Current Treatment Options in Neurology最新文献

{"title":"Ethical Considerations in the Treatment of Cerebrovascular Disease","authors":"Nathan A. Shlobin","doi":"10.1007/s11940-024-00789-4","DOIUrl":"https://doi.org/10.1007/s11940-024-00789-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of Review</h3><p>To care for patients with cerebrovascular disease (CVD), neurointerventionalists, intensivists, and other healthcare providers must be equipped to address associated ethical challenges. This review aims to delineate the applicability of fundamental bioethical approaches to CVD, highlight key ethical issues in CVD care, and delineate an ethical framework to streamline ethical decision-making for people with CVD.</p><h3 data-test=\"abstract-sub-heading\">Recent Findings</h3><p>Three introductory cases are presented. The four key principles of principalism and the approach of narrative ethics are described with reference to CVD. Key ethical considerations include decision-making capacity and informed consent, uncertainty, and resource allocation. A categorization of CVD as emergent/nonemergent and the recommended management as intervention/no intervention helps frame the spectrum of CVD. A different six-pathway may then be taken based on which category the patient case corresponds to.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>Physicians involved in the care of people with cerebrovascular disease must understand how the ethical issues manifest in individual patient cases to ensure appropriate care. The aforementioned ethical framework may aid physicians in providing ethically sound care. All decisions must involve a balance between clinical expertise and patient values and preferences or those articulated by a surrogate to properly respect the wishes of patients with CVD.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"25 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140151826","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":"Early Mobilization in Neurocritical Care","authors":"Kristen Nobles, Kiersten Norby, Kristina Small, Monisha A. Kumar","doi":"10.1007/s11940-023-00779-y","DOIUrl":"https://doi.org/10.1007/s11940-023-00779-y","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of Review</h3><p>Bed rest was a treatment recommended for critically ill patients admitted to the intensive care unit (ICU) that aimed to minimize energy expenditure, permit wound healing and minimize somatic stressors. However, evidence demonstrates that bed rest leads to disuse atrophy, which may be compounded by premorbid sarcopenia and ICU-acquired weakness (ICUAW). ICUAW partly results from muscle breakdown and systemic inflammation and may exacerbate critical illness. Coupled with analgosedation, ICUAW may prolong mechanical ventilation (Kho et al. in BMJ Open Respir Res. 2019;6(1) 2019; Maffei et al. in Arch Phys Med Rehabil. 2017;98 2017; McWilliams et al. in J Crit Care. 2018;44 2018; Sarfati et al. in J Crit Care. 2018;46 2018), increase risk of venous thromboembolism (Denehy et al. in Intensive Care Med. 2017;43(1) 2017; Lyles in J Am Geriatr Soc. 1988;36(11) 1988) create dependence on vasopressor agents (Lyles in J Am Geriatr Soc. 1988;36(11) 1988; Fortney et al. in Comprehen Physiol. 1996) restrict joint mobility, and induce pressure injuries. Neurologically injured patients may be at a higher risk of ICUAW than other critically-ill patients, given that neurological injury itself results in weakness, which may be focal or generalized. Early mobilization (EM), typically defined as physical therapy within 72 h of ICU (Cumming et al. in Neurology. 2019;93(7) 2019), may preempt or mitigate these deleterious consequences of critical care.</p><h3 data-test=\"abstract-sub-heading\">Recent Findings</h3><p>Retrospective data suggest that EM protocols reduce ventilator days, decrease venous thromboembolism, avert pressure wounds, and reduce the length of stay. EM may reduce the incidence, duration, and severity of delirium (Morris et al. in Crit Care Med. 2008;36(8) 2008; Needham et al. in Arch Phys Med Rehabil. 2010;91(4) 2010). Larger and more rigorous studies have not demonstrated benefit of EM on outcomes after critical care; some have demonstrated harm. Neurologically injured critical care patients have generally been excluded from early mobilization protocols due to safety concerns that stem from the increased potential for falls, disorders of consciousness, cognitive impairment, intracranial hypertension, and potential dislodgment of intracranial devices. Notably, data from patients with ischemic stroke suggest that EM may also be associated with harm in this group.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>EM may benefit neurologically injured patients once acute ischemia, elevated ICP, and seizures are resolved. Targeting moderate acuity patients may be critical to improving outcomes and optimizing resource utilization in this resource-intensive intervention. The duration of mobility session, optimal frequency of mobility session, and timing of session remain to be determined.