Skip to main content
SpringerLink
Log in

Treatment of Neurological Disorders

  • Chapter
  • First Online:
Neurology at the Bedside

Abstract

Not long ago, neurologists had hardly anything else to offer patients than a diagnosis and words of comfort. Indeed, the discrepancy between the elegance and precision of the clinical neurological diagnosis on one hand and the heartbreaking lack of any substantial therapeutic opportunities on the other was painfully clear to everyone. Fortunately, this situation has completely changed. Advances in our understanding of neurological disease due to modern neuroimaging, molecular neuroscience, and genetic testing, as well as more rigorous standards for the conduction of clinical trials, have translated into striking new therapeutic options. Apart from an ever-increasing drug arsenal, these include surgical therapies (e.g., deep brain stimulation for Parkinson’s disease and hemicraniectomy for middle cerebral artery stroke), intravenous thrombolysis and mechanical thrombectomy for ischemic stroke, and a variety of immunomodulatory biological agents. Although many neurological diseases remain incurable, nowadays practically no disorder is untreatable. This chapter provides an overview of available medical and selected nonmedical treatment options in neurological diseases. Due to space limitations, the information is restricted to indications and, where feasible, suggestions for drug dosages. The treatment of cerebrovascular disorders and epilepsy, however, is covered in greater detail since it usually constitutes the largest and most urgent part of the workload for neurology residents on call. Many neurological disorders may have implications for driving and medicolegal issues. Specific rehabilitation programs may improve motor or cognitive functions significantly and are important for improving quality of life and for preventing functional decline. Counseling and regular follow-up should be an integral part of neurological management. Although not covered by this book, the neurologist should therefore be aware of local regulations and programs for medicolegal issues, neurorehabilitation, counseling, as well as primary prevention of neurological disorders and palliative end-of-life care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    CPP equals MAP minus ICP.

  2. 2.

    Minor variations across countries exist regarding approved indications (concerning the severity and range of specific dementia syndromes).

  3. 3.

    For subjects in status epilepticus, intramuscular midazolam is at least as safe and effective as intravenous lorazepam for prehospital seizures (Silbergleit et al. 2012).

  4. 4.

    Propofol infusion syndrome is a rare, but potentially fatal, complication of prolonged administration (≥48 h) of high doses of propofol (≥4 mg/kg/h). It leads to metabolic acidosis, hypertriglyceridemia, rhabdomyolysis, cardiac arrhythmias, and multiorgan failure.

References and Suggested Reading

  • Baker GA. Depression and suicide in adolescents with epilepsy. Neurology. 2006;66(Suppl):S5–12.

    Article  PubMed  Google Scholar 

  • Baker WL, Colby JA, Tongbram V. Neurothrombectomy devices for the treatment of acute ischemic stroke: state of the evidence. Ann Intern Med. 2011;154:243–52.

    Article  PubMed  Google Scholar 

  • Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372:11–20.

    Article  PubMed  Google Scholar 

  • Boylan LS, Flint LA, Labovitz DL, et al. Depression but not seizure frequency predicts quality of life in treatment resistant epilepsy. Neurology. 2004;62:258–61.

    Article  CAS  PubMed  Google Scholar 

  • BrĂĄthen G, Ben-Menachem E, Brodtkorb E, et al. EFNS Task Force on Diagnosis and Treatment of Alcohol-Related Seizures. EFNS guideline on the diagnosis and management of alcohol-related seizures: report of an EFNS task force. Eur J Neurol. 2005;12:575–81.

    Article  PubMed  Google Scholar 

  • Burns A, editor. Standards in dementia care. London: Taylor & Francis; 2005.

    Google Scholar 

  • Calabresi PA, Radue EW, Goodin D, et al. Safety and efficacy of fingolimod in patients with relapsing-remitting multiple sclerosis (FREEDOMS II): a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Neurol. 2014;13:545–56.

    Article  CAS  PubMed  Google Scholar 

  • Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372:1009–18.

    Article  CAS  PubMed  Google Scholar 

  • Chaudhuri A, Martinez-Martin P, Kennedy PG, et al. EFNS Task Force. EFNS guideline on the management of community-acquired bacterial meningitis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults. Eur J Neurol. 2008;15:649–59.

    Article  CAS  PubMed  Google Scholar 

  • Chernyshev OY, Martin-Schild S, Albright KC, et al. Safety of tPA in stroke mimics and neuroimaging-negative cerebral ischemia. Neurology. 2010;74:1340–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Chimowitz MI, Lynn MJ, Derdeyn CP, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med. 2011;365:993–1003.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Chollet F, Tardy J, Albucher JF, et al. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial. Lancet Neurol. 2011;10:123–30.

