Current Treatment Options in Neurology最新文献

{"title":"Visual Impairment and Driving in Older Adults: A Narrative Review.","authors":"Shu Xu, Joshua R Ehrlich, Lindsey B De Lott","doi":"10.1007/s11940-026-00871-z","DOIUrl":"10.1007/s11940-026-00871-z","url":null,"abstract":"<p><strong>Purpose of review: </strong>This narrative review synthesizes current evidence on the relationship between visual impairment and driving safety in older adults, with a focus on the visual functions required for safe driving, the impact of common visual deficits, and current approaches to clinical evaluation and management.</p><p><strong>Recent findings: </strong>Recent studies have strengthened evidence that visual functions beyond high contrast visual acuity--particularly visual field sensitivity, contrast sensitivity, and visual processing speed--are associated with driving performance and crash risk. Emerging studies also highlight the role of higher-order visuospatial processing and the integration of visual input with cognitive, multisensory, and motor systems. Advances in functional assessment tools and in-vehicle technologies, such as advanced driver-assistance systems, may further enhance evaluation and support driving safety.</p><p><strong>Summary: </strong>Driving safety in older adults with visual impairment is multifactorial and cannot be adequately assessed by a single visual measure. A multidomain approach incorporating visual, cognitive, and functional assessment is essential for clinical decision-making. Management should emphasize treatment of reversible conditions, patient-centered counseling, and referral for functional driving evaluation when appropriate. Future research should focus on developing functionally relevant, real-world measures to better guide clinical practice and policy.</p><p><strong>Opinion statement: </strong>Driving is a visually intensive activity that plays a central role in maintaining independence, mobility, and social participation for older adults. As global populations age, the number of older drivers is increasing, making safe mobility an important public health concern. Visual impairment is common in later life and may arise from both ocular disease and neurologic conditions affecting the visual pathways or higher-order visual processing. Although driver licensing systems worldwide rely heavily on visual acuity thresholds to determine visual fitness to drive, growing evidence indicates that visual acuity alone provides an incomplete assessment of driving safety. Safe driving depends on the coordinated function of multiple visual domains, including central vision, peripheral vision, contrast sensitivity, motion and depth perception, visual processing speed, and higher-order visuospatial processing. Impairments in these domains may compromise hazard detection, situational awareness, and timely responses to changing traffic conditions, even when central visual acuity remains relatively preserved. In addition, driving performance requires integration of visual input with cognitive, multisensory, and motor systems, which may be affected by neurologic disease and age-related changes in sensory processing. Clinical evaluation of older drivers with visual impairment should therefore extend beyond ","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"28 1","pages":"11"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13194245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148013728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug Combination to Slow Down the Progression of Amyotrophic Lateral Sclerosis","authors":"Myriam Torres-Rico, Borja Marín-Rodríguez, Miriam Samira Arasmou-Idrovo, Antonio G. Garcı́a, Jorge Pascual-Guerra","doi":"10.1007/s11940-025-00835-9","DOIUrl":"https://doi.org/10.1007/s11940-025-00835-9","url":null,"abstract":"","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147888997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaccine Based Approaches for the Prevention and Treatment of Neurological Disease","authors":"Nicholas Aderinto, Israel Charles Abraham, Gbolahan Olatunji, Emmanuel Kokori, Patrick Ashinze, Emmanuel A. Babawale, Badrudeen Olalekan Alabi, Olaewe David Opeyemi, Adetola Emmanuel Babalola, Ayoola Ikeoluwa Oluwapelumi, Chidinma Udojike, Okikiola Sobuur Fagbolade, Festus O. Babarinde, Ololade Wiquoyat Oyesiji, Bonaventure Michael Ukoaka, Alexander Idu Entonu, Matthew Tolulope Olawoyin, Olayinka Fakorede","doi":"10.1007/s11940-025-00827-9","DOIUrl":"https://doi.org/10.1007/s11940-025-00827-9","url":null,"abstract":"","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147912842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update on the Treatment of Autonomic Disorders.","authors":"Abdulmunaim M Eid, Gabriel E Vázquez-Vélez, Beatriz Maliszewski, Michael Butler, Robert C Bucelli, Joel S Perlmutter, Daniel G Di Luca","doi":"10.1007/s11940-025-00830-0","DOIUrl":"10.1007/s11940-025-00830-0","url":null,"abstract":"<p><strong>Purposeof review: </strong>Autonomic disorders disrupt homeostasis and cause symptoms such as orthostatic hypotension, urinary urgency, bladder overfilling, sexual dysfunction, constipation, and gastroparesis. Pathophysiologic mechanisms include neurodegeneration, autoimmunity, toxic exposure, medication-induced, and an array of others. Despite the lack of disease-modifying treatments for the most common etiologies, there is a plethora of therapeutic options available to treat the manifestations of dysautonomia. Here we review established and recent therapeutic strategies available for dysautonomia. We also provide a general schema to approach the management of this class of disorders in the clinical setting.