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"254 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139758492","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 Amyloid Polyneuropathy and Treatment","authors":"","doi":"10.1007/s11940-024-00780-z","DOIUrl":"https://doi.org/10.1007/s11940-024-00780-z","url":null,"abstract":"<h3>Abstract</h3> <span> <h3>Purpose of Review</h3> <p>The purpose of this review is to summarize currently available and developing diagnostic and treatment options for hereditary transthyretin amyloid polyneuropathy. Transthyretin amyloidosis (ATTR) predominantly manifests with cardiomyopathy and/or peripheral neuropathy, but amyloid deposits may be found in other organs or tissues.</p> </span> <span> <h3>Recent Findings</h3> <p>Currently available treatments include transthyretin gene silencers (for hereditary ATTR peripheral neuropathy only) and transthyretin stabilizers (tafamidis for ATTR cardiomyopathy in the USA, and for both hereditary ATTR peripheral neuropathy and ATTR cardiomyopathy in Europe, Japan, Brazil, and some other countries), and liver transplantation. Gene silencers stop the progression of hereditary ATTR peripheral neuropathy in most patients, and transthyretin stabilizers reduce hospitalizations and mortality in patients with ATTR cardiomyopathy. The use of liver transplantation for ATTR has declined with the availability of more effective therapies, and shortage of available allografts. On the horizon are new treatments already in clinical trials including new gene silencers and gene editing agents, new transthyretin stabilizers, and amyloid removal treatments.</p> </span> <span> <h3>Summary</h3> <p>Recently approved treatments for ATTR have changed its natural history, and additional medications may get approved in the near future. Early diagnosis is still essential to improve treatment outcomes. New management strategies may include combinations of gene silencers, transthyretin stabilizers, gene editing, and amyloid removal agents, but the cost may become the limiting factor.</p> </span>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"3 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139662289","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":"Translating the ALS Genetic Revolution into Therapies: A Review","authors":"Christine Meadows, Naraharisetty Anita Rau, Warda Faridi, Cindy V. Ly","doi":"10.1007/s11940-024-00781-y","DOIUrl":"https://doi.org/10.1007/s11940-024-00781-y","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of Review</h3><p>Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease causing weakness, respiratory failure, and death within 3 to 5 years. Approximately, 10% of ALS cases have a genetic etiology (familial/fALS). The etiology of the remaining 90% of sporadic ALS (sALS) cases remains unknown. In this review, we provide an overview of approved and investigational therapies for fALS, as well as genetically informed therapeutic advances aimed at the larger sALS population.</p><h3 data-test=\"abstract-sub-heading\">Recent Findings</h3><p>Antisense oligonucleotides (ASOs) are a promising strategy to treat toxic gain-of-function mutations underlying most forms of fALS. We discuss the recent approval of tofersen for ALS caused by mutation in <i>SOD1</i>. We also discuss progress in the development of therapies for fALS associated with <i>C9orf72</i> hexanucleotide repeat expansions (<i>C9orf72</i>) and fused in sarcoma (<i>FUS</i>) mutations. Finally, we will discuss the rationale and status of molecular therapies for sALS targeting mediators of TDP-43 pathogenesis: ataxin-2 (<i>ATXN2</i>) and stathmin-2 (<i>STMN2</i>).</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>Advances in understanding the genetics of ALS have propelled the development of promising gene therapies. Lessons learned from tofersen continue to inform clinical trial design for a growing pipeline of therapies directed towards other fALS subtypes and sALS.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"22 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139579320","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":"A New Era in the Treatment of Myasthenia Gravis: Six New Medications in The Last 6 Years","authors":"Ashish D. Patel, Aashin Shah, J. David Avila","doi":"10.1007/s11940-024-00783-w","DOIUrl":"https://doi.org/10.1007/s11940-024-00783-w","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of Review</h3><p>This article presents a summary of the new medications approved for generalized myasthenia gravis (gMG) since 2017. Pivotal clinical trials that led to the approval of these medications and their open-label extension studies are reviewed. We also provide information on healthcare cost when available. Lastly, we propose an approach to selecting therapies.