Current Opinion in Neurology最新文献

{"title":"Burning vertex syndrome: a novel unclassified headache - its preliminary observations, and possible mechanisms.","authors":"Pravin Thomas, Paul Emmanuel L Yambao","doi":"10.1097/WCO.0000000000001367","DOIUrl":"https://doi.org/10.1097/WCO.0000000000001367","url":null,"abstract":"<p><strong>Purpose: </strong>Not all headaches are fully defined or characterized by the current classification systems. The variability in headache descriptions and presentation may be influenced by individual or group factors, or may even suggest the discovery of a new or an atypical phenotype. This paper aims to describe a novel headache syndrome characterized by a burning sensation on the vertex.</p><p><strong>Recent findings: </strong>Demographic and clinical profiles of 25 patients from a referral headache center in India were analyzed. The syndrome presents as episodic, burning headaches on the vertex (10-20 cm diameter). Most patients were women (16/25), with a mean age of 40.96 years (SD+ 0.75). Episodes occurred 1-3 times weekly or daily, lasting <4 h (range: 1 min to 24 h). Associated symptoms included nausea, vomiting, photophobia, phonophobia, or autonomic features (76%). Common comorbidities were hypertension, diabetes, and polycystic ovarian disease. Neurological exams were normal, except for a slight local temperature rise in 2 patients. Treatment responses varied, though two patients reported reduced frequency and severity after greater occipital nerve (GON) block.</p><p><strong>Summary: </strong>This syndrome is not completely compatible with any other primary headache disorders like nummular headache, migraine, cluster, or tension-type headaches. It potentially involves small fiber pathways from the scalp. Further studies are needed to better understand its clinical features, gender predilection, mechanisms, biomarkers, and treatment options.</p>","PeriodicalId":11059,"journal":{"name":"Current Opinion in Neurology","volume":"38 3","pages":"262-270"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cannabinoids in headache: helpful or harmful?","authors":"Deena E Kuruvilla","doi":"10.1097/WCO.0000000000001364","DOIUrl":"10.1097/WCO.0000000000001364","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cannabinoids have gained attention as a potential treatment for headache disorders, including migraine and cluster headache. While some studies suggest cannabinoids may provide analgesic and anti-inflammatory effects, concerns remain regarding their potential for overuse headache, cognitive impairment, and psychological dependence. This study critically evaluates the current evidence on cannabinoids in headache treatment, weighing their benefits and risks.</p><p><strong>Recent findings: </strong>With the migraine treatment landscape expanding faster than ever, recent studies explore immune cells as a target for cannabinoids. Immune cells express cannabinoid and CGRP (calcitonin gene-related peptide) receptors. As a result, cannabinoids might potentially modulate the efficacy of current CGRP-targeting drugs. Additionally, emerging studies suggest that cannabinoids may enhance neuronal resilience and mitigate central sensitization in chronic migraine. Research into optimal delivery mechanisms, including inhaled, sublingual, and transdermal formulations, is also expanding.</p><p><strong>Summary: </strong>Cannabinoids are being studied as a potential treatment for headache disorders, particularly migraine, due to their interaction with the endocannabinoid system, which regulates pain, inflammation, and vascular function. Studies suggest cannabinoids may help reduce headache frequency, alleviate pain, and improve sleep, though concerns remain about dependency, cognitive impairment, and medication overuse headache. While retrospective studies indicate benefits, the lack of standardized dosing, long-term safety data, and controlled trials limits conclusive recommendations. Comparisons with conventional treatments show mixed results, with cannabinoids presenting variable effectiveness and a risk of adverse effects. Further research, including randomized controlled trials, is needed to establish optimal dosing, safety, and efficacy in headache management.