Management Of Neurological Disorders Research Articles

Clinical utility of arterial spin labeling imaging in disorders of the nervous system.

Neuroimaging is an indispensable tool in the workup and management of patients with neurological disorders. Arterial spin labeling (ASL) is an imaging modality that permits the examination of blood flow and perfusion without the need for contrast injection. Noninvasive in nature, ASL provides a feasible alternative to existing vascular imaging techniques, including angiography and perfusion imaging. While promising, ASL has yet to be fully incorporated into the diagnosis and management of neurological disorders. This article presents a review of the most recent literature on ASL, with a special focus on its use in moyamoya disease, brain neoplasms, seizures, and migraines and a commentary on recent advances in ASL that make the imaging technique more attractive as a clinically useful tool.

Physical Activity, Sedentary Behavior, and Barriers to Exercise in People Living With Dystonia.

Background: Dystonia is a neurological movement disorder that presents as sustained or intermittent involuntary muscle contractions causing abnormal postures and movements. Knowledge of dystonia is mostly at the impairment level with minimal understanding of activity and participation limitations. Physical activity (PA) is an important aspect of neurological disease management, with wide-ranging benefits for overall health and quality of life. No studies have quantified PA and sedentary behavior (SB), nor explored barriers to being physically active in people with dystonia.Methods: Participants diagnosed with any form of dystonia completed a mixed-methods anonymous online survey on activity behaviors. The International Physical Activity Questionnaire (IPAQ) and Adult Sedentary Behavior Questionnaire (SBQ) assessed self-reported PA and SB. Barriers to exercise engagement were investigated according to the five-factor social-ecological framework and dystonia-specific questions regarding the impact of exercise on symptoms were included.Results: Two-hundred and sixty-three participants consented to the study (mean (SD) age = 55 (13) years, 76% Female). A large proportion of respondents (40%) reported living with cervical dystonia (CD). Overall, the median (IQR) time spent in walking, moderate, and vigorous activity was 60 (0–120), 120 (15–300), and 0 (0–13) min/day, respectively. SB time during weekdays was 285.0 (157.5–465.0) min/day and 345.0 (195.0–502.5) min/day on weekends. Fifty-five percent of participants were dissatisfied with their current level of PA and 75% reported dystonia had decreased their level of PA. Fifty-seven percent found their symptoms were worsened during exercise though the after-effects on symptoms varied. Fatigue, motor symptoms, pain, and poor balance were commonly cited limiting factors. Qualitative and quantitative data indicated difficulties with more vigorous intensity activity. The common barriers to engagement were personal and governmental factors, such as physical impairments, lack of funding and lack of trained exercise professionals.Conclusion: While more than half of respondents indicated they were not satisfied with their current level of PA, and exercise primarily worsened their dystonia symptoms, most participants were meeting the minimum guidelines. Future studies should incorporate robust objective methods of PA and SB measurement and explore the causal mechanisms underpinning exercise-induced aggravation of dystonic symptoms to further enhance life participation of people living with dystonia.

Comprehensive supportive care model for neurology cases

Issues: People living with neurological-disorders needs price-discounted-drugs & proper-nursing-care. Controversy is raging over euthanasia for terminal-cases. Appropriate public-health-program for supportive -care needed. Description: treatment-cost of neurological-disorders debatable. Over 82% patients in rural-asia cannot afford therapies, so life with neurology-disorder considered end-game. Since 2016 community-initiatives implemented to reduce therapy-cost. we need to facilitate development of sound/sustainable nursing-care-programs in marginalised communities. Establish Uniform public-health-policy to develop of sound/sustainable care-programs. This is policy-paper by efforts of group of Asian nurses and patient advocates Lessons learned: Community participation in administration of nursing-care/therapeuticRX is very effective in terms of cost-management, better-compliance. Community mass intervention & low-cost drug-supply-projects has proven useful in rural communities of resource poor-nations. participants must collaborate with health activists to address this issue. Uniform public health policy needed to implement supportive care services. Promoting dialogue between health-services & nurses accelerates health-care-efforts. nurses participation increases more compliance. Nurses have direct-communication with patients. Hence nurses must be involved in Public-health-policy issues. This would reduce difficulties faced by patients from resource poor southern countries. Its essential that common guideline manual on this issue affecting developing countries. This complex issue needs indepth discussion for better outcome in management of neurological-disorders.

