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The Spectrum of Movement Disorders Associated with Systemic Lupus Erythematosus. 与系统性红斑狼疮相关的运动障碍谱系。
IF 4.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-22 DOI: 10.1007/s11910-024-01397-0
Sarah M Brooker, Jennifer A Fokas, Danielle N Larson, Elena Grebenciucova

Purpose of review: This review seeks to examine the prevalence, pathophysiology, diagnostic challenges, and treatment strategies for movement disorders in patients with systemic lupus erythematosus (SLE).

Recent findings: In recent years, the spectrum and number of autoimmune movement disorders has rapidly expanded with the identification of neuronal and paraneoplastic antibodies which should be considered in the differential for patients with acute to subacute development of a movement disorder. The identification of SLE in a patient with a new onset movement disorder may lead to earlier treatment with immune therapies especially if other systemic manifestations are present. Current treatment for SLE-associated movement disorders involves co-management with rheumatology and is based on expert clinical opinion on symptomatic management. Further understanding of the contributing pathophysiology may lead to advancements in therapeutic approaches.

综述的目的:本综述旨在研究系统性红斑狼疮(SLE)患者运动障碍的发病率、病理生理学、诊断难题和治疗策略:近年来,随着神经元抗体和副肿瘤抗体的发现,自身免疫性运动障碍的范围和数量迅速扩大,在鉴别急性或亚急性运动障碍患者时应考虑到这些抗体。在新发运动障碍患者中识别出系统性红斑狼疮可能会导致更早地使用免疫疗法进行治疗,尤其是在出现其他系统性表现的情况下。目前对系统性红斑狼疮相关运动障碍的治疗包括与风湿免疫科共同管理,并基于专家对症治疗的临床意见。对病理生理学的进一步了解可能会促进治疗方法的进步。
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引用次数: 0
Improving Indigenous Stroke Outcomes by Shifting Our Focus from Health to Cultural Literacy. 将我们的关注点从健康转向文化素养,从而改善原住民中风的治疗效果。
IF 4.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-20 DOI: 10.1007/s11910-024-01395-2
Margaret Hart, Angela Dos Santos, Leanne Leclair, Bernadette Jones, Anna Ranta

Purpose of review: Stroke incidence and outcomes are disproportionately unfavorable among Indigenous populations in Western colonized countries. These inequities are often attributed to poor health literacy. This paper summarizes recent evidence on the topic of Indigenous health literacy, describes current gaps, and proposes priorities for future work/research.

Recent findings: Traditionally, much focus has been placed on improving health literacy for Indigenous Peoples as a key intervention to address Indigenous stroke and other health disparities. Recent literature, however, challenges this approach as it risks stigmatization and marginalization and portrays the deficiencies as sitting with Indigenous people. Increasingly, an emphasis is placed on the need for health literacy approaches to be culturally responsive for the populations of interest, for institutions to provide high quality culturally relevant stroke care, and for providers to upskill in cultural safety to better meet the needs of Indigenous patient populations. Very little evidence exists to indicate that stroke care providers are meeting these needs. To close the health gap and improve stroke care for Indigenous Peoples, the focus needs to shift from promoting health literacy among Indigenous Peoples to providing high quality culturally relevant health care. More research into this topic and monitoring of progress over time is needed.