</p><h3 data-test=\"abstract-sub-heading\">Recent Findings</h3><p>Six new medications have been approved for acetylcholine receptor antibody positive gMG. These include the complement inhibitors eculizumab, ravulizumab, and zilucoplan and the neonatal Fc receptor blockers efgartigimod, efgartigimod and hyaluronidase, and rozanolixizumab. The latter is also approved for muscle-specific kinase gMG. The Myasthenia Gravis Activities of Daily Living (MG-ADL) has become the most commonly used primary outcome measure in gMG clinical trials.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>All medications have shown safety and efficacy as measured by clinically meaningful changes in the MG-ADL. The medications differ in the need for meningococcal vaccination, the route and frequency of administration, and timing of treatments. Comparison studies are lacking and therefore there is limited evidence to guide the selection of therapy.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"195 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139559993","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":"Progressive Supranuclear Palsy Diagnosis and Treatment","authors":"Lauryn Currens, Alexander Pantelyat","doi":"10.1007/s11940-024-00784-9","DOIUrl":"https://doi.org/10.1007/s11940-024-00784-9","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of review</h3><p>This review describes the current approaches to the diagnosis and management of progressive supranuclear palsy (PSP)</p><h3 data-test=\"abstract-sub-heading\">Recent findings</h3><p>PSP is an atypical parkinsonian disorder associated with the accumulation of abnormal 4-repeat tau protein in the brain. Initially, the recognized clinical phenotype included a progressive disorder with vertical supranuclear gaze palsy and prominent postural instability leading to early falls. However, the current PSP diagnostic criteria recognize a broader range of clinical PSP presentations and define eight clinical PSP variants according to the levels of diagnostic certainty. While definite PSP remains a neuropathological diagnosis, imaging modalities including brain magnetic resonance imaging (MRI), dopamine transporter (DAT), and tau positron emission tomography (PET) scans may aid in the diagnosis. In the future, new tau PET ligands and CSF and genetic biomarkers may improve diagnostic accuracy. There is no disease-modifying therapy currently available for PSP. However, there are many pharmacological and non-pharmacological treatment options for symptomatic management. Because PSP is a multisystem disease, optimal management requires a coordinated multidisciplinary team approach.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>PSP is a fatal multisystem disease that can be challenging to diagnose and manage. However, improved clinical diagnostic criteria, emerging biomarkers, and availability of useful therapeutic approaches provide cause for optimism.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"34 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139501526","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":"Vasculitic Neuropathies","authors":"Avi Landman, Mark Levine, Andrés M. De León","doi":"10.1007/s11940-024-00782-x","DOIUrl":"https://doi.org/10.1007/s11940-024-00782-x","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of review</h3><p>To describe the clinical presentation, diagnosis, and treatment options of vasculitic neuropathies. Overall, vasculitic neuropathies can be divided into systemic and nonsystemic. Systemic vasculitic neuropathies form part of rheumatological diseases, where in some cases, the vasculitic is the predominant feature, and these are called primary vasculitis, while in others, the vasculitis is secondary to a connective tissue disease. Nonsystemic vasculitic neuropathies involve only the peripheral nervous system, and thus, diagnosis is more challenging as it requires a high degree of suspicion and confirmation with nerve biopsy results.</p><h3 data-test=\"abstract-sub-heading\">Recent findings</h3><p>Over the past few years, rituximab has been increasingly used for induction and maintenance treatment of vasculitis due to a more favorable side effect profile and similar efficacy when compared to cyclophosphamide.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>Herein, we describe the different types of vasculitic neuropathies. Regarding their treatment, have focused on the indications, dosing, and side effects for the most common options for primary systemic vasculitic neuropathies, as these tend to be similar for the classical nonsystemic vasculitic neuropathy phenotype.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"4 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139461100","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 Role of Rehabilitation in Neurological Critical Care: Innovations in Early Mobilization","authors":"Alicia O’Hara, Marie Newkirk, Mina Girgis, Carrie Esopenko, David Putrino, Laura Tabacof, Christopher Kellner, Jenna M. Tosto-Mancuso","doi":"10.1007/s11940-023-00775-2","DOIUrl":"https://doi.org/10.1007/s11940-023-00775-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of review</h3><p>This review appraises the existing literature to highlight the benefits, barriers, and role of rehabilitation in the early mobilization of patients in neurological critical care.