Pub Date : 2024-07-08DOI: 10.1007/s11940-024-00800-y
Elettra Cini, Roberto Salabelle, Maria Salsone, Nicola Canessa, Andrea Galbiati, Luigi Ferini-Strambi
Purpose of Review
In this review, we discuss the impact of Obstructive Sleep Apnea (OSA), a sleep-related breathing disorder characterized by repetitive episodes of complete cessation of airflow or decreases in airflow due to upper airway obstruction leading to sleep fragmentation, on decision-making. We will first delve into how OSA affects cognition and executive functions, which are pivotal for optimal decision-making. Subsequently, we will explore its impact on decision-making itself. Unveiling these dynamics is crucial to better understand their implications on patients’ well-being, aging, daily functioning, and treatment adherence.
Recent Findings
Previous research suggests that factors such as intermittent hypoxemia and sleep fragmentation may contribute to excessive daytime sleepiness, which is indeed the most prevalent daytime symptom observed in OSA. These factors also impact several neuropsychological domains, such as attention, memory, and executive functions. However, little is known about how OSA affects a complex cognitive domain like decision-making.
Summary
Interestingly, compared to control subjects, OSA patients showed impaired decision-making, with the degree of the impairment associated with the severity of the disorder. The heterogeneity of results is ascribable to the utilization of different tasks across studies and the inclusion of patients with different severities of OSA. Future studies are expected to address the neuro-cognitive mechanisms contributing to decision-making impairments in OSA, the precursors of individual differences, and the efficacy of targeted interventions. Longitudinal studies are required to unveil the trajectory of decision-making deficits and their effects on clinical outcomes and quality of life in OSA patients.
综述目的在这篇综述中，我们将讨论阻塞性睡眠呼吸暂停（OSA）对决策的影响。OSA 是一种与睡眠有关的呼吸障碍，其特点是由于上气道阻塞导致睡眠片段化，从而反复出现气流完全停止或气流减少的情况。我们将首先深入探讨 OSA 如何影响认知和执行功能，这些功能对于优化决策至关重要。随后，我们将探讨其对决策本身的影响。揭示这些动态变化对于更好地理解它们对患者的福祉、衰老、日常功能和治疗依从性的影响至关重要。这些因素还会影响多个神经心理领域，如注意力、记忆力和执行功能。摘要有趣的是，与对照组相比，OSA 患者的决策能力受损，受损程度与障碍的严重程度有关。研究结果的异质性可归因于不同研究采用了不同的任务，以及纳入了不同严重程度的 OSA 患者。未来的研究有望解决导致 OSA 决策障碍的神经认知机制、个体差异的前兆以及有针对性的干预措施的有效性等问题。还需要进行纵向研究，以揭示决策障碍的发展轨迹及其对 OSA 患者临床疗效和生活质量的影响。
{"title":"The Effect of Obstructive Sleep Apnea on Cognition: A Focus on Decision-Making","authors":"Elettra Cini, Roberto Salabelle, Maria Salsone, Nicola Canessa, Andrea Galbiati, Luigi Ferini-Strambi","doi":"10.1007/s11940-024-00800-y","DOIUrl":"https://doi.org/10.1007/s11940-024-00800-y","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of Review</h3><p>In this review, we discuss the impact of Obstructive Sleep Apnea (OSA), a sleep-related breathing disorder characterized by repetitive episodes of complete cessation of airflow or decreases in airflow due to upper airway obstruction leading to sleep fragmentation, on decision-making. We will first delve into how OSA affects cognition and executive functions, which are pivotal for optimal decision-making. Subsequently, we will explore its impact on decision-making itself. Unveiling these dynamics is crucial to better understand their implications on patients’ well-being, aging, daily functioning, and treatment adherence.</p><h3 data-test=\"abstract-sub-heading\">Recent Findings</h3><p>Previous research suggests that factors such as intermittent hypoxemia and sleep fragmentation may contribute to excessive daytime sleepiness, which is indeed the most prevalent daytime symptom observed in OSA. These factors also impact several neuropsychological domains, such as attention, memory, and executive functions. However, little is known about how OSA affects a complex cognitive domain like decision-making.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>Interestingly, compared to control subjects, OSA patients showed impaired decision-making, with the degree of the impairment associated with the severity of the disorder. The heterogeneity of results is ascribable to the utilization of different tasks across studies and the inclusion of patients with different severities of OSA. Future studies are expected to address the neuro-cognitive mechanisms contributing to decision-making impairments in OSA, the precursors of individual differences, and the efficacy of targeted interventions. Longitudinal studies are required to unveil the trajectory of decision-making deficits and their effects on clinical outcomes and quality of life in OSA patients.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"25 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141572668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-25DOI: 10.1007/s11940-024-00797-4