Artificial intelligence as an emerging technology in the current care of neurological disorders.

Artificial intelligence (AI) has influenced all aspects of human life and neurology is no exception to this growing trend. The aim of this paper is to guide medical practitioners on the relevant aspects of artificial intelligence, i.e., machine learning, and deep learning, to review the development of technological advancement equipped with AI, and to elucidate how machine learning can revolutionize the management of neurological diseases. This review focuses on unsupervised aspects of machine learning, and how these aspects could be applied to precision neurology to improve patient outcomes. We have mentioned various forms of available AI, prior research, outcomes, benefits and limitations of AI, effective accessibility and future of AI, keeping the current burden of neurological disorders in mind. The smart device system to monitor tremors and to recognize its phenotypes for better outcomes of deep brain stimulation, applications evaluating fine motor functions, AI integrated electroencephalogram learning to diagnose epilepsy and psychological non-epileptic seizure, predict outcome of seizure surgeries, recognize patterns of autonomic instability to prevent sudden unexpected death in epilepsy (SUDEP), identify the pattern of complex algorithm in neuroimaging classifying cognitive impairment, differentiating and classifying concussion phenotypes, smartwatches monitoring atrial fibrillation to prevent strokes, and prediction of prognosis in dementia are unique examples of experimental utilizations of AI in the field of neurology. Though there are obvious limitations of AI, the general consensus among several nationwide studies is that this new technology has the ability to improve the prognosis of neurological disorders and as a result should become a staple in the medical community. AI not only helps to analyze medical data in disease prevention, diagnosis, patient monitoring, and development of new protocols, but can also assist clinicians in dealing with voluminous data in a more accurate and efficient manner.

Simultaneous EEG-fMRI for Functional Neurological Assessment.

The increasing incidence of neurodegenerative and psychiatric diseases requires increasingly sophisticated tools for their diagnosis and monitoring. Clinical assessment takes advantage of objective parameters extracted by electroencephalogram and magnetic resonance imaging (MRI) among others, to support clinical management of neurological diseases. The complementarity of these two tools can be now emphasized by the possibility of integrating the two technologies in a hybrid solution, allowing simultaneous acquisition of the two signals by the novel EEG-fMRI technology. This review will focus on simultaneous EEG-fMRI technology and related early studies, dealing about issues related to the acquisition and processing of simultaneous signals, and including critical discussion about clinical and technological perspectives.

Independent Decision Path Fusion for Bimodal Asynchronous Brain–Computer Interface to Discriminate Multiclass Mental States

With the increasing development of brain imaging and sensing technologies, a wide variety of medical signals in multiple modalities have facilitated a better understanding of mental health. The brain-computer interface (BCI) is a technology capable of detecting mental states automatically by employing various brain sensing and machine learning methods. This contributes to efforts involving neurological disease management and restoration of cognitive function. In this study, we present an independent decision path fusion (IDPF) method by developing a bimodal asynchronous BCI based on electroencephalographs (EEGs) and functional near-infrared spectroscopy (fNIRS) to discriminate multiple mental states. The proposed IDPF method generates several independent decision paths, each of which is capable of analyzing cerebral information with respect to a specific aspect, thus interpreting the brain state from multiple points of view. Moreover, in one particular decision path for the fNIRS analysis of the IDPF method, we modified the EEG-based common spatial pattern (CSP) algorithm according to the characteristics of fNIRS. The results show that the modified common spatial pattern (MCSP) significantly outperforms CSP in fNIRS-based BCIs. Through validation on an open-access EEG-fNIRS dataset and comparison with recent studies, we found that our IDPF method achieves a high accuracy of 70.32% for a four-class classification problem (left hand motor imagery, right hand motor imagery, mental arithmetic, and resting state).

The history of intracranial infections.

