Current Opinion in Neurology最新文献

Purpose of review: The scope of this review is to discuss persistent aura without infarction, a rare, highly disabling, yet apparently benign clinical condition, straddling neurology, neuro-ophthalmology, and psychiatry, whose differential diagnosis is essential for an appropriate therapeutic approach and to avoid clinical complications. Here we attempt to report on the available literature, trying to present a summary, despite the scarcity of available literature.

Recent findings: Persistent aura without infarction is a diagnostic challenge, likely caused by cortical spreading depression and vasoconstriction, whose clinical features are not always easy to pigeonhole into the available diagnostic criteria. The diagnosis requires the exclusion of cerebral and retinal infarction, structural changes in the brain, epilepsy, and psychiatric symptoms. Triptans may be deleterious, anticoagulants are not indicated, and therapy with acetazolamide, valproic acid, zonisamide, furosemide, cortisone, and ketamine may be beneficial.

Summary: Persistent aura without infarction is a challenging diagnosis. However, an approach using zonisamide and ketamine might be beneficial. Randomized and controlled clinical trials are required for a better comprehension of the aetiopathogenesis and therapeutic approach.

Purpose of review: To review novel multiple sclerosis (MS) therapies currently in clinical trials.

Recent findings: Sixty-seven clinical trials were selected and grouped into the following categories: Bruton's tyrosine kinase inhibitors, remyelinating therapies, immunomodulators, B cell therapies, supplements/microbiome influencers, and cell-directed therapies. Important findings include tolebrutinib's successful trial in nonrelapsing secondary progressive MS that slowed CDP compared to placebo and simvastatin's failure to show an effect on disability in its phase 3 trial.

Summary: Multiple strategies are being investigated in MS to address progressive disability, myelin repair, neural protection and treatment refractory disease. Some of these strategies have successfully completed clinical trials giving hope that some of the most vexing aspects of MS will soon have new treatment options.

Purpose of review: The immunological processes that lead to multiple sclerosis (MS) and occur during the progressive phase of the disease are manifold and still not well understood. This review summarizes new insights on this topic that were gained through recent studies with diverse scientific approaches.

Recent findings: While genetic risk clearly contributes to MS, external factors play a key role in its pathogenesis as well. Epstein-Barr virus infection correlates significantly with MS risk and seems to be a major causal factor. Even though our knowledge on the human gut microbiome and its connection to the central nervous system is far from being complete, several studies have proven that the gut-brain axis influences neuroinflammation and disease progression in MS. It has become much clearer that MS is not solely a T cell-mediated disease but is also strongly driven by B cells and pathogenic antibodies. Beyond the peripheral immune cells, glial cells and their interactions with neurons are important players contributing to disease activity and progression in MS.

Summary: Taken together, recent publications on immunological processes in the context of MS implicate a multitude of noncanonical mechanisms that need to be further explored regarding their interplay and contribution to the degenerative course of the disease.

Purpose of review: This article explores the most recent developments in multiple sclerosis (MS), including a selection of advances in diagnostic neuroimaging markers. The proposed revision of diagnostic criteria, new concepts on the prodromal period, and differential diagnosis of MS are included as well.

Recent findings: Interesting changes have been introduced to the recently proposed 2024 revisions of MS diagnostic criteria. Optic nerve is proposed as the 5 th CNS topography, additional advanced MRI markers are included, as well as specific cases of "radiologically isolated syndrome" considered at risk of future relapses.The diagnostic power of the central vein sign, paramagnetic rim lesion, and cortical lesions have been demonstrated in recent lines of research in adult and pediatric patients with MS. The contribution of cortical lesions, slowly expanding lesions, choroid plexus enlargement, paramagnetic rim lesions, leptomeningeal enhancement, in addition to measurement of brain and spinal cord atrophy, have expanded our understanding of early disease progression.

Summary: This review highlights a selection of recent studies that have significantly contributed to increase the accuracy of MS diagnosis in both pediatric and adult patients, and demonstrated the potential to improve the early detection of disease progression.

Purpose of review: This comprehensive overview summarized the latest advances of multiple sclerosis (MS) in China, including the diagnostic and treatment challenges, research and future directions under health policy recommendations.

Recent findings: Given the rising prevalence of MS in China during the past decades, it has emerged as a significant public health concern due to the extensive population and pronounced disparities between urban and rural areas. The clinical manifestations of MS patients in China can be various due to the nation's diversity and evolving environmental factors. Advances in diagnostic practices, including the advances under 7T MRI radiological assessments, have enhanced the precision of MS diagnosis. Despite the introduction of disease-modifying therapeutic agents and the support of healthcare policies offering patients a wider range of treatment options, multiple ongoing research efforts and clinical trials will provide additional evidence. The ongoing China National Registry of Neuro-Inflammatory Diseases study (NCT05154370) holds promise for further enhancing the management of MS patients in China.

Summary: Improved recognition and management of MS in China have been facilitated, encompassing both prompt diagnosis and diverse treatment options. Simultaneously, research efforts and large-scale cohort studies have significantly advanced the overall status in this field.

