Current opinion in neurology
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Curr. Opin. Neurol. · Dec 2010
ReviewSteroids in neurooncology: actions, indications, side-effects.
Glucocorticoids are frequently used in the treatment of patients with neurooncological disorders. This review addresses different clinical indications and provides information on beneficial and undesired effects exerted by these drugs. The most important cellular mechanisms of action of glucocorticoids under different conditions are highlighted. ⋯ Although in clinical use for more than 40 years in the field of neurooncology, steroids remain a central and essential part in the treatment of brain tumor patients. Along with improved therapeutic options and prolonged life expectancy of many of these patients, careful administration is required and long-term side-effects must be considered.
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Curr. Opin. Neurol. · Dec 2010
ReviewConsciousness revealed: new insights into the vegetative and minimally conscious states.
In recent years, the results of neuroimaging studies have fundamentally changed the way we think about the vegetative and minimally conscious states. ⋯ The prognostic and diagnostic information provided by these new approaches clearly argues for their future use alongside conventional assessment techniques. By demonstrating that a behaviourally unresponsive patient could communicate by means of his/her thoughts using functional MRI, these new techniques open up a new direction of research into the development of more sophisticated communication devices that may be used more generally by these patients. In our opinion, such devices, employing electroencephalograph among other techniques, may soon allow for patients who retain sufficient cognitive abilities to communicate, to do so outside of an MRI scanner.
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The first randomized phase III trial in patients with primary central nervous system lymphoma was reported for the first time at the 2010 annual meeting of the American Society of Clinical Oncology, and concluded that the omission of whole brain radiotherapy from first-line treatment does not compromise survival. Two randomized trials investigated tailored treatment strategies for elderly patients with glioma and reached opposite conclusions. Novel treatment approaches in recurrent glioblastoma with alternating tumour treatment fields (NovoTTF), or antiangiogenic agents (cilengitide and bevacizumab) have been reported and updated. The role of vascular endothelial growth factor-inhibiting strategies in the management of recurrent glioma remains unclear and controversial.
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Curr. Opin. Neurol. · Oct 2010
ReviewChronic inflammatory demyelinating polyradiculoneuropathy and multifocal motor neuropathy: treatment update.
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and multifocal motor neuropathy usually respond to immune therapies including steroids and plasma exchange for CIDP and high-dose intravenous immunoglobulins (IVIgs) for both diseases. Other immune therapies have been used to reduce the costs or the side-effects of these therapies, but their efficacy was only recently assessed in randomized controlled trials (RCTs). ⋯ After several years of anecdotal reports, a number of RCT have now appeared in CIDP and multifocal motor neuropathy, but their results are still insufficient to support the use of new therapies in these diseases.
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Elucidating the genetic background of Parkinson disease and essential tremor is crucial to understand the pathogenesis and improve diagnostic and therapeutic strategies. ⋯ Although undoubtedly genes remain to be identified, considerable progress has been achieved in the understanding of the genetic basis of Parkinson disease. This same effort is now required for essential tremor. The use of next-generation high-throughput sequencing and genotyping technologies will help pave the way for future insight leading to advances in diagnosis, prevention and cure.