综述目的:在西方殖民地国家的土著居民中,中风的发病率和预后都不成比例。这些不平等现象通常归因于土著居民健康素养较差。本文总结了有关土著居民健康素养这一主题的最新证据,描述了目前存在的差距,并提出了未来工作/研究的重点:传统上,提高原住民的健康素养一直是解决原住民中风和其他健康差异的关键干预措施。然而,最近的文献对这种方法提出了质疑,因为这种方法有可能被污名化和边缘化,并将不足之处描绘成原住民的问题。人们越来越多地强调,健康知识普及方法需要对相关人群的文化作出反应,医疗机构需要提供高质量的文化相关性卒中护理,医疗服务提供者需要提高文化安全技能,以更好地满足土著患者群体的需求。很少有证据表明卒中医疗服务提供者满足了这些需求。为了缩小土著居民的健康差距并改善他们的卒中治疗,需要将重点从提高土著居民的健康素养转移到提供高质量的文化相关性医疗服务上来。需要对这一主题进行更多的研究,并随着时间的推移对进展情况进行监测。
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引用次数: 0
The Development of Epilepsy Following CNS Viral Infections: Mechanisms. 中枢神经系统病毒感染后癫痫的发生:机制。
IF 4.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-16 DOI: 10.1007/s11910-024-01393-4
Giulia Savoca, Arianna Gianfredi, Luca Bartolini

Purpose of review: This review examines the role of different viral infections in epileptogenesis, with a focus on Herpesviruses such as Human Herpesvirus 6 (HHV-6) and Epstein Barr Virus (EBV), Flaviviruses, Picornaviruses, Human Immunodeficiency Virus (HIV), Influenzavirus and Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2).

Recent findings: A growing literature on animal models, such as the paradigmatic Theiler's murine encephalomyelitis virus (TMEV) model, and clinical investigations in patients with epilepsy have started to elucidate cellular mechanisms implicated in seizure initiation and development of epilepsy following viral infections. A central role of neuroinflammation has emerged, with evidence of activation of the innate and adaptive immunity, dysregulation of microglial and astrocytic activity and production of multiple cytokines and other inflammatory mediators. Several chronic downstream effects result in increased blood-brain barrier permeability, direct neuronal damage, and modifications of ion channels ultimately leading to altered neuronal excitability and seizure generation. Key findings underscore the complex interplay between initial viral infection, neuroinflammation, and later development of epilepsy. Further research is needed to elucidate these mechanisms and develop targeted interventions.

综述目的:这篇综述探讨了不同病毒感染在癫痫发生中的作用,重点是疱疹病毒,如人类疱疹病毒 6 (HHV-6) 和爱泼斯坦巴氏病毒 (EBV)、黄病毒、皮卡病毒、人类免疫缺陷病毒 (HIV)、流感病毒和严重急性呼吸系统综合征冠状病毒 2 (SARS-CoV-2):越来越多关于动物模型(如典型的泰勒氏鼠脑脊髓炎病毒(TMEV)模型)和癫痫患者临床研究的文献开始阐明病毒感染后癫痫发作和发展的细胞机制。神经炎症的核心作用已经显现,有证据表明先天性和适应性免疫激活、微胶质细胞和星形胶质细胞活性失调以及多种细胞因子和其他炎症介质的产生。几种慢性下游效应导致血脑屏障通透性增加、神经元直接损伤和离子通道改变,最终导致神经元兴奋性改变和癫痫发作。主要发现强调了最初的病毒感染、神经炎症和后来的癫痫发展之间复杂的相互作用。要阐明这些机制并制定有针对性的干预措施,还需要进一步的研究。
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引用次数: 0
Apraxia: From Neuroanatomical Pathways to Clinical Manifestations. 失语症:从神经解剖路径到临床表现。
IF 4.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-16 DOI: 10.1007/s11910-024-01391-6
Sarah Stoll, Lukas Lorentz, Ferdinand Binkofski, Jennifer Randerath

Purpose of review: Apraxia typically involves impairments in gesture production and tool use, affecting daily life activities. This article reviews current conceptualizations and developments in diagnostic and therapy.

Recent findings: Apraxia has been studied in various neurological conditions, particularly stroke and dementia, but recent studies show gesturing deficits in psychiatric populations as well. Promising results have emerged from integrative treatment approaches involving intensive practice of gestures or daily activities. However, several reviews have noted the only marginal progress in apraxia therapy research despite new technologies, like virtual reality and brain stimulation, offering fresh opportunities for assessment and therapy. Advances in lesion-symptom mapping and connectivity analyses led to more detailed neuroanatomical models emphasizing parallel and gradual processing. These models facilitate the understanding of underlying mechanisms of motor cognitive performance and its decline. Finally, the digital era prompts the need to study digital tool use in apraxia, with initial efforts underway.

