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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Various neurostimulation modalities have emerged in the field of epilepsy. Despite the fact that delivery of an electrical current to the hyperexcitable epileptic brain might, at first, seem contradictory, neurostimulation has become an established therapeutic option with a promising efficacy and adverse effects profile. In "responsive" neurostimulation the strategy is to interfere as early as possible with the accumulation of seizure activity to prematurely abort or even prevent an upcoming seizure. ⋯ The achievement of therapeutic success is dependent on adequate sensing and stimulation algorithms and a fast coupling between both. The benefits of delivering current only at the time of an approaching seizure merit further investigation. Current experience with responsive neurostimulation in epilepsy is still limited, but seems promising.
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Intracerebral hemorrhage (ICH) is a stroke subtype with high mortality and significant disability among survivors. The management of ICH has been influenced by the results of several major trials completed in the last decade. It is now recognized that hematoma expansion is a major cause of morbidity and mortality. ⋯ Acute blood pressure management has recently been shown to be safe in the setting of acute ICH but there was no reduction in mortality with early blood pressure (BP) lowering. Two large trials of surgical evacuation of supratentorial ICH have not shown improvement in outcome with surgery, thus minimally invasive surgical strategies are currently being studied. Lastly, a better understanding of the pathophysiology of ICH has led to the identification of several new mechanisms of injury that could be potential therapeutic targets.