Pub Date : 2024-01-11DOI: 10.1007/s11940-024-00782-x
Avi Landman, Mark Levine, Andrés M. De León
Purpose of review
To describe the clinical presentation, diagnosis, and treatment options of vasculitic neuropathies. Overall, vasculitic neuropathies can be divided into systemic and nonsystemic. Systemic vasculitic neuropathies form part of rheumatological diseases, where in some cases, the vasculitic is the predominant feature, and these are called primary vasculitis, while in others, the vasculitis is secondary to a connective tissue disease. Nonsystemic vasculitic neuropathies involve only the peripheral nervous system, and thus, diagnosis is more challenging as it requires a high degree of suspicion and confirmation with nerve biopsy results.
Recent findings
Over the past few years, rituximab has been increasingly used for induction and maintenance treatment of vasculitis due to a more favorable side effect profile and similar efficacy when compared to cyclophosphamide.
Summary
Herein, we describe the different types of vasculitic neuropathies. Regarding their treatment, have focused on the indications, dosing, and side effects for the most common options for primary systemic vasculitic neuropathies, as these tend to be similar for the classical nonsystemic vasculitic neuropathy phenotype.
{"title":"Vasculitic Neuropathies","authors":"Avi Landman, Mark Levine, Andrés M. De León","doi":"10.1007/s11940-024-00782-x","DOIUrl":"https://doi.org/10.1007/s11940-024-00782-x","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of review</h3><p>To describe the clinical presentation, diagnosis, and treatment options of vasculitic neuropathies. Overall, vasculitic neuropathies can be divided into systemic and nonsystemic. Systemic vasculitic neuropathies form part of rheumatological diseases, where in some cases, the vasculitic is the predominant feature, and these are called primary vasculitis, while in others, the vasculitis is secondary to a connective tissue disease. Nonsystemic vasculitic neuropathies involve only the peripheral nervous system, and thus, diagnosis is more challenging as it requires a high degree of suspicion and confirmation with nerve biopsy results.</p><h3 data-test=\"abstract-sub-heading\">Recent findings</h3><p>Over the past few years, rituximab has been increasingly used for induction and maintenance treatment of vasculitis due to a more favorable side effect profile and similar efficacy when compared to cyclophosphamide.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>Herein, we describe the different types of vasculitic neuropathies. Regarding their treatment, have focused on the indications, dosing, and side effects for the most common options for primary systemic vasculitic neuropathies, as these tend to be similar for the classical nonsystemic vasculitic neuropathy phenotype.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"4 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139461100","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 : 2023-12-07DOI: 10.1007/s11940-023-00775-2
Alicia O’Hara, Marie Newkirk, Mina Girgis, Carrie Esopenko, David Putrino, Laura Tabacof, Christopher Kellner, Jenna M. Tosto-Mancuso
Purpose of review
This review appraises the existing literature to highlight the benefits, barriers, and role of rehabilitation in the early mobilization of patients in neurological critical care.
Recent findings
While the benefits of early mobilization in patients with critical illness have become more widely acknowledged, there are benefits and challenges to the successful implementation of early mobilization rehabilitation programming in the neurological critical care setting. The imperative role of rehabilitation providers is underscored in successful implementation. Furthermore, the discrete needs of patients and caregivers in neurocritical care necessitate interdisciplinary collaboration among medical and rehabilitation teams for the successful deployment of early mobilization programs.
Summary
This work discusses the expanding role of rehabilitation providers in neurocritical care and the importance of early mobilization for patients with neurological injuries. Experience-dependent neuroplasticity is a primary mechanism in facilitating recovery following neurological injury, and physical rehabilitation plays a critical role in this process. There is, however, a discrepancy in nomenclature regarding the definition of “early mobilization,” which makes it challenging to synthesize and translate evidence into practice. Despite the benefits of early mobilization, applying this evidence to the neurocritically ill patient is controversial given the innate medical complexity associated with these diagnoses. Nonetheless, early mobilization has been shown to decrease ICU and hospital length of stay, increase discharge to home, and reduce medical costs. Furthermore, consideration for those with severe acute brain injury and necessary medical interventions should be accounted for. While extensive literature has demonstrated the feasibility of adopting early mobilization to minimize secondary complications of ICU episodes of care, adoption of this paradigm has progressively expanded in the neurological population. Factors including the timing and frequency of mobilization are unclear and vary among studies, suggesting that more research is needed to better understand the role and benefits of early mobilization in neurocritical care.
