Pediatric MS is predominantly inflammatory in nature, with a presentation that is similar to a number of other conditions.
Functional imaging can help neurologists navigate diagnosis and inform treatment and patient outcomes.
There is significant evidence that opioids are not the right treatment of choice for migraine in the emergency department.
Multiple system atrophy is a rare, progressive neurodegenerative condition for which there is currently no cure.
The results highlight the importance of evaluating and monitoring cognitive function in individuals with recent critical illness or major infections, especially if they are already at risk for dementia.
The new guidelines will facilitate the design and development of clinical trials to test new therapies to minimize the burden of neurologic disability produced by neurosarcoidosis.
Having a higher burden of comorbidities is associated with greater disability progression and lower QoL, as well as increased healthcare utilization and mortality.
The continued observation of this delayed headache syndrome may point to a different pathophysiology from tension-type headache or acute poststroke headache.
In later stages of the condition, it is possible that the nerves become incapable of storing dopamine consistently, rendering levodopa practically useless, even if it is administered more regularly.
Recent high-quality clinical trial evidence has demonstrated that medications commonly prescribed for migraine prevention in pediatric patients were not superior to placebo for reducing headache symptoms.
There are considerations for treating these seizures as part of the overall goals of palliative care, which include the family's experience.
"Chasing the dragon" is an increasingly popular method of heroin inhalation among drug users.
Future studies on VR training for MS should include large randomized controlled trials using clear protocols and comparable between-group tasks.
Meta-analyses are only as good as the quality of the primary data, which is mostly low to medium evidence in the case of Chiari malformation.
Facilities with strict protocols to prevent problems have been able to report significantly lower complication rates.
Despite their advantages, many clinicians do not necessarily agree with the centrality or content of CPGs. Others — especially primary care physicians (PCPs) — are overwhelmed by the vast and ever-increasing numbers of guidelines issued by multiple societies.
A rapid increase in the female-to-male ratio of MS incidence has been observed through several population studies.
Current evidence highlights the potential role of cross-talk between the enteric and central nervous systems and the pathogenesis of Parkinson disease.
Companies touting these therapies may use impressive websites with endorsements by celebrities and physicians to instill a sense that the procedures are safe and acceptable.
People with migraines and comorbid mood disorders often need treatments that address both conditions, as well as management of sleep, stress, and lifestyle issues.
Pseudobulbar affect is a significant national health issue in the United States, with approximately 2 million individuals affected.
Data in children do support an association between pediatric obesity and headache disorders in general, but more research is needed to confirm the association specifically with pediatric migraine.
Although regarded as a miracle drug to some, nusinersen comes with some troublesome strings attached.
While it is now well-established that having MS should not limit patients' reproductive choices, this was not always the case.
The main constraint to botulinum toxin use for spasticity is dosage limitation.
Studies that have evaluated the use of VNS in children, including those as young as 6 months old, and have generally concluded that it is well tolerated and improves quality of life.
Pediatric neurologist Lalitha Sivaswamy, MD, discusses challenges in diagnosing primary intracranial hypertension in pediatric patients.
Even with thorough testing, declaring a patent foramen ovale as the most likely culprit responsible for a cryptogenic stroke remains a challenge.
The Parkinson's Foundation Prevalence Project estimates that within the next 2 years, 930,000 people in the United States will be living with the condition; that number is anticipated to rise to 1.2 million by 2030.
Headaches are a common occurrence in the general population and are often present in patients with an underlying brain tumor, although it is not yet clear to what degree they are related.
Direct-to-consumer genetic testing would enable consumers to bypass the safeguards set forth by professional guidelines, which could potentially increase the risk for harm associated with testing.
Cognitive and linguistic deficits have been cited as risk factors for psychiatric comorbidity in pediatric epilepsy, along with family factors such as parenting style and quality of the parent-child relationship.
Cannabis has been shown to reduce the use of prescription drugs that have more numerous and serious side effects, including opioids, benzodiazepines, and antidepressants.
Acute confusional migraine has not been specifically studied and many clinicians remain unaware of the condition, which may result in underestimation of the prevalence.
Geoffrey Littlejohn, MD, provides a clinical perspective on the pathophysiology of fibromyalgia and the role of neurogenic inflammation in the disease process.
Until more robust studies are completed, clinicians should encourage a dialogue with their patients to discuss the use of and questions regarding over-the-counter supplements and alternative medicines.
DBS has been known to generate other movement-related disorders such as dyskinesias, blepharospasm, and hypokinesia.
Current oral contraceptive products contain lower doses of estrogen than those used in the past, prompting reconsideration of risks and benefits.
A revised focus on exercise training for MS is advocated by a number of recent reviews, all showing benefits to cardiovascular and muscular fitness and improved quality of life in MS.
Several notable medical societies have issued ethical statements discouraging physicians from treating family members and friends.
ICU-acquired weakness syndromes manifest themselves in a range of ways among patients — as a spectrum of disease rather than in specific form.