The 19th and 20th centuries heralded the advancement of our understanding of surgical infections, reducing the risk of morbidity and mortality to patients by overturning long-held dogmas surrounding infections and perioperative care. These advancements impacted the development and establishment of the field of neurological surgery by minimizing surgical risk through aseptic techniques and promoting surgical benefit via improved neurological localization and surgical technique. Infections were significant contributors to morbidity and mortality for all surgical patients, and historically almost half of patients lost their lives as a consequence of perioperative wound contamination. With advancing understanding of germ theory, contagion, antisepsis, and subsequently asepsis, the surgeon began embracing the knowledge and techniques which would hone their craft and allow for a renaissance in the management of neurological disorders in an unprecedented manner.

Challenges and ethical issues in the course of palliative care management for people living with advanced neurologic diseases.

In the recent years, there has been an increase in awareness with regards to the role of palliative care (PC) in management of neurologic diseases. In 1996, the need to incorporate PC in the care for patients with neurologic conditions was recognized by the American Academy of Neurology (AAN) Ethics and Humanities Subcommittee. The gaps in research, education and the ability to deliver adequate PC were then acknowledged by the National Academy of Sciences with their publication of "Approaching death: improving care at the end of life" and most recently, continued goals in improving PC was highlighted by another recent publication "Dying in America: improving quality and honoring individual preferences near the end of life". The complexity of managing neurologic patients brings about challenges and ethical issues in this setting. The aim of this review is to discuss and summarize the challenges and ethical issues in the context of PC management of patients with advanced acute, rapidly progressive, slowly-progressive or degenerative neurological conditions that are commonly encountered in practice.

Clinical Notes on Chiari Malformation

Chiari malformations (CMs) are variant structural setup of cerebellum and brain stem at the craniovertebral junction. Normally the cerebellum and parts of the brain stem lie above the foramen magnum. When the part of the cerebellum and/or brainstem protrudes into the upper spinal canal through foramen magnum, it is defined as CM. Chiari malformations may develop when part of the skull is smaller than normal or misshapen, due to which the cerebellum herniates into spinal canal through foramen magnum. This compresses the cerebellum and brainstem affecting functions controlled by these parts and blocks the flow of cerebrospinal fluid that surrounds and cushions the brain and spinal cord. Chiari malformation may cause sensory loss, ataxia, weakness, nystagmus, spastic limbs to name a few. Thus, various morbid and mortal neurologic disorders result from CM. Therefore, sound and thorough knowledge of CM and its variant anatomy are essential for diagnosis and management of neurologic disorders. Therefore, review study has been carried out for updating and consolidating the knowledge of all the variations of CMs. Literature search was carried out using databases, SciELO, ScopeMed, MEDLINE, PubMed, and Wiley Online Library. Papers containing original data were selected and secondary references retrieved from bibliographies. Various terms related to CMs were used for net surfing. The knowledge will be of immense importance to neurologists and neurosurgeons to diagnose and treat the CMs and decrease the mortality associated with CM and to radiologists for correctly interpreting the magnetic resonance imaging.

IClinfMRI Software for Integrating Functional MRI Techniques in Presurgical Mapping and Clinical Studies.

Task-evoked and resting-state (rs) functional magnetic resonance imaging (fMRI) techniques have been applied to the clinical management of neurological diseases, exemplified by presurgical localization of eloquent cortex, to assist neurosurgeons in maximizing resection while preserving brain functions. In addition, recent studies have recommended incorporating cerebrovascular reactivity (CVR) imaging into clinical fMRI to evaluate the risk of lesion-induced neurovascular uncoupling (NVU). Although each of these imaging techniques possesses its own advantage for presurgical mapping, a specialized clinical software that integrates the three complementary techniques and promptly outputs the analyzed results to radiology and surgical navigation systems in a clinical format is still lacking. We developed the Integrated fMRI for Clinical Research (IClinfMRI) software to facilitate these needs. Beyond the independent processing of task-fMRI, rs-fMRI, and CVR mapping, IClinfMRI encompasses three unique functions: (1) supporting the interactive rs-fMRI mapping while visualizing task-fMRI results (or results from published meta-analysis) as a guidance map, (2) indicating/visualizing the NVU potential on analyzed fMRI maps, and (3) exporting these advanced mapping results in a Digital Imaging and Communications in Medicine (DICOM) format that are ready to export to a picture archiving and communication system (PACS) and a surgical navigation system. In summary, IClinfMRI has the merits of efficiently translating and integrating state-of-the-art imaging techniques for presurgical functional mapping and clinical fMRI studies.

