Pub Date : 2018-01-01DOI: 10.17925/ENR.2018.13.1.16
L. Battistin
In clinical neuroscience, the search to discover the cause and therapy for diseases was previously performed through the integrated approach of clinical observations with molecular neurobiology and neuroimaging. The new approach called “connectome” is mostly used in neuropsychological and behavioural studies correlated with neuroimaging data. However, to discover the causes and therapy of a disease, we should study not only connectivity but also cell processes and intercellular communications. Future research should be linked with clinical molecular neurobiology, and thus become true translational research.
{"title":"Reflections of a Clinician on the Current Trends in Clinical Neuroscience – Molecular Neurobiology and/or Connectome?","authors":"L. Battistin","doi":"10.17925/ENR.2018.13.1.16","DOIUrl":"https://doi.org/10.17925/ENR.2018.13.1.16","url":null,"abstract":"In clinical neuroscience, the search to discover the cause and therapy for diseases was previously performed through the integrated approach of clinical observations with molecular neurobiology and neuroimaging. The new approach called “connectome” is mostly used in neuropsychological and behavioural studies correlated with neuroimaging data. However, to discover the causes and therapy of a disease, we should study not only connectivity but also cell processes and intercellular communications. Future research should be linked with clinical molecular neurobiology, and thus become true translational research.","PeriodicalId":12047,"journal":{"name":"European neurological review","volume":"13 1","pages":"16"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67592521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-06-01DOI: 10.17925/ENR.2017.12.01.15
N. Titova, P. Jenner, K. Chaudhuri
he modern concept of Parkinson’s disease (PD) has changed and evolved and we consider Parkinson’s to be a multi-neurotransmitter dysfunction-related disorder with central and peripheral nervous system involvement. The clinical expression is thus a mixture of the outwardly evident motor symptoms and a range of ‘hidden’ non-motor symptoms. The complex underlying neuropathology of PD calls for a reassessment of the treatment strategies currently used. Treatment of PD is guideline-driven and in most cases based on a dopamine replacement strategy or surgical manipulation of brain dopaminergic pathways. Treatment of many non-dopaminergic non-motor and some motor symptoms, which have major effects on quality of life, continue to remain a key unmet need. Like in other chronic conditions such as rheumatology, the role of personalised medicine in PD needs to be increasingly considered. Personalised medicine for PD is not just a genetic approach to treatment but encompasses various strands of treatment. These include pharmacogenetic, pharmacological, as well as socio-demographic and lifestyle-related issues. Once these ‘enablers’ of personalised medicine are considered then satisfactory treatment for our patients with Parkinson’s can be achieved in an individualised manner. Future therapy for PD should move in that direction.
{"title":"The future of parkinson’s treatment – Personalised and precision medicine","authors":"N. Titova, P. Jenner, K. Chaudhuri","doi":"10.17925/ENR.2017.12.01.15","DOIUrl":"https://doi.org/10.17925/ENR.2017.12.01.15","url":null,"abstract":"he modern concept of Parkinson’s disease (PD) has changed and evolved and we consider Parkinson’s to be a multi-neurotransmitter dysfunction-related disorder with central and peripheral nervous system involvement. The clinical expression is thus a mixture of the outwardly evident motor symptoms and a range of ‘hidden’ non-motor symptoms. The complex underlying neuropathology of PD calls for a reassessment of the treatment strategies currently used. Treatment of PD is guideline-driven and in most cases based on a dopamine replacement strategy or surgical manipulation of brain dopaminergic pathways. Treatment of many non-dopaminergic non-motor and some motor symptoms, which have major effects on quality of life, continue to remain a key unmet need. Like in other chronic conditions such as rheumatology, the role of personalised medicine in PD needs to be increasingly considered. Personalised medicine for PD is not just a genetic approach to treatment but encompasses various strands of treatment. These include pharmacogenetic, pharmacological, as well as socio-demographic and lifestyle-related issues. Once these ‘enablers’ of personalised medicine are considered then satisfactory treatment for our patients with Parkinson’s can be achieved in an individualised manner. Future therapy for PD should move in that direction.","PeriodicalId":12047,"journal":{"name":"European neurological review","volume":"12 1","pages":"15-16"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45684616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-06-01DOI: 10.17925/ENR.2017.12.01.28
N. Karsan, P. Goadsby
I t has been historically accepted that migraine involves symptomatology outside of head pain. These symptoms can be as equally disabling as the pain, and can include tiredness, concentration impairment, memory impairment and mood change. The symptoms may start before the onset of pain and can persist throughout the headache phase, and even after effective headache treatment into the postdrome. Despite knowledge of these symptoms, their neurobiologic basis and relationship to migraine pain is poorly understood. The fact that these symptoms start early, up to hours to days before the onset of headache, and are so symptomatically heterogeneous, suggests that the neurobiology of migraine extends beyond conventionally accepted anatomical pain areas within the brain – what has been known as the pain matrix or network. In a research area where no effective acute abortive drugs have gained a license for migraine since the triptans (serotonin 5-HT 1B/1D receptor agonists), in the 1990s, further understanding of such symptomatology will allow therapeutic advances for treatments that may work before the onset of migraine pain and thus prevent it. This review will outline our current understanding about the phenotype and neurobiology of the premonitory (prodromal) symptoms, which for the purpose of this review will be called ‘premonitory-like’, given they can start before or during pain. Symptoms starting after pain resolution (postdromal symptoms) will not be covered here.
