Current opinion in neurology
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Curr. Opin. Neurol. · Aug 2015
ReviewSubtypes of Parkinson's disease: state of the field and future directions.
Previously, outstanding questions have been identified including the relationship of proposed subtypes to etiology, underlying biology, and prognosis. This situation presents an opportunity for major developments in the field. The review summarizes the progress made over the past 1-2 years. ⋯ It will be important to revisit PD-MCI classification to consider subtyping based upon data that relate cognitive phenotype to prognosis. Given the traction that traditional motor subtyping has had in the field it would be of value to consider how nonmotor symptom clusters can be used with or alongside the motor subtypes. Finally, incorporating subtypes into clinical trials remains a significant gap in Parkinson's disease research.
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Migraine is a common, complex disorder of the brain with significant morbidity. As the pathophysiology of the disorder has become better appreciated, the role of neuropeptides has been explored. Calcitonin gene-related peptide (CGRP) has emerged as a promising therapeutic target. ⋯ This article highlights the evidence behind the role of CGRP in migraine and the state of CGRP-based mechanism treatment development. We present a summary of the evidence base behind CGRP in migraine pathophysiology and the novel CGRP mechanism drugs and their potential future contribution to migraine management in our clinical practice.
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Neuromodulation is an alternative in the management of medically intractable cluster headache patients. Most of the techniques are invasive, but in the last 2 years, some studies using a noninvasive device have been presented. The objective of this article is to review the data using this approach. ⋯ In the last decade, invasive neuromodulation treatments have demonstrated good efficacy in cluster refractory patients. Noninvasive approaches such as the noninvasive vagal nerve stimulation have shown efficacy in one trial and could be an easier alternative in the management of this debilitating headache. We need to replicate these results with further controlled studies and conduct basic research in order to clarify the mechanism of action.
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Curr. Opin. Neurol. · Apr 2015
ReviewEpilepsy and malformations of cortical development: new developments.
Malformations of cortical development (MCD) are increasingly recognized as causes of epilepsy and neurodevelopmental disorders. This review summarizes recent developments in the classification, specifically focusing on how genetic and cellular pathway advances are changing our understanding of MCD and how this applies to clinical care. ⋯ The classification of MCD in epilepsy has progressed from simple correlations with syndromes and imaging data to molecular pathways underscoring the significance of common mechanism in brain maldevelopment and epilepsy.
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Curr. Opin. Neurol. · Apr 2015
ReviewResting-state functional connectivity in epilepsy: growing relevance for clinical decision making.
Seizures produce dysfunctional, maladaptive networks, making functional connectivity an ideal technique for identifying complex brain effects of epilepsy. We review the current status of resting-state functional connectivity (rsFC) research, highlighting its potential added value to epilepsy surgery programs. ⋯ The role of rsFC remains limited in most clinical settings, but shows great promise for identifying epileptic circuits and foci, predicting outcomes following surgery, and explaining cognitive deficits and psychiatric symptoms of epilepsy. RsFC has demonstrated that even focal epilepsies constitute a network and brain systems disorder. By providing a tool to both identify and characterize the brain network impact of epileptiform activity, rsFC can make a strong contribution to presurgical algorithms in epilepsy.