</p><p><strong>Recent findings: </strong>New emerging neuromodulatory devices are showing promise in treating dysautonomic orthostatic hypotension (spinal cord stimulators), urinary dysfunction (tibial and sacral nerve stimulators), sexual dysfunction (percutaneous perineal and sacral nerve stimulation), constipation (sacral anterior root stimulation), and gastroparesis (gastric electrical stimulation). However, most of these approaches are either experimental or not yet widely implemented. Recent medications are often more effective and/or better tolerated than older ones. These include droxidopa for orthostatic hypotension, β-3-adrenergic agonists for spastic bladder, and prucalopride, elobixibat and linaclotide for constipation.</p><p><strong>Summary: </strong>Autonomic disorders manifest with symptoms of homeostatic dysfunction. A wide variety of central and peripheral nervous system disorders cause dysautonomia. While the treatment of each specific disorder varies based on etiology, strategies overlap to manage dysautonomia. Treatments are divided into non-pharmacological, pharmacological, and neuromodulatory strategies. Here, we focus on the most common issues encountered in clinical practice and propose a stepwise approach to manage common symptoms that frequently integrates all three strategies.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"27 ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12705040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Progressive Aphasia Treatment: Current Treatment Options in Neurology Article Topic: Management of Primary Progressive Aphasia.","authors":"Joshua G Cahan, Borna Bonakdarpour","doi":"10.1007/s11940-025-00848-4","DOIUrl":"10.1007/s11940-025-00848-4","url":null,"abstract":"<p><p>Primary progressive aphasia(PPA) is a rare neurodegenerative condition and variant presentation of Alzheimer's disease or Frontotemporal Dementia. It is characterized by progressive decline isolated to language functions. PPA provides a model for understanding the anatomy of language, where each cortical language center corresponds to distinct PPA subtypes. Understanding this anatomy and its corresponding PPA subtypes helps clinicians choose testing, interpret imaging, and tailor treatment. These subtypes are termed agrammatic/nonfluent, semantic, and logopenic PPA. Each subtype is probabilistically associated with three proteinopathies: the amyloid and tau of Alzheimer's disease and frontotemporal lobar degeneration due to Tau or TDP-43. We will discuss when biomarker testing is indicated and the nuances of choosing among the increasing array of biomarker tests to improve diagnostic certainty. While medical treatment is limited, there are increasing pharmacologic options for treating Alzheimer's disease. Non-pharmacologic strategies can also be tailored to the patient's specific subtype and caregivers' needs.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"27 1","pages":"39"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Hypoxia-Inflammation Cycle and Multiple Sclerosis: Mechanisms and Therapeutic Implications.","authors":"Ateyeh Soroush, Jeff F Dunn","doi":"10.1007/s11940-024-00816-4","DOIUrl":"10.1007/s11940-024-00816-4","url":null,"abstract":"<p><strong>Purpose of review: </strong>Multiple sclerosis (MS) is a complex neurodegenerative disease characterized by inflammation, demyelination, and neurodegeneration. Significant hypoxia exists in brain of people with MS (pwMS), likely contributing to inflammatory, neurodegenerative, and vascular impairments. In this review, we explore the concept of a negative feedback loop between hypoxia and inflammation, discussing its potential role in disease progression based on evidence of hypoxia, and its implications for therapeutic targets.</p><p><strong>Recent findings: </strong>In the experimental autoimmune encephalomyelitis (EAE) model, hypoxia has been detected in gray matter (GM) using histological stains, susceptibility MRI and implanted oxygen sensitive probes. In pwMS, hypoxia has been quantified using near-infrared spectroscopy (NIRS) to measure cortical tissue oxygen saturation (StO₂), as well as through blood-based biomarkers such as Glucose Transporter-1 (GLUT-1). We outline the potential for the hypoxia-inflammation cycle to drive tissue damage even in the absence of plaques. Inflammation can drive hypoxia through blood-brain barrier (BBB) disruption and edema, mitochondrial dysfunction, oxidative stress, vessel blockage and vascular abnormalities. The hypoxia can, in turn, drive more inflammation.