审查目的:语用障碍通常包括手势做出和工具使用方面的障碍,影响日常生活活动。本文回顾了目前在诊断和治疗方面的概念和发展:最近的研究结果:对各种神经系统疾病,尤其是中风和痴呆症的失语症进行了研究,但最近的研究显示,精神病患者也存在手势障碍。涉及手势或日常活动强化练习的综合治疗方法取得了可喜的成果。然而,多篇综述指出,尽管虚拟现实和脑刺激等新技术为评估和治疗提供了新的机遇,但语言障碍治疗研究进展甚微。病变-症状图谱和连接分析的进步导致神经解剖学模型更加详细,强调并行和渐进处理。这些模型有助于了解运动认知能力及其衰退的内在机制。最后,数字时代的到来促使人们有必要对失语症患者使用数字工具的情况进行研究。
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引用次数: 0
Misdiagnosis of Multiple Sclerosis: Past, Present, and Future. 多发性硬化症的误诊:过去、现在和未来。
IF 4.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-01 Epub Date: 2024-09-07 DOI: 10.1007/s11910-024-01371-w
Nicole Bou Rjeily, Andrew J Solomon

Purpose of review: Misdiagnosis of multiple sclerosis (MS) is a prevalent worldwide problem. This review discusses how MS misdiagnosis has evolved over time and focuses on contemporary challenges and potential strategies for its prevention.

Recent findings: Recent studies report cohorts with a range of misdiagnosis between 5 and 18%. Common disorders are frequently misdiagnosed as MS. Overreliance on MRI findings and misapplication of MS diagnostic criteria are often associated with misdiagnosis. Emerging imaging biomarkers, including the central vein sign and paramagnetic rim lesions, may aid diagnostic accuracy when evaluating patients for suspected MS. MS misdiagnosis can have harmful consequences for patients and healthcare systems. Further research is needed to better understand its causes. Concerted and novel educational efforts to ensure accurate and widespread implementation of MS diagnostic criteria remain an unmet need. The incorporation of diagnostic biomarkers highly specific for MS in the future may prevent misdiagnosis.

审查目的:多发性硬化症(MS)的误诊是一个普遍存在的世界性问题。这篇综述讨论了多发性硬化症误诊随着时间的推移是如何演变的,并重点探讨了当代的挑战和预防误诊的潜在策略:最近的研究报告显示,误诊率在 5% 到 18% 之间。常见疾病经常被误诊为多发性硬化症。过度依赖核磁共振成像结果和误用多发性硬化症诊断标准往往与误诊有关。在对疑似多发性硬化症患者进行评估时,包括中央静脉征和顺磁性边缘病变在内的新兴成像生物标志物可能有助于提高诊断的准确性。多发性硬化症误诊会给患者和医疗系统带来有害后果。要更好地了解其原因,还需要进一步的研究。为确保多发性硬化症诊断标准的准确和广泛实施而开展的协调一致的新型教育工作仍是一项尚未满足的需求。未来纳入对多发性硬化症具有高度特异性的诊断生物标志物可能会避免误诊。
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引用次数: 0
Stroke Prevention and Treatment for Youth with Sickle Cell Anemia: Current Practice and Challenges and Promises for the Future. 镰状细胞性贫血青少年的中风预防和治疗:镰状细胞性贫血青少年的中风预防和治疗:当前的实践、挑战和未来的希望。
IF 4.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-01 Epub Date: 2024-09-21 DOI: 10.1007/s11910-024-01372-9
Susan Creary, Melissa G Chung, Anthony D Villella, Warren D Lo

Purpose of review: Sickle cell anemia (SCA) is an autosomal recessive inherited hemoglobinopathy that results in a high risk of stroke. SCA primarily affects an underserved minority population of children who are frequently not receiving effective, multi-disciplinary, preventative care. This article reviews primary and secondary stroke prevention and treatment for children with SCA for the general adult and pediatric neurologist, who may play an important role in providing critical neurologic evaluation and care to these children.