Claire Delpirou Nouh, Kyan Younes
Purpose of review
The purpose of this review is to discuss the clinical, radiological, and neuropathological heterogeneity of corticobasal syndrome (CBS), which can complicate the determination of underlying etiology and lead to inaccurate treatment decisions. Though the most common diagnosis is corticobasal degeneration (CBD), the spectrum of underlying pathologies expands beyond CBD and can overlap with other neurodegenerative diseases and even the neuroimmunology field. We will review possible clinical presentations and cues that can point towards the etiology. We will also discuss the most recent available biomarkers to facilitate a more accurate diagnosis. Additionally, we will examine current and future potential therapeutic options.
Recent findings
The range of available fluid and neuroimaging biomarkers is increasing and some are already being used in clinical practice. While the treatment of neurodegenerative diseases is largely aimed at managing symptoms, early detection and accurate diagnosis are crucial for initiating early management and enrollment in clinical trials. The recent approval of a disease-modifying therapy for Alzheimer's disease (AD) has raised hopes for the development of more therapeutic options for other proteinopathies. Several candidates are currently being studied in clinical trial pipelines, particularly those targeting tau pathology.
Summary
Recent advancements in understanding the genetic and neuropathological diversity of CBS, along with the promising development of fluid and imaging biomarkers, are driving clinical trial research forward, instilling optimism for creating more effective disease-modifying treatments for brain proteinopathies.
综述目的本综述旨在讨论皮质基底层综合征（CBS）在临床、放射学和神经病理学方面的异质性，这种异质性会使潜在病因的确定变得复杂，并导致治疗决策的不准确。虽然最常见的诊断是皮质基底层变性（CBD），但潜在病理的范围超出了 CBD，可能与其他神经退行性疾病甚至神经免疫学领域重叠。我们将回顾可能的临床表现和病因线索。我们还将讨论最新的生物标记物，以帮助进行更准确的诊断。此外，我们还将探讨当前和未来的潜在治疗方案。最新研究结果现有的体液和神经影像生物标志物的范围正在不断扩大，其中一些已经用于临床实践。虽然神经退行性疾病的治疗主要以控制症状为目的，但早期检测和准确诊断对于启动早期治疗和加入临床试验至关重要。最近，一种针对阿尔茨海默病（AD）的疾病改变疗法获得批准，这为开发更多针对其他蛋白病的治疗方案带来了希望。摘要最近在了解 CBS 遗传和神经病理学多样性方面取得的进展，以及液体和成像生物标志物的良好发展，正推动着临床试验研究向前发展，为创造更有效的脑蛋白病疾病调节疗法注入了乐观精神。
{"title":"Diagnosis and Management of Progressive Corticobasal Syndrome","authors":"Claire Delpirou Nouh, Kyan Younes","doi":"10.1007/s11940-024-00797-4","DOIUrl":"https://doi.org/10.1007/s11940-024-00797-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of review</h3><p>The purpose of this review is to discuss the clinical, radiological, and neuropathological heterogeneity of corticobasal syndrome (CBS), which can complicate the determination of underlying etiology and lead to inaccurate treatment decisions. Though the most common diagnosis is corticobasal degeneration (CBD), the spectrum of underlying pathologies expands beyond CBD and can overlap with other neurodegenerative diseases and even the neuroimmunology field. We will review possible clinical presentations and cues that can point towards the etiology. We will also discuss the most recent available biomarkers to facilitate a more accurate diagnosis. Additionally, we will examine current and future potential therapeutic options.</p><h3 data-test=\"abstract-sub-heading\">Recent findings</h3><p>The range of available fluid and neuroimaging biomarkers is increasing and some are already being used in clinical practice. While the treatment of neurodegenerative diseases is largely aimed at managing symptoms, early detection and accurate diagnosis are crucial for initiating early management and enrollment in clinical trials. The recent approval of a disease-modifying therapy for Alzheimer's disease (AD) has raised hopes for the development of more therapeutic options for other proteinopathies. Several candidates are currently being studied in clinical trial pipelines, particularly those targeting tau pathology.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>Recent advancements in understanding the genetic and neuropathological diversity of CBS, along with the promising development of fluid and imaging biomarkers, are driving clinical trial research forward, instilling optimism for creating more effective disease-modifying treatments for brain proteinopathies.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"16 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141501610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-24DOI: 10.1007/s11940-024-00799-2
