Expert Review of Neurotherapeutics最新文献

Introduction: Post-operative delirium (POD) is a common neuropsychiatric complication that is associated with increased morbidity, prolonged hospital stays, and persistent cognitive deficits. Despite its clinical relevance, pharmacologic treatment options remain limited and inconsistently supported by evidence.

Areas covered: In this review, the authors synthesize the current understanding of pathophysiological mechanisms underlying POD then critically evaluate the evidence around pharmacotherapeutic interventions, focusing on the use of antipsychotics, cholinesterase inhibitors, sleep-wake cycle modulators, and dexmedetomidine, in the treatment of established delirium. Relevant articles were identified using PubMed, EMBASE, and Cochrane databases.

Expert opinion: There remains insufficient evidence to support the routine use of pharmacologic interventions in the treatment of POD. While the evidence supporting dexmedetomidine seems most promising, its clinical significance is questionable and therefore its impact is likely in prevention rather than treatment. Various methodological challenges, including heterogeneity in trial design and insufficient stratification by delirium subtype, hinder generalizability of study results and advancements in how delirium is understood. Future progress will depend on reconceptualizing delirium away from a purely descriptive condition and toward a heterogenous, biologically driven disorder.

Introduction: Electroconvulsive therapy (ECT) is one the most effective interventions for treatment-resistant depression. There is a link between trauma history and the development of depression, and frequent comorbidity with post-traumatic stress disorder (PTSD) and personality disorders. The impact of comorbid trauma and personality disorders on the efficacy of ECT has attracted research interest, with the possibility raised for using ECT to target other core symptoms of these disorders.

Areas covered: In this scoping review, the authors describe the available evidence on the use of ECT in personality disorders, PTSD, and individuals with a trauma history. The article is based on literature derived from Embase, APA PsycInfo, Web of Science, CINAHL, and Cochrane CENTRAL databases on relevant studies published up until 9 December 2024.

Expert opinion: Preliminary evidence supports the efficacy of ECT to treat depressive symptoms in patients with comorbid PTSD while there is more conflicting evidence for its use in patients with comorbid personality disorders, particularly borderline personality disorder. A careful exploration of trauma history, baseline mood symptoms, and previous treatment trials should be undertaken prior to the recommendation of ECT. Randomized controlled trials are needed to verify the therapeutic benefits of ECT for core symptom domains in other disorders.

Introduction: Rivastigmine, a cholinesterase inhibitor, was first approved for the treatment of Alzheimer's disease (AD) dementia more than 20 years ago. Initially available as an oral formulation, a transdermal system was subsequently developed with the aim of improving tolerability while providing similar efficacy. Transdermal rivastigmine is approved for the treatment of severe AD as well as mild-to-moderate AD.

Areas covered: Herein, the authors review randomized clinical trials, meta-analyses, and post-marketing observational studies involving the rivastigmine 13.3 mg/24 h patch for the treatment of patients with AD.

Expert opinion: Cholinesterase inhibitors are a mainstay of the symptomatic treatment of patients with AD. Rivastigmine is available as oral and transdermal formulations, with the latter providing improved tolerability and convenience while maintaining efficacy. The high-dose 13.3 mg/24 h patch might offer benefits for some patients compared to the lower dose patch (4.6 mg/24 h) in patients with mild-to-moderate or severe AD, showing improvements in daily functioning and global clinical status on top of the cognitive benefits. The ability to titrate up to a dose of 13.3 mg/24 h provides an option for patients with severe AD or with an inadequate response to lower doses of rivastigmine.

Introduction: Suicide is a global health issue that affects both individuals and communities, with significant costs for society. Given the complex nature of suicide, it is crucial to have profound knowledge of this matter and integrate traditional frameworks with innovative strategies.

Areas covered: The paper explores suicide risk with a focus on prevention. Through the lenses of eight experts from academic and medical contexts, an exploration of suicide has been proposed that underlines the importance of considering transdiagnostic elements and specific subpopulations, examines specific theoretical frameworks and emerging models, such as the Suicide Crisis Syndrome, and presents both pharmacological and psychotherapeutic interventions for suicide prevention.

Expert opinion: Tailored approaches are paramount, allowing for practical knowledge of the unique experiences of those at risk of suicide and encouraging cooperation among mental health professionals to enhance the development of strategies to manage suicide risk; they should also help to improve patient health and quality of life with positive consequences for families, communities and ultimately society in general. It is also recommended that evidence-based interventions, both pharmacological and psychotherapeutic, need to consider the individual's mental pain in the broader context of the evolving challenges in global suicide prevention efforts.

Introduction: Blepharospasm is a type of dystonia associated with overactivity of the orbicularis oculi and nearby muscles causing significant disability. Available treatments are only symptomatic, and many patients experience disability related to incomplete symptom relief.

