Seminars in Neurology最新文献_第5页

Top 10 Clinical Pearls in Vasculitic Neuropathies. 血管炎性神经病的十大临床宝典。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-09-30 DOI: 10.1055/s-0044-1791499

Peter Pacut, Kelly G Gwathmey

{"title":"Top 10 Clinical Pearls in Vasculitic Neuropathies.","authors":"Peter Pacut, Kelly G Gwathmey","doi":"10.1055/s-0044-1791499","DOIUrl":"https://doi.org/10.1055/s-0044-1791499","url":null,"abstract":"Vasculitic neuropathies are a diverse group of inflammatory polyneuropathies that result from systemic vasculitis (e.g., polyarteritis nodosa, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, microscopic polyangiitis), vasculitis resulting from rheumatological disorders (e.g., rheumatoid arthritis and Sjögren's syndrome), paraneoplastic conditions, viruses, and medications. Occasionally, vasculitis is restricted to the peripheral nerves and termed nonsystemic vasculitic neuropathy. Presenting with an acute or subacute onset of painful sensory and motor deficits, ischemia to individual peripheral nerves results in the classic \"mononeuritis multiplex\" pattern. Over time, overlapping mononeuropathies will result in a symmetrical or asymmetrical sensorimotor axonal polyneuropathy. The diagnosis of vasculitic neuropathies relies on extensive laboratory testing, electrodiagnostic testing, and nerve and/or other tissue biopsy. Treatment consists primarily of immunosuppressant medications such as corticosteroids, cyclophosphamide, rituximab, methotrexate, or azathioprine, in addition to neuropathic pain treatments. Frequently, other specialists such as rheumatologists, pulmonologists, and nephrologists will comanage these complex patients with systemic vasculitis. Prompt recognition of these conditions is imperative, as delays in treatment may result in permanent deficits and even death.","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331054","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}

引用次数: 0

Opioid-Associated Nervous System Injuries. 阿片类药物相关神经系统损伤。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-08-01 Epub Date: 2024-06-07 DOI: 10.1055/s-0044-1787545

Kim Griffin, Derek Stitt

引用次数: 0

Neurological Complications of Cannabinoids. 大麻素的神经并发症。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-08-01 Epub Date: 2024-06-24 DOI: 10.1055/s-0044-1787570

Mariyam Humayun, Jose I Suarez, Vishank A Shah

{"title":"Neurological Complications of Cannabinoids.","authors":"Mariyam Humayun, Jose I Suarez, Vishank A Shah","doi":"10.1055/s-0044-1787570","DOIUrl":"10.1055/s-0044-1787570","url":null,"abstract":"Cannabinoid use, particularly for recreational purposes, is increasing exponentially across all age groups, especially in younger populations, due to its perceived low risk and legalization. While cannabinoids may be largely considered as safe, there is mounting evidence of increased risk of systemic and neurological complications through their interaction with the poorly understood endocannabinoid receptor network within the central nervous system and other organ systems. Acute cannabinoid exposure can cause neuropsychiatric symptoms in addition to altering cerebral blood flow, leading to cerebrovascular complications such as ischemic stroke, subarachnoid hemorrhage, and reversible cerebral vasoconstriction syndrome (RCVS). Chronic use, particularly among adolescents, may be associated with increased risk of long-term cognitive deficits, schizophrenia, and other neuropsychiatric effects. Synthetic cannabinoids have increased potency, with reports of causing profound neurological complications including coma, seizures, posterior reversible encephalopathy syndrome, and RCVS. Despite increasing evidence, the quality of literature describing neurologic complications with cannabinoids remains limited to case series and retrospective cohort studies, with significant confounding factors such as concomitant use of other illicit drugs, limiting interpretation. In this review, we summarize the effect of cannabinoids on the neurologic system and associated neurological complications.","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":"430-440"},"PeriodicalIF":1.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447399","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}

引用次数: 0

Derek Stitt, MD, and Justin McArthur MBBS, MPH, FAAN. 医学博士德里克-斯蒂特（Derek Stitt）和医学博士、公共卫生硕士、FAAN 贾斯汀-麦克阿瑟（Justin McArthur）。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-08-01 Epub Date: 2024-07-16 DOI: 10.1055/s-0044-1787573

David M Greer

引用次数: 0

Availability and Opportunities for Expansion of Buprenorphine for the Treatment of Opioid Use Disorder. 用于治疗阿片类药物使用障碍的丁丙诺啡的可用性和推广机会。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-08-01 Epub Date: 2024-06-14 DOI: 10.1055/s-0044-1787569

