Expert Review of Neurotherapeutics最新文献

Introduction: Neuromyelitis optica spectrum disorder (NMOSD) is a rare, relapsing autoimmune disorder of the central nervous system, characterized by inflammatory attacks affecting the optic nerves, spinal cord and brain. In most cases, pathogenic antibodies against aquaporin-4 (AQP4-IgG) are detectable. These antibodies target astrocytes, triggering complement activation and the release of proinflammatory cytokines such as interleukin-6 (IL-6), culminating in an astrocytopathy and neurological disability.

Areas covered: In this review, Medical Subject Heading (MeSH) and related entry terms were used to search English literature in PubMed and ClinicalTrial.gov databases, respectively. MeSH included but were not limited to Neuromyelitis optica (NMO), Neuromyelitis Optica Spectrum Disorders (NMOSD), pathogenesis, complement, immune cells, B-cell, T-cell, cytokines, and therapy.

Expert opinion: Over the past decade, significant strides in our understanding of NMOSD immunopathogenesis have led to the development of targeted therapies that have revolutionized patient outcomes and survival. This review outlines the clinical features of NMOSD and examines current and emerging therapeutic strategies in the context of disease biology. It also addresses ongoing challenges, including optimization of acute attack management, strategies for treatment de-escalation, and prospects for achieving immune tolerance.

Introduction: While there are many treatment options available for Tourette Syndrome, including pharmacotherapy and behavioral therapy, these treatments may lead to incomplete symptom relief or side effects. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that uses constant, low current delivered via electrodes attached to the scalp in order to modulate brain signals. tDCS has been explored as an alternative treatment option for tics in both pediatric and adult populations. While some studies have demonstrated that cathodal tDCS over the Supplementary Motor Area leads to improvement in tics compared to baseline as well as trends toward improvement in tics compared to sham stimulation, other studies have had mixed results or worsening of symptoms.

Areas covered: Herein, the authors discuss the recent studies on tDCS for Tourette syndrome and highlight the most common side effects found. The authors also comment on the limitations these studies have and provide their expert perspectives on its prospects as a treatment option. This article is based on a PubMed literature focusing on the terms 'transcranial direct current stimulation OR tDCS' AND 'tic OR Tourette.'

Expert opinion: While tDCS is a promising treatment to explore, it is premature to recommend it as a primary or adjunctive therapy outside the experimental setting. The optimal stimulation protocol, brain target, and treatment duration have yet to be elucidated; therefore, additional larger, sham-controlled, randomized studies are needed to determine the best way to incorporate tDCS into clinical practice.

Introduction: Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by classic motor symptoms such as tremor, bradykinesia, rigidity, and postural instability as well as several non-motor symptoms. The heterogenous nature of PD has increased interest in classifying patients into subtypes based on clinical and/or pathologic features. This approach might allow for personalized therapies ranging from non-medical interventions to disease modifying therapies.

Areas covered: As the field continues to advance, PD can be classified into simple motor, non-motor, or genetic subtypes among many others, though more complex subtypes have emerged because of artificial intelligence (AI) and machine learning (ML) systems. Herein, the authors describe the current state of subtyping in PD and the effects of subtyping on the development of personalized PD treatment strategies. The article was based on a literature search using PubMed to identify relevant peer-reviewed articles on PD subtypes and treatment strategies.

Expert opinion: Subtyping PD effectively may allow for the development of patient-specific treatment regimens, disease prediction strategies, and improved clinical trial designs, though limitations exist. Future investigations should aim to provide more robust subtyping criteria that allows for disease fluidity.

Introduction: Intracranial arteriovenous malformations (AVMs) and cavernous malformations (CMs) pose substantial diagnostic, prognostic, and therapeutic challenges. Traditional imaging techniques used for AVM/CM diagnostic and treatment decision-making are limited by subjectivity and reliance on human interpretation. Radiomics, an artificial intelligence-driven technique that extracts quantitative imaging biomarkers, is a promising tool for improving detection, risk assessment, and treatment planning.