Recent findings: Primary stroke prevention is efficacious at reducing ischemic stroke risk, but it is not consistently implemented into clinical practice in the United States, resulting in these children remaining at high risk. Acute symptomatic stroke management requires neurology involvement and emergent transfusion to limit ischemia. Furthermore, while chronic transfusion therapy is a proven secondary preventative modality for those with prior symptomatic or silent cerebral infarcts, it carries significant burden. Newer therapies (e.g., stem cell therapies and voxelotor) deserve further study as they may hold promise in reducing stroke risk and treatment burden. Effective primary and secondary stroke prevention and treatment remain a challenge. Informing and engaging neurology providers to recognize and provide critical neurologic evaluation and treatment has potential to close care gaps.

审查目的:镰状细胞性贫血(SCA)是一种常染色体隐性遗传血红蛋白病,导致中风的风险很高。SCA 主要影响服务不足的少数群体儿童,他们往往得不到有效的多学科预防性治疗。本文为普通成人和儿科神经科医生回顾了 SCA 儿童卒中的一级和二级预防及治疗,他们可能在为这些儿童提供关键的神经评估和护理方面发挥重要作用:脑卒中一级预防可有效降低缺血性脑卒中风险,但在美国并未在临床实践中持续实施,导致这些儿童仍处于高风险状态。急性症状性中风的治疗需要神经内科的参与和紧急输血以限制缺血。此外,虽然慢性输血疗法是一种行之有效的二级预防方法,适用于既往有症状或无症状的脑梗塞患者,但它也带来了巨大的负担。较新的疗法(如干细胞疗法和体视细胞疗法)值得进一步研究,因为它们可能有望降低中风风险并减轻治疗负担。有效的脑卒中一级和二级预防与治疗仍是一项挑战。让神经科医疗人员了解并参与识别和提供关键的神经评估和治疗,有可能缩小医疗差距。
{"title":"Stroke Prevention and Treatment for Youth with Sickle Cell Anemia: Current Practice and Challenges and Promises for the Future.","authors":"Susan Creary, Melissa G Chung, Anthony D Villella, Warren D Lo","doi":"10.1007/s11910-024-01372-9","DOIUrl":"10.1007/s11910-024-01372-9","url":null,"abstract":"<p><strong>Purpose of review: </strong>Sickle cell anemia (SCA) is an autosomal recessive inherited hemoglobinopathy that results in a high risk of stroke. SCA primarily affects an underserved minority population of children who are frequently not receiving effective, multi-disciplinary, preventative care. This article reviews primary and secondary stroke prevention and treatment for children with SCA for the general adult and pediatric neurologist, who may play an important role in providing critical neurologic evaluation and care to these children.</p><p><strong>Recent findings: </strong>Primary stroke prevention is efficacious at reducing ischemic stroke risk, but it is not consistently implemented into clinical practice in the United States, resulting in these children remaining at high risk. Acute symptomatic stroke management requires neurology involvement and emergent transfusion to limit ischemia. Furthermore, while chronic transfusion therapy is a proven secondary preventative modality for those with prior symptomatic or silent cerebral infarcts, it carries significant burden. Newer therapies (e.g., stem cell therapies and voxelotor) deserve further study as they may hold promise in reducing stroke risk and treatment burden. Effective primary and secondary stroke prevention and treatment remain a challenge. Informing and engaging neurology providers to recognize and provide critical neurologic evaluation and treatment has potential to close care gaps.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":" ","pages":"537-546"},"PeriodicalIF":4.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11455693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Glymphatic System and its Relationship to Migraine. 淋巴系统及其与偏头痛的关系。
IF 4.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-16 DOI: 10.1007/s11910-024-01368-5
Alana Fretes Burgos, Patricia A Olson, Angeliki Vgontzas

Purpose of review: We aim to critically review animal and human studies of the glymphatic system in migraine and propose a model for how the glymphatic system may function in migraine, based on the available evidence.

