Current opinion in neurology
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Curr. Opin. Neurol. · Apr 2012
ReviewFunctional imaging of seizures and epilepsy: evolution from zones to networks.
Epilepsy research has extended from studies at the cellular level to the investigation of interactions of large neuronal populations distant from one another: 'epileptic networks'. This article underlines the concept of epilepsies as network disorders, adding empirical evidence from electroencephalography-combined functional MRI (EEG-fMRI) studies. ⋯ The appreciation of epileptic processes at the network level will foster the development of both anticonvulsive as well as true antiepileptic treatment strategies locally modulating hub regions within the epileptic network architecture as well as entire networks by targeting their characteristic properties such as neurotransmitter or neuronal firing profiles. Treatment should reach beyond seizure control and include the improvement of cognitive function.
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Curr. Opin. Neurol. · Apr 2012
ReviewSudden unexpected death in epilepsy: mechanisms, prevalence, and prevention.
Sudden unexpected death in epilepsy (SUDEP) is a fatal complication of epilepsy with incidence rates of up to nine per 1000 patient-years in candidates for epilepsy surgery. Ongoing collaborative research is aiming to improve assessment of individual SUDEP risk and to develop preventive measures based on pathophysiological considerations. This review focuses on novel findings in humans and animal models related to pathophysiology, risk factors and prevention of SUDEP. ⋯ Novel clinical features may help to define better the individual risk of SUDEP. Potentially therapeutic strategies including pharmacological modulation of respiratory arrest and implantation of cardiac devices could reduce the risk of SUDEP in some individuals. Antiepileptic drugs lower the risk, stressing the importance of successful seizure control for prevention.
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This review provides a comprehensive overview of the management of acute stroke within the framework of telestroke services. ⋯ At the beginning of the millennium, telestroke networks started to develop. Ten years later, there is a collection of about 40 various networks in North America and Europe performing teleconsultations on a regular basis. Telestroke is not a new therapeutic modality, but rather a set of tools to enable more efficient delivery of acute stroke care and to improve the quality of stroke care in neurologically underserved areas. Depending on the level of available regional resources, telestroke networks can support affiliated hospitals by implementing measures that improve the quality of stroke management such as regional campaigns, stroke units and stroke teams, medical education and programs encouraging the usage of guidelines.
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Curr. Opin. Neurol. · Dec 2011
ReviewClinical appraisal of chronic traumatic encephalopathy: current perspectives and future directions.
There are currently no consensus-based clinical diagnostic criteria for chronic traumatic encephalopathy (CTE). This review provides an update on recent literature pertaining to clinically relevant procedures that--presently or in the future--may be useful for the in-vivo detection, characterization, and/or prediction of CTE. ⋯ On the basis of recent research in the fields of dementia and traumatic brain injury, several in-vivo procedures (including neurological examination, neuropsychological assessment, neuroimaging techniques, and blood and cerebrospinal fluid biomarkers) each have the potential to contribute unique information about the manifestations of CTE, including clinical and preclinical stages. More research is needed to develop a set of consensus diagnostic criteria that provide a reliable and valid indicator of neuropathologically verified CTE. Until such criteria are developed, the clinical assessment of CTE should be informed by modern research that is of relevance to traumatic brain injury and neurodegenerative diseases.
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Frontotemporal dementia (FTD) is a clinically, pathologically and genetically heterogeneous disorder. Mutations in a number of genes are associated with FTD, although until recently only two [progranulin (GRN) and microtubule-associated protein tau (MAPT)] were known to be major causes of the disease. This review describes recent progress in identifying clinical and neuroanatomical phenotypes associated with autosomal-dominant FTD. ⋯ Genetic FTD is heterogeneous but certain phenotypic signatures of the major causative genes can be identified.