bluuebunny/crossref_metadata_2025 huggingface dataset:
An Overview of the Recent European Federation of Neurological Societies Guidelines on the Treatment of Tension-type Headache
Authors: Bendtsen Lars ,   Senior Consultant, Danish Headache Centre, Department of Neurology, Glostrup Hospital, University of Copenhagen
Published: October 2015

Tension-type headache (TTH) is the most prevalent headache type and causes a high degree of disability. This paper provides an overview of the recently published European Federation of Neurological Societies guideline on the treatment of TTH, which recommended that non-drug management should always be considered for this condition. For example: information, reassurance and identification of trigger factors may be rewarding; electromyograph biofeedback has a documented effect in TTH; cognitive-behavioural therapy and relaxation training most likely also are effective; and physical therapy and acupuncture may be valuable options for patients with frequent TTH. Simple analgesics and non-steroidal anti-inflammatory drugs are recommended for treatment of episodic TTH. Combination analgesics containing caffeine are drugs of second choice. Excessive use of analgesics should be avoided to prevent the development of medication-overuse headache. The tricyclic antidepressant amitriptyline is the first choice for prophylactic treatment of chronic TTH. Mirtazapine and venlafaxine may be used second line.
Multimodal Computed Tomography in Acute Ischaemic Stroke
Authors: Rastogi Sachin , Liebeskind David S ,   Fellow, Neuro-interventional Radiology,   Associate Professor of Neurology, University of California, Los Angeles
Published: October 2015

Stroke is the third leading cause of death in the US, affecting 795,000 individuals annually. Currently, only a small percentage of acute stroke patients receive thrombolytic treatment. A significant limitation is the current use of strict time criteria in the decision to treat. As there are significant inter-individual variations in response to an acute vascular occlusion, the goal of modern imaging such as multimodal computed tomography (CT) is to rapidly identify acute ischaemic stroke patients and determine which patients are likely to benefit from treatment based on tissue perfusion status rather than time of presentation alone. Multimodal CT consists of a non-contrast head CT, CT angiogram (CTA) of the head and neck, and CT perfusion (CTP). The non-contrast head CT allows rapid triage of a patient with haemorrhagic versus ischaemic stroke. The CTA allows identification of the site of vascular pathology with similar quality to digital subtraction angiography. The CTP scan allows for determination of the infarct core and surrounding ischaemic penumbra, which remains at risk for infarction if perfusion is not restored. This allows the potential to prospectively treat only those patients likely to benefit from thrombolysis while protecting those patients unlikely to benefit from the risks associated with treatment.
Disparities in Nursing of Multiple Sclerosis Patients - Results of a European Nurse Survey
Authors: Hartung Hans-Peter , Matthews Vicki , Ross Amy Perrin , Pitschnau-Michel Dorothea , Thalheim Christoph , Ward-Abel Nicki ,   Professor, and Chair, Department of Neurology, Neurology Clinic, Heinrich-Heine University, Düsseldorf,   MS Specialist Nurse Advisor, MS Trust and Clinical Nurse Specialist, Southampton University Hospitals Trust,   MS Specialist Nurse, Department of Neurosciences, Loyola University, Chicago,   Secretary General, German National MS Society and Board Member, European MS Platform,   Secretary General, European MS Platform,   Specialist MS Lecturer Practitioner, Birmingham City University, University Hospital
Published: October 2015

Nurses play a critical role in caring for patients with multiple sclerosis (MS). The Multiple Sclerosis-Nurse Empowering Education (MS-NEED): European Survey was conducted to understand the role of nurses in MS and the provision of care across Europe. The survey focused on four key areas: clinical practice, advocacy, research and publication, and training and education. A total of 280 nurses were included from the UK, Germany, Italy, Poland, Finland and the Czech Republic. All participants were nurses actively working with MS patients. The role of the nurse in MS is diverse and varies substantially across Europe, leading to inequalities in patient care. A European consensus to define the roles and responsibilities of the MS nurse would facilitate consistency of care across all countries and help to achieve the best possible outcome for patients with MS in Europe.
Neuropathic Pain Assessment - An Overview of Existing Guidelines and Discussion Points for the Future
Authors: üçeyler Nurcan , Sommer Claudia ,   Neurologist,   Professor of Neurology, Department of Neurology, University of Würzburg
Published: October 2015

Neuropathic pain is a common and disabling condition that may accompany disorders of the somatosensory system at different anatomical levels. Making the diagnosis of neuropathic pain is a prerequisite for offering the patient specific therapy. In the last few years, the methodological toolbox for the assessment of neuropathic pain has been improved and replenished so that different instruments are available to examine patients and to find out if and to what extent neuropathic pain is present. Currently, three published guidelines are available on the assessment of neuropathic pain. These guidelines are summarised and detailed below, and suggestions are made for future studies investigating known and new methods for the improvement of neuropathic pain assessment.
Amyloid-β and Hyperphosphorylated Tau in the Prediction of Alzheimer’s Disease
Authors: Rummukainen Jaana , Koivisto Anne M , Alafuzoff Irina , Leinonen Ville ,   Post-doctoral Researcher, Department of Pathology, Kuopio University Hospital,   Post-doctoral Researcher, Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland and Department of Neurology, Kuopio University Hospital,   Professor, Unit of Pathology and Neurology, Department of Clinical Medicine, University of Eastern Finland and Department of Genetics and Pathology, Uppsala University,   Post-doctoral Researcher, Department of Neurosurgery, Kuopio University Hospital
Published: October 2015