In individuals who can adequately access healthcare appointments, medications, and other treatments, the combination of driving restrictions and sparse or nonexistent public transportation options interferes with daily living and their overall quality of life.
The Future of Freezing of Gait in Parkinson's: Exploring Potential Treatments and Preventive Strategies
More than half of patients diagnosed with Parkinson disease experience freezing of gait.
Providing guidance to improve dietary behavior, which may include supplementation to achieve an optimal nutritional status, can contribute to improved control of fibromyalgia symptoms.
Nonpharmacological strategies, including bed rest, have a lack of evidence supporting their use in the treatment of postdural puncture headache.
Surgical interventions for Parkinson disease are experiencing a swell in innovation, thanks in part to the entry of two additional medical device companies into a field previously dominated by one company.
In April 2018, the American Academy of Neurology released updated guidelines for the treatment of multiple sclerosis (MS). The new recommendations are based on a panel review of 20 Cochrane reviews and 73 full-text articles pertaining to starting, switching, and stopping disease-modifying treatment in patients with clinically isolated syndrome, relapsing-remitting MS, and progressive forms of MS.
Neurology Advisor spoke with Dr Peter McAllister about how to best discern migraine with aura from stroke.
Each component of NEDA has limitations — for example, measures of brain atrophy may be confounded by various factors, and the correlation between short-term measures of EDSS progression and long-term disability outcomes is unclear.
Migraine is highly prevalent in children and adolescents, affecting almost 10% of children between 5 and 15 years old and 30% of adolescents between 15 and 19 years old.
Experts discuss the symptoms and prevalence of neurological manifestations in Sjogren syndrome.
While immunocompromised patients are the most susceptible to CNS fungal infections, they can also occur in immunocompetent patients undergoing invasive procedures such as neurosurgery and in patients exposed to contaminated devices or drugs.
Neurology Advisor speaks with Annabelle Baughan, a retired hematologist-oncologist, and discusses her personal experience with Andersen-Tawil syndrome.
Multiple Sclerosis Guidelines: AAN's Recommendations for Initiating, Switching, Stopping Disease-Modifying Therapy
The new guidelines focus on helping clinicians decide when to initiate, switch, or discontinue disease-modifying therapies for multiple sclerosis.
In this article, we explore research findings to provide a deeper understanding of the factors associated with increased risk for impulse control disorders in Parkinson disease. Deputy Director of the Parkinson's UK charity, Professor David Dexter, also provides insights on the mechanisms of impulse control disorders and the implications of new findings on the management of Parkinson disease.
Neurology Advisor will provide live coverage of the 2018 American Academy of Neurology Annual Meeting from Los Angeles, CA.
Although compensating for their difficulties may help people with ASD connect with others, get jobs, and successfully navigate social situations, accumulating research suggests it can also lead to exhaustion, burnout, anxiety, and depression.
It is important for clinicians to quickly and accurately determine potential underlying causes and to prescribe treatments that take into account comorbidities and medications that older patients may be taking for them.
Although deep brain stimulation, similar to all Parkinson disease therapies, cannot cure, modify, or slow progression of the disease, some recent research suggests that the symptom alleviation and quality-of-life improvement it provides might lead to mild improvements in longevity.
As the most effective treatment for a patient with multiple sclerosis is one that is specifically tailored to the patient's individual needs and preferences, recognition of the unique characteristics, preferences, and trends shared by the millennial generation should drive innovative solutions.
"Since the current generation of psychiatrists has been raised on second-generation antipsychotics and has relatively little experience with first-generation antipsychotics, keeping tardive dyskinesia in mind is not, on the whole, part of their experience or training," said Christoph U. Correll, MD.
Early intervention in the case of respiratory compromise in patients with multiple sclerosis has the potential to prevent infection and maintain pulmonary function.
The ultimate goal of stroke assessment is to enable physicians to make treatment decisions that are individualized and appropriate to the patient's needs, thereby improving patient outcomes.
Neurology Advisor spoke with Annabelle Baughan, a retired hematologist-oncologist, who discussed her personal experience with Andersen-Tawil syndrome.
The focus on enhanced cognitive function could sideline equally important aspects of life such as health and relationships.
Clinicians discuss the clinical implications of headache and comorbid sleep disturbances.
While ICD-10-CM may be an improvement on an old process, big data is the revolution that has the potential to change health care forever.
Before we begin to rely more heavily on technology for seizure detection, clinician-patient trust needs to improve.
Parkinsonism syndromes are associated with progressive disability and increased mortality, with symptom burden comparable to that of advanced cancer.
Although the main risks associated with migraine include ischemic and hemorrhagic stroke, new evidence suggests that the risks for venous thromboembolism and atrial fibrillation — but not heart failure or peripheral artery disease — are also higher.
For more details about differences in stroke risk, prevention, and treatment in women, Neurology Advisor spoke with Elisabeth B. Marsh, MD, from Johns Hopkins School of Medicine and Kristy Yuan, MD, from the University of Pennsylvania.