Johanna Yun, Marc Dinkin
Purpose of Review
Endovascular interventions have dramatically contemporized neuro-ophthalmological care in the twenty-first century. This review summarizes interventions with their advantages and disadvantages for intracranial aneurysms, carotid cavernous fistulas (CCF), and idiopathic intracranial hypertension (IIH), all of which are encountered in routine neuro-ophthalmologic practice.
Recent Findings
There is a paucity of randomized, controlled trials comparing therapies for intracranial aneurysms, CCFs and IIH, specifically for neuro-ophthalmic outcomes. Flow diversion is a favorable treatment for intracranial aneurysms compressing the optic nerve and other cranial nerves. Coil embolization remains the most common treatment for cavernous carotid fistulas with low rates of secondary cranial neuropathy. Flow diversion has recently been explored in both direct and Type B indirect carotid cavernous fistulas. Lastly, for IIH, venous sinus stenting has become a popular alternative to surgical shunting, though, as with shunts, there is a risk of stent-related complications.
Summary
Endovascular therapy has evolved for each vascular disease and continues to transform to meet the needs of its patients. There are advantages and disadvantages to each type of treatment – endovascular or surgical – and the decision is patient-, surgeon-, and institution-dependent.
综述目的血管内介入治疗在二十一世纪极大地推动了神经眼科医疗的发展。本综述总结了针对颅内动脉瘤、颈动脉海绵状瘘（CCF）和特发性颅内高压（IIH）的干预措施及其优缺点，所有这些都是神经眼科常规治疗中会遇到的问题。最近的研究结果目前缺乏随机对照试验来比较颅内动脉瘤、颈动脉海绵状瘘和 IIH 的治疗方法，特别是神经眼科的治疗效果。对于压迫视神经和其他颅神经的颅内动脉瘤，血流改道是一种有效的治疗方法。线圈栓塞仍然是治疗颈动脉海绵状瘘最常用的方法，其继发性颅神经病变的发生率较低。最近，对直接型和 B 型间接型颈动脉海绵瘘进行了血流分流治疗。最后，对于 IIH，静脉窦支架植入术已成为替代手术分流的常用方法，但与分流术一样，也存在支架相关并发症的风险。 总结血管内治疗在每种血管疾病中都得到了发展，并将继续转变以满足患者的需求。血管内治疗和手术治疗各有利弊，患者、外科医生和医疗机构均可自行决定。
{"title":"Current Endovascular Treatments in Neuro-Ophthalmology","authors":"Johanna Yun, Marc Dinkin","doi":"10.1007/s11940-024-00799-2","DOIUrl":"https://doi.org/10.1007/s11940-024-00799-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of Review</h3><p>Endovascular interventions have dramatically contemporized neuro-ophthalmological care in the twenty-first century. This review summarizes interventions with their advantages and disadvantages for intracranial aneurysms, carotid cavernous fistulas (CCF), and idiopathic intracranial hypertension (IIH), all of which are encountered in routine neuro-ophthalmologic practice.</p><h3 data-test=\"abstract-sub-heading\">Recent Findings</h3><p>There is a paucity of randomized, controlled trials comparing therapies for intracranial aneurysms, CCFs and IIH, specifically for neuro-ophthalmic outcomes. Flow diversion is a favorable treatment for intracranial aneurysms compressing the optic nerve and other cranial nerves. Coil embolization remains the most common treatment for cavernous carotid fistulas with low rates of secondary cranial neuropathy. Flow diversion has recently been explored in both direct and Type B indirect carotid cavernous fistulas. Lastly, for IIH, venous sinus stenting has become a popular alternative to surgical shunting, though, as with shunts, there is a risk of stent-related complications.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>Endovascular therapy has evolved for each vascular disease and continues to transform to meet the needs of its patients. There are advantages and disadvantages to each type of treatment – endovascular or surgical – and the decision is patient-, surgeon-, and institution-dependent.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"37 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141501465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-19DOI: 10.1007/s11940-024-00801-x
Bhathika Perera, David O’Regan
Purpose of Review
We performed a narrative review of the current knowledge in epidemiology, mechanisms, clinical presentation, and treatment of sleep disorders in adults with intellectual disability.