Brain amyloid-β (Aβ) deposition is widely believed to be an early event in Alzheimer’s disease (AD). Aβ plaques, along with intracellular neurofibrillary tangles, which largely comprise hyperphosphorylated tau (HPτ), are considered to be neuropathological hallmarks of AD. Brain biopsies from living subjects could be used to evaluate these findings. It is possible to obtain biopsies from patients with presumed normal pressure hydrocephalus during diagnostic or shunt procedures. The presence of both Aβ and HPτ in frontal cortex biopsy samples seems to be a strong indicator of AD with high specificity (98 %) but rather low sensitivity (36 %). Aβ alone is associated with AD and exhibits high sensitivity (87 %) but lower specificity (69 %), indicating that many patients with Aβ only may also develop clinical dementia other than AD. Although a definite diagnosis of AD can only be confirmed at autopsy, brain biopsies may be useful for identification of novel markers of AD in a research context. In addition, when available, brain biopsy can be a useful diagnostic aid and validate non-invasive techniques in the diagnosis of dementia.
Stroke Rehabilitation - An Overview of Existing Guidelines and Standards of Care
Authors: Zorowitz Richard D ,   Associate Professor of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine and Chairman, Department of Physical Medicine and Rehabilitation, Johns Hopkins Bayview Medical Center
Published: October 2015

Over seven million stroke survivors live in the US today. Despite the publication of the first post-stroke rehabilitation clinical practice guideline in 1995, many healthcare providers are unaware not only of stroke survivors’ potential for functional recovery, but also common secondary complications of stroke. This article summarises the best available evidence-based recommendations for the interdisciplinary management of stroke survivors and caregivers from five sources: two in the US, one in Canada, and two in the UK. Unique characteristics of each guideline are described, followed by a list of common clinical recommendations found in most, if not all, of the guidelines. Despite the advances in stroke rehabilitation over the past 16 years, much research still needs to be done to improve the level of evidence in stroke rehabilitation.
Environmental Risk Factors for Paediatric Multiple Sclerosis
Authors: Makhani Naila , Banwell Brenda ,   Fellow, Paediatric Demyelinating Disease Program, The Hospital for Sick Children and University of Toronto,   Associate Professor of Paediatrics (Neurology), Associate Scientist, Research Institute, and Director, Paediatric Multiple Sclerosis Clinic, The Hospital for Sick Children and University of Toronto
Published: October 2015

Multiple sclerosis (MS) is a common neurological disorder that is likely the result of aberrant immune responses to key childhood environmental exposures in genetically predisposed individuals. ThisGarticle discusses the current understanding of environmental risk factors implicated in MS with a focus on paediatric research. The study of children with MS is a powerful means of understanding MS biology and is highly relevant to the development of disease prevention strategies.
The Role of Rechargeable Systems in Neuromodulation
Authors: Eldridge Paul , Simpson Brian , Gilbart James ,   Consultant Neurosurgeon, The Walton Centre for Neurology and Neurosurgery,   Consultant Neurosurgeon, University Hospital of Wales, Cardiff,   Senior Medical Writer, Touch Briefings
Published: October 2015

Neuromodulation is an effective treatment for many types of neuropathic pain but a significant limitation of any neuromodulating system is that electrical power must be conveyed in a reliable and sterile way to an implanted electronic device and transmitted to its associated electrodes. In recent decades radio-frequency-coupled devices and internal pulse generators have been developed. These were significant advances but were limited either by the need for bulky external power sources or the need for surgery at intervals to replace the internal system battery. More recently, rechargeable neuromodulatory systems have become available. These considerably improve patient convenience and mobility. After surgical implantation, the system can be charged from an antenna placed at the skin surface, avoiding the need for repeated surgery, external equipment or wires penetrating the skin. Charging can be completed within a few hours and can last for up to one month, depending on use. Battery life is up to 25 years, depending on the manufacturer. Varied system programmability and availability of high power output make rechargeable systems applicable to a range of different neurological conditions and will make these systems a valuable approach to controlling chronic neuropathic pain.
Anterior Cervical Discectomy - An Overview of Technique and Developments for the Future
Authors: tels Ronald HMA Bar ,   Neurosurgeon and Chairman, Department of Neurosurgery, Radboud University Nijmegen Medical Centre
Published: October 2015