Occurrence of pathogenic and endophytic fungi and their influence on quality of medicinal plants applied in management of neurological diseases and mental disorders

Summary Due to increasing demand of medicinal plants (MPs), quality and safety more attention to the plant health should be paid. Among herb pathogens, especially fungi cause serious diseases in these plants decreasing yield and quality of herbal raw material. Some species, i.e. Fusarium sp., Alternaria sp., Penicillium sp. are known as mycotoxin producers. Paradoxically, self-treatment with herbal raw material can expose the patient to mycotoxin activity. In tissues of some MPs species, asymptomatically endophytic fungi residue. It is known that they are able to influence a biosynthesis of secondary metabolites in their host plant or produce biologically active compounds. Until recently these microorganisms have been neglected as a component of MPs, the reason why there have unexplored bioactivity and biodiversity. The paper presents an overview of herbal plants that are used in the treatment of nervous system diseases. Pathogenic fungi that infect these plants are described. It focused mainly on species producing harmful mycotoxins. The publication presents a list of these mycotoxins and a brief description of their effects on human health. The second part of this article provides information on the occurrence of endophytic fungi in herbal plants and their effects on human health. Coexistence of fungi and medicinal plants is not fully understood but can be crucial to ensure health and safety of patients with neurological diseases and mental disorders.

Advances and insights into neurological practice 2016−17

Papers published by the European Journal of Neurology reflect the broad interest of practicing neurologists in advances in the aetiology, diagnosis and management of neurological disorders. As a general journal, the proportion of papers in the different subject areas reasonably reflects the case load of a practising neurologist. Stroke represents the largest proportion of papers published, including those on pathophysiology (1-23), acute stroke management (24-47) and the outcome of patients who have suffered stroke (48-72). This article is protected by copyright. All rights reserved.

Surgical management of neurological manifestations of mucopolysaccharidosis disorders.

The mucopolysaccharidosis (MPS) disorders are ultra-rare lysosomal storage disorders associated with progressive accumulation of glycosaminoglycans (GAGs) in cells and tissues throughout the body. Clinical manifestations and progression rates vary widely across and within the different types of MPS. Neurological symptoms occur frequently, and may result directly from brain damage caused by infiltration of GAGs, or develop secondary to somatic manifestations such as spinal cord compression, hydrocephalus, and peripheral nerve entrapment. Management of secondary neurological manifestations often requires surgical correction of the underlying somatic cause. The present review discusses the surgical management of neurological disease in patients with MPS, including diagnostic imaging. Background information is derived from presentations and discussions during a meeting on the brain in MPS, attended by an international group of experts (April 28-30, 2016, Stockholm, Sweden), and additional literature searches.

The nature, consequences, and management of neurological disorders in chronic kidney disease.

Perhaps no other organ in the body is affected as often and in as many ways as the brain is in patients with chronic kidney disease (CKD). Several factors contribute to the neurological disorders in CKD including accumulation of uremic toxins, metabolic and hemodynamic disorders, oxidative stress, inflammation, and impaired blood brain barrier among others. The neurological disorders in CKD involve both peripheral and central nervous system. The peripheral neurological symptoms of CKD are due to somatic and cranial peripheral neuropathies as well as a myopathy. The central neurological symptoms of CKD are due to the cortical predominantly cortical, or subcortical lesions. Cognitive decline, encephalopathy, cortical myoclonus, asterixis and epileptic seizures are distinct features of the cortical disorders of CKD. Diffuse white matter disease due to ischemia and hypoxia may be an important cause of subcortical encephalopathy. A special and more benign form of subcortical disorder caused by brain edema in CKD is termed posterior reversible encephalopathy. Subcortical pathology especially when it affects the basal ganglia causes a number of movement disorders including Parkinsonism, chorea and dystonia. A stimulus-sensitive reflex myoclonus is believed to originate from the medullary structures. Sleep disorder and restless leg syndrome are common in CKD and have both central and peripheral origin. This article provides an overview of the available data on the nature, prevalence, pathophysiology, consequences and treatment of neurological complications of CKD.