Recent findings: Early studies in animal models report migraine attacks temporarily disrupt glymphatic flow. Human imaging studies suggest chronic migraine may be associated with alterations in glymphatic system function, albeit with conflicting results. Presently, it remains unknown whether repetitive migraine attacks or frequent nights of insomnia impair glymphatic system function over time in those with migraine, and whether alterations in glymphatic function could contribute to worsening migraine disability or risk for cognitive disease. Longitudinal studies of glymphatic function in patients with migraine and insomnia, with inclusion of cognitive assessments, may be informative.

综述的目的:我们旨在批判性地回顾偏头痛中甘液系统的动物和人体研究,并根据现有证据提出一个模型,说明偏头痛中甘液系统可能如何发挥作用:早期的动物模型研究报告称,偏头痛发作时会暂时扰乱甘液流。人体成像研究表明,慢性偏头痛可能与甘回流系统功能的改变有关,但结果相互矛盾。目前,人们仍不清楚偏头痛反复发作或经常失眠是否会长期损害偏头痛患者的脑 glymphatic 系统功能,也不清楚脑 glymphatic 功能的改变是否会导致偏头痛残疾或认知疾病风险的恶化。对偏头痛和失眠患者的脑 glymphatic 功能进行纵向研究,并纳入认知评估,可能会有所启发。
{"title":"The Glymphatic System and its Relationship to Migraine.","authors":"Alana Fretes Burgos, Patricia A Olson, Angeliki Vgontzas","doi":"10.1007/s11910-024-01368-5","DOIUrl":"10.1007/s11910-024-01368-5","url":null,"abstract":"<p><strong>Purpose of review: </strong>We aim to critically review animal and human studies of the glymphatic system in migraine and propose a model for how the glymphatic system may function in migraine, based on the available evidence.</p><p><strong>Recent findings: </strong>Early studies in animal models report migraine attacks temporarily disrupt glymphatic flow. Human imaging studies suggest chronic migraine may be associated with alterations in glymphatic system function, albeit with conflicting results. Presently, it remains unknown whether repetitive migraine attacks or frequent nights of insomnia impair glymphatic system function over time in those with migraine, and whether alterations in glymphatic function could contribute to worsening migraine disability or risk for cognitive disease. Longitudinal studies of glymphatic function in patients with migraine and insomnia, with inclusion of cognitive assessments, may be informative.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":" ","pages":"517-525"},"PeriodicalIF":4.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hyper-Acute Stroke Systems of Care and Workflow. 超急性期中风护理系统和工作流程。
IF 4.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-16 DOI: 10.1007/s11910-024-01367-6
Timothy J Kleinig, Patrick McMullan, Geoffrey C Cloud, Prof Christopher Bladin, Anna Ranta

Purpose of review: Recent stroke treatment advances have necessitated agile, broad-scale healthcare system redesign, to achieve optimal patient outcomes and access equity. Optimised hyperacute stroke care requires integrated pre-hospital, emergency department, stroke specialist, radiology, neurosurgical and endovascular neurointervention services, guided by a population-wide needs analysis. In this review, we survey system integration efforts, providing case studies, and identify common elements of successful initiatives.

Recent findings: Different regions and nations have evolved varied acute stroke systems depending on geography, population density and workforce. However, common facilitators to these solutions have included stroke unit care as a foundation, government-clinician synergy, pre-hospital pathway coordination, service centralisation, and stroke data guiding system improvement. Further technological advantages will minimize the geographical distance disadvantages and facilitate virtual expertise redistribution to remote areas. Continued treatment advances necessitate an integrated, adaptable, population-wide trans-disciplinary approach. A well-designed clinician-led and government-supported system can facilitate hyperacute care and scaffold future system enhancements.