Cervical anterior discectomy was introduced in the late 1950s. The main indication was radicular symptoms due to cervical degenerative disc disease. The results for this straightforward procedure are in most instances excellent. An overview is given of current anterior surgical possibilities including the necessity of implants. Attention is also given to possible future developments.
Advanced Neuroimaging for Modern Epilepsy Surgery
Authors: Wang Doris D , Santos-Sanchez Carlos , Garcia Paul A , Chang Edward F ,   Resident, Department of Neurological Surgery and Comprehensive Epilepsy Center,   Junior Specialist, Comprehensive Epilepsy Center and Department of Neurology,   Professor of Clinical Neurology, Comprehensive Epilepsy Center and Department of Neurology,   Assistant Professor of Neurological Surgery and Physiology, Department of Neurological Surgery and Comprehensive Epilepsy Center, University of California, San Francisco
Published: October 2015

Localising the onset of seizures to guide epilepsy surgery can be notoriously difficult. Modern neuroimaging has revolutionised the field by improving the diagnosis and treatment of epilepsy. In order to ameliorate seizures without causing new neurological morbidity, many imaging tools have been developed to guide safe and effective resective surgery. In this article, we discuss recent advances in structural imaging using ultrahigh-field magnetic resonance imaging, metabolic functional imaging techniques of positron emission tomography and single photon emission computed tomography and electrophysiological imaging using magnetoencephalography. Our goal is to provide an overview of these state-of-the-art imaging modalities, their role in guiding surgery, and how they are incorporated into the pre-surgical evaluation of epilepsy.
Frovatriptan for the Acute Treatment of Migraine
Authors: Hansen Peer Tfelt ,   Senior Consultant, Department of Neurology and Danish Headache Centre, Glostrup Hospital, University of Copenhagen
Published: October 2015

Frovatriptan 2.5 mg has been investigated for the treatment of moderate or severe migraine attacks in six placebo-controlled, randomised controlled trials (RCTs). The mean headache relief (a decrease from moderate or severe to none or mild) was 43 % after frovatriptan and 24 % after placebo. The mean therapeutic gain (active minus placebo) was 19 % (95 % confidence interval 16–22 %). In one large comparative RCT, sumatriptan 100 mg was superior to frovatriptan 2.5 mg for headache relief at two hours (47 versus 37 %). In three cross-over RCTs in which the patients treated migraine attacks as early as possible, frovatriptan 2.5 mg was quite similar to zolmitriptan 2.5 mg, rizatriptan 10 mg and almotriptan 12.5 mg for preference – the primary efficacy measure. It is concluded that frovatriptan is not the triptan of first choice in established moderate to severe migraine attacks (based on systematic reviews and one comparative RCT). However, if the patients can treat their migraine attacks at the start of an attack (and are not triptan-resistant), then frovatriptan is a reasonable treatment choice among the triptans.
Complex Regional Pain Syndrome - Diagnosis, Treatment and Future Perspectives
Authors: Fischer Sigrid GL , Perez Roberto SGM ,   Physician and Researcher,   Associate Professor and Researcher, Department of Anaesthesiology, VU University Medical Center Amsterdam
Published: October 2015

Complex regional pain syndrome (CRPS) is a pain syndrome of the extremities that can result in severe disability. CRPS is diagnosed using diagnostic Budapest criteria based on signs and symptoms, whereby sensory, autonomic, vasomotor, motor and trophic disturbances are assessed. Many pathophysiological mechanisms are proposed in the development and disease course of CRPS, starting with exaggerated inflammation and resulting in vascular deregulation, central sensitisation and cortical reorganisation. Treatment is based primarily on reducing inflammation by using medicinal anti-inflammatory therapy and increasing motor function by physiotherapy. Furthermore, pain reduction, normalisation of vasomotor and motor function, and psychological interventions might be needed. Future research should focus on the efficacy of anti-inflammatory therapy, effective rehabilitation programmes, modulating neuropathic pain and cortical reorganisation.
Ischaemic Stroke - Stenting versus Surgery for Carotid Disease
Authors: Pawar Swaroop , Messé Steven R ,   Fellow, Vascular Neurology,   Assistant Professor of Neurology, Department of Neurology, Hospital of the University of Pennsylvania
Published: October 2015

Extracranial internal carotid artery stenosis is one of the most common and best studied causes of stroke. Revascularisation with carotid endarterectomy (CEA) has been shown to be beneficial for patients with severe stenosis associated with stroke or transient ischaemic attack (TIA) and for many patients with moderate stenosis associated with stroke or TIA. CEA has also been shown to be beneficial for patients with asymptomatic severe stenosis if they have a reasonable expected lifespan and surgical risk, but the benefit is greater for men compared with women. Carotid angioplasty and stenting (CAS) has become a viable alternative procedure for carotid revascularisation with less risk of major bleeding complications and cranial nerve injury. Randomised studies of CEA versus CAS have found that the endovascular approach is associated with a lower risk of myocardial infarction but a higher risk of peri-procedural stroke which has a greater impact on long-term quality of life. Thus, recommending CEA or CAS must be based upon individual patient characteristics and their preferences, but at this point it appears that most patients should still be receiving CEA if an intervention is required.
The Evolving Role of the Multiple Sclerosis Nurse - Implications of Future Management Directions
Authors: Chrysovitsanou Chrysa , Thomas Del , Duddy Martin ,   Specialist Multiple Sclerosis Nurse, Eginitio Hospital University of Athens, Athens,   Specialist Multiple Sclerosis Nurse, Wye Valley NHS Trust, Hereford,   Neurologist, Royal Victoria Infirmary, Newcastle upon Tyne
Published: October 2015

