Spotlight on Affective disorders in neurologic disease

In this article, Dr. Sergio Starkstein of the University of Western Australia and Dr. Jaime Pahissa of the Instituto Universitario CEMIC review the frequency, diagnostic strategies, clinical correlates, mechanism, differential diagnoses, and management of affective disorders in frequent acute and chronic neurologic disorders, such as stroke, traumatic brain injury, dementia, Parkinson disease, Huntington disease, multiple sclerosis, and epilepsy. Studies using sophisticated neuroimaging techniques have provided important clues regarding the mechanism of depression and disinhibition in neurologic conditions. Randomized clinical trials have been reported for depression in stroke, Parkinson disease, and Alzheimer disease as well as for the prevention of depression after stroke.

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Spotlight on Gaucher disease

Gaucher disease is a storage disorder caused by mutations in the GBA1 gene, which codes for lysosomal acid beta-glucocerebrosidase (glucocerebrosidase), resulting in accumulation of glucosylceramide (glucocerebroside). Type 2 (acute neuronopathic) and type 3 (chronic neuronopathic) Gaucher disease are in a phenotypic continuum of neurologic abnormalities with variable courses. Enzyme replacement therapy has no effect on the neurologic complications of the disease. CSF glycoprotein nonmetastatic B (GPNMB) may be used to quantify neurologic involvement in Gaucher disease. Mutations in the GBA1 gene are the most common genetic risk factor for Parkinson disease and other synucleinopathies. Glucocerebrosidase activity in brain and peripheral blood is low in Parkinson patients compared to controls.

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Spotlight on Neurodegenerative disorders: treatment with neurotrophic factors

Neurotrophic factors are polypeptides that regulate the proliferation, survival, migration, and differentiation of cells in the nervous system. Neurotrophic factor therapy is based on the evidence that these factors stimulate the survival of degenerating neurons. In this clinical summary, Dr. K K Jain of Basel, Switzerland reviews the role of neurotrophic factors for therapy of neurodegenerative disorders. Delivery to the CNS is a problem because the large neurotrophic molecules cannot cross the blood-brain barrier, and methods to overcome this are described. Several clinical trials have failed, but others are in progress. Gene therapy with stereotactic implantation into the putamen of the gene for neurturin, a member of the same family as glial cell line-derived neurotrophic factor, is in phase II clinical trials for Parkinson disease. A similar gene therapy approach for Alzheimer disease using nerve growth factor has shown neuroprotective effect in phase I clinical trials. Vascular endothelial growth factor, delivered by an intracerebroventricular pump, is in phase II/III clinical trials for amyotrophic lateral sclerosis.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Drug-induced parkinsonism

Despite the development of atypical antipsychotic drugs, parkinsonism is still a common problem among patients treated with these drugs as well as with antiemetics. Because drug-induced parkinsonism frequently produces disability in the elderly, it has replaced tardive dyskinesia as the most significant neurologic complication of antipsychotic drugs in the elderly. Despite the FDA’s concern about increased mortality with these drugs, carried in a “black box warning,” these drugs are widely used in the elderly, particularly in nursing homes. In this clinical summary, Dr. Friedman of Brown University discusses phenomenology, pathophysiology, diagnosis, and treatment.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.