Expert Review of Neurotherapeutics最新文献

Introduction: The COVID-19 pandemic has taught myriad lessons and left several questions we are yet to comprehend. Initially, the scientific community was concerned with the management of acute disease and immunization. Once the peak of the pandemic receded, it became clear that a proportion of patients were far from fully recovered. Researchers started to recognize those persisting symptoms as a new entity termed 'Long COVID,' where neurological symptoms are evident and have a major impact on quality of life.

Areas covered: The main purpose of this narrative review is to analyze and synthesize the current literature regarding Long COVID, its relation to the nervous system, and to explore the evidence on treatments for persistent neurological symptoms. The most common reported and observed neurologic manifestations include fatigue, cognitive impairment, pain, polyneuropathy, and neuropsychiatric disorders. A variety of pharmacologic and non-pharmacologic therapies have been evaluated and yielded mixed results. Many of them focused on immunomodulation and none currently have U.S. FDA approval.

Expert opinion: Challenges remain in terms of clinical characterization and prognosis of Long COVID, besides understanding its pathophysiology. Standardization of biomarkers and diagnostic criteria will allow the use of common nomenclature and data elements in the design of future clinical studies.

Introduction: Alzheimer's disease (AD) is the most common neurodegenerative disorder, which is characterized by a progressive loss of cognitive functions. The high prevalence, chronicity, and multimorbidity are very common in AD, which significantly impair the quality of life and functioning of patients. Early detection and accurate diagnosis of Alzheimer's disease (AD) can stop the illness from progressing thereby postponing its symptoms. Therefore, for the early diagnosis and monitoring of AD, more sensitive, noninvasive, straightforward, and affordable screening tools are needed.

Areas covered: This review summarizes the importance of early detection methods and novel techniques for Alzheimer's disease diagnosis that can be used by healthcare professionals.

Expert opinion: Early diagnosis assists the patient and caregivers to understand the problem establishing reasonable goals and making future plans together. Early diagnosis techniques not only help in monitoring disease progression but also provide crucial information for the development of novel therapeutic targets. Researchers can plan to potentially alleviate symptoms or slow down the progression of Alzheimer's disease by identifying early molecular changes and targeting altered pathways.

Introduction: There is a growing body of evidence implicating gut-brain axis dysfunction in the pathophysiology of mood disorders. Accordingly, gut microbiota has become a promising target for the development of biomarkers and novel therapeutics for bipolar and depressive disorders.

Areas covered: We describe the observed changes in the gut microbiota of patients with mood disorders and discuss the available studies assessing microbiota-based strategies for their treatment.

Expert opinion: Microbiota-targeted interventions, such as symbiotics, prebiotics, paraprobiotics, and fecal microbiota transplants seem to attenuate the severity of depressive symptoms. The available results must be seen as preliminary and need to be replicated and/or confirmed in larger and independent studies, also considering the pathophysiological and clinical heterogeneity of mood disorders.

Introduction: Cognitive reserve (CR) is a crucial factor in explaining individual differences in the risk of Alzheimer's disease (AD) and cognitive decline. CR refers to the brain's ability to cope with pathology through compensatory mechanisms. This review examines the various methods used to measure, predict, and influence CR.

Areas covered: Based on a search of PubMed, PubMed Central, EMBASE, Scopus, and the Cochrane Library (up to 1 June 2024), this review addresses key CR proxies, highlighting their strengths and limitations. The review also explores established and emerging interventions. We critically evaluate the statistical methods used to measure CR and assess its practical application.

Expert opinion: CR plays a crucial role in delaying the onset and progression of AD. Lifestyle choices and experiences build CR and impact cognitive aging. However, practical challenges remain in applying CR in clinical settings, particularly in individuals with advanced cognitive decline. Education, while commonly used as a proxy for CR, may not fully capture its complexity. Alternatives like occupational complexity could offer more practical measures, but their application is still evolving. Addressing these limitations is key to advancing dementia prevention strategies.

Introduction: After a long period of obscurantism, a possible role of psychedelics in clinical practice has progressively become a tangible perspective during the last two decades. However, the resounding enthusiasm linked to such 'psychedelic renaissance' runs the risk to unduly minimize the possible hazards associated with these compounds, while expanding their alleged benefits to improbable panacea-like proportions. In order to avoid mystifying or demonizing the properties of 5-HT2a agonists on emotional grounds, this subject requires a strictly unprejudiced and cautious approach to the evidence.

Areas covered: In this article, the authors attempted to comprehensively analyze the available literature to provide a balanced overview of the possible benefits of psychedelics in healthcare, taking into account their potential risks.

Expert opinion: To date, psychedelics have shown a therapeutic potential in a wide range of conditions, with a seemingly limited risk of inducing adverse reactions, including abuse and dependence, when administered in a controlled environment by specialized personnel. In any case, although several questions remain unanswered before drawing firm conclusions, further studies are needed to establish which conditions and subjects could benefit from psychedelics and which patients bear the greater risk of adversities.

Introduction: Rimegepant is an oral small-molecule calcitonin gene-related peptide receptor antagonist approved in several countries for acute treatment of migraine and preventive treatment of episodic migraine in adults. This review summarizes the evidence, published to date, for the use of rimegepant as an acute or preventive treatment of migraine.

Areas covered: A brief overview of migraine, the pharmacokinetics of rimegepant, and the mechanism of action of rimegepant are provided. Evidence evaluating rimegepant as an acute or preventive treatment of migraine is then summarized in more detail, based on a literature search for full-length publications related to clinical or real-world use of rimegepant.

Expert opinion: Several clinical trials established rimegepant as a safe and effective treatment (acute and preventive) of migraine in adults. There are few head-to-head studies with other migraine treatments to determine relative efficacy. However, the favorable safety profile of rimegepant makes it appropriate for many patients, particularly those with contraindication, intolerance, or inadequate response to other classes of standard-of-care migraine treatments. Additional studies on the efficacy and cost-effectiveness relative to other treatments may further define the role of rimegepant in migraine treatment.

Background: Generalized anxiety disorder (GAD) is a common mental health condition. The endocannabinoid system has become a focus for new therapies, increasing interest in cannabis-based medicinal products (CBMPs). This study uses data from the UK Medical Cannabis Registry (UKMCR) to investigate real-world outcomes and safety of different CBMP formulations in GAD patients.

Methods: This study analyzed patient-reported outcomes from 302 GAD patients prescribed CBMPs (oil-based, dried flower, or a combination). Anxiety (GAD-7), sleep quality (SQS), and quality of life (EQ-5D-5 L) were assessed at 1, 3, 6, and 12 months. Adverse events were recorded.

Results: All CBMP formulations were associated with improvements in anxiety, sleep, and quality of life over 12 months (p < 0.050). At 12 months, there were no significant differences in outcomes between formulations (p > 0.050). The majority of reported adverse events (n = 707) were mild (n = 343) or moderate (n = 285) in severity, with no life-threatening events observed.

Conclusion: This study provides real-world evidence supporting the potential of CBMPs for improving GAD symptoms. Patients prescribed both oil-based and dried flower formulations have similar outcomes over 12 months. Further research is needed to determine the optimal CBMP formulation and long-term effects.