Hadjivassiliou
PURPOSE OF REVIEW: The aim of this paper was to overview the current literature in order to establish the available treatment options for the neurological manifestations of gluten-related disorders (serologically confirmed gluten sensitivity and coeliac disease). RECENT FINDINGS: A range of debilitating neurological manifestations is increasingly being recognized in patients with gluten sensitivity with and without enteropathy even in the absence of gastrointestinal symptoms...
February 26, 2019: Current Treatment Options in Neurology
Christopher D Stephen, Kate T Brizzi, Marc A Bouffard, Pablo Gomery, Stacey L Sullivan, Julie Mello, Julie MacLean, Jeremy D Schmahmann
PURPOSE OF REVIEW: In this review, we present the multidisciplinary approach to the management of the many neurological, medical, social, and emotional issues facing patients with cerebellar ataxia. RECENT FINDINGS: Our holistic approach to treatment, developed over the past 25 years in the Massachusetts General Hospital Ataxia Unit, is centered on the compassionate care of the patient and their family, empowering them through engagement, and including the families as partners in the healing process...
February 21, 2019: Current Treatment Options in Neurology
Stephanie Ahrens, Margie A Ream, Laurel A Slaughter
PURPOSE OF REVIEW: The purpose of this review is to report recent advances in treatment of neonatal seizures, with a specific focus on new literature since a 2013 systematic review performed by this author (Slaughter) and others. There is a paucity of data with regard to well-defined status epilepticus (SE) in neonates, so treatment of recurrent seizures was also included in this inquiry. We aimed to summarize the efficacy and safety profiles of current therapeutic options as well as describe trends in medication selection in the neonatal intensive care unit (NICU) setting...
February 18, 2019: Current Treatment Options in Neurology
Robyn Whitney, Elizabeth J Donner
PURPOSE OF REVIEW: People with epilepsy have an increased risk of mortality when compared to the general population. Sudden unexpected death in epilepsy (SUDEP) is the most common cause of epilepsy-related death in children and adults. The purpose of this review is to discuss SUDEP, with an emphasis on SUDEP risk factors, their mitigation and prevention. RECENT FINDINGS: SUDEP affects approximately 1 in 1000 people with epilepsy each year. Recent studies suggest that the incidence in children is similar to that of adults...
February 13, 2019: Current Treatment Options in Neurology
Johannes Kraft, Jaap Zindler, Giuseppe Minniti, Matthias Guckenberger, Nicolaus Andratschke
PURPOSE OF REVIEW: To give an overview on the current evidence for stereotactic radiosurgery of brain metastases with a special focus on multiple brain metastases. RECENT FINDINGS: While the use of stereotactic radiosurgery in patients with limited brain metastases has been clearly defined, its role in patients with multiple lesions (> 4) is still a matter of controversy. Whole-brain radiation therapy (WBRT) has been the standard treatment approach for patients with multiple brain lesions and is still the most commonly used treatment approach worldwide...
February 13, 2019: Current Treatment Options in Neurology
Joanna M Jefferis, Simon J Hickman
PURPOSE OF REVIEW: Nutritional optic neuropathy is a potential cause of severe visual loss; however, appropriate and timely management can result in excellent visual outcomes. The purpose of this review is to outline our current understanding of the treatment and outcomes for nutritional optic neuropathy. RECENT FINDINGS: Current understanding of nutritional optic neuropathy has been greatly aided by some well-reported and investigated epidemics of the condition, most notably the Cuban epidemic optic neuropathy of the early 1990s...
February 7, 2019: Current Treatment Options in Neurology
Giorgos K Sakkas, Christoforos D Giannaki, Christina Karatzaferi, Mauro Manconi
PURPOSE OF REVIEW: This review summarizes the most well-documented sleep disorders seen in patients with multiple sclerosis (MS), with a special focus on the impact on quality of life. RECENT FINDINGS: Sleep abnormalities in patients with MS are a multifactorial and relatively complex issue affecting approximately 60% of the patients while the pathophysiology of these symptoms is not fully understood. Circadian rhythm disorders and increased levels of pro-inflammatory cytokines have been recognized as potential players in affecting sleep homeostasis in MS patients...
January 31, 2019: Current Treatment Options in Neurology
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