The following represent additions to UpToDate since the last version that were considered by the authors and editors to be of particular interest. The new material described below represents a small subset of the updating that has been performed, since approximately 40 percent of the topic reviews are updated during each four-month cycle.
CEREBROVASCULAR DISEASE
Carotid artery disease — Randomized controlled trials comparing carotid artery stenting with endarterectomy for the treatment of symptomatic carotid stenosis have shown that the periprocedural and short term rates of serious complications are higher with stenting than with endarterectomy, whereas both techniques provide similar long-term outcomes for patients with symptomatic carotid occlusive disease. Adding to this body of data are results from the ICSS and CREST trials [1,2].
- The ICSS trial (n = 1713 subjects) found that the proportion of patients who reached the combined endpoint of stroke, death, or myocardial infarction at 120 days was significantly higher for the group assigned to carotid artery stenting compared with the group assigned to carotid endarterectomy (8.5 versus 5.2 percent) [1]. (See "Management of symptomatic carotid atherosclerotic disease", section on 'ICSS'.)
- In the CREST trial (n = 2502 subjects), the proportion of enrolled patients with asymptomatic and symptomatic carotid disease was 47 and 53 percent, respectively [2]. Therefore, the results from CREST are not directly comparable to trials that enrolled only symptomatic patients. With that caveat in mind, CREST found that the periprocedural incidence of stroke in the stenting group was significantly higher, while that of myocardial infarction was significantly lower, compared with the endarterectomy group. At 2.5 years after the procedure, the overall effectiveness and safety of carotid stenting and endarterectomy were similar. (See "Management of symptomatic carotid atherosclerotic disease", section on 'CREST'.)
DEMENTIA
Driving guidelines — A new American Academy of Neurology practice parameter suggests an algorithm for evaluating driving safety in patients with dementia based upon the clinical dementia rating (CDR) [3]. Patients with a CDR of 2 should not drive. Patients with a CDR of 0.5 or 1 should undergo further risk assessment and/or an on-road driving evaluation. (See "Safety and societal issues related to dementia", section on 'Driving'.)
Risk factors — A higher risk of cognitive decline and dementia has been postulated to occur in survivors of acute medical illness, particularly in older adults. In a prospective cohort study, higher rates of cognitive decline and incident dementia were observed among those who had had acute care hospitalization compared to those who did not [4]. An even higher risk was observed for critical illness hospitalizations. (See "Risk factors for dementia", section on 'Acute medical illness'.)
DEMYELINATING DISEASE
Epidemiology of multiple sclerosis — There is a widely held belief that the risk of multiple sclerosis increases with latitude from south to north. However, this notion has been challenged by findings from a 2010 systematic review and meta-analysis [5]. (See "Epidemiology and clinical features of multiple sclerosis in adults", section on 'Geographic factors'.)
EPILEPSY
Childhood absence epilepsy — A randomized clinical trial compared ethosuximide, valproate, and lamotrigine in 453 children with childhood absence epilepsy [6]. Ethosuximide and valproic acid were found to be more effective than lamotrigine in eliminating seizures; ethosuximide had a more favorable adverse event profile compared with valproic acid. (See "Epilepsy syndromes in children", section on 'Absence seizures'.)
Valproate risk in pregnancy — A case-control study using the European Surveillance of Congenital Anomalies database (registering a combined total of 98,075 major congenital malformations) confirmed results of previous smaller studies that valproic acid is associated with an increased risk for several congenital malformations compared to no AED use and compared to other AED use [7]. (See "Management of epilepsy and pregnancy".)
New onset refractory status epilepticus — New onset refractory status epilepticus (NORSE) is a syndrome described in a number of reports of patients who present with severe generalized seizures of unclear etiology in the setting of a prodromal febrile illness [8-11]. Patients typically do not respond to AEDs and mortality and morbidity are high. (See "Status epilepticus in adults", section on 'Etiology'.)
HEADACHE
New daily persistent headache — New daily persistent headache (NDPH) is a type of daily headache that is unremitting from onset or very soon after onset. However, current International Classification of Headache Disorders-2 criteria for NDPH are problematic because they emphasize tension-type headache features while excluding patients with predominant migrainous features. A new study that used modified criteria for the diagnosis found that 56 percent of patients with NDPH had prominent migraine features [12]. Among all patients with NDPH, there was no significant difference between those with or without migraine features regarding pain severity, treatment responsiveness, or prognosis. (See "New daily persistent headache", section on 'Diagnostic criteria'.)
MEDICAL NEUROLOGY
Hypoxic ischemic encephalopathy — There is accumulating evidence that suggests that clinical and laboratory features used to assess neurologic prognosis after cardiac arrest may not be reliable in early evaluations in the setting of induced hypothermia therapy [13,14]. (See "Hypoxic-ischemic brain injury", section on 'Clinical assessment' and "Hypoxic-ischemic brain injury", section on 'Ancillary testing'.)
Lumbar spinal stenosis — A review of a Medicare claims database demonstrated that over the 2002 to 2007 time period, the incidence of major complications and 30-day mortality associated with lumbar spine surgery increased in association with an increased frequency of complex fusion procedures [15]. (See "Lumbar spinal stenosis: Treatment and prognosis", section on Surgical therapy.)