</p><p><strong>Summary: </strong>The hypoxia-inflammation cycle could exacerbate neuroinflammation and disease progression. We explore therapeutic approaches that target this cycle, providing information about potential treatments in MS. There are many therapeutic approaches that could block this cycle, including inhibiting hypoxia-inducible factor 1-α (HIF-1α), blocking cell adhesion or using vasodilators or oxygen, which could reduce either inflammation or hypoxia. This review highlights the potential significance of the hypoxia-inflammation pathway in MS and suggests strategies to break the cycle. Such treatments could improve quality of life or reduce rates of progression.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"27 1","pages":"6"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-Cognitive Symptoms in Alzheimer's Disease and Their Likely Impact on Patient Outcomes. A Scoping Review.","authors":"Andrew Thaliath, Jagan A Pillai","doi":"10.1007/s11940-025-00852-8","DOIUrl":"10.1007/s11940-025-00852-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>Increased understanding of the pathophysiology of Alzheimer's disease (AD) has led to development of disease modifying therapies. The therapies primarily target measures of cognitive decline since AD has been thought of as a cognitive disorder. However, the non-cognitive symptoms seen in AD contribute to overall quality-of-life. This scoping review was undertaken to further our understanding of the non-cognitive features of AD.</p><p><strong>Recent findings: </strong>The non-cognitive symptoms in AD range from changes in sensory perception, systemic changes, and neuropsychiatric manifestations. We targeted the following non-cognitive domains: vision, olfaction, GI, muscle, sleep, circadian rhythm, immune and behavioral symptoms as it relates to AD for this review. Non-cognitive features impact the ability of individuals to perform their activities of daily living, have safety implications and lead to increased caregiver burden. The review explores non-pharmacological and pharmacological measures targeted at the non-cognitive changes in AD.</p><p><strong>Summary: </strong>Non-cognitive symptoms contribute to significant disease burden in Alzheimer's disease. It is important to screen for and provide supportive care for these symptoms to help improve clinical care. Incorporation of non-cognitive features of AD in clinical trials will help ascertain the true societal and economic impact of AD and that of potential therapeutics.</p><p><strong>Opinion statement: </strong>Alzheimer's disease (AD) is primarily recognized as a disorder of cognition; however, non-cognitive symptoms significantly contribute to disease burden and clinical presentation. These manifestations particularly behavioral symptoms and systemic changes beyond the central nervous system impact patients' quality of life and increase caregiver stress. Often, such symptoms necessitate a transition from home-based care to more intensive settings, such as memory care facilities. As AD prevalence rises alongside an aging population, the shortage of dedicated memory care providers in community settings challenges access and quality of care. Improved awareness and early recognition of non-cognitive features among healthcare professionals can aid identification of modifiable systemic issues and allow timely behavioral management during clinical encounters. Treatment of these symptoms requires a multifaceted approach, incorporating pharmacological and non-pharmacological strategies. Non-pharmacological interventions, including tailored behavioral approaches and environmental modifications, can enhance quality of life for individuals with AD and reduce caregiver burden especially where specialized medical resources are limited.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"27 ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12799250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update on Simulation in Neurocritical Care – Current Applications and Future Directions","authors":"Nicholas A. Morris, Sherri Braksick, Jenna Ford, J. Palmer Greene, Hera A. Kamdar, Hannah Kirsch, Nina Massad, Melissa B. Pergakis, Shivani Ghoshal","doi":"10.1007/s11940-024-00810-w","DOIUrl":"https://doi.org/10.1007/s11940-024-00810-w","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of review</h3><p>This review presents a critical appraisal of the current state of simulation-based education in neurocritical care, including a brief summary of its supporting conceptual frameworks and its emergence as a tool for quality improvement and patient safety. We discuss technological developments that will expand the uses of simulation within the field and/or lower entry costs.