Recent Findings
Adults with Intellectual disability face significant mental and physical health disparities, including in sleep medicine. Despite sleep disorders having been identified as adversely affecting the health and quality of life of both adults with intellectual disabilities and their caregivers, the evidence base for assessment, diagnosis and treatment in this population remains under developed when compared to that of the general population. This review summarises the existing literature on insomnia, sleep disordered breathing, and other common sleep disorders in adults with intellectual disability. Emphasising the existing gaps in our understanding of sleep disorders in adults with intellectual disabilities, we propose strategies to address and mitigate these gaps.
Summary
Sleep disorders are common, yet frequently ignored in adults with intellectual disabilities. To address sleep health inequality gaps, future research should adopt tailored approaches, considering the heterogeneity within the intellectual disability population, including stratification by aetiology and health comorbidities. This is essential to improve the diagnostic accuracy and treatment of sleep disorders in adults with intellectual disability.
{"title":"Sleep Disorders in Adults with Intellectual Disability: Current Status and Future Directions","authors":"Bhathika Perera, David O’Regan","doi":"10.1007/s11940-024-00801-x","DOIUrl":"https://doi.org/10.1007/s11940-024-00801-x","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of Review</h3><p>We performed a narrative review of the current knowledge in epidemiology, mechanisms, clinical presentation, and treatment of sleep disorders in adults with intellectual disability.</p><h3 data-test=\"abstract-sub-heading\">Recent Findings</h3><p>Adults with Intellectual disability face significant mental and physical health disparities, including in sleep medicine. Despite sleep disorders having been identified as adversely affecting the health and quality of life of both adults with intellectual disabilities and their caregivers, the evidence base for assessment, diagnosis and treatment in this population remains under developed when compared to that of the general population. This review summarises the existing literature on insomnia, sleep disordered breathing, and other common sleep disorders in adults with intellectual disability. Emphasising the existing gaps in our understanding of sleep disorders in adults with intellectual disabilities, we propose strategies to address and mitigate these gaps.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>Sleep disorders are common, yet frequently ignored in adults with intellectual disabilities. To address sleep health inequality gaps, future research should adopt tailored approaches, considering the heterogeneity within the intellectual disability population, including stratification by aetiology and health comorbidities. This is essential to improve the diagnostic accuracy and treatment of sleep disorders in adults with intellectual disability.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"64 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141501611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-18DOI: 10.1007/s11940-024-00802-w
Simone Rossi, Marco Mandalà
Purpose of the Review
Chronic tinnitus affects millions of people worldwide, but it remains an unmet clinical problem, particularly from a therapeutic perspective.
Recent Findings
Neuroimaging and neurophysiological investigations have consistently unveiled that tinnitus can be considered as a form of maladaptive plasticity taking place not only in primary and associative auditory areas but also involving large-scale brain networks. Based on these premises, treatment strategies that aim to manipulate in a controllable way plastic capabilities of the brain are being under investigation as emerging treatments.
