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 shared 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.
Neuraxial anesthetics and analgesics are associated with fewer systemic adverse effects.
Despite mounting evidence suggesting the contrary, the debate on the potential benefits of patent foramen ovale closure for migraine is still ongoing.
Evaluating the risk factors of neurocognitive decline in HIV.
Withholding negative research results not only skews scientific evidence but also puts into question the whole validity of medical research.
Ischemic and hemorrhagic strokes are a common complication of infective endocarditis, but guidance on intervention is varied.
Risk for mortality in posttraumatic epilepsy is high, and negative outcomes affecting cognitive, affective, and physical function are common.
Presport evaluations are a great opportunity to check in with players about their mental health, and to guide those who are suffering to the relevant specialist.
While parkinsonian disorders share a common mechanism of protein aggregation, manifestations are quite varied.
The 2 treatments for cluster headache with Level A recommendations are either not readily accessible via public or private insurance or are not recommended in a large subset of patients with cardiovascular disease.
Findings from animal studies indicate that anesthetics may be neurotoxic and could result in long-term central nervous system alterations and cognitive dysfunction.
Research has shown significant gaps in knowledge on palliative services among neurology residents, resulting in low referral rates.
Despite a recent study concluding that oxygen therapy for cluster headache is not cost-prohibitive, many private payers and Medicare and Medicaid do not cover the effective therapy. Matthew Robbins, MD, Stewart Tepper, MD, and others weigh in on the controversial decision.
John Stoffel, MD, Professor of Urology, Service Chief, and Associate Chair for Ambulatory Urology in the University of Michigan Department of Urology discusses the management of urinary retention in patients with MS.
There are guidelines that should be followed when treating patients with insomnia.
There is speculation that dystonia is the result of dysfunction occurring in either the cerebellum or basal ganglia or as a result of an abnormal interaction between the two.
Physicians must remember that they will be a business owner in addition to being a health care provider.
While several theories have evolved over the years, none have unequivocally provided robust evidence to fully explain the clinical spectrum of migraine.
MRI may be used to identify Parkinson disease biomarkers that can inform diagnosis, track disease progression, and elucidate the neurobiological underpinnings of symptoms.
Brief periods of oxygen deprivation to the brain have been shown to provide neuroprotective effects that reduce stroke infarct size and improve recovery times.
Assessments showed a 66% reduction in pain during the session and a 33% reduction in pain at the end of the session.
The main challenge is to determine when treating tardive dyskinesia with any pharmacological agent would provide a net benefit.
Nearly 10% of pediatric patients with migraine also experience various episodic syndromes. Drs Amy Gelfand and Diana Lebron weigh in on what to look for to help you achieve the right diagnosis.
Multidisciplinary treatment may consist of psychological support and physical or occupational therapy along with the medical care provided by the referring physician.
Nearly 10% of pediatric patients with migraine also experience various episodic syndromes involving gastrointestinal pain, vomiting, or vertigo.
Many in the medical field are wondering whether now may be the right time for medical malpractice reform.
Debate continues as to whether ocular tremor represents a clinical marker of Parkinson's disease or a compensatory movement related to other bodily tremors.
Woman with SLE complains of headache, confusion, and mild somnolence to the emergency department.
Catastrophizing makes pain more painful, makes it last longer, and makes pain much harder to treat.
Accountable Care Organizations (ACOs) are increasingly taking responsibility for health care management, record-keeping, and payment.
Putative pathogensis insights have grown tremendously in the past 10 years.
Doctors suggest that urban landscapes may be a cause for headaches.
While post-traumatic headache (PTH) often resolves within 3 months, a substantial number of patients experience chronic PTH.
Investigators identified a series of prodromal signs that appear anywhere from 1 to 18 years before a clinical diagnosis of SCA2.
There is up to a 4-fold increase in risk in people with a first-degree relative affected by migraines, and twin studies have demonstrated heritability of approximately 42%.
For survivors of nontraumatic cardiac arrest, brain injury becomes a major factor in disability and long-term survival.
New guidelines for progressive supranuclear palsy provide very specific and sensitive criteria that allow for identification of clinical features of the disease at much earlier stages.
A hostile medical litigation climate is one of the major problems with the existing malpractice insurance system, driving significant losses of access to quality health care.
Several mechanisms involving trigeminovascular activation are often proposed in the literature as mechanisms underlying nonhemorrhagic headache in patients with AVM.
Neurologists need to engage their emergency medicine colleagues to identify protocols and pathways for when to trigger appropriate neurological consultation or initiate acute stroke therapies.
A patient should be notified of the possibility of developing an ICD before initiating any dopaminergic treatment for PD, particularly dopamine agonists.
This year's annual meeting of the American Academy of Neurology takes place in Boston, MA from April 22-28, 2017.
Neurology Advisor Articles
- Efficacy of Cladribine Tablets in Patients With Relapsing Multiple Sclerosis
- Cognitive Performance, Mood Deficits, White Matter Hyperintensities in Migraine
- Disrupted Thalamo-Striato-Hypothalamic Function May Serve as a Good Biomarker for Parkinson Disease
- FDA to Review Sublingual Tx for Motor Fluctuations in Parkinson Disease
- Shortened MS Quality-of-Life Questionnaire Compares With Longer Test in Reliability and Consistency
- Polyphenol-Rich Diet May Reduce Dementia Risk in Older Adults
- Addressing Migraine That Mimics Stroke
- Visual Association Test, MMSE Highly Predictive of Dementia in Older Adults
- Prediction Algorithm Stratifies ICH Patients at Risk for Hematoma Expansion
- Medical Cannabis Shows Promise in Treating Symptoms of Multiple Sclerosis
- Rituximab Effectively Reduces Disease Activity in Multiple Sclerosis
- Characteristics, Treatment Response Similar in Idiopathic, 22q11.2 Deletion Syndrome-Associated Parkinson Disease
- Lifestyle, Behavioral Factors Contribute to Dementia Risk Assessment
- FDA Lifts Clinical Hold on Trial for Duchenne Muscular Dystrophy Treatment
- Fremanezumab Chronic Cluster Headache Study Discontinued