Expert review of neurotherapeutics
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Expert Rev Neurother · Nov 2016
ReviewAnesthesia and cognitive disorders: a systematic review of the clinical evidence.
Preclinical and clinical evidence suggest an association between anesthesia and cognitive disorders ranging from postoperative chronic dysfunction to Alzheimer's disease. Recent clinical insights are summarized in this paper. ⋯ Expert commentary: There is a growing interest in establishing the possible relationship between anesthesia and the onset and progression of cognitive disorders. Further studies are required to determine the methods of monitoring anesthesia in older adults with dementia undergoing surgical procedures.
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WHO ranks migraine as the 6th highest cause of disability worldwide when considered alone, and the 3rd highest when medication overuse headache (MOH) is included. Migraine is an episodic disorder but in its natural course, its frequency could progressively increase and evolve to a chronic form. More than 50% of chronic migraine patients show acute pain medications overuse which is linked to the development of MOH. ⋯ Our goal is to review the existing data on OnabotulinoumtoxinA and CGRP-targeting drugs such as anti-CGRP monoclonal antibodies, one of the most promising migraine drugs under development. The research of bibliographic databases has included only published peer-reviewed articles from indexed journals. Expert commentary: To date, real-life studies are supporting OnabotulinumtoxinA in the treatment of chronic migraine. Additionally, anti-CGRP mAbs showed good efficacy and safety in recent RCTs and may soon contribute to improve the quality of life of patients suffering with migraine.
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Expert Rev Neurother · Sep 2016
ReviewInnovations in interventional pain management of chronic spinal pain.
Interventional pain management dates back to 1901, with significant innovations, which include the definition, literature synthesis, pathophysiology, and technical interventions. ⋯ Interventional pain management and interventional techniques include neural blockade, neural ablative procedures, spinal cord and peripheral nerve stimulation, intrathecal drug delivery systems, minimally invasive lumbar decompression (MILD®), percutaneous endoscopic spinal decompression, and regenerative medicine. In addition, advances are also related to the evidence synthesis of comparative effectiveness research. Expert commentary: Multiple innovations in interventional pain management and potential innovations may reduce costs and improve care and outcomes with proper evidence synthesis and application of principles of evidence-based medicine. Innovations in interventional pain management in managing chronic spinal pain depend on extensive research and appropriate evidence synthesis. Innovations should be developed in conjunction with health care policy based on principles of evidence-based medicine.
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Expert Rev Neurother · Aug 2016
ReviewAripiprazole for the treatment of irritability and aggression in children and adolescents affected by autism spectrum disorders.
Aripiprazole is an atypical antipsychotic approved for the treatment of irritability and aggression in children and adolescents aged 6-17 years with autism spectrum disorder. ⋯ This review will discuss the drug profile as well as available studies of aripiprazole in individuals with autism spectrum disorder as documented in prospective randomized controlled trials. Expert commentary: The heterogeneity of autism spectrum disorder has implications for assessing the effectiveness and safety of aripiprazole as it may not produce the same results in two individuals with the same diagnosis but different etiologies. Subgrouping of patients according to their overall presentation of symptoms may therefore be warranted. In addition, consideration should be given to the potential causes of irritability and aggression, such as coexisting medical conditions and environmental factors including inappropriate intervention of parents and teachers. In these cases, the identification of the underlying cause is important because the appropriate management.
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Acute ischemic stroke (AIS) is one of the leading causes of mortality and adult disability worldwide. For two decades, the preferred approach for AIS was intravenous recombinant tissue plasminogen activator (IV tPA). However, IV tPA cannot be given to many AIS patients who do not meet strict criteria for its use. IV tPA has also had lesser benefit in patients with large clot burden in the context of large vessel occlusion (LVO). ⋯ Endovascular stroke therapy had been an 'unproven' therapy despite numerous trials of intra-arterial pharmacologic thrombolysis and mechanical thrombectomy. With the advent of stent-retriever devices, there has been a paradigm shift in the utilization of endovascular therapies for AIS. Our review discusses cerebrovascular hemodynamics, the basis of the recanalization models in AIS, aspects of intravenous thrombolysis, prior generations of endovascular therapy, and the recent successful AIS stent retriever trials. Expert commentary: Recently 'stent-retrievers', a new generation of mechanical thrombectomy devices, were shown to be associated with improved functional outcomes in AIS secondary to proximal intracranial anterior circulation LVO. Stent retrievers are a major advance in AIS care and will have significant impact on the evolution of stroke systems of care.