Expert review of neurotherapeutics
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Expert Rev Neurother · Jan 2015
A pivotal moment in Alzheimer's disease and dementia: how global unity of purpose and action can beat the disease by 2025.
The world is at a pivotal moment in the global fight against Alzheimer's disease, a disease that by 2013 affected 44.4 million people globally and is expected to affect 75.6 million by 2030. France, Australia, Japan, US and Great Britain are among the countries that have adopted national policies to address the growing numbers. Multilateral organizations have also prioritized the disease, and possibly most significantly, the G8, under British Prime Minister David Cameron's leadership, set its focus on dementia starting December 2013. Despite the growing attention, the response has not been commensurate with the urgency of the situation, and we need to promote comprehensive collaboration that catalyzes the development of new treatments, initiates the creation of innovative financial models for research and drives the utilization of technological innovation with the aim to reverse the trajectory of this devastating disease.
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Expert Rev Neurother · Jan 2015
ReviewEffect of Sativex on spasticity-associated symptoms in patients with multiple sclerosis.
Individuals with multiple sclerosis (MS) spasticity may experience a range of symptoms, such as bladder dysfunction, pain, impaired sleep quality and mobility restrictions that worsen as spasticity severity increases. In this review, the effects of Sativex(®) oromucosal spray on symptoms and functional impairment associated with MS-related spasticity were examined. ⋯ Meaningful symptomatic improvement was achieved within the recommended dosage limit of ≤12 sprays per day. In appropriate patients, Sativex has the potential to minimize the consequences of spasticity-related symptoms on quality of life and reduce the economic burden on healthcare systems.
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Intracerebral hemorrhages (ICH) cause high levels of morbidity and mortality. Secondary neuronal injury from perihematomal edema is thought to contribute to poor outcomes. ⋯ Recent exploration of minimally invasive techniques for ICH removal includes stereotactic surgery combined with intra-clot thrombolysis, as well as endoscopic hematoma evacuation. Ongoing trials have demonstrated the safety of such minimally invasive approaches, and pending efficacy data from these studies is likely to change the standard management of ICH.
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Expert Rev Neurother · Jan 2015
ReviewNew understanding of nonconvulsive status epilepticus in adults: treatments and challenges.
Nonconvulsive status epilepticus (NCSE) in adults represents a constellation of conditions producing ongoing ictal impairment with myriad clinical presentations. These may vary from minimal obtundation, to psychosis to coma for which electroencephalography is essential to diagnosis. ⋯ There is a new and emerging understanding of the nature of NCSE, its classification and the challenges in treatment. The aim of this article is to review the classic and most recent literature on NCSE in adults focusing attention on the clinical settings in which NCSE frequently occurs, in order to improve awareness of the issues involved in electroclinical diagnosis, treatment and prognostication.
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Expert Rev Neurother · Jan 2015
ReviewPrehospital stroke care: telemedicine, thrombolysis and neuroprotection.
Over the last 15 years, new approaches regarding neuroprotective and thrombolytic strategies in stroke management have been evaluated in the prehospital setting. These efforts have provided exciting new potentials of hyperacute stroke care. Trials have shown that the use of specialized stroke ambulances increases the proportion of patients receiving intravenous thrombolysis and shortens alarm-to-treatment time by approximately half an hour compared to standard care. ⋯ However, direct effects of prehospital stroke care on functional outcome have yet to be shown and other approaches such as neuroprotective treatments could not demonstrate clinical benefit so far. There is a clear need for systematic research in the prehospital field to test the clinical effectiveness and cost-effectiveness of new therapeutic strategies. It will be necessary to test various components of prehospital stroke care alone and in combination.