{"title":"The Role of Rehabilitation in Neurological Critical Care: Innovations in Early Mobilization","authors":"Alicia O’Hara, Marie Newkirk, Mina Girgis, Carrie Esopenko, David Putrino, Laura Tabacof, Christopher Kellner, Jenna M. Tosto-Mancuso","doi":"10.1007/s11940-023-00775-2","DOIUrl":"https://doi.org/10.1007/s11940-023-00775-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of review</h3><p>This review appraises the existing literature to highlight the benefits, barriers, and role of rehabilitation in the early mobilization of patients in neurological critical care.</p><h3 data-test=\"abstract-sub-heading\">Recent findings</h3><p>While the benefits of early mobilization in patients with critical illness have become more widely acknowledged, there are benefits and challenges to the successful implementation of early mobilization rehabilitation programming in the neurological critical care setting. The imperative role of rehabilitation providers is underscored in successful implementation. Furthermore, the discrete needs of patients and caregivers in neurocritical care necessitate interdisciplinary collaboration among medical and rehabilitation teams for the successful deployment of early mobilization programs.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>This work discusses the expanding role of rehabilitation providers in neurocritical care and the importance of early mobilization for patients with neurological injuries. Experience-dependent neuroplasticity is a primary mechanism in facilitating recovery following neurological injury, and physical rehabilitation plays a critical role in this process. There is, however, a discrepancy in nomenclature regarding the definition of “early mobilization,” which makes it challenging to synthesize and translate evidence into practice. Despite the benefits of early mobilization, applying this evidence to the neurocritically ill patient is controversial given the innate medical complexity associated with these diagnoses. Nonetheless, early mobilization has been shown to decrease ICU and hospital length of stay, increase discharge to home, and reduce medical costs. Furthermore, consideration for those with severe acute brain injury and necessary medical interventions should be accounted for. While extensive literature has demonstrated the feasibility of adopting early mobilization to minimize secondary complications of ICU episodes of care, adoption of this paradigm has progressively expanded in the neurological population. Factors including the timing and frequency of mobilization are unclear and vary among studies, suggesting that more research is needed to better understand the role and benefits of early mobilization in neurocritical care.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"108 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138548342","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 : 2023-12-05DOI: 10.1007/s11940-023-00778-z
Kristopher A. Hendershot, Maya N. Elias, Breana L. Taylor, Sarah Wahlster, Claire J. Creutzfeldt
Purpose of review
We investigate the complexities and interplay between the concepts of prognostic uncertainty and patient preferences as they relate to the delivery of goal-concordant care to patients with severe acute brain injuries (SABI) in the Neurological Intensive Care Unit (Neuro-ICU).
Recent findings
Patients with SABI in the Neuro-ICU have unique palliative care needs due to sudden, often unexpected changes in personhood and quality of life. A substantial amount of uncertainty is inherent and poses a challenge to both the patient’s prognosis and treatment preferences. The delivery of goal-concordant care can be difficult to achieve.
Summary
The uncertainty inherent to both prognosis and patient preferences challenges the provision of goal-concordant care to patients with SABI. The best case/worst case/most likely case scenario is a communication strategy that can aid clinicians when discussing the patient’s uncertain prognosis. A time-limited trial may provide a framework for families and clinicians to pursue aggressive life-sustaining treatment for a certain amount of time, in which prognosis may become more defined, patient goals may become clearer, and clinicians and families may establish a common ground. Although the delivery of goal-concordant care in the Neuro-ICU may be an unachievable, lofty goal, it is a level of care that we should continue to strive for and discuss.