{"title":"Premonitory-like symptomatology in migraine","authors":"N. Karsan, P. Goadsby","doi":"10.17925/ENR.2017.12.01.28","DOIUrl":"https://doi.org/10.17925/ENR.2017.12.01.28","url":null,"abstract":"I t has been historically accepted that migraine involves symptomatology outside of head pain. These symptoms can be as equally disabling as the pain, and can include tiredness, concentration impairment, memory impairment and mood change. The symptoms may start before the onset of pain and can persist throughout the headache phase, and even after effective headache treatment into the postdrome. Despite knowledge of these symptoms, their neurobiologic basis and relationship to migraine pain is poorly understood. The fact that these symptoms start early, up to hours to days before the onset of headache, and are so symptomatically heterogeneous, suggests that the neurobiology of migraine extends beyond conventionally accepted anatomical pain areas within the brain – what has been known as the pain matrix or network. In a research area where no effective acute abortive drugs have gained a license for migraine since the triptans (serotonin 5-HT 1B/1D receptor agonists), in the 1990s, further understanding of such symptomatology will allow therapeutic advances for treatments that may work before the onset of migraine pain and thus prevent it. This review will outline our current understanding about the phenotype and neurobiology of the premonitory (prodromal) symptoms, which for the purpose of this review will be called ‘premonitory-like’, given they can start before or during pain. Symptoms starting after pain resolution (postdromal symptoms) will not be covered here.","PeriodicalId":12047,"journal":{"name":"European neurological review","volume":"12 1","pages":"28-30"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44842039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.17925/ENR.2017.12.01.17
E. Trinka, M. Carreño
O ptimal epilepsy management includes five important elements: rational treatment selection, efficacy, off-target effects, adherence and interactions and dosing issues. Perampanel (2-[2-oxo-1-phenyl-5-pyridin-2-yl-1,2-dihydropyridin-3-yl]benzonitrile; E2007) is the first potent, selective, orally-active non-competitive alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antagonist approved for the treatment of patients with epilepsy. Results from randomised controlled trials and real-world studies of refractory epilepsy populations treated with perampanel showed effective frequency reduction for both focal-onset seizures (without and with secondary generalisation) and for primary generalised tonic-clonic seizures. Perampanel therapeutic doses have been calculated to only inhibit a fraction of AMPA receptors, thereby to enable sufficient seizure control without substantial impairment of neurological function. Further investigation in special subpopulations of people with epilepsy, including the elderly and people with learning disability or psychiatric comorbidities, is warranted. With an average long half-life of 105 hours, perampanel may be more forgiving in circumstances of suboptimal adherence. Perampanel is not a strong inducer or inhibitor of cytochrome P450 enzymes, and dose adjustment is not always required for the elderly or for those with mild renal impairment.
