Current opinion in neurology
-
Curr. Opin. Neurol. · Jun 2017
ReviewAutoimmune encephalitis in children: clinical phenomenology, therapeutics, and emerging challenges.
Auto-antibodies that bind to conformational extracellular epitopes of neuronal receptors or synaptic proteins have provided clinicians with essential biomarkers in acute neurology. This review summarizes the current status and challenges in the field. ⋯ Although there have been significant developments, future priorities include the need for paediatric-specific consensus definitions for seronegative suspected autoimmune encephalitis, novel tools for monitoring patients with autoimmune encephalitis, consensus treatment recommendations, and neuroprotective strategies.
-
Curr. Opin. Neurol. · Jun 2017
ReviewCalcitonin gene-related peptide in peripheral blood as a biomarker for migraine.
There is no available biomarker for any of the primary headaches, including migraine. As demonstrated in jugular blood, during a migraine attack, trigeminal activation releases several neuropeptides, very especially calcitonin gene-related peptide (CGRP), which gives rise to the typical throbbing migraine pain. Here, we review the current evidence for measurement of peripheral CGRP levels as a potential biomarker for trigemino-vascular activation in migraine. ⋯ Although CGRP data must be confirmed and expanded in future studies and specificity of CGRP levels should be studied in entities able to resemble migraine, it seems that peripheral CGRP levels are a good biomarker of acute migraine and somewhat specific and sensitive interictally in chronic migraine.
-
Cerebral microbleeds (CMBs) are a radiological marker of cerebral small vessel disease corresponding to small haemosiderin foci identified by blood-sensitive MRI. CMBs are common in older community populations, and in individuals with ischaemic stroke or transient ischaemic attack (TIA), and intracerebral haemorrhage (ICH). We summarize how CMBs might contribute to assessing the future risk of ischaemic stroke and ICH to inform antithrombotic (antiplatelet or anticoagulant) decisions. ⋯ In ischaemic stroke or patients with TIA less than five CMBs should not affect antithrombotic decisions, although with more than five CMBs the risks of future ICH and ischaemic stroke are finely balanced, and antithrombotics might cause net harm. In lobar ICH populations, a high burden of strictly lobar CMBs is associated with CAA and high ICH risk; antithrombotics should be avoided unless there is a compelling indication.
-
Although there is no cure for motor neurone disease (MND), the advent of multidisciplinary care and neuroprotective agents has improved treatment interventions and enhanced quality of life for MND patients and their carers. ⋯ Recent progress in the understanding of the clinical, pathophysiological and genetic heterogeneity of MND has improved the approach of clinicians to treatment. Notwithstanding improvement to care and quality of life, survival benefit has become evident with the advent of a multidisciplinary care framework, early treatment with riluzole and noninvasive ventilation. Weight maintenance remains critical, with weight loss associated with more rapid disease progression. The end-of-life phase is poorly defined and treatment is challenging, but effective symptom control through palliative care is achievable and essential. Encouragingly, current progress of clinical trials continues to close the gap towards the successful development of curative treatment in MND.
-
Curr. Opin. Neurol. · Jun 2016
ReviewGenome-wide association studies in migraine: current state and route to follow.
Genome-wide association studies (GWAS) have revealed over a dozen genetic factors robustly associated with the common forms of migraine. The identification of these factors, the implicated biological mechanisms, and whether they are of use in basic research and clinic practice will be discussed. ⋯ The identification of genetic factors that confer risk for the common forms of migraine by GWAS has given insight into the genetic underpinning of migraine pathophysiology. Still, the interpretation of the findings of GWAS is not straightforward. Various strategies are being tested to investigate which pathophysiological mechanisms are involved, how they can be studied, and what this means for clinical diagnosis, and even care.