Dental pulp stem cells and the management of neurological diseases: An update.

Medical research in regenerative medicine has brought promising perspectives for the use of stem cells in clinical trials. Stem cells are undifferentiated cells capable of multilineage differentiation and available in numerous sources in the human body. Dental pulp constitutes an attractive source of these cells since collecting mesenchymal stem cells from this site is a noninvasive practice that can be performed after a common surgical extraction of supernumerary or wisdom teeth. Thus, tissue sacrifice is very low and several cytotypes can be obtained owing to these cells' multipotency, in addition to the fact that they can be cryopreserved and stored for long periods. Mesenchymal stem cells have high proliferation rates, making them favorable for clinical application. These multipotent cells, present in biological waste, constitute an appropriate resource in the treatment of many neurological diseases.

Neurogenic bowel dysfunction: Clinical management recommendations of the Neurologic Incontinence Committee of the Fifth International Consultation on Incontinence 2013.

Evidence-based guidelines for the management of neurological disease and lower bowel dysfunction have been produced by the International Consultations on Incontinence (ICI). These are comprehensive guidelines, and were developed to have world-wide relevance. To update clinical management of neurogenic bowel dysfunction from the recommendations of the 4th ICI, 2009. A series of evidence reviews and updates were performed by members of the working group. The resulting guidelines were presented at the 2012 meeting of the European Association of Urology for consultation, and modifications applied to deliver evidence based conclusions and recommendations for the scientific report of the 5th edition of the ICI in 2013. The current review is a synthesis of the conclusions and recommendations, including the algorithms for initial and specialized management of neurogenic bowel dysfunction. The pathophysiology is described in terms of spinal cord injury, multiple sclerosis, and Parkinson's disease. Assessment requires detailed history and clinical assessment, general investigations, and specialized testing, if required. Treatment primarily focuses on optimizing stool consistency and regulating bowel evacuation to improve quality of life. Symptom management covers conservative and interventional measures to promote good habits and assist stool evacuation, along with prevention of incontinence. Education is essential to achieving optimal bowel management. The review offers a pragmatic approach to management in the context of complex pathophysiology and varied evidence base.

Vitamin-Derived Nanolipoidal Carriers for Brain Delivery of Dimethyl Fumarate: A Novel Approach with Preclinical Evidence.

Various oral treatment options have been reported for relapsing multiple sclerosis. Recently, dimethyl fumarate (DMF) has been approved for the management of the same. Though effective, DMF is associated with concerns like multiple dosing, patient incompliance, gastrointestinal flushing, lower brain permeation, and economic hurdles. Henceforth, the objective of the present study was to develop vitamin-based solid lipid nanoparticles (SLNs) for effective brain delivery of DMF with a promise of once-a-day dosing. The developed SLNs were characterized for micromeritics, morphology, entrapment efficiency, drug loading and in vitro drug release. Caco-2 and SH-SY5Y cell lines were used to assess the intestinal permeability and neuronal uptake. Pharmacokinetic and biodistribution studies were performed on rats. The developed nanometeric lipidparticles were able to control the drug release and substantially enhance the Caco-2 as well as SH-5YSY cell permeability. The developed systems not only enhanced the oral bioavailability of the drug, but also offered substantially elevated brain drug levels to that of plain drug. The drug was protected from liver and biological residence was increased, indicating promising potential of the carriers in effective brain delivery of DMF. Enhanced bioavailability and elevated bioresidence of DMF by vitamin-based SLNs provided the evidence for once-a-day delivery potential for DMF in the management of neurological disorders.

Dental Pulp Stem Cells and Neurogenesis.