{"title":"Reflections on the Use of Perampanel in Epilepsy – Lessons from the Clinic and Real-world Evidence","authors":"E. Trinka, M. Carreño","doi":"10.17925/ENR.2017.12.01.17","DOIUrl":"https://doi.org/10.17925/ENR.2017.12.01.17","url":null,"abstract":"O ptimal epilepsy management includes five important elements: rational treatment selection, efficacy, off-target effects, adherence and interactions and dosing issues. Perampanel (2-[2-oxo-1-phenyl-5-pyridin-2-yl-1,2-dihydropyridin-3-yl]benzonitrile; E2007) is the first potent, selective, orally-active non-competitive alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antagonist approved for the treatment of patients with epilepsy. Results from randomised controlled trials and real-world studies of refractory epilepsy populations treated with perampanel showed effective frequency reduction for both focal-onset seizures (without and with secondary generalisation) and for primary generalised tonic-clonic seizures. Perampanel therapeutic doses have been calculated to only inhibit a fraction of AMPA receptors, thereby to enable sufficient seizure control without substantial impairment of neurological function. Further investigation in special subpopulations of people with epilepsy, including the elderly and people with learning disability or psychiatric comorbidities, is warranted. With an average long half-life of 105 hours, perampanel may be more forgiving in circumstances of suboptimal adherence. Perampanel is not a strong inducer or inhibitor of cytochrome P450 enzymes, and dose adjustment is not always required for the elderly or for those with mild renal impairment.","PeriodicalId":12047,"journal":{"name":"European neurological review","volume":"12 1","pages":"17"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67592096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.17925/USN.2017.13.01.35
O. Mayer, E. Henricson, C. McDonald, G. Buyse
{"title":"Advances in pulmonary care in duchenne muscular dystrophy","authors":"O. Mayer, E. Henricson, C. McDonald, G. Buyse","doi":"10.17925/USN.2017.13.01.35","DOIUrl":"https://doi.org/10.17925/USN.2017.13.01.35","url":null,"abstract":"","PeriodicalId":12047,"journal":{"name":"European neurological review","volume":"13 1","pages":"35-41"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67611705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.17925/ENR.2017.12.02.64
U. Reuter
Support: No funding was received in the publication of this article. Shortly after the 18th Congress of the International Headache Society in Vancouver, Canada, in September 2017, Uwe Reuter participated in an expert interview. Here, he shares his insights and perspective on preventative therapies for migraine, discontinuation rates on current therapies, the need for new therapies with alternate targets and most promising potential therapies currently in development.
{"title":"Preventative Therapies for Migraine","authors":"U. Reuter","doi":"10.17925/ENR.2017.12.02.64","DOIUrl":"https://doi.org/10.17925/ENR.2017.12.02.64","url":null,"abstract":"Support: No funding was received in the publication of this article. Shortly after the 18th Congress of the International Headache Society in Vancouver, Canada, in September 2017, Uwe Reuter participated in an expert interview. Here, he shares his insights and perspective on preventative therapies for migraine, discontinuation rates on current therapies, the need for new therapies with alternate targets and most promising potential therapies currently in development.","PeriodicalId":12047,"journal":{"name":"European neurological review","volume":"12 1","pages":"64"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67591811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.17925/ENR.2017.12.02.66
G. Giovannoni
Disclosure: Gavin Giovannoni has received compensation for serving as a consultant or speaker for, or has received research support from: AbbVie, Almirall, Atara Bio, Bayer Schering Healthcare, Biogen Idec, Canbex, Eisai, Elan, Fiveprime Therapeutics, Genzyme, Genentech, GlaxoSmithKline, Ironwood Pharmaceuticals, Merck-Serono, Novartis, Pfizer, Roche, Sanofi-Aventis, Synthon BV, Teva Pharmaceutical Industries, UCB and Vertex Pharmaceuticals. This is an expert interview and as such, has not undergone the journal’s standard peer review process.
{"title":"First Oral Short-course Treatment for Adults with Highly Active Relapsing Multiple Sclerosis Now Approved in Europe","authors":"G. Giovannoni","doi":"10.17925/ENR.2017.12.02.66","DOIUrl":"https://doi.org/10.17925/ENR.2017.12.02.66","url":null,"abstract":"Disclosure: Gavin Giovannoni has received compensation for serving as a consultant or speaker for, or has received research support from: AbbVie, Almirall, Atara Bio, Bayer Schering Healthcare, Biogen Idec, Canbex, Eisai, Elan, Fiveprime Therapeutics, Genzyme, Genentech, GlaxoSmithKline, Ironwood Pharmaceuticals, Merck-Serono, Novartis, Pfizer, Roche, Sanofi-Aventis, Synthon BV, Teva Pharmaceutical Industries, UCB and Vertex Pharmaceuticals. This is an expert interview and as such, has not undergone the journal’s standard peer review process.","PeriodicalId":12047,"journal":{"name":"European neurological review","volume":"12 1","pages":"66"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67591828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.17925/ENR.2017.12.02.71
P. Cortelli, G. Allais, C. Benedetto
T he advent of triptans for effective relief of migraine represented a therapeutic breakthrough. Triptans are serotonin (5-hydroxytryptamine, or 5-HT) agonists with high affinity for 5-HT1B and 5-HT1D receptors. There are, at present, seven commonly used triptans: almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan. Some controversy still surrounds the mode of action of this class. When first studied, it was thought that triptans provided relief from migraine through cranial vasoconstriction, probably via action at postsynaptic 5-HT1B receptors on the smooth-muscle cells of blood vessels. More recently, however, triptans have also been demonstrated to block release of vasoactive peptides from the perivascular trigeminal neurons owing to their action at presynaptic 5-HT1D receptors on the nerve terminal. Triptans may also facilitate descending pain inhibitory systems. However, it is not certain whether or not the activation of vascular 5-HT1B receptors is essential for relieving migraine. Many drug characteristics need to be taken into account when selecting the best triptan for an individual patient. Clinical characteristics of the migraine attack and the patient’s lifestyle and medical history are also important. Despite their biochemical similarity, triptans have distinct pharmacokinetic and pharmacodynamic profiles. Frovatriptan and naratriptan, for example, have a longer half-life and therefore a delayed onset of action and prolonged duration compared with the other triptans, which are fast acting, with a rapid dose-dependent efficacy and higher risk of adverse events and migraine recurrence. Migraine recurrence is affected by the pharmacological and pharmacokinetic properties of the triptan but is unrelated to initial clinical efficacy. Triptans with a longer half-life and largest 5-HT1B receptor affinity have the lowest rates of headache recurrence.