</p><h3 data-test=\"abstract-sub-heading\">Recent findings</h3><p>While the benefits of early mobilization in patients with critical illness have become more widely acknowledged, there are benefits and challenges to the successful implementation of early mobilization rehabilitation programming in the neurological critical care setting. The imperative role of rehabilitation providers is underscored in successful implementation. Furthermore, the discrete needs of patients and caregivers in neurocritical care necessitate interdisciplinary collaboration among medical and rehabilitation teams for the successful deployment of early mobilization programs.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>This work discusses the expanding role of rehabilitation providers in neurocritical care and the importance of early mobilization for patients with neurological injuries. Experience-dependent neuroplasticity is a primary mechanism in facilitating recovery following neurological injury, and physical rehabilitation plays a critical role in this process. There is, however, a discrepancy in nomenclature regarding the definition of “early mobilization,” which makes it challenging to synthesize and translate evidence into practice. Despite the benefits of early mobilization, applying this evidence to the neurocritically ill patient is controversial given the innate medical complexity associated with these diagnoses. Nonetheless, early mobilization has been shown to decrease ICU and hospital length of stay, increase discharge to home, and reduce medical costs. Furthermore, consideration for those with severe acute brain injury and necessary medical interventions should be accounted for. While extensive literature has demonstrated the feasibility of adopting early mobilization to minimize secondary complications of ICU episodes of care, adoption of this paradigm has progressively expanded in the neurological population. Factors including the timing and frequency of mobilization are unclear and vary among studies, suggesting that more research is needed to better understand the role and benefits of early mobilization in neurocritical care.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"108 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138548342","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":"An Update on Palliative Care in Neurocritical Care: Providing Goal-Concordant Care in the Face of Prognostic Uncertainty","authors":"Kristopher A. Hendershot, Maya N. Elias, Breana L. Taylor, Sarah Wahlster, Claire J. Creutzfeldt","doi":"10.1007/s11940-023-00778-z","DOIUrl":"https://doi.org/10.1007/s11940-023-00778-z","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of review</h3><p>We investigate the complexities and interplay between the concepts of prognostic uncertainty and patient preferences as they relate to the delivery of goal-concordant care to patients with severe acute brain injuries (SABI) in the Neurological Intensive Care Unit (Neuro-ICU).</p><h3 data-test=\"abstract-sub-heading\">Recent findings</h3><p>Patients with SABI in the Neuro-ICU have unique palliative care needs due to sudden, often unexpected changes in personhood and quality of life. A substantial amount of uncertainty is inherent and poses a challenge to both the patient’s prognosis and treatment preferences. The delivery of goal-concordant care can be difficult to achieve.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>The uncertainty inherent to both prognosis and patient preferences challenges the provision of goal-concordant care to patients with SABI. The best case/worst case/most likely case scenario is a communication strategy that can aid clinicians when discussing the patient’s uncertain prognosis. A time-limited trial may provide a framework for families and clinicians to pursue aggressive life-sustaining treatment for a certain amount of time, in which prognosis may become more defined, patient goals may become clearer, and clinicians and families may establish a common ground. Although the delivery of goal-concordant care in the Neuro-ICU may be an unachievable, lofty goal, it is a level of care that we should continue to strive for and discuss.</p>","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"20 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138516181","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":"Correction to: Clinical Practice Update Part I: Diagnosis and Treatment for Benign Paroxysmal Positional Vertigo","authors":"Allison L. Nogi, Daniel Ludwig, Jennifer Millar","doi":"10.1007/s11940-023-00773-4","DOIUrl":"https://doi.org/10.1007/s11940-023-00773-4","url":null,"abstract":"","PeriodicalId":10975,"journal":{"name":"Current Treatment Options in Neurology","volume":"5 2","pages":"1"},"PeriodicalIF":2.0,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139247970","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}