Summary
here, we review the rationale for using so called Non-Invasive Brain stimulation (NiBS) techniques, such as navigated repetitive transcranial magnetic stimulation (rTMS) and other forms of transcranial electrical stimulation (tES) or peripheral stimulations, to alleviate tinnitus. We also provide an overview of available clinical results of these various non-invasive neuromodulatory approaches, trying to identify how to translate their unquestionable therapeutic potential into real-life contexts, beyond the lab boundaries.
{"title":"TINNITUS. A Non-invasive Neuromodulatory Perspective","authors":"Simone Rossi, Marco Mandalà","doi":"10.1007/s11940-024-00802-w","DOIUrl":"https://doi.org/10.1007/s11940-024-00802-w","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of the Review</h3><p>Chronic tinnitus affects millions of people worldwide, but it remains an unmet clinical problem, particularly from a therapeutic perspective.</p><h3 data-test=\"abstract-sub-heading\">Recent Findings</h3><p>Neuroimaging and neurophysiological investigations have consistently unveiled that tinnitus can be considered as a form of maladaptive plasticity taking place not only in primary and associative auditory areas but also involving large-scale brain networks. Based on these premises, treatment strategies that aim to manipulate in a controllable way plastic capabilities of the brain are being under investigation as emerging treatments.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>here, we review the rationale for using so called Non-Invasive Brain stimulation (NiBS) techniques, such as navigated repetitive transcranial magnetic stimulation (rTMS) and other forms of transcranial electrical stimulation (tES) or peripheral stimulations, to alleviate tinnitus. We also provide an overview of available clinical results of these various non-invasive neuromodulatory approaches, trying to identify how to translate their unquestionable therapeutic potential into real-life contexts, beyond the lab boundaries.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"78 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141501466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This narrative review summarized the major studies focusing on the association between revascularization therapies (intravenous thrombolysis and endovascular thrombectomy) and collateral circulation status in terms of outcome and safety. Our aim is to elucidate, drawing upon the latest scientific evidence, the pivotal role that collateral circulation plays in shaping the prognosis and potential therapeutic in patients with ischemic stroke.
Recent findings
The data currently available suggest that pre-treatment assessment of collateral circulation may be crucial, as a good collateral circulation status appears to be associated with better outcomes in terms of both early revascularization and long-term disability. There is limited literature about the assessment of collateral circulation prior to acute reperfusion therapy.
Summary
The role of the intracranial collateral circulation is gaining increasing attention in the field of ischemic stroke, both in terms of outcome prognosis and therapeutic interventions. These findings need to be confirmed by more structured randomized controlled trials (RCTs), but they suggest that investigating therapeutic strategies to maintain and support collateral circulation may represent the future of ischemic stroke therapy.
{"title":"Delving Into the Significance of Brain’s Collateral Circulation in the Era of Revascularization Therapy","authors":"Marilena Mangiardi, Sergio Soeren Rossi, Adriano Bonura, Gianmarco Iaccarino, Michele Alessiani, Sabrina Anticoli, Gianluca De Rubeis, Enrico Pampana, Francesca Romana Pezzella","doi":"10.1007/s11940-024-00794-7","DOIUrl":"https://doi.org/10.1007/s11940-024-00794-7","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of review</h3><p>This narrative review summarized the major studies focusing on the association between revascularization therapies (intravenous thrombolysis and endovascular thrombectomy) and collateral circulation status in terms of outcome and safety. Our aim is to elucidate, drawing upon the latest scientific evidence, the pivotal role that collateral circulation plays in shaping the prognosis and potential therapeutic in patients with ischemic stroke.</p><h3 data-test=\"abstract-sub-heading\">Recent findings</h3><p>The data currently available suggest that pre-treatment assessment of collateral circulation may be crucial, as a good collateral circulation status appears to be associated with better outcomes in terms of both early revascularization and long-term disability. There is limited literature about the assessment of collateral circulation prior to acute reperfusion therapy.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>The role of the intracranial collateral circulation is gaining increasing attention in the field of ischemic stroke, both in terms of outcome prognosis and therapeutic interventions. These findings need to be confirmed by more structured randomized controlled trials (RCTs), but they suggest that investigating therapeutic strategies to maintain and support collateral circulation may represent the future of ischemic stroke therapy.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"83 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140883527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-04DOI: 10.1007/s11940-024-00791-w
Samantha K. Holden
Purpose of Review
Dementia with Lewy bodies (DLB) remains underrecognized and underdiagnosed due to its clinical and pathological heterogeneity. Diagnosis currently relies on recognition of clinical features and imaging and neurophysiologic biomarkers. However, clinical features are less obvious in mixed neurodegenerative pathologies, advanced imaging techniques are often inaccessible, and current DLB indicative biomarkers do not directly identify Lewy pathology.