回顾的目的:近期中风治疗的进展要求对医疗系统进行灵活、广泛的重新设计,以实现最佳的患者预后和公平就医。优化超急性期卒中治疗需要在全人群需求分析的指导下,整合院前、急诊科、卒中专科、放射科、神经外科和血管内神经介入服务。在这篇综述中,我们对系统整合工作进行了调查,提供了案例研究,并确定了成功举措的共同要素:不同地区和国家的急性卒中系统因地理位置、人口密度和劳动力而各不相同。然而,这些解决方案的共同促进因素包括:以卒中单元护理为基础、政府与医生协同合作、院前路径协调、服务集中化以及卒中数据指导系统改进。进一步的技术优势将最大限度地减少地理距离的劣势,促进虚拟专业技术向偏远地区的再分配。治疗技术的不断进步需要一种综合的、适应性强的、覆盖全民的跨学科方法。一个由临床医生主导、政府支持的精心设计的系统可以促进超急性期护理,并为未来的系统改进提供支架。
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引用次数: 0
Advances in the Treatment of Pediatric Low-Grade Gliomas. 小儿低级别胶质瘤的治疗进展。
IF 4.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-15 DOI: 10.1007/s11910-024-01369-4
Inci Yaman Bajin, Eric Bouffet

Purpose of review: Pediatric low-grade gliomas (pLGGs) often result in significant long-term morbidities despite high overall survival rates. This review aims to consolidate the current understanding of pLGG biology and molecular features and provide an overview of current and emerging treatment strategies.

Recent findings: Surgical resection remains a primary treatment modality, supplemented by chemotherapy and radiotherapy in specific cases. However, recent advances have elucidated the molecular underpinnings of pLGGs, revealing key genetic abnormalities such as BRAF fusions and mutations and the involvement of the RAS/MAPK and mTOR pathways. Novel targeted therapies, including MEK, BRAF and pan-RAF inhibitors, have shown promise in clinical trials, demonstrating significant efficacy and manageable toxicity. Understanding of pLGGs has significantly improved, leading to more personalized treatment approaches. Targeted therapies have emerged as effective alternatives, potentially reducing long-term toxicities. Future research should focus on optimizing therapy sequences, understanding long-term impacts, and ensuring global accessibility to advanced treatments.

综述的目的:小儿低级别胶质瘤(pLGGs)尽管总体存活率高,但往往会导致严重的长期发病。本综述旨在巩固当前对 pLGG 生物学和分子特征的认识,并概述当前和新兴的治疗策略:最近的研究结果:手术切除仍是主要的治疗方式,在特定病例中辅以化疗和放疗。然而,最近的研究进展阐明了 pLGGs 的分子基础,揭示了关键的遗传异常,如 BRAF 融合和突变,以及 RAS/MAPK 和 mTOR 通路的参与。包括 MEK、BRAF 和泛 RAF 抑制剂在内的新型靶向疗法已在临床试验中显示出良好的前景,疗效显著,毒性可控。人们对 pLGGs 的认识有了显著提高,从而产生了更加个性化的治疗方法。靶向疗法已成为有效的替代疗法,有可能减少长期毒性。未来的研究应侧重于优化治疗顺序、了解长期影响并确保全球都能获得先进的治疗方法。
{"title":"Advances in the Treatment of Pediatric Low-Grade Gliomas.","authors":"Inci Yaman Bajin, Eric Bouffet","doi":"10.1007/s11910-024-01369-4","DOIUrl":"10.1007/s11910-024-01369-4","url":null,"abstract":"<p><strong>Purpose of review: </strong>Pediatric low-grade gliomas (pLGGs) often result in significant long-term morbidities despite high overall survival rates. This review aims to consolidate the current understanding of pLGG biology and molecular features and provide an overview of current and emerging treatment strategies.</p><p><strong>Recent findings: </strong>Surgical resection remains a primary treatment modality, supplemented by chemotherapy and radiotherapy in specific cases. However, recent advances have elucidated the molecular underpinnings of pLGGs, revealing key genetic abnormalities such as BRAF fusions and mutations and the involvement of the RAS/MAPK and mTOR pathways. Novel targeted therapies, including MEK, BRAF and pan-RAF inhibitors, have shown promise in clinical trials, demonstrating significant efficacy and manageable toxicity. Understanding of pLGGs has significantly improved, leading to more personalized treatment approaches. Targeted therapies have emerged as effective alternatives, potentially reducing long-term toxicities. Future research should focus on optimizing therapy sequences, understanding long-term impacts, and ensuring global accessibility to advanced treatments.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":" ","pages":"527-535"},"PeriodicalIF":4.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141981940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Lifestyle Factors and Stroke Prevention: From the Individual to the Community. 生活方式因素与中风预防:从个人到社区。
IF 4.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-24 DOI: 10.1007/s11910-024-01370-x
Ali Saad, Laurel Cherian, Karima Benameur

