European Neurological Journal Vol II Issue 3

Cognitive Evoked Potentials in Obstructive Sleep Apnea Syndrome

Cognitive functions may be altered in patients with obstructive sleep apnea syndrome (OSAS), and it has been proposed that vigilance and attention changes play a fundamental role in all aspects of cognitive deficits noted in this disease. Event-related potentials (ERPs) are a high-time-resolution technique that can be used to explore the presence of cognitive dysfunction. We review 21 empirical articles on ERPs in OSAS in order to contribute to clarify the pattern of cognitive deficits that are specific to this disease and to see whether there might be an improvement of abnormal psychophysiological findings with continuous positive airway pressure (CPAP) treatment. We conclude that ERP studies have contributed toward demonstrating changes in cognitive attentive processing in OSAS, mainly in association with altered functioning of the prefrontal cortex, and that CPAP treatment may improve vigilance and attention and, more generally, cerebral information processing in these patients. However, deficits remaining during a sufficient CPAP-therapy may reflect irreversible hypoxic cerebral damage.

Azathioprine for Multiple Sclerosis

Psychiatric Comorbidities and Risk Factors in Psychogenic Movement Disorders: A Biopsychosocial Approach

Psychogenic movement disorders, while gaining wider recognition in the literature as well as in clinical practice, continue to present a diagnostic and therapeutic challenge for neurologists and psychiatrists. Essential to the diagnosis of psychogenic movement disorder or conversion disorder-motor subtype is that the patient's abnormal movements are considered to be psychologically mediated, rather than the result of any neurological lesion, but there remains a significant gap between the assumption of “unconscious stress” and a consensus on how to best describe, counsel, or treat these patients psychologically. In an attempt to understand these patients from a biopsychosocial perspective, we describe the current literature regarding psychiatric comorbidity in these patients and how genetic susceptibility may undermine an individual's response to stressful life events.

Hallucinations in the Differential Diagnosis of Parkinsonism

Visual hallucinations (VH) occur commonly in Parkinson's disease (PD) and dementia with Lewy bodies (DLB), but are reported much less frequently in other neurodegenerative causes of parkinsonism, such as progressive supranuclear palsy, multiple system atrophy, and corticobasal degeneration. This clinical sign may be helpful when considering the differential diagnosis of patients with parkinsonism. The observation that VH may be specific to Lewy body pathology probably reflects a greater vulnerability of the visual systems to PD and DLB neurodegeneration compared to other diseases. Topographic differences in pathology are probably the major factor producing VH in Lewy body diseases, rather than neurophysiological changes that are specific to α-synuclein protein accumulation. VH correlate with pathology in the limbic system and more specifically the amygdala that is frequently affected in PD and DLB but relatively preserved in other forms of parkinsonism often misdiagnosed as PD. In this review, we compare the published frequencies of VH in these different conditions to put into context the notion of VH as a clinical clue to underlying Lewy body pathology.

Contribution of CSF Biomarkers to the Early Diagnosis of Human Genetic Transmissible Spongiform Encephalopathies

In this study, mainly the genetic forms of ‘Human transmissible spongiform encephalopathies’ (TSEs) are described. Subtypes of genetic TSEs, that is, genetic Creutzfeldt–Jakob disease, Gerstmann–Sträussler–Sheinker syndrome, and fatal familial insomnia are characterized. Available data on the penetrance of mutations of the prion protein gene are presented. The specific features of genetic TSEs, as anticipation and asymptomatic carriers of disease-specific mutations, are underlined. Attention was drawn to advantages of genetic TSEs concerning the early diagnosis, prevention, and prophylaxis. CSF biomarkers, used in the TSE diagnosis, are described. Implementation of assays detecting most frequently used brain-derived proteins in the CSF (protein 14-3-3, tau, S100b, neuron-specific enolase) and their usefulness alone or in combination for early diagnosis of genetic Creutzfeldt–Jakob disease is discussed.

Topiramate in Migraine Prophylaxis

Review Article

Mark Obermann , Steffen Naegel, Charly Gaul, and Hans-Christoph Diener

Affiliation : Department of Neurology and Headache Center, University of Duisburg-Essen, Essen, Germany

ABSTRACT

The prevalence of migraine in the global adult population is approximately 10%. Migraine has a serious socioeconomic impact on society in general and is associated with considerable medical disability for individual patients. Migraine is characterized by the combination of typical headache with associated autonomic symptoms and/or the presence of aura. Within the past years, considerable advances were made in understanding the pathophysiology of migraine. This has led to improved treatment options for the acute migraine attack as well as migraine prophylaxis. Topiramate is an antiepileptic drug (AED) with a complex mode of action, which has proven its efficacy and safety in the prophylactic treatment of episodic migraine in a number of randomized controlled clinical trials. Topiramate is also effective in treating patients with chronic migraine with and without medication overuse headache. In clinical trials, it was generally considered to be well tolerated by patients, but in everyday clinical practice, side effects can be therapy-limiting in some patients. Treatment benefits and potential adverse events have to be considered carefully for each individual patient to assure optimal treatment success with topiramate. This is a revised and updated version of a previous review by Naegel and Obermann (2010).