{"title":"An Update on Palliative Care in Neurocritical Care: Providing Goal-Concordant Care in the Face of Prognostic Uncertainty","authors":"Kristopher A. Hendershot, Maya N. Elias, Breana L. Taylor, Sarah Wahlster, Claire J. Creutzfeldt","doi":"10.1007/s11940-023-00778-z","DOIUrl":"https://doi.org/10.1007/s11940-023-00778-z","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of review</h3><p>We investigate the complexities and interplay between the concepts of prognostic uncertainty and patient preferences as they relate to the delivery of goal-concordant care to patients with severe acute brain injuries (SABI) in the Neurological Intensive Care Unit (Neuro-ICU).</p><h3 data-test=\"abstract-sub-heading\">Recent findings</h3><p>Patients with SABI in the Neuro-ICU have unique palliative care needs due to sudden, often unexpected changes in personhood and quality of life. A substantial amount of uncertainty is inherent and poses a challenge to both the patient’s prognosis and treatment preferences. The delivery of goal-concordant care can be difficult to achieve.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>The uncertainty inherent to both prognosis and patient preferences challenges the provision of goal-concordant care to patients with SABI. The best case/worst case/most likely case scenario is a communication strategy that can aid clinicians when discussing the patient’s uncertain prognosis. A time-limited trial may provide a framework for families and clinicians to pursue aggressive life-sustaining treatment for a certain amount of time, in which prognosis may become more defined, patient goals may become clearer, and clinicians and families may establish a common ground. Although the delivery of goal-concordant care in the Neuro-ICU may be an unachievable, lofty goal, it is a level of care that we should continue to strive for and discuss.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"20 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138516181","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 : 2023-11-22DOI: 10.1007/s11940-023-00773-4
Allison L. Nogi, Daniel Ludwig, Jennifer Millar
{"title":"Correction to: Clinical Practice Update Part I: Diagnosis and Treatment for Benign Paroxysmal Positional Vertigo","authors":"Allison L. Nogi, Daniel Ludwig, Jennifer Millar","doi":"10.1007/s11940-023-00773-4","DOIUrl":"https://doi.org/10.1007/s11940-023-00773-4","url":null,"abstract":"","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"5 2","pages":"1"},"PeriodicalIF":2.0,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139247970","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 : 2023-11-22DOI: 10.1007/s11940-023-00776-1
Andrew B. Wolf, Jacqueline Palace, Jeffrey L. Bennett
Purpose of review
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare inflammatory disorder of the central nervous system that affects both adults and children. Neurologic disability is relapse-driven; therefore, early diagnosis and targeted treatment are critical for effective care. We review the new MOGAD diagnostic criteria and evidence for current acute and preventative therapies.
Recent findings
The International MOGAD Panel has released the first clinical, laboratory, and radiographic criteria for MOGAD diagnosis. These criteria set the stage for evaluating clinical investigations and designing future randomized clinical trials. Prior retrospective studies have evaluated multiple off-label agents for the acute care or prevention of MOGAD attacks, and prospective randomized clinical trials are now underway.
Summary
Acute MOGAD attacks are generally responsive to high-dose corticosteroids; however, early use of plasma exchange or intravenous immunoglobulin may be beneficial for severe attacks or cases lacking corticosteroid response. A slow corticosteroid taper may lower the risk of relapse. Preventative treatment has been typically limited to patients with a definitive relapsing disease. While there is no consensus on the choice or duration of treatment, multiple therapies have been retrospectively evaluated. Prospective placebo-controlled trials for interleukin-6 receptor inhibition and neonatal Fc receptor inhibition may open new frontiers for patient care.