</p><h3 data-test=\"abstract-sub-heading\">Recent findings</h3><p>Simulation-based educational interventions have improved learner performance in simulation-based assessments of interpretation of continuous electroencephalography ( as well as management of acute stroke and status epilepticus. Three recent studies demonstrate improved door-to-needle times for thrombolytics in acute ischemic stroke after simulation-based training, especially when such training focuses on interprofessional teamwork. Simulation can also be used to teach safety analysis and to identify patient safety threats.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>Access to simulation and its application is growing in neurocritical care. More rigorous, multicenter studies are required to demonstrate translational outcomes for improved patient care.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"39 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142175627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current and Emerging Sleep Interventions for Older Adults with or without Mild Cognitive Impairment","authors":"Anastasia Suraev, Shawn Dexiao Kong, Zoe Menczel Schrire, Bonnie A. Tran, Nathan Cross, Elie Matar, Sharon L. Naismith","doi":"10.1007/s11940-024-00808-4","DOIUrl":"https://doi.org/10.1007/s11940-024-00808-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of Review</h3><p>This systematic scoping review examines evidence from the last five years on sleep interventions in cognitive healthy older adults and those with mild cognitive impairment.</p><h3 data-test=\"abstract-sub-heading\">Recent Findings</h3><p>Sleep disturbance has been identified as a potential early, modifiable risk factor for dementia, making it crucial to investigate if these interventions also enhance cognitive function and neurodegenerative biomarkers.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>Since 2019, research on sleep interventions in older adults with or without cognitive impairment has gradually expanded, especially on non-pharmacological treatments including CBT-I, exercise, and multi-modal interventions, which show promise but require further study to confirm cognitive benefits. Pharmacological interventions have primarily focused on melatonin and orexin antagonists, with long-term safety remaining a concern. Tailored, clinically effective interventions that consider the presence of Alzheimer’s disease biomarkers, such as amyloid, tau, cerebrovascular disease, or alpha-synuclein in key sleep-related circuits, are essential to developing feasible, cost-effective, and scalable treatments for older adults with or without cognitive impairment.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"19 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142175628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Epstein-Barr Virus on Autoimmune Neuromuscular Disorders: A Comparative Study of Myasthenia Gravis and Guillain–Barre Syndrome","authors":"Anu Shibi Anilkumar, Ramakrishnan Veerabathiran","doi":"10.1007/s11940-024-00809-3","DOIUrl":"https://doi.org/10.1007/s11940-024-00809-3","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of Review</h3><p>The aim is to elucidate the mechanisms of autoimmune dysregulation that contribute to the onset and course of Guillain–Barre Syndrome (GBS) and Myasthenia Gravis (MG), with an emphasis on the important role that the Epstein-Barr virus (EBV) plays as an exacerbator or trigger of these autoimmune reactions. It further explores diagnostic strategies and therapeutic approaches to improve patient outcomes.</p><h3 data-test=\"abstract-sub-heading\">Recent Findings</h3><p>Recent researches have underscored the challenging nature of EBV due to its insidious behavior and persistent latency, which make it difficult to create successful preventive and therapeutic approaches. These discoveries have revealed how EBV's ability to induce host immune dysfunction can exacerbate or spark inflammatory processes, leading to its association with various autoimmune diseases such as systemic lupus erythematosus, multiple sclerosis, rheumatoid arthritis, and Sjögren's syndrome. Moreover, this review will shed light on the intricate connections between EBV and autoimmune neuromuscular disorders like MG and GBS, emphasizing the urgent requirement for further investigation to devise effective strategies against EBV-related conditions.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>MG and GBS, while both autoimmune illnesses affecting the neuromuscular system, differ greatly in their pathogenesis and clinical presentation. Viral infections, notably EBV, are vital in causing or aggravating these diseases. Understanding the link between EBV and autoimmune dysregulation could enhance diagnostic accuracy, therapeutic approaches, and preventive options, such as antiviral medications or vaccinations. Continued research and interdisciplinary collaboration are crucial to clarify how EBV affects MG and GBS, potentially leading to tailored treatments. Identifying precise biomarkers and pathways will improve clinical protocols, public health standards, and education on the EBV-autoimmunity relationship.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142175645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}