Recent Findings
Seed amplification assay techniques have allowed for in vivo detection of pathological alpha-synuclein protein in the cerebrospinal fluid, blood, and dermal biosamples. Incorporation of co-pathology markers and refinement of the application and interpretation of existing tests for DLB, including brain and cardiac imaging, are also ongoing. Strategic combinations of Lewy biomarkers with other markers of neurodegeneration and neuroinflammation could create individualized patient profiles for diagnosis, prognosis, treatment selection, and response monitoring.
Summary
Continued validation and technical harmonization efforts will be needed prior to widespread clinical application of new Lewy body biomarkers. Combining existing and novel DLB and co-pathology biomarkers, along with thorough clinical evaluation, will lead to increased reliability and accuracy of etiological dementia diagnosis. Use of biomarker profiles and biologically based disease definitions will improve care and accelerate treatment discovery for people living with DLB.
{"title":"Updates in Fluid, Tissue, and Imaging Biomarkers for Dementia with Lewy Bodies and Implications for Biologically Based Disease Definitions","authors":"Samantha K. Holden","doi":"10.1007/s11940-024-00791-w","DOIUrl":"https://doi.org/10.1007/s11940-024-00791-w","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of Review</h3><p>Dementia with Lewy bodies (DLB) remains underrecognized and underdiagnosed due to its clinical and pathological heterogeneity. Diagnosis currently relies on recognition of clinical features and imaging and neurophysiologic biomarkers. However, clinical features are less obvious in mixed neurodegenerative pathologies, advanced imaging techniques are often inaccessible, and current DLB indicative biomarkers do not directly identify Lewy pathology.</p><h3 data-test=\"abstract-sub-heading\">Recent Findings</h3><p>Seed amplification assay techniques have allowed for in vivo detection of pathological alpha-synuclein protein in the cerebrospinal fluid, blood, and dermal biosamples. Incorporation of co-pathology markers and refinement of the application and interpretation of existing tests for DLB, including brain and cardiac imaging, are also ongoing. Strategic combinations of Lewy biomarkers with other markers of neurodegeneration and neuroinflammation could create individualized patient profiles for diagnosis, prognosis, treatment selection, and response monitoring.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>Continued validation and technical harmonization efforts will be needed prior to widespread clinical application of new Lewy body biomarkers. Combining existing and novel DLB and co-pathology biomarkers, along with thorough clinical evaluation, will lead to increased reliability and accuracy of etiological dementia diagnosis. Use of biomarker profiles and biologically based disease definitions will improve care and accelerate treatment discovery for people living with DLB.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"53 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140883791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-03DOI: 10.1007/s11940-024-00795-6
Fazladin T. Temurov, Asel A. Biseytova, Bakhytkul A. Ernazarova, Bibifatima D. Mukhambetova, Asan S. Ubaydullaev
Purpose of Review
The research aims to determine the effectiveness of the main approaches in the diagnosis and treatment of trigeminal neuralgia. Analysis, synthesis, comparison, and generalisation were used as methods of studying the object of research.