</p>","PeriodicalId":11059,"journal":{"name":"Current Opinion in Neurology","volume":" ","pages":"277-280"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How can you manage an indomethacin-responsive headache in someone who cannot take indomethacin?","authors":"Aleksander Osiowski, Kacper Stolarz, Dominik Taterra","doi":"10.1097/WCO.0000000000001347","DOIUrl":"10.1097/WCO.0000000000001347","url":null,"abstract":"<p><strong>Purpose of review: </strong>Paroxysmal hemicrania and hemicrania continua are rare primary headache disorders which are distinguished by an absolute response to indomethacin. As a matter of importance, no guidelines have been proposed for alternative therapeutic options in case of indomethacin intolerance. The purpose of this review is to provide an update on the current findings, especially focusing on the past 18 months, in the treatment of both paroxysmal hemicrania and hemicrania continua and to provide proposed management recommendations based on summarized evidence.</p><p><strong>Recent findings: </strong>Apart from well recognized gastrolesive effects of indomethacin, a substantial number of patients may suffer from neuropsychiatric adverse reactions. Recent studies demonstrated that melatonin, which has been known for its effectiveness for hemicrania continua, is also useful for paroxysmal hemicrania. Promising nonpharmacological treatment option, which is noninvasive vagus nerve stimulation, has been shown to be beneficial for both indomethacin-responsive headache disorders allowing the reduction of indomethacin dosage. Although the data on substitutive medication choice for indomethacin are currently scarce, the most consistent results have been repeatedly achieved with acemethacin, selective COX-2 inhibitors, and anticonvulsants. However, considering the crucial role of pathophysiology, research investigating the efficacy of drugs targeting the trigemino-vascular system activation, as well as controlled trials assessing the efficacy involving the aforementioned therapeutic options are still vague.</p><p><strong>Summary: </strong>In spite of numerous reports suggesting reliable alternatives to indomethacin, the consensus on pharmacological therapy guidelines for indomethacin-responsive headache disorders has not yet been reached. Further research and agreement from the experts' standpoint are needed for an establishment of reliable treatment recommendations.</p>","PeriodicalId":11059,"journal":{"name":"Current Opinion in Neurology","volume":" ","pages":"254-261"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Headache in infections.","authors":"Rithvik Ramesh, Lakshmi Narasimhan Ranganathan","doi":"10.1097/WCO.0000000000001348","DOIUrl":"10.1097/WCO.0000000000001348","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review explores the phenomenology, pathogenesis, and nosology of headaches associated with infections, an often-overlooked yet clinically significant symptom. With the increasing recognition of secondary headaches in infections, understanding their clinical patterns, mechanisms, and classifications is crucial for accurate diagnosis and management.</p><p><strong>Recent findings: </strong>Headaches in infections are ubiquitous but vary in presentation, severity, and underlying mechanisms depending on the causative pathogen. Elevated intracranial pressure, meningeal irritation, and activation of the trigeminovascular system are key contributors to headache generation, which varies depending on each pathogen. Pathogen-specific predilection for one of these mechanisms may subtly alter the clinical phenotype of the headache, which can be used to guide management. Emerging evidence highlights postinfectious headache syndromes, particularly following bacterial meningitis and SARS-CoV-2 infection, underscoring the need for long-term follow-up in these patients.</p><p><strong>Summary: </strong>The diverse presentations of infection-related headaches necessitate a systematic approach to evaluation and management. While the pathophysiology is complex and multifaceted, understanding these mechanisms aids in differentiating primary headaches from those secondary to infections.</p>","PeriodicalId":11059,"journal":{"name":"Current Opinion in Neurology","volume":" ","pages":"281-287"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent aura without infarction.","authors":"Maurizio Severino, Mark W Green","doi":"10.1097/WCO.0000000000001357","DOIUrl":"10.1097/WCO.0000000000001357","url":null,"abstract":"<p><strong>Purpose of review: </strong>The scope of this review is to discuss persistent aura without infarction, a rare, highly disabling, yet apparently benign clinical condition, straddling neurology, neuro-ophthalmology, and psychiatry, whose differential diagnosis is essential for an appropriate therapeutic approach and to avoid clinical complications. Here we attempt to report on the available literature, trying to present a summary, despite the scarcity of available literature.