Neurology September 2012 Volume 2 Issue 3

Summary: A 63-year-old woman is referred for neurologic consultation because of electrical shocks of pain in a left V3 distribution. The attacks are very brief, but occur many times a day, triggered by cold, touch, and chewing. In between attacks, she is pain free. Her neurologic examination is normal. This straightforward presentation of trigeminal neuralgia leaves the consulting neurologist wondering what to do with the other 45 minutes of the visit. The current article is vignette-based and deals with patients who may not fit into such a neat category. It is meant for the general neurologist, not the headache specialist. Aside from routine scenarios, it includes discussions of atypical facial pain, temporomandibular joint disorder, burning mouth syndrome, and other vexing types of facial pain.(C)2012AAN Enterprises, Inc.

Summary: Rapidly progressive dementias are conditions that typically cause dementia over weeks or months. They are a particular challenge to neurologists as the differential diagnosis often is different from the more typical, slowly progressive dementias. Early and accurate diagnosis is essential, as many of the etiologies are treatable. The information in this review is in part based on experience through our rapidly progressive dementia program at the University of California San Francisco, Memory and Aging Center. As treatment of a rapidly progressive dementia is entirely dependent on the diagnosis, we present a comprehensive, structured, but pragmatic approach to diagnosis, including key clinical, laboratory, and radiologic features. For the 2 most common causes of rapid dementia, treatment algorithms for the autoimmune encephalopathies and symptomatic management for the neurodegenerative causes are discussed.(C)2012AAN Enterprises, Inc.

Summary: Advancements in the field of smell and taste disorders have allowed easier and more reliable diagnosis with minimal effort and cost. Posttraumatic smell and taste disorders have shown a better prognosis than previously recognized. The recognition that many neurodegenerative disorders, such as amnestic mild cognitive impairment, Alzheimer disease, and premotor and idiopathic Parkinson disease have impaired smell loss is an important advancement in the clinical course of these disorders. Smell and taste abnormalities often lead to unexplained weight loss, decreased appetite, depression, and inability to smell smoke and recognize spoiled foods. Symptoms of dysosmia and dysgeusia have been more clinically defined and treated in the last 10 years, but treatment benefits are anecdotal. The morbidity and impaired quality of life in smell and taste disorders has been increasingly recognized and reported this last decade. Information on changes in food preparation has increased for those with impaired taste who do not enjoy eating.(C)2012AAN Enterprises, Inc.

Summary: The growth in health care spending in the United States, though slowed in the last few years, remains unsustainable. Since higher health care spending does not correlate with most measures of improved patient outcome, there are new attempts to define "value" in health care as the ratio of quality to cost. This article reviews newer proposed models for provider payment and organization and their possible effects on neurologic practice.(C)2012AAN Enterprises, Inc.

Summary: Four antiseizure drugs have been approved in the United States since 2008. Clobazam, a 1,5-benzodiazepine, was approved in October 2011 as an adjunctive therapy for Lennox-Gastaut syndrome (LGS) in patients 2 years and older. Lacosamide, an amino acid that selectively enhances the slow inactivation of voltage-gated sodium channels, was approved in October 2008 as an add-on therapy for partial onset seizures in patients 17 years and older. Rufinamide, a triazole derivative, was approved in November 2008 as an adjunctive therapy for LGS in patients 4 years and older. Vigabatrin, an irreversible inhibitor of GABA transaminase, was approved in August 2009 for the treatment of infantile spasms in children ages 1 month to 2 years and intractable complex partial seizures in adults.(C)2012AAN Enterprises, Inc.