Seminars in Neurology最新文献

Essential tremor (ET) is the most common cause of tremor worldwide and can become profoundly disabling in many patients, with pharmacological treatments often providing insufficient relief. Surgical interventions have emerged as effective strategies for long-term tremor control. This review summarizes the current evidence on surgical therapies, including deep brain stimulation (DBS), radiofrequency (RF) thalamotomy, magnetic resonance-guided focused ultrasound (MRgFUS), and Gamma Knife radiosurgery (GKSR) for ET and other tremor-inducing syndromes. These techniques demonstrate comparable efficacy. DBS offers the advantage of adjustable parameters, allowing optimization of the therapeutic window while minimizing adverse effects. MRgFUS is particularly attractive due to its minimally invasive nature, whereas RF thalamotomy and GKSR remain viable alternatives for patients who are ineligible for DBS or MRgFUS. Bilateral interventions are increasingly feasible, and treatment selection should be individualized, considering clinical characteristics and patient preference. Ongoing advances in magnetic resonance imaging (MRI) technology and neurostimulation are poised to further refine surgical management and improve outcomes for patients with tremor.

Essential tremor (ET) is among the most common movement disorders, yet pharmacologic options remain limited. Recent mechanistic insights implicate abnormal cerebello-thalamo-cortical oscillations arising from impaired GABAergic inhibition, T-type calcium channel-driven rhythmicity, and SK/AMPA receptor-mediated hyperexcitability. Translational studies have explored neuroactive steroids targeting extrasynaptic GABA_A receptors, T-type calcium channel blockers, SK-channel enhancers, and AMPA antagonists, with variable clinical efficacy. These findings highlight the biological heterogeneity of ET and the challenge of aligning molecular targets with meaningful clinical outcomes. Future progress will require precision-based pharmacotherapy, integrating circuit-specific biomarkers, mechanistic patient stratification, and real-world measures of tremor impact to transform the landscape of ET treatment.

Over the past two decades, advances in assessment, treatment, and neuroscience of functional neurological disorder (FND) have reshaped care, yet many patients still face limited access and persistent disability. This review offers a practical, evidence-informed guide to initiating multidisciplinary treatment, emphasizing clear diagnostic communication, an individualized biopsychosocial formulation, and strategies to support engagement. Psychological and rehabilitative interventions are summarized within stepped models of care. Mechanistic perspectives are considered in linking clinical interventions with plausible neurobiological processes. Additionally, we examine emerging adjunctive modalities-such as noninvasive neuromodulation and psychedelic-assisted therapies-which may hold promise as future therapeutic interventions.

Links between the eye and the central nervous system (CNS) have been recognized since the origins of the ophthalmoscope. Owing to the elegant topography of the afferent visual pathway and its close embryonic, anatomical, and physiological connections to the brain, it is possible to capture structural effects of CNS injury in the retina. The availability of large-scale, high-quality retinal imaging datasets and ongoing advances in artificial intelligence (AI) have paved the way for Oculomics, a field in which ocular measures act as biomarkers for systemic diseases. Similarly, ocular images have been used in AI models to provide critical insights about neurologic disorders in the fledgling discipline of what might be considered Neuro-Oculomics. In this review, we will describe key ocular imaging techniques and highlight emerging roles for AI in the diagnosis and management of important neurological conditions.

Carotid tumors are rare, hyper-vascular structures arising from the chemoreceptors of the carotid body. In this study, we will discuss the classification and diagnosis of carotid body tumors, as well as surgical resection, which is the definitive treatment for these lesions. We will highlight important preoperative considerations to minimize the risk of bleeding, cranial nerve injury, and stroke with surgical resection.

Radiation therapy remains an important component of the treatment of head and neck cancers. Carotid stenosis is a well-known complication of this intervention, and surgical management of this condition is complicated by scarring and inflammation in the cervical region. We discuss the pathogenesis of radiation-induced carotid stenosis as well as its management using open and endovascular techniques.

Essential tremor is a chronic, progressive neurological disease, or perhaps a family of diseases, whose clinical characteristics place it among the disorders of involuntary movement, and more specifically, among the tremor disorders. Its underlying pathology places it within the disorders of cerebellar degeneration. Its core clinical feature, among many potential clinical features, is a 4 to 12 Hz simple kinetic tremor of the arms, which is a tremor that occurs during voluntary movements such as eating, drinking, or writing. This review summarizes current understanding of the epidemiology, health care costs, clinical features (motor features; nonmotor features; and associated embarrassment, functional disability, impaired quality of life, and caregiver burden), clinical considerations (stratification points, putative staging scheme), diagnosis (based on clinical findings and more recently, grounded in postmortem findings in the cerebellum), associations with other neurodegenerative diseases (Parkinson's disease and dementia), pathophysiology (focusing on the observed neurodegenerative changes in the cerebellar cortex), and treatment.

Over the last decade, there has been a rapid expansion in medical devices utilizing artificial intelligence (AI) and machine learning (ML), with a growing role in neurologic care. These devices are beginning to augment clinical workflows and reshape how neurologists engage with technology to deliver patient care. In this review, we first introduce core ML techniques that are used within devices. We then describe the AI-enabled medical devices that have received U.S. Food and Drug Administration authorization as of December 31, 2024, including an analysis of the 147 devices across neuroradiology and broader neurology indications. We also highlight key trends in how these devices are being integrated into clinical practice. We conclude by examining emerging models of human-machine interaction and their implications for future neurologic care.