The role of the multiple sclerosis (MS) nurse is constantly evolving, owing to the introduction of new MS therapies and new patient treatment and support strategies. The second MS nurse symposium, ‘The Evolving Role of the MS Nurse: Implications of Future Management Directions’ took place in Athens between 22–24 September 2011 and was attended by approximately 300 participants from 30 countries. Presentations at the symposium outlined the mechanisms of action and clinical evidence for novel therapies for MS treatment. The importance of making clinical trial data available and understandable to people with MS was addressed, followed by a summary of the latest data on established MS therapies and an update on autoinjectors and their role in improving adherence. Novel patient support strategies were outlined followed by presentations by MS nurses from different countries who discussed their roles and their opportunities to evolve against a background of very different healthcare systems. Group discussions of typical MS case examples emphasised the need for good communications and relationships between patients and MS nurses. The final session focused on communication skills, highlighting ‘tips’ for engaging with people with MS and examining the challenges that different patient expectations and communication media can bring.
Use of Melatonin to Promote Sleep in Older People
Authors: Wurtman Richard J ,   Cecil H Green Distinguished Professor Emeritus, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, US
Published: October 2015

Many older Americans purchase the hormone melatonin and take it orally, nightly, to promote sleep onset and to help them fall back asleep after the frequent nocturnal awakenings associated with ageing. This need for exogenous melatonin reflects the fact that the progressive calcification of the human pineal diminishes the organ’s ability to secrete its hormone, so that instead of plasma melatonin levels rising normally by 10-fold or more around bedtime the rise may be only by twofold, or even less. The quantity of melatonin that most ageing people need to restore nocturnal plasma melatonin levels to what they are in youth – and, concurrently, to promote sleep – is tiny, only about 0.2–0.5 mg. However, this dosage is generally unavailable, so patients may take doses 10-fold greater, or more, producing side-effects (e.g., hypothermia; hypoprolactinaemia; morning grogginess) and ultimately desensitising melatonin receptors in the brain. The reasons why low-dose melatonin is generally unavailable are described and a strategy is proposed for enabling patients to consume the correct dosage even when preparations containing that dosage cannot be obtained.
Combination Drug Therapy for the Treatment of Alzheimer’s Disease
Authors: álvarez X Antón , Linares Carlos , Masliah Eliezer ,   Director of Research, Fundación Antidemencia Al Andalus, A Coruña, Spain,   Assistant Professor, Medicine Department, School of Medicine, Málaga, Spain,   Professor, Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, California, US
Published: October 2015

Alzheimer’s disease (AD) is a complex and progressive neurodegenerative disorder resulting in continuous deterioration of cognition, daily living abilities and motor functions and consequently has a huge social and familial burden. To date, the drugs approved for AD treatment provide only modest symptomatic effects. At present, the combined therapy with memantine plus one cholinesterase inhibitor (ChEI) is the best option for the treatment of moderate-to-severe AD. This combination has demonstrated higher clinical efficacy than monotherapy with ChEIs, with similar safety and tolerability in several randomised-controlled clinical trials (RCTs). Recent long-term observational studies have shown that combination therapy slows the rate of cognitive and functional deterioration, delays the placement of patients in nursing homes and also provides evidence that it is more effective when initiated early. None of the drugs for AD tested in Phase III trials show evidence of disease modification. A few studies have shown that the newer drugs, particularly anti-amyloid and neurotrophic agents, may provide improved disease-modifying treatments of AD in the near future. Meanwhile, combination therapy with available drugs is the most effective AD treatment.
Efficient Investigation and Differential Diagnosis of Childhood Onset Niemann-Pick Type C
Authors: Parker Alasdair ,   Consultant Paediatric Neurologist, Department of Paediatric Neurology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
Published: October 2015

Niemann-Pick disease type C (NPC) is a fatal, neurodegenerative, lysosomal storage disorder. It is rare with a broad phenotypic spectrum and variable age of onset. This complicates diagnosis, which is often delayed by several years after presentation of the first symptoms. It is a treatable condition if detected early, therefore reliable means of diagnosis are essential. Clinical diagnosis of NPC involves identifying characteristic neurological features, taking a detailed history of the patient’s details, and must be confirmed by biochemical and/or genetic testing. The key laboratory diagnostic test for NPC is filipin staining of cultured skin fibroblasts, which shows free cholesterol accumulation in lysosomes resulting from impaired intracellular cholesterol transport. Genetic testing for mutations in theNPC1andNPC2genes is also important for confirmation of the diagnosis. However, there is an unmet need for cheaper diagnostic tests with greater specificity and sensitivity
The Treatment of Diabetes after an Acute Ischaemic Stroke
Authors: Biessels Geert Jan , Kappelle L Jaap ,   Professor of Neurology, Department of Neurology, UMC Utrecht Stroke Centre and Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, The Netherlands,   Professor of Neurology, Department of Neurology, UMC Utrecht Stroke Centre and Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, The Netherlands
Published: October 2015