Areas covered: The authors provide a review the phenomenology of blepharospasm and its usual treatments. The evidence for botulinum toxin, oral pharmaceuticals and surgical treatments are summarized. Despite considerable phenotypic heterogeneity, the literature indicates a standardized approach to treatment is often pursued. PubMed was used as the primary source database for the literature reviewed relating to the treatment of blepharospasm published between April 1985 and May 2025.

Expert opinion: Although a standardized approach to treatment is common, a customized approach with attention to the particular combination of motor and non-motor symptoms occurring in individual patients improves therapeutic outcomes. The anatomical rationale and experience supporting a more personalized treatment strategy is emphasized. Also summarized are specific topics and strategies that are the subject of ongoing research to optimize the care of blepharospasm in the future.

Introduction: Arterial ischemic stroke (AIS) represents a significant cause of neurological morbidity and mortality in the pediatric population, with reported mortality rates ranging from 2% to 9%. The growing evidence supporting the efficacy and safety of reperfusion therapies in pediatric AIS underscores the critical importance of timely and accurate diagnosis. There are many barriers to achieving this, including a lack of clinical recognition and diagnostic imaging delays.

Areas covered: This narrative review highlights key advances in reperfusion therapies, acute neuroimaging, advanced imaging, and the development of stroke pathways. It explores the growing understanding of the etiology and genetics of childhood AIS. A comprehensive literature search was performed using PubMed, Medline, and EMBASE for relevant studies and reports, as well as reviewing published guidelines available through March 2025.

Expert opinion: Pediatric AIS remains challenging due to its infrequent occurrence, diagnostic complexity, and system-level barriers. Advances in imaging and development of streamlined pediatric stroke pathways are shortening the time to diagnosis, but future advances will rely on integration within established adult systems of care, the use of telemedicine and the development of pediatric perfusion imaging expertise. Evolving knowledge of pediatric neurovascular genetics and secondary imaging modalities will lead to tailored management of conditions with stroke risk.

Introduction: High-grade gliomas remain difficult to treat due to their infiltrative growth, therapeutic resistance, and the restrictive blood-brain barrier (BBB). Focused ultrasound (FUS) offers a noninvasive method to transiently disrupt the BBB, enhancing the delivery of therapeutics to the tumor site.

Areas covered: Herein, the authors discuss the emerging role of FUS in glioma treatment including enhanced drug delivery, real-time monitoring techniques, and biomarker-driven patient selection. They also explore the impact of combined FUS with immunotherapy, gene therapy, exosome-based drug delivery, sonobiopsy, and radiotherapy (RT) sensitization. The authors have based their article on literature published between January 2010 and October 2024 from PubMed, Web of Science, and Google Scholar. By tailoring FUS parameters to individual tumor characteristics and patient responses, these strategies aim to overcome glioma heterogeneity and treatment resistance, further advancing personalized therapeutic approaches.

Expert opinion: The integration of FUS into neuro-oncology represents a paradigm shift, requiring interdisciplinary collaboration to maximize its potential as a cornerstone of precision medicine in glioma treatment. Future advancements in FUS will likely focus on refining treatment protocols, optimizing real-time targeting, and integrating artificial intelligence (AI)-driven predictive models to personalize therapy.

Introduction: Cerebral amyloid angiopathy (CAA) is a leading cause of intracranial hemorrhage and cognitive decline, resulting from amyloid-β accumulation in the walls of small cortical and leptomeningeal arterioles. While models of pathogenesis exist, the mechanisms leading to the diverse clinical manifestations of CAA remain largely unknown. There are no proven treatments, but a few clinical trials are ongoing. Meanwhile, emerging anti-amyloid-β therapies and managing patients with comorbidities including atrial fibrillation complicate clinical-practice in peopel with CAA.

Areas covered: Herein, the authors provide their perspectives on CAA from initial amyloid-β deposition to clinical disease manifestations. They also discuss the emergence of iatrogenic CAA and the potential role of inflammation across CAA, questioning the concept of a single entity. Finally, the authors examine management challenges, future research horizons, and treatment directions.

Expert opinion: Recent insights challenge the traditional view of a linearly progressive disease, suggesting a dynamic natural history with periods of high activity and remission. Inflammation is a topic of active investigation, with potential therapeutic relevance. Challenges remain, including the need for improved neuroimaging and fluid biomarkers for noninvasive early diagnosis. Iatrogenic CAA is a recently described amyloid-β prion disease in younger people, with known Aβ innoculation and exposure times, providing a potential 'pure' model of CAA. Research into limiting Aβ production, improving perivascular clearance, or modifying vascular remodeling and inflammation may guide novel therapeutics.