{"title":"Emerging Principles for Treating Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD)","authors":"Andrew B. Wolf, Jacqueline Palace, Jeffrey L. Bennett","doi":"10.1007/s11940-023-00776-1","DOIUrl":"https://doi.org/10.1007/s11940-023-00776-1","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of review</h3><p>Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare inflammatory disorder of the central nervous system that affects both adults and children. Neurologic disability is relapse-driven; therefore, early diagnosis and targeted treatment are critical for effective care. We review the new MOGAD diagnostic criteria and evidence for current acute and preventative therapies.</p><h3 data-test=\"abstract-sub-heading\">Recent findings</h3><p>The International MOGAD Panel has released the first clinical, laboratory, and radiographic criteria for MOGAD diagnosis. These criteria set the stage for evaluating clinical investigations and designing future randomized clinical trials. Prior retrospective studies have evaluated multiple off-label agents for the acute care or prevention of MOGAD attacks, and prospective randomized clinical trials are now underway.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>Acute MOGAD attacks are generally responsive to high-dose corticosteroids; however, early use of plasma exchange or intravenous immunoglobulin may be beneficial for severe attacks or cases lacking corticosteroid response. A slow corticosteroid taper may lower the risk of relapse. Preventative treatment has been typically limited to patients with a definitive relapsing disease. While there is no consensus on the choice or duration of treatment, multiple therapies have been retrospectively evaluated. Prospective placebo-controlled trials for interleukin-6 receptor inhibition and neonatal Fc receptor inhibition may open new frontiers for patient care.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"7 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138516189","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 : 2023-11-14DOI: 10.1007/s11940-023-00777-0
Nicole Frost, Gavin Yuan, Julia Zhang, Amy Rickard, Erin McGee, Michelle DiMattia, Stephan A. Mayer
{"title":"Correction to: Speech Language Pathology in the Neurocritical Care Unit","authors":"Nicole Frost, Gavin Yuan, Julia Zhang, Amy Rickard, Erin McGee, Michelle DiMattia, Stephan A. Mayer","doi":"10.1007/s11940-023-00777-0","DOIUrl":"https://doi.org/10.1007/s11940-023-00777-0","url":null,"abstract":"","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"28 19","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134991940","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 : 2023-11-06DOI: 10.1007/s11940-023-00774-3
Scott Mintzer
{"title":"Epilepsy Treatment in Patients with Heart Disease","authors":"Scott Mintzer","doi":"10.1007/s11940-023-00774-3","DOIUrl":"https://doi.org/10.1007/s11940-023-00774-3","url":null,"abstract":"","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135585702","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 : 2023-10-09DOI: 10.1007/s11940-023-00772-5
Nicole Frost, Gavin Yuan, Julie Zhang, Amy Rickard, Erin McGee, Michelle DiMattia, Stephan A. Mayer
{"title":"Speech Language Pathology in the Neurocritical Care Unit","authors":"Nicole Frost, Gavin Yuan, Julie Zhang, Amy Rickard, Erin McGee, Michelle DiMattia, Stephan A. Mayer","doi":"10.1007/s11940-023-00772-5","DOIUrl":"https://doi.org/10.1007/s11940-023-00772-5","url":null,"abstract":"","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135095307","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 : 2023-10-07DOI: 10.1007/s11940-023-00771-6
Catherine V. Kulick-Soper, Genna Waldman
{"title":"Epilepsy Management in Transgender and Gender Diverse People","authors":"Catherine V. Kulick-Soper, Genna Waldman","doi":"10.1007/s11940-023-00771-6","DOIUrl":"https://doi.org/10.1007/s11940-023-00771-6","url":null,"abstract":"","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135253381","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 : 2023-10-05DOI: 10.1007/s11940-023-00769-0
Jeffrey J. Mucksavage, Eljim P. Tesoro
{"title":"The Role of Pharmacy in Neurocritical Care","authors":"Jeffrey J. Mucksavage, Eljim P. Tesoro","doi":"10.1007/s11940-023-00769-0","DOIUrl":"https://doi.org/10.1007/s11940-023-00769-0","url":null,"abstract":"","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134947468","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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