</p><p><strong>Recent findings: </strong>Persistent aura without infarction is a diagnostic challenge, likely caused by cortical spreading depression and vasoconstriction, whose clinical features are not always easy to pigeonhole into the available diagnostic criteria. The diagnosis requires the exclusion of cerebral and retinal infarction, structural changes in the brain, epilepsy, and psychiatric symptoms. Triptans may be deleterious, anticoagulants are not indicated, and therapy with acetazolamide, valproic acid, zonisamide, furosemide, cortisone, and ketamine may be beneficial.</p><p><strong>Summary: </strong>Persistent aura without infarction is a challenging diagnosis. However, an approach using zonisamide and ketamine might be beneficial. Randomized and controlled clinical trials are required for a better comprehension of the aetiopathogenesis and therapeutic approach.</p>","PeriodicalId":11059,"journal":{"name":"Current Opinion in Neurology","volume":" ","pages":"249-253"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in neuroimaging of multiple sclerosis.","authors":"Maria A Rocca, Paolo Preziosa, Massimo Filippi","doi":"10.1097/WCO.0000000000001360","DOIUrl":"10.1097/WCO.0000000000001360","url":null,"abstract":"<p><strong>Purpose of review: </strong>To summarize recent advancements in understanding multiple sclerosis (MS) pathophysiology, predicting disease course, and monitoring treatment responses using MRI.</p><p><strong>Recent findings: </strong>Paramagnetic rim lesions (PRLs) are highly specific to MS and clinically relevant. Detected from the earliest disease phases, PRLs aid in distinguishing MS from other conditions, improving diagnostic accuracy. Moreover, PRLs are associated with more severe disability and measures of brain damage and may predict disease progression. Similarly, slowly expanding lesions (SELs) are associated with more severe disability and predict a more severe disease course. Disease-modifying therapies have limited effectiveness in reducing PRLs or SELs. Choroid plexus (CP) enlargement is associated with structural brain damage and clinical disability and predicts disease evolution. Enlarged perivascular spaces (ePVS) suggest microangiopathic changes rather than direct MS-related inflammation. Glymphatic dysfunction, evaluated using diffusion tensor image analysis along the perivascular space, emerges early in MS and correlates with disability, cognitive impairment, and structural brain damage. Aging and comorbidities exacerbate MS-related damage, complicating diagnosis and treatment. Emerging technologies, such as brain-age paradigms, aim to disentangle aging from MS-specific neurodegeneration.</p><p><strong>Summary: </strong>Advances in MRI have highlighted the clinical significance of chronic inflammation and glymphatic dysfunction as early contributors to MS progression as well as the interplay between aging, comorbidities and MS.</p>","PeriodicalId":11059,"journal":{"name":"Current Opinion in Neurology","volume":" ","pages":"205-216"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Red flags in multiple sclerosis.","authors":"Eser Bulus, Ayse Altintas, Aksel Siva","doi":"10.1097/WCO.0000000000001362","DOIUrl":"10.1097/WCO.0000000000001362","url":null,"abstract":"<p><strong>Purpose of review: </strong>The diagnosis of multiple sclerosis (MS) is often challenging and misdiagnosis remains an important contemporary problem, with considerable consequences for patients. This review aims to specify the appropriate approach in differential diagnosis of MS, highlight the clinical and paraclinical red flags and create a new perspective to the clinicians.</p><p><strong>Recent findings: </strong>The accurate diagnosis of MS is challenged by a broad and heterogeneous spectrum of diseases. The differential diagnosis should be based on the combined evaluation of typical clinical, radiological and laboratory findings. Studies have been recently published reported that 7.1-24.4% of patients have been misdiagnosed with MS. The most frequent correct alternative diagnoses were white matter ischemic disease and migraine.</p><p><strong>Summary: </strong>Differential diagnosis of MS requires a holistic approach dependent on the clinical presentation and accompanied by vigilance for clinical and paraclinical red flags suggesting alternative diagnoses. Misdiagnosis could have the potential dangerous consequences for patients, including aggressive immunosuppressive therapies.</p>","PeriodicalId":11059,"journal":{"name":"Current Opinion in Neurology","volume":" ","pages":"217-225"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update on novel multiple sclerosis treatments: from dismal defeat to scintillating success.","authors":"Bruce Cree, Hans-Peter Hartung","doi":"10.1097/WCO.0000000000001363","DOIUrl":"10.1097/WCO.0000000000001363","url":null,"abstract":"<p><strong>Purpose of review: </strong>To review novel multiple sclerosis (MS) therapies currently in clinical trials.