People with diabetes are at increased risk of ischaemic stroke and outcome after stroke is worse. This paper reviews the treatment of patients with diabetes after ischaemic stroke. First, management of hyperglycaemia in the acute stage will be addressed. We will make the point that, despite the fact that admission hyperglycaemia is a common risk factor for poor outcome after ischaemic stroke, there is still much uncertainty about whether intensive glucose-lowering therapy after stroke benefits clinical outcome. Secondary prevention of further cardiovascular events after stroke is the other main topic of this review. We will show that there are important opportunities for the reduction of stroke risk in diabetes, through a rigorous evaluation and treatment of associated risk factors.
Current State of the Art in Preclinical Research in Alzheimer’s Disease - A Focus on Mode of Action in Pharmacological and Non-pharmacological Approaches
Authors: Ubhi Kiren , Masliah Eliezer ,   Postgraduate Research Fellow, Department of Neurosciences,   Professor of Neuroscience and Pathology, Departments of Neurosciences and Pathology, university of California, San Diego, La ¡olla, California, us
Published: October 2015

Alzheimer’s disease (AD) is an age-related neurodegenerative disorder characterised by progressive memory deficits and other cognitive disturbances. Neuropathologically, AD is characterised by synaptic deficits, progressive loss of neocortical, limbic and basal forebrain cholinergic neurons and the abnormal extracellular accumulation of amyloid-beta (Aß) and the intracellular aggregation of the cvtoskeletal protein tau. Currently available AD therapies either only temporarily delay disease progression or address the symptoms but are unable to alter the underlying mechanisms of disease. Therefore, ongoing AD research is focused at better understanding pathogenesis and at developing disease-modifying experimental therapeutic approaches. This review will summarise the main areas of preclinical research for AD therapeutics that includes those aimed at modulating the processing of amyloid precursor protein (APP) and the production of Aß; ameliorating the pathological accumulation of Aß or tau; augmenting neuroprotective activities in the AD brain; and augmenting neurorestoration in the AD brain. The review will also discuss a novel multimodal therapeutic approach to AD using Cerebrolysin, a peptidergic mixture with neurotrophic-like effects.
Childhood Absence Epilepsy - A Review of Treatment Strategies and Perspectives for the Future
Authors: Rheims Sylvain , Ryvlin Philippe ,   Neurologist,   Professor, Department of Functional Neurology and Epileptology and institute for Children and Adolescents with Epilepsy, Hospices Civils de Lyon, and INSERM U1028, CNRS UMR5292, Translational and Integrative Group in Epilepsy Research, Lyon Neuroscience Research Center, Lyon, France
Published: October 2015

Childhood absence epilepsy (CAE) is one of the most common forms of paediatric epilepsy. However, there is still a gap between the prevalence of CAE in paediatric epilepsies and the paucity of available data regarding its therapeutic management. Only nine randomised controlled trials have been published in the field over the past four decades, with many suffering from major methodological limitations. A recent large randomised double-blind controlled trial reported that ethosuximide and sodium valproate are the most effective anti-epileptic dugs in CAE and that cognitive performance appears to be better with ethosuximide than with sodium valproate. Although lamotrigine also demonstrated anti-absence properties in the same trial, it proved to be significantly less efficacious than ethosuximide or sodium valproate. Despite these recent advances, several questions, including long-term outcomes, management of refractory CAE and treatment duration, remain unanswered and further studies are required to refine therapeutic decisions.
Sympathetic Hyperactivity and Sympathovagal Imbalance in Amyotrophic Lateral Sclerosis
Authors: Shimizu Toshio ,   Director, Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
Published: October 2015

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with progressive loss of upper and lower motor neurons. Autonomic nervous abnormalities, including sympathetic hyperactivity and sympathovagal imbalance, have been found in both early and advanced stages of ALS. In early stage, the dysfunction may be subclinical. Occasionally, elevated blood pressure or heart rate and increased sweating may be observed. In advanced stage when ventilators are required, the sympathetic hyperactivity may lead to hypertensive crisis without counter-regulation of heart rate, followed by the consecutive circulatory collapse, known as the ‘autonomic storm’. The symptoms of ‘autonomic storm’ are similar to that of ‘baroreflex failure’, and ‘autonomic storm’ indicates poor prognosis and may result in sudden death. Careful evaluation and individual treatment are strongly suggested, although appropriate therapeutic approaches have not been established. Causative central nervous lesions remain to be elucidated, although the limbic system may be involved. The autonomic dysfunction further supports the concept that ALS is a multisystem-degenerative disease.
Multiple Sclerosis Management – A Changing Landscape 2013
Authors: Sørensen Per Soelberg , Filippi Massimo , Brück Wolfgang ,   Director, Danish Multiple Sclerosis Center and Professor of Clinical Neurology, University of Copenhagen, Denmark,   Associate Professor of Neurology, Vita-Salute San Raffaele University, Milan, Italy,   Professor of Neuropathology, Göttingen University Medical School, Göttingen, Germany
Published: October 2015