MOVEMENT DISORDERS
Deep brain stimulation for Parkinson disease — Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and globus pallidus pars interna (GPi) appear to have similar effectiveness and safety. Supporting evidence comes from the multicenter VA-NIH trial, which is the first to directly compare STN DBS versus GPi DBS [16]. At 24 months, the mean change in motor function while off medication did not differ significantly between the two treatment groups. (See "Surgical treatment of Parkinson disease", section on 'Subthalamic nucleus versus globus pallidus DBS'.)
NEUROMUSCULAR DISEASE
Chronic inflammatory demyelinating polyneuropathy — Glucocorticoids are considered to be effective for treating chronic inflammatory demyelinating polyneuropathy (CIDP), but few studies have compared different regimens. The PREDICT trial evaluated 40 patients with newly diagnosed, treatment naive CIDP and found no significant difference in the remission rate at 12 months between treatment with pulsed high-dose oral dexamethasone versus standard oral prednisolone treatment [17]. (See "Chronic inflammatory demyelinating polyneuropathy: Treatment and prognosis".)
Myotonic dystrophy — Myotonic symptoms in patients with myotonic dystrophy often do not require treatment. When they do, evidence regarding therapeutic options is limited. In two small seven-week randomized controlled trials involving patients with myotonic dystrophy type 1, treatment with mexiletine was superior to placebo for improvement in grip relaxation time and was well tolerated [18]. However, mexiletine is contraindicated in instances of second and third degree heart block. (See "Myotonic dystrophy: Prognosis and management", section on 'Myotonia'.)
PEDIATRIC NEUROLOGY
Ischemic stroke in children — Strong evidence supporting an association of prothrombotic conditions with pediatric stroke comes from a meta-analysis of 22 observational studies [19]. Conditions associated with an increased risk of arterial ischemic stroke in children (neonates to 18 years old) included protein C deficiency, antiphospholipid antibodies/lupus anticoagulant, elevated lipoprotein(a), factor V Leiden mutation, antithrombin III deficiency, prothrombin gene mutation, MTHFR TT genotype, and protein S deficiency. The association was statistically significant for all of these traits except antithrombin III deficiency and protein S deficiency [19]. (See "Ischemic stroke in children and young adults: Etiology and clinical features", section on 'Hematologic'.)
REFERENCES
- Ederle, J, Dobson, J, Featherstone, RL, et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet 2010; 375:985.
- Brott, TG, Hobson RW, 2nd, Howard, G, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis [Epub ahead of print]. N Engl J Med 2010; :.
- Iverson, DJ, Gronseth, GS, Reger, MA, et al. Practice parameter update: evaluation and management of driving risk in dementia: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2010; 74:1316.
- Ehlenbach, WJ, Hough, CL, Crane, PK, et al. Association between acute care and critical illness hospitalization and cognitive function in older adults. JAMA 2010; 303:763.
- Koch-Henriksen, N, Sorensen, PS. The changing demographic pattern of multiple sclerosis epidemiology. Lancet Neurol 2010; 9:520.
- Glauser, TA, Cnaan, A, Shinnar, S, et al. Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy. N Engl J Med 2010; 362:790.
- Jentink, J, Loane, MA, Dolk, H, et al. Valproic Acid Monotherapy in Pregnancy and Major Congenital Malformations. New Engl J Med 2010; 362:2185.
- Boyd, JG, Taylor, S, Rossiter, JP, et al. New-onset refractory status epilepticus with restricted DWI and neuronophagia in the pulvinar. Neurology 2010; 74:1003.
- Wilder-Smith, EP, Lim, EC, Teoh, HL, et al. The NORSE (new-onset refractory status epilepticus) syndrome: defining a disease entity. Ann Acad Med Singapore 2005; 34:417.
- Costello, DJ, Kilbride, RD, Cole, AJ. Cryptogenic New Onset Refractory Status Epilepticus (NORSE) in adults-Infectious or not?. J Neurol Sci 2009; 277:26.
- Rathakrishnan, R, Wilder-Smith, EP. New onset refractory status epilepticus (NORSE). J Neurol Sci 2009; 284:220;.
- Robbins, MS, Grosberg, BM, Napchan, U, et al. Clinical and prognostic subforms of new daily-persistent headache. Neurology 2010; 74:1358.
- Rossetti, AO, Oddo, M, Logroscino, G, Kaplan, PW. Prognostication after cardiac arrest and hypothermia: a prospective study. Ann Neurol 2010; 67:301.
- Leithner, C, Ploner, CJ, Hasper, D, Storm, C. Does hypothermia influence the predictive value of bilateral absent N20 after cardiac arrest?. Neurology 2010; 74:965.
- Deyo, RA, Mirza, SK, Martin, BI, et al. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 2010; 303:1259.
- Follett, KA, Weaver, FM, Stern, M, et al. Pallidal versus subthalamic deep-brain stimulation for Parkinson's disease. N Engl J Med 2010; 362:2077.
- van Schaik, IN, Eftimov, F, van Doorn, PA, et al. Pulsed high-dose dexamethasone versus standard prednisolone treatment for chronic inflammatory demyelinating polyradiculoneuropathy (PREDICT study): a double-blind, randomised, controlled trial. Lancet Neurol 2010; 9:245.
- Logigian, EL, Martens, WB, Moxley RT, 4th, et al. Mexiletine is an effective antimyotonia treatment in myotonic dystrophy type 1. Neurology 2010; 74:1441.
- Kenet, G, Lutkhoff, LK, Albisetti, M, et al. Impact of thrombophilia on risk of arterial ischemic stroke or cerebral sinovenous thrombosis in neonates and children: a systematic review and meta-analysis of observational studies. Circulation 2010; 121:1838.