Keywords: topiramate, migraine, migraine prophylaxis, chronic migraine, migraine treatment

Correspondence: Mark Obermann, Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany.
Tel: (+49)-201-723-84385; Fax: (+49)-201-723-5542; e-mail: mark.obermann@uni-due.de

Recent Developments in the Management of Posttraumatic Neuropathic Pain

Review Article

Kurien Koshy and Cory Toth

Affiliation : Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada

ABSTRACT

Injury to the nervous system may lead to posttraumatic neuropathic pain (NeP), an often refractory condition associated with pain, sensory disturbance, and potential weakness and autonomic dysfunction (such as with complex regional pain syndrome). In addition, NeP is often associated with insomnia, difficulties with mood or anxiety, and impaired quality of life. This review will review the causes and nature of NeP with a discussion on the recent breakthroughs in understanding its pathophysiology. Management of this condition is often difficult and requires a multidisciplinary approach consisting of both pharmacological and nonpharmacological treatment. Recent studies identifying gabapentinoids as effective in posttraumatic forms of NeP will be reviewed. Posttraumatic NeP is a complicated and complex disease process that requires ongoing research to understand and manage the needs of its patient population.

Keywords: neuropathic pain, posttraumatic neuropathic pain, complex regional pain syndrome, neuropathy, pharmacotherapy, pregabalin,antidepressants

Correspondence: Cory Toth, Department of Clinical Neurosciences, University of Calgary, HMRB Room 155, 3330 Hospital Drive NW,
Calgary, Alberta, Canada T2N 4N1. Tel: +1-(403)-220-8831; Fax: +1-(403)-283-8731; e-mail: corytoth@shaw.ca

Differential Diagnosis of Longitudinally Extensive Transverse Myelitis in Adults

Review Article


Christopher Eckstein, Stephanie Syc and Shiv Saidha

Affiliation: Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

ABSTRACT

Longitudinally extensive transverse myelitis (LETM), characterized by spinal cord inflammation extending three or more vertebral segments in length, may be caused by a multitude of disorders. LETM is most commonly associated with neuromyelitis optica (NMO). Such is the frequent association between these two entities that there is a growing tendency amongst physicians to regard them as being practically synonymous with each other. The objective of this review is to highlight the wide range of disorders that may cause LETM and to emphasize the need to carefully consider all potential etiologies in the assessment of LETM. In particular, we focus on the salient clinical, laboratory, and radiographic features of these various disorders, which help them to be differentiated from one another.

Keywords: Longitudinally Extensive Transverse Myelitis, LETM, NMO, neuromyelitis optica, myelopathy

Correspondence: Dr Shiv Saidha, Department of Neurology, Johns Hopkins University School of Medicine, Pathology 627, 600 North Wolfe Street, Baltimore, MD 21287, USA. Tel: +1-4106141653; Fax: +1-4105026736; e-mail: ssaidha2@jhmi.edu

Clinical Data on the Prolonged Release Formulation of Ropinirole

Review Article

Wolfgang H. Jost¹ and Lars Bergmann²

Affiliations: ¹Deutsche Klinik für Diagnostik, Wiesbaden and ²GlaxoSmithKline GmbH, Munich, Germany

ABSTRACT

In the treatment of Parkinson's disease (PD), non-ergoline dopamine agonists are considered the first-choice therapy. Ropinirole has been an internationally established therapy used to treat the signs and symptoms of idiopathic PD for more than 10 years. Because of its moderate elimination half-life, the immediate release (IR) formulation is administered three times daily. Now a prolonged release (PR) form is available, and despite administration once-daily in the morning, plasma level fluctuations are reduced over 24 hours, versus IR, allowing for symptomatic treatment during day and night time with once-daily dosing. The PR formulation can be up-titrated more rapidly and simply, reaching clinical efficacy as early as the second week of therapy. In clinical studies, higher doses of ropinirole were achieved with the PR formulation compared with the IR formulation. The results of a randomized double-blind head-to-head study of both formulations in patients with advanced PD demonstrated significantly greater efficacy and a larger l-dopa dose reduction. A positive effect on nighttime motor symptoms and quality of sleep has already been established. Because of once-daily administration, compliance and adherence may also be improved.

Keywords: ropinirole, Parkinson’s disease, dopamine agonist, prolonged release

Correspondence: Prof. Dr.Wolfgang Jost, Deutsche Klinik für Diagnostik, Aukammallee 33, 65191 Wiesbaden/Germany. Tel: 0049-611-577430;Fax: 0049-611-577311; e-mail: jost.neuro@dkd-wiesbaden.de

Neurological Manifestations of Celiac Disease in Children and Adults

Review Article

Aaron Lerner^1, Badira F. Makhoul² and Rami Eliakim³

Affiliation : ¹Pediatric Gastroenterology and nutrition Unit, Carmel Medical Center and ²Department of Gastroenterology, Rambam Health Care Campus and ^1,2Bruce Rappaport School of Medicine, Technion-Israel institute of Technology, Haifa, Israel

ABSTRACT

Celiac disease (CD) is a common, life-long, autoimmune condition, affecting the small intestine of genetically susceptible individuals. The classical clinical picture is disappearing as awareness progresses and the extra-intestinal presentation is emerging. Skin, endocrine, hepatic, skeletal, hematological, gynecological, infertility, dental, and behavioral abnormalities are emerging. Among the new growing domains is the extra-intestinal presentation of CD affecting the peripheral and central neurological systems. This review highlights neurological presentations in these patients, focusing on the clinical signs/symptoms in the pediatric and the adult age group, separately.

Keywords: Celiac disease, neurology, children, adults

Correspondence: Rami Eliakim, Department of Gastroenterology, Rambam Health Care Campus, Bat Galim, Haifa, Israel, 31096. Tel: +972-4-854-3784; Fax: +972-4-854-3058; e-mail: r_eliakim@rambam.health.gov.il