Spotlight on Migraine in childhood

Childhood migraine is common, affecting 4% of children. Migraine in children commonly causes bilateral or midfrontal headaches. The peak incidence for migraine in males of all ages is 10 to 14 years, and for females, it is 20 to 24 years. The biggest concerns parents have regarding the etiology of childhood headaches are brain tumors or vascular problems, particularly aneurysms. However, when the exam is normal and the headaches are episodic, these concerns are usually unwarranted. The CHAMP trial has led some clinicians to question the utility of pharmacological treatment for migraine. However, many pharmacological approaches are still warranted. In addition, alternative treatments, including acupuncture, biofeedback, and nutraceuticals, have not been adequately studied to show efficacy. The benefit of a healthy lifestyle to treat acute migraine and to forestall chronic migraine is increasingly recognized. For chronic migraine, one treatment to be considered is injection of the greater occipital nerve. In this article, Dr. Raymond Kandt of Johns Hopkins University reviews the clinical manifestations and discusses treatment strategies.

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Spotlight on Neurostimulation in sleep medicine

Sleep ventilatory disorders are prevalent and include, commonly, both obstructive and central sleep apnea. Positive airway pressure therapy, although widely used, has inherent drawbacks, clinically. Alternative treatment modalities have been approved and hold interest within certain spheres.

Dr. Richard Knudsen of the Pacific Sleep Tech in Aiea, Hawaii reviews the first-in-class, novel “electroceuticals” in this article. These “electroceuticals” rely on the pathway of neural signal modulation via products that regulate the firing of neural circuits, in contradistinction to prescription drugs or pharmaceuticals that harbor untoward, systemic, and generalized side effects.

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Twitter Digest for June 25, 2020

Spotlight on Primary CNS angiitis

Diffuse inflammation of small- and medium-sized blood vessels confined exclusively to the brain, meninges, or spinal cord is called primary angiitis of the central nervous system (PACNS). There have been significant advances in the understanding of this disorder due to the identification of pathological and clinical subsets, along with advances in the imaging modality of vessel wall abnormalities. A considerable gap still exists, however, particularly with respect to its pathophysiological mechanisms. Although various laboratory and neuroimaging findings may support the diagnosis of primary CNS angiitis, they are not highly specific, and neurologists often face a substantial challenge when diagnosing this disorder because they need to rule out a vast array of nonvasculitic conditions and secondary causes of central nervous system vasculitis. Therefore, a correct and timely diagnosis of primary CNS angiitis requires a high degree of suspicion coupled with knowledge of other diseases that can masquerade as primary CNS vasculitis.

In this article, Dr. Jorge Moncayo-Gaete of the International University of Ecuador and Dr. Julien Bogousslavsky of the Genolier Swiss Medical Network focus on the clinical and pathological findings, diagnostic work-up, differential diagnosis, and current therapeutic options of this still enigmatic and complex entity.

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Twitter Digest for June 24, 2020