Purpose of review: The purpose of this review is to provide an update on the clinical course and management of migraine in women.

Recent findings: Migraine is two to three times more prevalent in women who report a longer, more severe attacks with more disability, an increased risk of recurrence, and a longer recovery period. Consequently, women use more acute and preventive medications, have more comorbid conditions and are more likely to run a chronic disease course.Real-life experience and evidence suggest that onabotulinumtoxinA and the newer generation antibody treatments against the calcitonin gene-related peptide (CGRP) ligand and its receptor are highly effective in the management of migraine in women.Pregnancy, breast feeding, and menstrual cycles should be taken into account when treating women with migraine. Topiramate and sodium valproate should be avoided in women of childbearing age (WCBA). Hormonal options can be considered in menstrual or menopausal migraines. NSAIDs and prostaglandins such as mefenamic acid can be used at onset of menstrual migraine. Venlafaxine can be effective in menopausal migraine while also treating the vasomotor symptoms. Migraine usually improves during pregnancy; however, if required nonpharmacological options should be considered.

Summary: Effectively managing migraine in women of productive and reproductive age, can reduce the socioeconomic burden of this debilitating disease.

Purpose of review: Technological innovations and clinical research in SEEG have dramatically increased with its worldwide dissemination. In this review, we summarize the main advances in the field from the last 5 years.

Recent findings: Several large series and meta-analyses have provided consistent data regarding a lower risk of serious complications with SEEG as compared to sub-dural grids, while some studies also suggest a greater diagnostic value. The safety and precision of SEEG partly depends on the type of vascular imaging and method of implantation, with some series suggesting that MR angiography might not provide an optimal delineation of electrode-vessel conflicts and that frameless stereotaxy lacks precision. Noninvasive frame coupled with robot-guided implantation might offer the best precision/invasiveness tradeoff. Small series suggest that SEEG can be safely performed from the age of 16 months, and that adding electrodes during SEEG often prove beneficial. Transhemispheric electrodes targeting the mesial frontal structures, bilaterally, proved safe and informative. Several interictal and ictal biomarkers of the epileptogenic zone have been investigated. Although high-frequency oscillations (HFOs) remain a biomarker of interest, a randomized controlled trial failed to demonstrate its diagnostic value against spikes. Furthermore, other interictal biomarkers proved to better correlate with the epileptogenic zone than HFOs rate, including spike-gamma and spike-ripples. Ictal biomarkers of interest include the so-called chirp and epileptogenic zone fingerprint. Overall, recent data suggest that high-frequency activities are not a mandatory feature of interictal and ictal biomarkers of the epileptogenic zone. Radiofrequency thermocoagulation (RFTC) performed during SEEG investigation have also progressed, with some authors reporting spectacular rates of seizure freedom in patients with localized epileptogenic lesion but also mesial temporal sclerosis. However, a systematic assessment of memory and mental health demonstrated the presence of altered memory and psychiatric complications in a significant proportion of mesial temporal lobe RFTC.

Summary: Progress has been made in the technology and methods used to perform SEEG and RFTC, with the view to increase safety and effectiveness. Several interictal and ictal biomarkers appear promising but still face challenges in their validation and implementation in clinical practice. Future research requires harmonization in the concepts of the seizure onset and epileptogenic zones, and prospective pathology-specific studies.

Purpose of review: Epilepsy surgery is a potentially curative intervention for medically refractory epilepsy. In the last several decades, epilepsy has been studied as a network disorder. How has this disease model influenced surgical interventions?

Recent findings: Surgical outcomes for resection are increasingly being tied to network features, such as node hubness score. These findings imply that measuring network features may augment epileptologist seizure onset zone designation for surgical planning. Network models are also leveraged for neuromodulation, specifically in studies with thalamic targets. Recent findings suggest that the thalamus may function as a reasonable target for neuromodulation because of its role in the seizure propagation networks.

Summary: In this review, we discuss the degree these models of epilepsy are influencing surgery today and barriers for the widespread adoption of network models when planning epilepsy surgery.

Purpose of review: Immunometabolism is an emerging field of research investigating the ability of immune cells to modulate their metabolic activity for optimal function. While this has been extensively examined in peripheral immune cells like macrophages, only recently have these studies been extended to assess the immunometabolic activity of microglia, the innate immune cells of the brain.

Recent findings: Microglia are highly metabolically flexible and can utilize different nutrients for their diverse functions. Like other immune cells, they undergo metabolic reprogramming on immune stimulation and in inflammatory, neurodegenerative conditions such as Alzheimer's disease (AD). In recent years, researchers have looked at the intricate mechanisms that modulate microglial activity and have uncovered key links between altered metabolism, neuroinflammation, and the involvement of disease-associated risk genes.

Summary: This review highlights the recent studies that have significantly contributed to our understanding of the metabolic dysregulation observed in activated microglia in conditions such as AD, unveiling novel targets for therapeutic intervention.