Recent Findings
According to the results of the study, the most effective method of diagnosis was found to be examination and history taking. Correct performance of these actions allows to find out whether the nature of the patient’s pain is a symptom of trigeminal neuralgia. For this purpose, the location, nature, and triggering factors of the pain are determined. At the same time, pain characteristics are compared to exclude other diseases that are also accompanied by pain in the face. Among the instrumental diagnostic methods, magnetic resonance imaging has proven to be the most effective, allowing to determine the form of neuralgia and its causes. To determine the effectiveness of treatment methods, the parameters of pain relief rate, duration of the therapeutic effect and the presence of side effects were used. The most effective approach in the conservative treatment of trigeminal neuralgia was determined to be a complex drug therapy, including anticonvulsants, muscle relaxants, antispasmodics, and physiotherapy procedures. The most effective method of surgical intervention is microvascular decompression, which provides immediate pain relief in most cases and has the longest-lasting effect compared to other methods.
Summary
Rhizotomy was defined as a less effective procedure, but its advantage was its minimally invasive nature. Even though trigeminal neuralgia is a recurrent disease, the right treatment approach can maximise the duration of remission and return the patient to a normal lifestyle.
{"title":"The Efficiency of Established Diagnostic and Therapeutic Approaches in the Treatment of Trigeminal Neuralgia","authors":"Fazladin T. Temurov, Asel A. Biseytova, Bakhytkul A. Ernazarova, Bibifatima D. Mukhambetova, Asan S. Ubaydullaev","doi":"10.1007/s11940-024-00795-6","DOIUrl":"https://doi.org/10.1007/s11940-024-00795-6","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of Review</h3><p>The research aims to determine the effectiveness of the main approaches in the diagnosis and treatment of trigeminal neuralgia. Analysis, synthesis, comparison, and generalisation were used as methods of studying the object of research.</p><h3 data-test=\"abstract-sub-heading\">Recent Findings</h3><p>According to the results of the study, the most effective method of diagnosis was found to be examination and history taking. Correct performance of these actions allows to find out whether the nature of the patient’s pain is a symptom of trigeminal neuralgia. For this purpose, the location, nature, and triggering factors of the pain are determined. At the same time, pain characteristics are compared to exclude other diseases that are also accompanied by pain in the face. Among the instrumental diagnostic methods, magnetic resonance imaging has proven to be the most effective, allowing to determine the form of neuralgia and its causes. To determine the effectiveness of treatment methods, the parameters of pain relief rate, duration of the therapeutic effect and the presence of side effects were used. The most effective approach in the conservative treatment of trigeminal neuralgia was determined to be a complex drug therapy, including anticonvulsants, muscle relaxants, antispasmodics, and physiotherapy procedures. The most effective method of surgical intervention is microvascular decompression, which provides immediate pain relief in most cases and has the longest-lasting effect compared to other methods.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>Rhizotomy was defined as a less effective procedure, but its advantage was its minimally invasive nature. Even though trigeminal neuralgia is a recurrent disease, the right treatment approach can maximise the duration of remission and return the patient to a normal lifestyle.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"14 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140883600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-19DOI: 10.1007/s11940-024-00793-8
Maximiliano A. Hawkes, Alejandro A. Rabinstein
Purpose of review
To provide an updated summary on the diagnosis and treatment of patients with malignant cerebral edema after ischemic stroke.
Recent findings
The risk of malignant middle cerebral artery (MCA) stroke is highest in young patients with large vessel occlusion and unsuccessful revascularization. Several scores are available for risk stratification. Treatment includes supportive care, close neurologic monitoring, and hyperosmolar therapy. Yet, the main therapeutic decision is whether to proceed with decompressive craniectomy. Multiple randomized clinical trials and several meta-analyses have demonstrated that decompressive hemicraniectomy is the single most important intervention associated with survival. Survivors may face severe disability regardless of surgical treatment, and the definition of acceptable outcome in this context remains elusive.
Summary
Malignant MCA infarcts are life-threatening and invariably cause disability, most often severe. Neurologic deterioration requires airway management and hyperosmolar therapy. Decompressive hemicraniectomy is a lifesaving procedure; approximately 50% of surgically treated patients younger than 60 years can regain independent ambulation, and one nearly in five may become functionally independent at 1 year. Older patients face a much worse functional prognosis; surgical decisions in these patients should be assessed case by case.
