Current Neurology and Neuroscience Reports

Sim, Hao-Wen; Lorrey, Selena; Khasraw, Mustafa

doi: 10.1007/s11910-023-01268-0pmid: 37154886

Purpose of ReviewThe management of isocitrate dehydrogenase (IDH)-wildtype glioblastomas is an area of unmet need. Despite multimodal therapy incorporating maximal safe resection, radiotherapy, and temozolomide, clinical outcomes remain poor. At disease progression or relapse, available systemic agents such as temozolomide, lomustine, and bevacizumab have limited efficacy. We review the recent advances in the treatment of IDH-wildtype glioblastomas.Recent FindingsA broad repertoire of systemic agents is in the early stages of development, encompassing the areas of precision medicine, immunotherapy, and repurposed medications. The use of medical devices may present opportunities to bypass the blood–brain barrier. Novel clinical trial designs aim to efficiently test treatment options to advance the field.SummaryThere are a number of emerging treatment options for IDH-wildtype glioblastomas which are undergoing evaluation in clinical trials. Advances in our scientific understanding of IDH-wildtype glioblastomas offer hope and the prospect of incremental improvements in clinical outcomes.

Banks, Samantha A; Sartori Valinotti, Julio C; Go, Ronald S; Abeykoon, Jithma P; Goyal, Gaurav; Young, Jason R; Koster, Matthew J; Vassallo, Robert; Ryu, Jay H; Davidge-Pitts, Caroline J; Ravindran, Aishwarya; Bennani, N Nora; Shah, Mithun V; Rech, Karen L; Tobin, W Oliver;

Bhome, Rohan; Thomas, George Edward Calver; Zarkali, Angeliki; Weil, Rimona Sharon

doi: 10.1007/s11910-023-01267-1pmid: 37126201

Purpose of ReviewTo review recent structural and functional MRI studies of visual hallucinations in Parkinson’s disease.Recent FindingsPreviously, neuroimaging had shown inconsistent findings in patients with Parkinson’s hallucinations, especially in studies examining grey matter volume. However, recent advances in structural and functional MRI techniques allow better estimates of structural connections, as well as the direction of connectivity in functional MRI. These provide more sensitive measures of changes in structural connectivity and allow models of the changes in directional functional connectivity to be tested.SummaryWe identified 27 relevant studies and found that grey matter imaging continues to show heterogeneous findings in Parkinson’s patients with visual hallucinations. Newer approaches in diffusion imaging and functional MRI are consistent with emerging models of Parkinson’s hallucinations, suggesting shifts in attentional networks. In particular, reduced bottom-up, incoming sensory information, and over-weighting of top-down signals appear to be important drivers of visual hallucinations in Parkinson’s disease.

Osteraas, Nicholas D.; Dafer, Rima M.

doi: 10.1007/s11910-023-01269-zpmid: 37247169

Purpose of ReviewUncommon causes of stroke merit specific attention; when clinicians have less common etiologies of stoke in mind, the diagnosis may come more easily. This is key, as optimal management will in many cases differs significantly from “standard” care.Recent FindingsRandomized controlled trials (RCT) on the best medical therapy in the treatment of cervical artery dissection (CeAD) have demonstrated low rates of ischemia with both antiplatelet and vitamin K antagonism. RCT evidence supports the use of anticoagulation with vitamin K antagonism in “high-risk” patients with antiphospholipid antibody syndrome (APLAS), and there is new evidence supporting the utilization of direct oral anticoagulation in malignancy-associated thrombosis. Migraine with aura has been more conclusively linked not only with increased risk of ischemic and hemorrhagic stroke, but also with cardiovascular mortality. Recent literature has surprisingly not provided support the utilization of l-arginine in the treatment of patients with mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS); however, there is evidence at this time that support use of enzyme replacement in patients with Fabry disease. Additional triggers for reversible cerebral vasoconstriction syndrome (RCVS) have been identified, such as capsaicin. Imaging of cerebral blood vessel walls utilizing contrast-enhanced MRA is an emerging modality that may ultimately prove to be very useful in the evaluation of patients with uncommon causes of stroke. A plethora of associations between cerebrovascular disease and COVID-19 have been described. Where pertinent, authors provide additional tips and guidance.SummaryLess commonly encountered conditions with updates in diagnosis, and management along with clinical tips are reviewed.

Gainotti, Guido; Quaranta, Davide; Luzzi, Simona

doi: 10.1007/s11910-023-01271-5pmid: 37133717

Purpose of ReviewPronagnosia is a rare acquired or developmental pathological condition that consists of a selective difficulty to recognize familiar people by their voices. It can be distinguished into two different categories: apperceptive phonagnosia, which denotes a purely perceptual form of voice recognition disorder; and associative phonagnosia, in which patients have no perceptual defects, but cannot evaluate if the voice of a known person is or not familiar. The neural substrate of these two forms of voice recognition is still controversial, but it could concern different components of the core temporal voice areas and of extratemporal voice processing areas. This article reviews recent research on the neuropsychological and anatomo-clinical aspects of this condition.Recent FindingsData obtained in group studies or single case reports of phonagnosic patients suggest that apperceptive phonagnosia might be due to disruption of the core temporal voice areas, bilaterally located in the posterior parts of the superior temporal gyrus, whereas associative phonagnosia might result from impaired access to structures where voice representations are stored, due to a disconnection of these areas from structures of the voice extended system.SummaryAlthough these results must be confirmed by further investigations, they represent an important step toward understanding the nature and neural substrate of apperceptive and associative forms of phonagnosia.

Stockbridge, Melissa D.; Keser, Zafer

doi: 10.1007/s11910-023-01273-3pmid: 37271792

Purpose of ReviewThere is enormous enthusiasm for the possibility of pharmacotherapies to treat language deficits that can arise after stroke. Speech language therapy remains the most frequently utilized and most strongly evidenced treatment, but the numerous barriers to patients receiving the therapy necessary to recover have motivated the creation of a relatively modest, yet highly cited, body of evidence to support the use of pharmacotherapy to treat post-stroke aphasia directly or to augment traditional post-stroke aphasia treatment. In this review, we survey the use of pharmacotherapy to preserve and support language and cognition in the context of stroke across phases of care, discuss key ongoing clinical trials, and identify targets that may become emerging interventions in the future.Recent FindingsRecent trials have shifted focus from short periods of drug therapy supporting therapy in the chronic phase to longer terms approaching pharmacological maintenance beginning more acutely. Recent innovations in hyperacute stroke care, such as tenecteplase, and acute initiation of neuroprotective agents and serotonin reuptake inhibitors are important areas of ongoing research that complement the ongoing search for effective adjuvants to later therapy.SummaryCurrently there are no drugs approved in the United States for the treatment of aphasia. Nevertheless, pharmacological intervention may provide a benefit to all phases of stroke care.