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Volume 5, No 3 - Summer 2008

Volume 5, No 3 - Summer 2008

Table of Contents

Immunology and Epilepsy Mechanisms of Disease
Immune mechanisms play a critical role in systemic disorders (systemic lupus erythematosus, Sjögren’s syndrome, Crohn’s disease, and sarcoidosis) and in localized central nervous system (CNS) disorders (CNS vasculitis, multiple sclerosis, acute disseminated encephalomyelitis, and encephalitides). Both humoral and cell-mediated mechanisms are involved in the systemic and CNS-limited disorders. Immune mechanisms may also be a factor in a number of epilepsies such as Rasmussen’s encephalitis, Lennox-Gastaut syndrome, Landau-Kleffner syndrome, and temporal lobe epilepsy. Immunologic abnormalities are found in routine epilepsy surgical specimens, suggesting a broader role of immunopathology in the etiology of epilepsy. The prevalence and impact of immunopathology in epilepsy syndromes remains to be determined by future research. [Rev Neurol Dis. 2008;5(3):109-116]
Treatment of Intracranial Atherosclerotic Stenosis Treatment Update
Atherosclerotic stenosis of the major intracranial arteries is an important cause of ischemic stroke. Antiplatelet agents and aggressive management of atherosclerotic risk factors, including hypertension, should play a central role in the prevention of vascular events in patients with intracranial arterial stenosis. Angioplasty and stenting are also among current therapeutic options. A randomized controlled trial of intracranial stenting plus aggressive medical therapy versus aggressive medical therapy alone is needed to determine the optimal treatment for patients with severe symptomatic intracranial stenosis. [Rev Neurol Dis. 2008;5(3):117-124]
Neuroimaging of Nonmotor Features of Parkinson’s Disease Diagnosis and Treatment Update
Parkinson’s disease (PD) is a neurodegenerative disorder characterized by motor symptoms that respond to dopaminergic therapy. However, there is increasing interest in nonmotor PD features such as hyposmia, sleep disorders, dementia, depression, and psychoses. We review neuroimaging studies in nonmotor symptoms of PD and the use of dopaminergic imaging to support screening of nonmotor symptoms for early PD. Neuroimaging data document nonmotor pathophysiologic involvement of systems beyond the nigrostriatal dopaminergic pathway. These neuroimaging studies support a broader view of PD with early involvement in time and wider involvement of monoamine and cortical systems that may provide targets for novel therapies for nonmotor symptoms. [Rev Neurol Dis. 2008;5(3):125-133]
Changing Aspects of Care in Critically Ill Neurologic Patients Management Update
The care of critically ill neurologic patients is not a simple combination of critical care and neurological assessment, but an amalgamated treatment plan that is specific to the cause of injury. Many of the intensive care principles apply to acutely ill neurologic patients, but some specific interventions are available for this category of patients. There is now a better understanding of medical and neurosurgical care of critically ill neurologic patients, and several of the new clinical parameters that impact on our day-to-day care are discussed here. [Rev Neurol Dis. 2008;5(3):134-139]
The Treatment of Giant Cell Arteritis Treatment Update
Although giant cell arteritis (GCA) is a well-known vasculitis sensitive to corticosteroid-mediated immunosuppression, numerous issues of long-term therapeutic management remain unresolved. Because GCA encompasses a broad spectrum of clinical subtypes, ranging from devastating visual loss and neurological deficits to isolated systemic symptoms, the treatment of GCA must be adjusted to each case, and recommendations vary widely in the literature. This article systematically reviews the treatment options for patients with neuro-ophthalmic and neurological complications of GCA, as well as the evidence for possible adjuvant therapies for patients with GCA. Although there is no randomized controlled clinical trial specifically evaluating GCA patients with ocular and neurological complications, we recommend that GCA patients with acute visual loss or brain ischemia be admitted to the hospital for high-dose intravenous methylprednisolone, close monitoring, and prevention of steroid-induced complications. Aspirin may also be helpful in these cases. The evidence supporting the use of steroid-sparing immunomodulatory agents such as methotrexate for long-term management remains debated. [Rev Neurol Dis. 2008;5(3):140-152]
Sleep Disorders and Neuromuscular Diseases Meeting Review
Highlights of the 60th Annual Meeting of the American Academy of Neurology, April 12-19, 2008, Chicago, IL [Rev Neurol Dis. 2008;5(3):153-158]
I. Acute Paraplegia With Vanishing White Matter Lesions Presentation
Young adults presenting with an acute myelopathy often represent a diagnostic challenge. We present the case of a 20-year-old man who demonstrated many of the diagnostic issues involved in the evaluation of this syndrome. [Rev Neurol Dis. 2008;5(3):159-160]
II. Acute Paraplegia With Vanishing White Matter Lesions Discussion
A discussion of the case presented on pages 159-160 of this issue. [Rev Neurol Dis. 2008;5(3):164-166]