The aims of this educational meeting, held in Vienna, Austria, were to explore the significant advances that have occurred in multiple sclerosis (MS) management over the past two decades, to highlight modern-day perspectives and challenges and to consider the impact of the new oral first-line treatments expected to enter the MS market shortly. The meeting was attended by 372 delegates with neurological interests from 30 countries and was opened by Per Soelberg Sørensen (Copenhagen, Denmark).
Current Perspectives in Post-stroke Cognitive Impairment
Authors: Federico Antonio , Guekht Alla , Brainin Michael ,   Professor of Neurology, Department of Clinical Neurology and Neurometabolic Diseases, University of Siena, Siena, Italy,   Professor of Neurology, Department of Neurology and Neurosurgery, Russian National Research Medical University and Moscow Research and Clinical Centre for Neuropsychiatry, Moscow, Russia,   Professor of Clinical Neurology, Department of Clinical Neurosciences and Preventative Medicine, Danube University Krems, Krems, Austria
Published: October 2015

Post-stroke cognitive impairment (PSCI) is a particularly serious consequence of cerebral ischaemia and often inhibits or retards patient rehabilitation. Current treatments do not improve long-term outcomes for a significant proportion of patients and remain a substantially unmet medical need. Initiatives to address the challenge of post-stroke rehabilitation have included therapies that modify multiple pathogenetic mechanisms and provide protection to neural networks and facilitate their regeneration. Promising biological agents have been tested, but few have so far yielded clinically conclusive evidence further emphasising the shortage of therapies available to treat this disease. The multimolecular agent Actovegin® has been shown to stimulate capillary flow and neurometabolism after stroke and to provide promising results in the treatment of mixed dementia. Clinical trials are now in progress to fully evaluate this pleiotropic neurometabolic therapy.
Early Mobilisation Following Stroke
Authors: Auriel Eitan , Bornstein Natan M ,   Physician,   Professor, Stroke Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
Published: October 2015

Rehabilitation has been shown to influence brain recovery and to reduce the number of patients who are left handicapped following stroke; however, a question emerges in terms of the optimal time-point to initiate mobilisation. Very early mobilisation involves starting mobilisation including sitting up, getting out of bed, standing and walking, soon after stroke and continuing at frequent intervals. Several studies show evidence that very early rehabilitation has the potential to prevent complications and improve long-term outcomes compared with standard care. This article will discuss the benefits as well as safety concerns of this distinctive type of post-stroke care.
Algoritmo del trattamento dell’emicrania
Authors: Evers di Stefan , Lisotto e Carlo ,   Professore di Neurologia, Università di Münster; Direttore del Dipartimento di Neurologia, Krankenhaus Lindenbrunn, Germania;,   Neurologo, Centro Cefalee, Dipartimento di Neuroscienze, Università di Padova, Italia
Published: October 2015

Nel corso di un simposio satellite tenutosi nel corso del XXI Congresso Mondiale di Neurologia 2013 è stata presentata la terza edizione della Classificazione Internazionale delle Cefalee, con una descrizione sintetica delle variazioni apportate rispetto alla precedente edizione, che riflettono l’importanza della diagnosi basata sulla fenomenologia piuttosto che sull’eziologia dei disturbi. Per questo motivo è stato creato un algoritmo di trattamento per l’emicrania, mirato a valutare il percorso corretto e a rafforzare il messaggio che i triptani rappresentano l’opzione terapeutica più efficace. Nel corso del simposio sono state inoltre discusse le nuove linee guida sui parametri di efficacia utilizzati negli studi clinici, sottolineando l’importanza della protratta scomparsa del dolore senza recidiva, un parametro di grande rilevanza per i pazienti. Gli studi incrossoverdi preferenza del paziente rappresentano un reale confronto intra-individuale tra diversi triptani e consentono di valutareendpointsmultipli definiti dalla preferenza del paziente invece che dallo sperimentatore. Negli studi clinici frovatriptan ha mostrato una tollerabilità favorevole e un effetto protratto nel tempo, con un tasso di recidive inferiore a quello riportato con gli altri triptani. Questi risultati sono stati ottenuti dai diversi studi di preferenza condotti in Italia e in altri paesi europei.
Novel Non-invasive Magnetic Resonance Imaging Methods in Cerebrovascular Disease
Authors: Donahue Manus J , Strother Megan K ,   Assistant Professor, Departments of Radiology, Neurology, Psychiatry, and Physics and Astronomy,   Associate Professor, Department of Radiology, School of Medicine, Vanderbilt University Nashville, Tennessee, US
Published: October 2015