Greer McKendrick, Samuel W Stull, Anjalee Sharma, Kelly E Dunn

{"title":"Availability and Opportunities for Expansion of Buprenorphine for the Treatment of Opioid Use Disorder.","authors":"Greer McKendrick, Samuel W Stull, Anjalee Sharma, Kelly E Dunn","doi":"10.1055/s-0044-1787569","DOIUrl":"10.1055/s-0044-1787569","url":null,"abstract":"There is an urgent need to expand access to treatment for persons with opioid use disorder (OUD). As neurologists may frequently encounter patients with chronic pain who have developed OUD, they are in a position to serve as advocates for treatment. Buprenorphine is the most scalable medication for OUD in the United States, yet expansion has plateaued in recent years despite growing treatment needs. Reluctance of providers to establish treatment with new patients, challenges with rural expansion, stigma related to buprenorphine-based care, and pharmacy pressures that incentivize low dispensing and inventories may have stalled expansion. This review introduces these challenges before outlining actionable and evidenced-based strategies that warrant investigation, including methods to improve patient access to care (remotely delivered care, mobile delivery programs, Bridge programs) and provider retention and confidence in prescribing (expert consults, Extension for Community Healthcare Outcomes, a telementoring model, hub-and-spoke services), as well as novel innovations (virtual reality, artificial intelligence, wearable technologies). Overall, fortifying existing delivery systems while developing new transformative models may be necessary to achieve more optimal levels of buprenorphine treatment expansion.","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":"419-429"},"PeriodicalIF":1.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141321918","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}

引用次数: 0

Substance Use Disorder Treatment: Opportunities for Interdisciplinary Collaboration in Neurology and Beyond. 药物使用障碍治疗：神经病学及其他学科的跨学科合作机会。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-08-01 Epub Date: 2024-06-18 DOI: 10.1055/s-0044-1787654

Kenneth B Stoller

引用次数: 0

Opioid Maintenance Therapy: A Review of Methadone, Buprenorphine, and Naltrexone Treatments for Opioid Use Disorder. 阿片类药物维持疗法：美沙酮、丁丙诺啡和纳曲酮治疗阿片类药物使用障碍综述》。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-08-01 Epub Date: 2024-06-07 DOI: 10.1055/s-0044-1787571

David C Fipps, Tyler S Oesterle, Bhanu P Kolla

引用次数: 0

Neurological Effects of Stimulants and Hallucinogens. 兴奋剂和致幻剂对神经系统的影响。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-08-01 Epub Date: 2024-06-18 DOI: 10.1055/s-0044-1787572

Reece M Hass, Derek Stitt

引用次数: 0

Neurological Aspects of Substance Use Disorder: An Introduction. 药物使用障碍的神经学方面：简介。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-08-01 Epub Date: 2024-07-16 DOI: 10.1055/s-0044-1787551

Justin C McArthur, Derek W Stitt

引用次数: 0

Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know. 儿科神经重症监护的最新进展：护理重症儿童的神经科医生须知》。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-06-01 Epub Date: 2024-05-24 DOI: 10.1055/s-0044-1787047

Virginie Plante, Meera Basu, Jennifer V Gettings, Matthew Luchette, Kerri L LaRovere

{"title":"Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know.","authors":"Virginie Plante, Meera Basu, Jennifer V Gettings, Matthew Luchette, Kerri L LaRovere","doi":"10.1055/s-0044-1787047","DOIUrl":"10.1055/s-0044-1787047","url":null,"abstract":"Currently nearly one-quarter of admissions to pediatric intensive care units (PICUs) worldwide are for neurocritical care diagnoses that are associated with significant morbidity and mortality. Pediatric neurocritical care is a rapidly evolving field with unique challenges due to not only age-related responses to primary neurologic insults and their treatments but also the rarity of pediatric neurocritical care conditions at any given institution. The structure of pediatric neurocritical care services therefore is most commonly a collaborative model where critical care medicine physicians coordinate care and are supported by a multidisciplinary team of pediatric subspecialists, including neurologists. While pediatric neurocritical care lies at the intersection between critical care and the neurosciences, this narrative review focuses on the most common clinical scenarios encountered by pediatric neurologists as consultants in the PICU and synthesizes the recent evidence, best practices, and ongoing research in these cases. We provide an in-depth review of (1) the evaluation and management of abnormal movements (seizures/status epilepticus and status dystonicus); (2) acute weakness and paralysis (focusing on pediatric stroke and select pediatric neuroimmune conditions); (3) neuromonitoring modalities using a pathophysiology-driven approach; (4) neuroprotective strategies for which there is evidence (e.g., pediatric severe traumatic brain injury, post-cardiac arrest care, and ischemic stroke and hemorrhagic stroke); and (5) best practices for neuroprognostication in pediatric traumatic brain injury, cardiac arrest, and disorders of consciousness, with highlights of the 2023 updates on Brain Death/Death by Neurological Criteria. Our review of the current state of pediatric neurocritical care from the viewpoint of what a pediatric neurologist in the PICU needs to know is intended to improve knowledge for providers at the bedside with the goal of better patient care and outcomes.","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":"362-388"},"PeriodicalIF":1.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141094544","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}

引用次数: 0