Current opinion in neurology
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This review discusses the interpretation of regulatory randomized controlled trials of antiepileptic drugs. An ever increasing number of drugs have been licensed, more so for add-on treatment than for monotherapy. Regulatory trials constitute the main body of evidence to inform clinical decisions about their use. Designs of regulatory trials for monotherapy are the most controversial as regulators take different views as to the type of designs that are required, which has implications for interpretation and for the risks to which patients are exposed. ⋯ Regulatory trials continue to have major limitations for informing clinical decisions and this should be addressed.
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Cognitive impairment and dementia are among the most common nonmotor changes in Parkinson's disease. The purpose of this review is to present recent findings of clinical and neurobiological aspects of dementia in Parkinson's disease. ⋯ Increased understanding of underlying mechanisms of cognitive decline and dementia in Parkinson's disease has been achieved. This will hopefully lead to novel treatment with the potential of preventing or delaying the onset of dementia by influencing these mechanisms.
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Curr. Opin. Neurol. · Aug 2008
ReviewGait disorders and balance disturbances in Parkinson's disease: clinical update and pathophysiology.
Gait disorders and balance impairments are one of the most incapacitating symptoms of Parkinson's disease. Here, we discuss the latest findings regarding epidemiology, assessment, pathophysiology and treatment of gait and balance impairments in Parkinson's disease. ⋯ Insights into the pathophysiology of Parkinson's disease continue to grow. At the same time, it is becoming clear that some patients may in fact deteriorate with treatment. Future research should focus on the development and evaluation of multifactorial fall prevention strategies.
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Headaches occur frequently in the pediatric population and have a significant impact on both the patient and their family. Migraine, the most common headache disorder for which patients see a physician, still remains underdiagnosed and undertreated. Recent studies have revealed the increasing incidence of migraine and chronic migraine in the pediatric population. ⋯ A comprehensive management approach blending the most current acute, preventive, and biobehavioral treatments will be reviewed. Further research, with novel study designs, in pediatric headaches is needed to help reveal additional pathophysiological mechanisms, improve diagnostic criteria, and advance optimal treatment. Prospective studies are needed to fully evaluate the efficacy of preventive management in this population and to establish whether early intervention might slow this disease progression.