Neuroimaging is a critical component of patient care in multiple stages of cerebrovascular disease. Most imaging focuses on measurements of tissue or vascular structure, with comparatively less emphasis on function. Furthermore, imaging approaches that rely on exogenous contrast agents or ionising radiation are common and provide crucial information regarding treatment decisions; however, they are suboptimal for monitoring patients longitudinally or in response to therapy due to dose restrictions and related health concerns. We review the state of non-invasive magnetic resonance imaging (MRI) approaches that have demonstrated clinical potential in patients with cerebrovascular disease, yet have not been incorporated into routine radiological protocols at most hospitals. These approaches include blood oxygenation level-dependent (BOLD) for cerebrovascular reactivity, arterial spin labelling (ASL) for cerebral blood flow quantification, chemical exchange saturation transfer (CEST) for macromolecule and pH determination and arterial vessel wall imaging for plaque visualisation. The strengths and limitations of these approaches are presented, as well as a summary of their implementation in stroke.
Anaesthetic Concerns for Patients Undergoing Neurosurgical Procedures Utilising Intra-operative Magnetic Resonance Imaging
Authors: McClain Craig D , Chimbira Wilson T ,   Senior Associate in Perioperative Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts and Assistant Professor of Anesthesia, Harvard Medical School, Boston, Massachusetts, US,   Assistant Professor of Anesthesiology, Department of Anesthesiology, Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan, US
Published: October 2015

Intra-operative magnetic resonance imaging (ioMRI) is an evolving technology that offers precise intra-cranial lesion localisation and intra-operative navigation by combining the high-resolution imaging capabilities of MRI with an operative suite. Developed in the 1990s, ioMRI presents caregivers with a variety of unique challenges revolving around performing surgical procedures in an operating theatre with a high-strength magnetic field. Different types of ioMRI systems exist, differentiated by the relative mobility of the patient and magnet. As with any MRI environment, safety is of paramount concern. Published safety guidelines exist from both the American College of Radiology and the American Society of Anesthesiologists. A variety of checklists can be used to enhance the safety of the ioMRI suite. There are a variety of anaesthetic considerations when caring for patients in this environment including concerns related to the anaesthesia equipment, the patient and the general MRI environment. A multidisciplinary approach can encourage safety and efficiency in this unique operating room. The purpose of this review is to discuss the variety of topics that anaesthesiologists need to consider using this technology, including the indications, specific equipment considerations and unique safety aspects of caring for patients in the ioMRI suite. While performing surgery in a high-strength magnetic field environment carries its own special risks, each type of ioMRI suite presents its own unique challenges to patient safety. Although the challenges are significant, safe care and optimal outcomes are certainly possible with appropriate understanding of the factors unique to the ioMRI environment, good communication, a collaborative approach and proper procedural planning.
Latest Perspectives in Genetic Risk Factors for Restless Legs Syndrome
Authors: Jiménez-Jiménez Félix Javier , Alonso-Navarro Hortensia , García-Martín Elena , Agûndez José AG ,   Professor and Head, Section of Neurology, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain,   Consultant Neurologist, Section of Neurology, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain,   Professor, Department of Biochemistry and Molecular Biology University of Extremadura and AMGenomics, Cáceres, Spain,   Full Professor, Department of Pharmacology, University of Extremadura and AMGenomics, Cáceres, Spain
Published: October 2015

The high frequency of positive family history of restless legs syndrome (RLS) in patients with this disease and the observed high concordance rates in monozygotic compared with dizygotic twins support a major role of genetic factors in the development of RLS. Although a number of variants for several genes may increase the risk of RLS, no definitive causative genes have been identified to date. In this review, we summarise the studies performed on families with RLS, twin studies, linkage studies, genome-wide association studies, case-control association studies and exome sequencing in RLS. The strongest candidate genes are ofPTPRD, BTBD9andMEIS.
The Manifold Economic Impact of Multiple Sclerosis  Indirect and Direct Costs of Managing Patients
Authors: Brandes David W , Rieckmann Peter ,   Neurologist, Hope Neurology, Knoxville, Tennessee, US,   Professor and Director, Department of Neurology, Bamberg Academic Hospital, University of Erlangen, Bamberg, Germany
Published: October 2015

Multiple sclerosis (MS) is associated with a significant economic burden, not only in terms of direct costs (drugs, hospital admissions, healthcare aids), but also indirect costs including loss of income, reduction of productivity, burden on caregivers and family members, and a reduction in patient quality of life (QoL). The disease has a marked effect on employment, with less than 20 % of patients of working age in employment at higher disability levels (Expanded Disability Status Scale [EDSS] 6.88.0). Disabilities, fatigue, cognitive impairments, transportation difficulties, speech impairments and bladder and bowel problems all impact on the patients ability to work and their QoL. The economic costs of MS do not just impact the patient. The stress and physical burden of caring for a friend or relative with MS may also impact on the finances and health of caregivers and increase their own requirement for healthcare resources. The increasing availability of disease-modifying drugs (DMDs) and earlier diagnosis of the condition has resulted in an increase in the direct costs of MS related to expenditure on DMDs. However, due to the significant increase in costs that are associated with increasing disease severity, interventions aimed at delaying disease progression may help to reduce the economic burden of MS. This article will review the direct, indirect and intangible costs of MS and discuss the economic impact of drug development on these costs.
Quality of Life in Parkinson’s Disease – Patient, Clinical and Research Perspectives
Authors: Stocchi Fabrizio , Martin Pablo Martínez , Reichmann Heinz ,   Professor of Neurology and Director, Parkinson’s Disease and Movement Disorders Research Centre, Institute for Research and Medical Care, IRCCS San Raffaele, Rome, Italy,   Neurologist, Tenured Scientist of the Public Boards of Research, and Head of the Neuroepidemiology Section, National Centre of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain,   Professor of Neurology and Chairman, Department of Neurology, University of Dresden Medical School, Dresden, Germany
Published: October 2015