{"title":"Treatment of Malignant Cerebral Edema in Acute Ischemic Stroke","authors":"Maximiliano A. Hawkes, Alejandro A. Rabinstein","doi":"10.1007/s11940-024-00793-8","DOIUrl":"https://doi.org/10.1007/s11940-024-00793-8","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of review</h3><p>To provide an updated summary on the diagnosis and treatment of patients with malignant cerebral edema after ischemic stroke.</p><h3 data-test=\"abstract-sub-heading\">Recent findings</h3><p>The risk of malignant middle cerebral artery (MCA) stroke is highest in young patients with large vessel occlusion and unsuccessful revascularization. Several scores are available for risk stratification. Treatment includes supportive care, close neurologic monitoring, and hyperosmolar therapy. Yet, the main therapeutic decision is whether to proceed with decompressive craniectomy. Multiple randomized clinical trials and several meta-analyses have demonstrated that decompressive hemicraniectomy is the single most important intervention associated with survival. Survivors may face severe disability regardless of surgical treatment, and the definition of acceptable outcome in this context remains elusive.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>Malignant MCA infarcts are life-threatening and invariably cause disability, most often severe. Neurologic deterioration requires airway management and hyperosmolar therapy. Decompressive hemicraniectomy is a lifesaving procedure; approximately 50% of surgically treated patients younger than 60 years can regain independent ambulation, and one nearly in five may become functionally independent at 1 year. Older patients face a much worse functional prognosis; surgical decisions in these patients should be assessed case by case.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"3 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140623403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-02DOI: 10.1007/s11940-024-00790-x
Amanda X. Y. Chin, Zhi Xuan Quak, Yee Cheun Chan, Amy M. L. Quek, Kay W. P. Ng
Purpose of review
This review aims to provide a summary of the pathophysiology, clinical presentation and management options for facioscapulohumeral dystrophy (FSHD). We discuss current management options and delve into updates about developments in targeted therapy.
Recent findings
New breakthroughs in FSHD research have led to a further understanding of aberrant DUX4 protein expression in the underlying pathophysiology of FSHD. This has paved the way for the development of targeted therapies aimed at targeting DUX4 expression or its downstream effects. Therapeutic strategies for FSHD primarily target DUX4 through three main avenues: small molecules, antisense oligonucleotide therapeutics and CRISPR-based approaches. This review discusses these strategies further. Presently, all prospective targeted therapies are in the pre-clinical phase, except for losmapimod, which is currently undergoing a phase 3 clinical trial.
Summary
Given the absence of approved disease-modifying treatments for FSHD, the primary approach for management currently involves multidisciplinary supportive measures which are limited. Recent developments in the form of targeted therapies and strategies for the definitive treatment of FSHD indicate a promising era.
{"title":"Updates on Facioscapulohumeral Muscular Dystrophy (FSHD)","authors":"Amanda X. Y. Chin, Zhi Xuan Quak, Yee Cheun Chan, Amy M. L. Quek, Kay W. P. Ng","doi":"10.1007/s11940-024-00790-x","DOIUrl":"https://doi.org/10.1007/s11940-024-00790-x","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of review</h3><p>This review aims to provide a summary of the pathophysiology, clinical presentation and management options for facioscapulohumeral dystrophy (FSHD). We discuss current management options and delve into updates about developments in targeted therapy.</p><h3 data-test=\"abstract-sub-heading\">Recent findings</h3><p>New breakthroughs in FSHD research have led to a further understanding of aberrant DUX4 protein expression in the underlying pathophysiology of FSHD. This has paved the way for the development of targeted therapies aimed at targeting DUX4 expression or its downstream effects. Therapeutic strategies for FSHD primarily target DUX4 through three main avenues: small molecules, antisense oligonucleotide therapeutics and CRISPR-based approaches. This review discusses these strategies further. Presently, all prospective targeted therapies are in the pre-clinical phase, except for losmapimod, which is currently undergoing a phase 3 clinical trial.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>Given the absence of approved disease-modifying treatments for FSHD, the primary approach for management currently involves multidisciplinary supportive measures which are limited. Recent developments in the form of targeted therapies and strategies for the definitive treatment of FSHD indicate a promising era.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"49 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140566277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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