Purpose of review: The overwhelming majority of stroke burden can be prevented through the pillars of lifestyle medicine: diet, exercise, sleep, substance abuse, stress management, and healthy relationships. Among these, diet confers the greatest attributable risk.

Recent findings: Despite abundant data and integration of lifestyle medicine within major stroke prevention guidelines, several barriers to effective implementation remain. These include lack of emphasis in medical education, integration in hospital certification metrics, reimbursement from medical insurance, and health policy that inadequately addresses social determinants of health. However, both top-down and bottom-up solutions introduced within the last few years are helping to break down these barriers. This review highlights recent literature and interventions that are closing the gap between the theory and practice of stroke prevention through lifestyle risk factors from a US perspective. By strategically targeting the various institutional barriers, it is possible and essential to substantially reduce stroke burden.

回顾的目的:绝大多数中风都可以通过生活方式医学的支柱来预防:饮食、运动、睡眠、药物滥用、压力管理和健康的人际关系。其中,饮食带来的可归因风险最大:尽管有丰富的数据并将生活方式医学纳入了主要的中风预防指南,但有效实施仍存在一些障碍。这些障碍包括医学教育中缺乏重视、医院认证指标中缺乏整合、医疗保险报销以及卫生政策未充分考虑健康的社会决定因素。不过,在过去几年中,自上而下和自下而上的解决方案都有助于打破这些障碍。本综述重点介绍了最近的文献和干预措施,从美国的角度来看,这些措施正在缩小通过生活方式风险因素预防中风的理论与实践之间的差距。通过战略性地针对各种体制障碍,有可能也有必要大幅降低中风负担。
{"title":"Lifestyle Factors and Stroke Prevention: From the Individual to the Community.","authors":"Ali Saad, Laurel Cherian, Karima Benameur","doi":"10.1007/s11910-024-01370-x","DOIUrl":"10.1007/s11910-024-01370-x","url":null,"abstract":"<p><strong>Purpose of review: </strong>The overwhelming majority of stroke burden can be prevented through the pillars of lifestyle medicine: diet, exercise, sleep, substance abuse, stress management, and healthy relationships. Among these, diet confers the greatest attributable risk.</p><p><strong>Recent findings: </strong>Despite abundant data and integration of lifestyle medicine within major stroke prevention guidelines, several barriers to effective implementation remain. These include lack of emphasis in medical education, integration in hospital certification metrics, reimbursement from medical insurance, and health policy that inadequately addresses social determinants of health. However, both top-down and bottom-up solutions introduced within the last few years are helping to break down these barriers. This review highlights recent literature and interventions that are closing the gap between the theory and practice of stroke prevention through lifestyle risk factors from a US perspective. By strategically targeting the various institutional barriers, it is possible and essential to substantially reduce stroke burden.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":" ","pages":"507-515"},"PeriodicalIF":4.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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