Expert Review of Neurotherapeutics

INTRODUCTION: Alzheimer's disease (AD) is one of the most common neurodegenerative disorders among the older population. Sleep disruption and circadian rhythm disorders often develop in AD patients, and many experience sleeping difficulties requiring pharmacological and non-pharmacological interventions. AREAS COVERED: This review appraised the evidence from clinical studies on various pharmacological and non-pharmacological therapies for sleep disturbances in AD patients and proposed an algorithm to manage sleep disturbances in this population of patients...

INTRODUCTION: Tuberous sclerosis complex (TSC) is a common genetic cause of epilepsy. Infantile epileptic spasm syndrome (IESS) is often the presenting neurologic feature, progressively evolving into refractory epilepsy. Vigabatrin (VGB) is often used in clinical practice as a first-line therapy in TSC with IESS. This systematic review aims to collect and analyze the efficacy data about VGB in TSC cases with IESS, in order to evaluate the strength of evidence in the literature. METHODS: A systematic search of trials, observational studies, and case series involving patients with TSC and IESS treated with VGB was performed using MEDLINE, CENTRAL, and the US NIH Clinical Trials Registry...

INTRODUCTION: There remains a lack of effective regenerative therapies to treat traumatic spinal cord injury (SCI). On a global level, patients living with SCI, their families, and the healthcare system are impacted by the extensive financial burden associated with the management of SCI. Clinical trials are crucial to assess the real-world efficacy of the different emerging neuroregenerative approaches that have shown promise in the pre-clinical stages of research. AREAS COVERED: This perspective summarizes and discusses potential solutions to several key challenges that clinical investigators evaluating novel therapeutic strategies to treat SCI might face: 1) the challenges in patient recruitment and meeting enrollment targets with adequate statistical power; 2) the loss of patients to follow-up; 3) the heterogeneity in patient presentation and recovery trajectories; 4) the complex multifaceted pathophysiology of SCI that renders investigations of single therapeutic approaches difficult; 5) the challenge of capturing positive treatment effects of investigative therapies; 6) the high costs associated with conducting clinical trials; 7) the implementation of current guidelines for treating SCI to optimize care delivery and clinical trial conduct; 8) the shift in SCI patient demographics reflective of an aging population; and 9) navigating regulatory bodies to translate therapies into the clinic...

INTRODUCTION: The experience of psychosis involves changes in an individual's sense of self and their understanding of others and the world around them. Studying life narratives and narrative identity offers one way to better understand these changes. AREAS COVERED: Narratives of persons with psychosis display alterations in their themes, structures, and processes. These narratives often portray the person as possessing relatively little sense of agency, without meaningful connections to others, and often describe events in a negative emotional tone...

INTRODUCTION: The clinical application of disease modifying therapies has dramatically changed the paradigm of the management of people with spinal muscular atrophy (SMA), from sole reliance on symptomatic care directed towards the downstream consequences of muscle weakness, to proactive intervention and even preventative care. AREAS COVERED: In this perspective, the authors evaluate the contemporary therapeutic landscape of SMA and discuss the evolution of novel phenotypes and the treatment algorithm, including the key factors that define individual treatment choice and treatment response...

No abstract text is available yet for this article.

INTRODUCTION: The transition from reproductive to menopausal status constitutes amajor rite of passage for women, biologically, psychologically, and socially. For women with adiagnosis of schizophrenia, this stage of life is complicated by worsening psychotic symptoms and diminished effectiveness of antipsychotic drugs. This frequently leads to increased doses and subsequently increased adverse effects. AREAS COVERED: The aim of this narrative review is to determine what management changes are needed at this time of life for women with schizophrenia...

INTRODUCTION: Despite recent advances in neuroimaging and genetics, electroencephalography (EEG) continues to play a central role in the diagnosis and management of epilepsy. One application of EEG is called pharmaco-EEG. This technique is highly sensitive in detecting the effects of drugs on brain functioning and shows potential in predicting the efficacy and tolerability of anti-seizure medications (ASMs). AREAS COVERED: In this narrative review, the authors discuss the most salient data concerning the effects of different ASMs on EEG...

INTRODUCTION: Generalized Anxiety Disorder (GAD) is a common psychiatric condition, characterized by the presence of general apprehensiveness and excessive worry. Current management consists of a range of pharmacological and psychological treatments. However, many patients do not respond to first-line pharmacological treatments and novel anxiolytic drugs are being developed. AREAS COVERED: In this review, the authors first discuss the diagnostic criteria and epidemiology of GAD...

INTRODUCTION: Guillain-Barré syndrome or acute inflammatory polyradiculoneuropathy is an inflammatory disease of peripheral nerves, which usually leads to tetraparesis of acute onset. It can lead to major residual disability in some patients despite current treatment options that have shown a favorable impact on the natural course of the disease. AREAS COVERED: This review focuses on the disease-modifying treatments that have been approved or are currently investigated for the treatment of Guillain-Barré syndrome...