{"title":"Overview of Triptans in the Treatment of Acute Migraine","authors":"P. Cortelli, G. Allais, C. Benedetto","doi":"10.17925/ENR.2017.12.02.71","DOIUrl":"https://doi.org/10.17925/ENR.2017.12.02.71","url":null,"abstract":"T he advent of triptans for effective relief of migraine represented a therapeutic breakthrough. Triptans are serotonin (5-hydroxytryptamine, or 5-HT) agonists with high affinity for 5-HT1B and 5-HT1D receptors. There are, at present, seven commonly used triptans: almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan. Some controversy still surrounds the mode of action of this class. When first studied, it was thought that triptans provided relief from migraine through cranial vasoconstriction, probably via action at postsynaptic 5-HT1B receptors on the smooth-muscle cells of blood vessels. More recently, however, triptans have also been demonstrated to block release of vasoactive peptides from the perivascular trigeminal neurons owing to their action at presynaptic 5-HT1D receptors on the nerve terminal. Triptans may also facilitate descending pain inhibitory systems. However, it is not certain whether or not the activation of vascular 5-HT1B receptors is essential for relieving migraine. Many drug characteristics need to be taken into account when selecting the best triptan for an individual patient. Clinical characteristics of the migraine attack and the patient’s lifestyle and medical history are also important. Despite their biochemical similarity, triptans have distinct pharmacokinetic and pharmacodynamic profiles. Frovatriptan and naratriptan, for example, have a longer half-life and therefore a delayed onset of action and prolonged duration compared with the other triptans, which are fast acting, with a rapid dose-dependent efficacy and higher risk of adverse events and migraine recurrence. Migraine recurrence is affected by the pharmacological and pharmacokinetic properties of the triptan but is unrelated to initial clinical efficacy. Triptans with a longer half-life and largest 5-HT1B receptor affinity have the lowest rates of headache recurrence.","PeriodicalId":12047,"journal":{"name":"European neurological review","volume":"12 1","pages":"71"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67591904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.17925/ENR.2017.12.02.60
C. Ballard
Support: No funding was received in the publication of this article. P sychotic episodes, particularly delusions, hallucinations, agitation, apathy, depression and sleep disturbance are characteristic and harmful effects of Alzheimer’s disease (AD); they are often the first manifestion of the condition and frequently appear before dementia begins. Despite their importance, they are frequently unrecognised and are difficult to treat. There is currently much interest in the mechanisms causing these symptoms, their impact on the disease process and the possibility of new, more effective treatment approaches. In an expert interview, Clive Ballard of Exeter University discusses the current situation of psychosis in AD.
{"title":"Psychotic Episodes in Alzheimer’s Disease","authors":"C. Ballard","doi":"10.17925/ENR.2017.12.02.60","DOIUrl":"https://doi.org/10.17925/ENR.2017.12.02.60","url":null,"abstract":"Support: No funding was received in the publication of this article. P sychotic episodes, particularly delusions, hallucinations, agitation, apathy, depression and sleep disturbance are characteristic and harmful effects of Alzheimer’s disease (AD); they are often the first manifestion of the condition and frequently appear before dementia begins. Despite their importance, they are frequently unrecognised and are difficult to treat. There is currently much interest in the mechanisms causing these symptoms, their impact on the disease process and the possibility of new, more effective treatment approaches. In an expert interview, Clive Ballard of Exeter University discusses the current situation of psychosis in AD.","PeriodicalId":12047,"journal":{"name":"European neurological review","volume":"12 1","pages":"60"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67592211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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