Recent advances in regenerative medicine and cell-based therapy are bringing promising perspectives for the use of stem cells in clinical trials. Stem cells are undifferentiated cells capable of multilineage differentiation and available in numerous sources in the human body. Dental pulp constitutes an attractive source of these cells since collecting mesenchymal stem cells from this site is a noninvasive procedure which can be done following a common surgical extraction of supernumerary or wisdom teeth. Thus tissue sacrifice is very low and several cytotypes can be obtained owing to these cells' multipotency, in addition to the fact that they can be cryopreserved and stored for long periods. Mesenchymal stem cells have high proliferation rates making them favorable for clinical application. These multipotent cells present in a biological waste constitute an appropriate support in the management of many neurological disorders. After a brief overview on the different types of dental stem cells, this chapter will focus on the characteristics of dental pulp stem cells, their handling and applications in neural tissue engineering, as well as neural induction protocols leading to their potential therapeutic use in the management of neurological diseases.

Acquired and Congenital Hemolytic Anemia.

1. Suzie A. Noronha, MD* 1. *Division of Pediatric Hematology/Oncology, University of Rochester, Golisano Children’s Hospital, Rochester, NY. 1. Pediatricians and other general practitioners may not be aware of the significance of central nervous system disease in children who have sickle cell disease, particularly the more subtle silent infarct. 2. Pediatricians frequently fail to order a reticulocyte count or detect splenomegaly on physical examination before referring a patient with anemia. These findings are critical to diagnosing hemolytic anemia. After completing this article, the reader should be able to: 1. Recognize clinical features of hemolysis, including reticulocytosis and splenomegaly. 2. List the different types of acquired autoimmune hemolytic anemias that can manifest throughout childhood. 3. Understand the role of transfusion in the management of neurologic disease in patients who have sickle cell disease. 4. Review the spectrum of disease of α- and β-thalassemias. 5. Recognize clinical findings associated with hereditary spherocytosis. 6. Determine when to suspect glucose-6-phosphate dehydrogenase deficiency and how to counsel families on triggers to avoid. Hemolytic anemia (HA) affects a substantial proportion of the pediatric population globally. Many children are hospitalized every year due to sequelae of this heterogeneous disease. Clinicians should be facile in recognizing its presentation. HA may be defined as increased destruction of red blood cells (RBCs). RBCs are cleared from the circulation via extravascular or intravascular mechanisms (Figure). HA can be caused by congenital or acquired RBC abnormalities (Table 1). Figure. Mechanism of extravascular versus intravascular hemolysis. RBC=red blood cell. Courtesy of Jessica Shand, MD. View this table: Table 1. Classification of Common Hemolytic Anemias Extravascular hemolysis is mediated by the reticuloendothelial system (RES) of the spleen and liver. Most HAs, such as warm autoimmune hemolytic anemia (AIHA), sickle cell disease (SCD), and hereditary spherocytosis (HS), are characterized by extravascular hemolysis. The hallmark of extravascular hemolysis is …

Neurogenic lower urinary tract dysfunction: Clinical management recommendations of the Neurologic Incontinence committee of the fifth International Consultation on Incontinence 2013

Evidence-based guidelines for the management of neurological disease and lower urinary tract dysfunction have been produced by the International Consultations on Incontinence (ICI). These are comprehensive guidelines, and were developed to have world-wide relevance. To update clinical management of neurogenic bladder dysfunction from the recommendations of the fourth ICI, 2009. A series of evidence reviews and updates were performed by members of the working group. The resulting guidelines were presented at the 2012 meeting of the European Association of Urology for consultation, and consequently amended to deliver evidence-based conclusions and recommendations in 2013. The current review is a synthesis of the conclusions and recommendations, including the algorithms for initial and specialized management of neurogenic lower urinary tract dysfunction. The pathophysiology is categorized according to the nature of onset of neurological disease and the part(s) of the nervous system affected. Assessment requires clinical evaluation, general investigations, and specialized testing. Treatment primarily focuses on ensuring safety of the patient and optimizing quality of life. Symptom management covers conservative and interventional measures to aid urine storage and bladder emptying, along with containment of incontinence. A multidisciplinary approach to management is essential. The review offers a pragmatic review of management in the context of complex pathophysiology and varied evidence base. Neurourol. Urodynam. 35:657-665, 2016. © 2016 Wiley Periodicals, Inc.