Parkinson’s disease (PD) has a severely negative impact on the quality of life (QoL) of patients and their caregivers. Health-related QoL (HRQoL) is a patient-reported component of QoL that includes physical, mental and social domains and in PD is an increasingly important part of patient monitoring. HRQoL in PD is assessed using a range of different generic (e.g. Short Form-36) and PD-specific (e.g. 39-item Parkinson’s Disease Questionnaire) instruments/questionnaires. It is important that HRQoL is regularly determined in patients with PD to identify determinants of their HRQoL deterioration and appropriately manage them. The perspectives of PD patients, clinicians and researchers, however, can be different. In PD, motor symptoms such as slowness or tremor are the most visible manifestations of the disease and these tend to be concentrated on by doctors. PD patients, however, are likely to also have a range of non-motor symptoms such as nocturia, urinary frequency, fatigue, drooling and forgetfulness, which can be more troubling than motor symptoms. These can increase distress and social isolation but are often unreported or overlooked. In addition, morning akinesia and wearing-off phenomena may cause additional difficulty. However, these symptoms and patient concerns can be readily identified using simple HRQoL measures. The management of PD should therefore take into account patient, clinical and research perspectives of HRQoL in order to recognise and adequately address the consequences of motor and non-motor symptoms in PD.
Cognitive Impairment in Lacunar Strokes
Authors: Appelros Peter ,   Associate Professor, Faculty of Medicine and Health, örebro University, örebro, Sweden and esearch Fellow, Department of Neurobiology, Care Sciences and Health, Karolinska Institute, Stockholm, Sweden
Published: October 2015

Vascular cognitive impairment is closely related to stroke. Each condition is a risk factor for the other. Cognitive impairment is a symptom that makes it difficult for a stroke patient to live at home. In this review paper, different types of vascular cognitive impairment are iscussed, with emphasis on cognitive impairment related to lacunar strokes (LACS). Symptoms, diagnostics, epidemiology, treatment and prognosis are surveyed. LACS are often associated with leukoaraiosis, which is related to subcortical ischaemic vascular dementia. Even if LACS often are mild, they may therefore be associated with cognitive impairment in the longer term.
Cortical Superficial Siderosis of the Central Nervous System – An Overview
Authors: Reuck Jacques L De ,   Professor, Stroke Research Team, Université Lille Nord de France, Lille, France
Published: October 2015

Cortical superficial siderosis (cSS) is observed on gradient echo T2*-weighted magnetic resonance imaging (MRI) as a hypo-intensity outlining the convexity of the cerebral hemispheres. It is composed of haemosiderin deposits in the subpial space. It was initially thought to be a rare condition but with 7.0 Tesla (T) MRI it appears to be not uncommon. Its symptomatology depends on the underlying cortical pathology. Diffuse cSS is mainly related to the sequels of an underlying lobar haematoma, mainly due to cerebral amyloid angiopathy (CAA). Focal cSS is more due to cortical microinfarcts, that underwent haemorrhagic transformation, rather than due to cortical microbleeds. cSS is not only found in patients suffering from CAA but also in those suffering from several neurodegenerative dementia syndromes and after cerebral trauma.
An Update on the Less-known Group of Other Primary Headaches – A Review
Authors: Kararizou Evangelia , Bougea Anastasia , Giotopoulou Dimitra , Anagnostou Evangelos , Gkiata Annika , Gkiatas Konstantinos , Stamboulis Elefterios ,   Assistant Professor,   Doctoral Fellow,   Resident,   Neurologist, Department of Neurology, University of Athens Medical School, Aeginition Hospital, Athens, Greece,   Resident,   Colonel Neurologist, Department of Neurology, Air Force Hospital, Athens, Greece,   Professor, Department of Neurology, University of Athens Medical School, Aeginition Hospital, Athens, Greece
Published: October 2015

Headache represents one of the most common symptoms in the emergency department. A systematic approach to headache classification is essential for diagnosis and efficient therapeutic management. New International Headache Classification (ICHD-3 beta) criteria provide a dynamic clinically useful instrument, establishing both uniform terminology and consistent operational diagnostic criteria for a broad range of headache disorders. This article reviews and highlights developments in our knowledge of “Other Primary Headaches”, including primary stabbing headache, primary cough headache, primary exercise headache, primary headache associated with sexual activity, hypnic headache, primary thunderclap headache, cold-stimulus headache, nummular headache, external-pressure headache and new daily persistent headache. Clinicians should be aware that these headaches may be symptomatic to structural lesions and therefore require careful neuroimaging and laboratory evaluation.