INTRODUCTION: Idiopathic intracranial hypertension is characterized by raised intracranial pressure that triggers disabling headaches and can cause permanent visual loss. There is an increased incidence and prevalence of the condition linked to location-specific obesity rates. There are no licensed treatments for the condition. The majority of approaches to managing the disease prioritize resolution of papilledema. However, evidence is emerging that idiopathic intracranial hypertension is a systemic metabolic disease...

INTRODUCTION: Myasthenia gravis (MG) is caused by IgG antibodies forming against different proteins at the neuromuscular junction. Anti-acetylcholine receptor (AChR) Abs are detected in the great majority of patients. MG management consists of long-term immunotherapy, based on steroids and immunosuppressants, short-term treatments and therapeutic thymectomy. Targeted immunotherapies that reduce B cell survival, inhibit complement activation, and decrease serum IgG concentration have been evaluated in trials and have entered clinical practice...

No abstract text is available yet for this article.

INTRODUCTION: Estrogen fluctuations modulate pain threshold and play a pivotal role in the central and peripheral pathogenesis of menstrually related migraine (MRM). Estrogen-withdrawal during the perimenstrual phase of a spontaneous menstrual cycle or the hormone-free interval (HFI) of hormonal treatments seems to be the culprit. AREA COVERED: The authors report the most relevant data on risks, benefits, and limitations of exogenous estrogens as a treatment for MRM considering gynecological comorbidities associated with chronic pelvic pain that may be effectively managed by the use of combined hormonal contraception (CHC)...

INTRODUCTION: Suboptimal adherence is a well-established, pervasive problem in individuals with bipolar disorder (BD) causing disability, suffering, and cost. AREAS COVERED: This review covers new research since January 2016 regarding internal (patient-centered) and external (system level) barriers and facilitators to adherence. Measures of adherence, the efficacy of psychosocial adherence enhancement interventions in individuals with BD, and, finally, novel delivery systems for BD medication are also covered...

BACKGROUND: The following study evaluated the clinical outcomes of patients enrolled in the UK Medical Cannabis Registry, who were treated with inhaled dried flower (Adven® EMT2, Curaleaf International, Guernsey), and sublingual/oral medium-chain triglyceride-based oils (Adven, Curaleaf International, Guernsey) for chronic pain. METHODS: In this cohort study, the primary outcomes were changes in validated patient reported outcome measures (PROMs) at 1, 3, and 6 months compared to baseline, and adverse event analysis...

INTRODUCTION: Since the discovery of the presynaptic protein α-synuclein (aSyn) as a central player in Parkinson's disease (PD), several key questions on the function of the protein in neurodegeneration processes remain unclear, including: is there a synergy between dopamine metabolism and the formation of toxic aSyn species in neurons? What is the role of aSyn in the immunological system? AREAS COVERED: Herein, the authors revisit the intricate pathways related to dopamine metabolism and how it impacts on aSyn aggregation/function...

INTRODUCTION: Stiripentol (STP) is a structurally unique molecule with anticonvulsant and neuroprotective properties in animal and human studies. STP enhances gamma-aminobutyric acid (GABA)ergic neurotransmission and inhibits multiple hepatic isoenzymes (i.e. cytochrome P450 system) involved in the metabolism of other antiseizure medications (ASMs) potentiating their anticonvulsant effects and has proven to be a promising therapy in Dravet Syndrome (DS). AREAS COVERED: The authors review randomized clinical trials and observational studies showing STP efficacy, safety, and tolerability when used as adjunctive therapy with VPA and clobazam in patients with DS...

INTRODUCTION: Epilepsy is a chronic disorder of the brain characterized by an enduring predisposition to generate epileptic seizures. Most patients can achieve complete seizure control (seizure freedom) with antiseizure medications (ASMs). In some of them, the withdrawal of ASMs can be considered. Guidance is required to identify patients in whom drug discontinuation can be safely attempted and to inform when and how ASM withdrawal can be done. AREAS COVERED: In this perspective, the authors discuss the evidence on ASM withdrawal in epilepsy patients who are seizure-free and provide some suggestions on how to do it effectively in clinical practice, minimizing the risk of seizure recurrence...

BACKGROUND: When spinal stabilization exercises (SSE) are performed regularly, they may provide benefits on outcome measures in chronic nonspecific neck pain (CNNP) patients. The pandemic has made it difficult for CNNP patients to access regular physiotherapy-exercise services. This study aims to compare telerehabilitation (TR) with face-to-face rehabilitation in CNNP patients. METHODS: Neck Functional Capacity Evaluation Test (NFCET) results were the primary outcomes...