Areas covered: The use of radiomic data for diagnosis, clinical course prediction, and outcome forecasting in patients with AVMs/CMs is reviewed, following a comprehensive search of the PubMed database for iterative terms of 'radiomics,' 'arteriovenous malformations,' and 'cavernous malformations.' Radiomic techniques demonstrate high diagnostic accuracy for differentiating AVM-related hemorrhages from other causes. Additionally, radiomic models have shown promise in predicting AVM rupture risk, epilepsy occurrence, and response to radiosurgery. In limited studies, radiomics have also shown utility in distinguishing CMs from other intracranial lesions and predicting CM hemorrhage risk.

Expert opinion: Radiomics may enhance personalized neurosurgical decision-making and patient outcomes for AVMs and CMs. Ongoing technological refinements, iterative testing, and addressing barriers to equitable access to this technology will be critical for widespread application.

Introduction: Frontotemporal dementia (FTD) refers to a group of neurodegenerative disorders characterized clinically by behavioral disturbances and pathologically by frontal and anterior temporal lobe neurodegeneration, resulting in brain atrophy. No disease-modifying therapy currently exists for FTD. Familial FTD is primarily caused by three major genetic mutations, extensively investigated during the preclinical phases. Compounds developed to date have been designed to target specific mutations. A shift to broader approaches targeting abnormal protein deposition must employ endpoints that are meaningful to genetic and sporadic FTD, despite the diversity of their symptoms.

Areas covered: The authors review the most recent pharmacological and non-pharmacological randomized clinical trials (RCTs), focusing on the molecules involved, mechanisms of action, and pharmacological testing. The present review article is based on multiple database searches (MEDLINE, EMBASE, Scopus, Ovid, and Google Scholar) on all the available literature up to the 1 May 2025.

Expert opinion: Ongoing RCTs aimed to evaluate new disease-modifying or symptomatic treatment for FTD and to determine whether therapeutic strategies should target specific genetic mutations or focus on common protein deposits in the brain. These studies are laying the groundwork for future innovations. This shift could enable the transition from treating genetic FTD to tackling sporadic cases as well.

Introduction: The rising incidence of meningiomas, coupled with the aggressive behavior observed in a subset of these tumors, presents significant clinical challenges. Accurate diagnosis and risk stratification are essential for effective patient management.

Areas covered: This review offers a comprehensive overview of the evolving diagnostic landscape for meningiomas. It examines the roles of MRI, CT, and PET imaging - particularly somatostatin receptor type 2 (SSTR2) PET - in tumor detection and differentiation. In addition, it discusses the integration of molecular markers into the 2021 WHO classification and highlights the potential of multiomics analyses to enhance tumor classification and prognostication. It also addresses challenges related to standardization, clinical implementation, and accessibility of these advanced diagnostic tools. A literature search was conducted using PubMed and clinicaltrials.gov to identify clinical trials exploring the use of SSTR2 PET and treatments informed by molecular diagnostic findings.

Expert opinion: The integration of molecular data with advanced imaging techniques offers significant promise for the development of an integrated diagnostic framework for meningiomas. This approach has the potential to improve risk stratification and support the implementation of personalized treatment strategies. However, achieving this will require extensive correlative research and the establishment of large, high-quality datasets that combine imaging, molecular, and clinical information.

Introduction: Donanemab (Kisunla) is a humanized IgG1 monoclonal antibody specifically targeting a modified form of β-amyloid found predominantly within plaques (characterized as N-terminal pyroglutamate Aβ). Recently, it has gained approval for the use in early-stage Alzheimer's disease (AD) encompassing mild cognitive impairment due to AD or mild AD with confirmed brain amyloid pathology.

Areas covered: This drug profile discusses donanemab's function, clinical effectiveness, safety, tolerability, health economics, access challenges, and future prospects. This article is based on systematic review that was derived from PubMed.

Expert opinion: Donanemab is the third monoclonal antibody introduced for the treatment of individuals in the early stage of AD. While critical dialog continues regarding the potential impacts and role of antibody therapies, its approval signifies considerable progress in addressing the underlying pathology of AD. The authors are confident in the potential of antibodies against Aβ as a promising treatment option and foresee exciting advancements. However, further research is needed on trials extending beyond 18 months of follow-up, postmarketing surveillance, and the application of donanemab in combination with existing treatments and lifestyle interventions. Additionally, significant knowledge gaps and implementation limitations persist and must be addressed.