The cluster of diagnoses known as periodic paralyses — including hypokalemic periodic paralysis, hyperkalemic periodic paralysis, and Anderson-Tawil syndrome — are rare genetic disorders of spontaneous muscle weakness or paralysis that can last from minutes to days.
Malpractice liability reform would best be analyzed on a specialty-by-specialty basis.
New cases of headache in older adults should be carefully evaluated for a differential diagnosis of primary headache and to examine underlying causes of secondary headache.
Researchers recently identified 5 key challenges that collectively hinder the design of amyotrophic lateral sclerosis clinical trials and the development of new treatments.
For individuals with migraine frequency of 4 to 14 episodes per month, prophylactic medications and analgesics are required.
Benefits of migraine markers include facilitating diagnosis, monitoring treatment, and discovering more about the pathogenesis of the disorder.
Research on therapies that may rouse a patient in a persistent vegetative state needs to include the ethical considerations of waking a patient in a state of incomplete recovery.
Anesthetic medications have been identified as a potential cause of morbidity in this population due to their interaction with the drugs used to manage Parkinson disease.
Conflict-of-interest statements should be included in medical journals in order to enhance transparency.
Headache screening should be a routine part of a prenatal visit so that if and when a patient presents with an attack, a suitable plan of action is already established.
Because of dementia's prolonged disease course, advance care decisions and planning are often overlooked until it is too late.
Treating Tension-Type Headache: Contradictions in Real-Life vs Research Expose Cracks in Differential Diagnosis
While there is some moderate quality evidence supporting the use of onabotulinumtoxinA for the treatment of tension-type headache, it is not adequate enough to influence current clinical practice.
This clinician discusses the application of conscious vs unconscious thinking in a medical practice.
Increasing evidence suggests a relationship between migraine and MS that is beyond basic comorbidity.
There is a growing emphasis on provider responsibility with the increasing focus of the overprescribing of opioids.
Interventions aimed at motor and cognitive impairments in Huntington disease may result in long-term functional improvement.
The judicious use of caffeine as adjuvant therapy to over-the-counter pain relievers can improve or relieve pain for patients with migraine or tension-type headaches.
The automated diagnosis suggestion at the top of the EKG strip is the output of what is known as a decision support system.
The scourge of defensive medicine — the practice of recommending tests or treatments for the purpose of avoiding or mitigating litigation — is discussed in this opinion piece.
Several studies have uncovered sex-dependent variations in the symptomatic manifestations of Parkinson disease, as well as in the response to dopamine therapies.
Depression is one of the most commonly reported complications resulting from stroke.
Throughout the life course, higher body mass index and obesity are linked to cognitive decline, brain atrophy, reduced white matter and integrity of the blood-brain barrier, and elevated risk for late-onset Alzheimer disease.
The 2017 revision takes aim at better differentiating relapsing-remitting and primary-progressive forms of multiple sclerosis.
Chronic pain is common after traumatic brain injury.
The responsibility for discussing cessation of driving in patients with mild cognitive impairment or dementia often rests on the clinician, who may have little preparation for this difficult conversation.
Numerous factors are likely contribute to the rate of progression, with different combinations of factors showing relevance for individual patients.
Although pharmacotherapy remains the standard strategy for migraine management, there are many patients for whom nonpharmacological approaches are indicated.
Although peripheral nerve decompression has been found to be effective in relieving some symptoms for burn patients, there is still some uncertainty.
Although evidence of cognitive impairment in MSA is admittedly more limited than in Parkinson disease, it is now substantial enough to address modification of diagnostic criteria to include the potential for cognitive impairment at any stage of the disease.
Neurology Advisor Articles
- Multiple System Atrophy: A Common Form of Atypical Parkinsonism
- Migraine Treatment in the ED: Overcoming Our Penchant for Opioids
- Oral Film Formulation of Clobazam Gets FDA Approval for LGS
- Erenumab as a Therapy for Hard to Treat Episodic Migraine
- Nusinersen May Be Effective for Short-Term Motor Function Improvements in Spinal Muscular Atrophy
- New Diagnostic Criteria for Neurosarcoidosis: What You Need to Know
- Guideline for Diagnosis and Treatment of Idiopathic Intracranial Hypertension
- Guidelines on the Use of OnabotulinumtoxinA for Chronic Migraine
- Ivy League Rule Change Linked to Fewer Concussions During NCAA Football Games
- Biomarkers of Alzheimer Disease Observed in Down Syndrome
- Ocrevus Labeling Updated With New Info on Timing of Vaccine Administration
- Approaches for Better Diagnosis of Pediatric Multiple Sclerosis
- Short Segment Sensory Nerve Stimulation Offers Potential Diagnostic Value for Ulnar Neuropathy
- Incidence of Guillain-Barré Syndrome Linked With Recent Bone, Digestive Organ Surgery
- Pharmacist-Led Effort Cuts Inappropriate Rx in Older Adults