</p><p><strong>Recent findings: </strong>Sixty-seven clinical trials were selected and grouped into the following categories: Bruton's tyrosine kinase inhibitors, remyelinating therapies, immunomodulators, B cell therapies, supplements/microbiome influencers, and cell-directed therapies. Important findings include tolebrutinib's successful trial in nonrelapsing secondary progressive MS that slowed CDP compared to placebo and simvastatin's failure to show an effect on disability in its phase 3 trial.</p><p><strong>Summary: </strong>Multiple strategies are being investigated in MS to address progressive disability, myelin repair, neural protection and treatment refractory disease. Some of these strategies have successfully completed clinical trials giving hope that some of the most vexing aspects of MS will soon have new treatment options.</p>","PeriodicalId":11059,"journal":{"name":"Current Opinion in Neurology","volume":" ","pages":"226-235"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunology of multiple sclerosis: an update.","authors":"Patricia Kirschner, Marc Pawlitzki, Hans-Peter Hartung, Sven G Meuth","doi":"10.1097/WCO.0000000000001361","DOIUrl":"https://doi.org/10.1097/WCO.0000000000001361","url":null,"abstract":"<p><strong>Purpose of review: </strong>The immunological processes that lead to multiple sclerosis (MS) and occur during the progressive phase of the disease are manifold and still not well understood. This review summarizes new insights on this topic that were gained through recent studies with diverse scientific approaches.</p><p><strong>Recent findings: </strong>While genetic risk clearly contributes to MS, external factors play a key role in its pathogenesis as well. Epstein-Barr virus infection correlates significantly with MS risk and seems to be a major causal factor. Even though our knowledge on the human gut microbiome and its connection to the central nervous system is far from being complete, several studies have proven that the gut-brain axis influences neuroinflammation and disease progression in MS. It has become much clearer that MS is not solely a T cell-mediated disease but is also strongly driven by B cells and pathogenic antibodies. Beyond the peripheral immune cells, glial cells and their interactions with neurons are important players contributing to disease activity and progression in MS.</p><p><strong>Summary: </strong>Taken together, recent publications on immunological processes in the context of MS implicate a multitude of noncanonical mechanisms that need to be further explored regarding their interplay and contribution to the degenerative course of the disease.</p>","PeriodicalId":11059,"journal":{"name":"Current Opinion in Neurology","volume":"38 3","pages":"180-187"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple sclerosis: advances and challenges in diagnosis.","authors":"Silvia Tenembaum, Hans-Peter Hartung","doi":"10.1097/WCO.0000000000001366","DOIUrl":"10.1097/WCO.0000000000001366","url":null,"abstract":"<p><strong>Purpose of review: </strong>This article explores the most recent developments in multiple sclerosis (MS), including a selection of advances in diagnostic neuroimaging markers. The proposed revision of diagnostic criteria, new concepts on the prodromal period, and differential diagnosis of MS are included as well.</p><p><strong>Recent findings: </strong>Interesting changes have been introduced to the recently proposed 2024 revisions of MS diagnostic criteria. Optic nerve is proposed as the 5 th CNS topography, additional advanced MRI markers are included, as well as specific cases of \"radiologically isolated syndrome\" considered at risk of future relapses.The diagnostic power of the central vein sign, paramagnetic rim lesion, and cortical lesions have been demonstrated in recent lines of research in adult and pediatric patients with MS. The contribution of cortical lesions, slowly expanding lesions, choroid plexus enlargement, paramagnetic rim lesions, leptomeningeal enhancement, in addition to measurement of brain and spinal cord atrophy, have expanded our understanding of early disease progression.</p><p><strong>Summary: </strong>This review highlights a selection of recent studies that have significantly contributed to increase the accuracy of MS diagnosis in both pediatric and adult patients, and demonstrated the potential to improve the early detection of disease progression.</p>","PeriodicalId":11059,"journal":{"name":"Current Opinion in Neurology","volume":" ","pages":"197-204"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}