    Article  CAS  PubMed  Google Scholar 

  • CLOTS (Clots in Legs Or sTockings after Stroke) Trials Collaboration. Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial. Lancet. 2013;382:516–24.

    Article  Google Scholar 

  • CLOTS Trials Collaboration, Dennis M, Sandercock PA, et al. Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial. Lancet. 2009;373(9679):1958–65.

    Article  Google Scholar 

  • Compter A, van der Worp HB, Schonewille WJ, et al. Stenting versus medical treatment in patients with symptomatic vertebral artery stenosis: a randomised open-label phase 2 trial. Lancet Neurol. 2015;14:606–14.

    Article  PubMed  Google Scholar 

  • Confavreux C, O’Connor P, Comi G, et al. Oral teriflunomide for patients with relapsing-remitting multiple sclerosis (TOWER): a randomized, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol. 2014;13:247–56.

    Article  CAS  PubMed  Google Scholar 

  • Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364(9431):331–7.

    Article  CAS  PubMed  Google Scholar 

  • Etninan N, Brown Jr RD, Breseoglo K, et al. The unruptured intracranial aneurysm treatment score: a multidisciplinary consensus. Neurology. 2015;85:881–9.

    Article  Google Scholar 

  • European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm AJ, et al. ESC Committee for Practice Guidelines. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace. 2010;12:1360–420.

    Article  Google Scholar 

  • Glauser T, Ben-Menachem E, Bourgeois B, et al. Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia. 2013;54:551–63.

    Article  CAS  PubMed  Google Scholar 

  • Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372:1019–30.

    Article  CAS  PubMed  Google Scholar 

  • Hemphill JC, Greenberg SM, Anderson CS, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46:2032–60.

    Article  PubMed  Google Scholar 

  • Hofmeijer J, Kappelle LJ, Algra A, et al. Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol. 2009;8:326–33.

    Article  PubMed  Google Scholar 

  • Hort J, O’Brien JT, Gainotti G, et al. EFNS guidelines for the diagnosis and management of Alzheimer’s disease. Eur J Neurol. 2010;17:1236–48.

    Article  CAS  PubMed  Google Scholar 

  • Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372:2296–306.

    Article  CAS  PubMed  Google Scholar 

  • JĂĽttler E, Schwab S, Schmiedek P, et al. Decompressive surgery for the treatment of malignant infarction of the middle cerebral artery (DESTINY): a randomized, controlled trial. Stroke. 2007;38:2518–25.

    Article  PubMed  Google Scholar 

  • JĂĽttler E, Unterberg A, Woitzik J, et al. Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. N Engl J Med. 2014;279:1091–100.

    Article  Google Scholar 

  • Kanner AM. Depression in epilepsy: prevalence, clinical semiology, pathogenic mechanisms, and treatment. Biol Psychiatry. 2003;54:388–98.

    Article  PubMed  Google Scholar 

  • Kondziella D, Cortsen M, Eskesen V, Hansen K, Holtmannspötter M, Højgaard J, Stavngaard T, Søndergaard H, Wagner A, Welling KL. Update on acute endovascular and surgical stroke treatment. Acta Neurol Scand. 2013;127:1–9.

    Article  CAS  PubMed  Google Scholar 

  • Lansberg MG, Schrooten M, Bluhmki E, Thijs VN, Saver JL. Treatment time-specific number needed to treat estimates for tissue plasminogen activator therapy in acute stroke based on shifts over the entire range of the modified Rankin Scale. Stroke. 2009;40:2079–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • LavallĂ©e PC, Meseguer E, Abboud H, et al. A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects. Lancet Neurol. 2007;6:953–60.

    Article  PubMed  Google Scholar 

  • Lip GY. Using the CHA2DS2-VASc score for stroke risk stratification in atrial fibrillation: a clinical perspective. Expert Rev Cardiovasc Ther. 2013;11:259–62.

    Article  CAS  PubMed  Google Scholar 

  • Mendelow AD, Gregson BA, Fernandes HM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet. 2005;365:387–97.

    Article  PubMed  Google Scholar 

  • Mohr JP, Parides MK, Stapf C, et al. Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial. Lancet. 2014;383:614–21.

    Article  CAS  PubMed  Google Scholar 

  • Neal EG, Chaffe H, Schwartz RH, et al. The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. Lancet Neurol. 2008;7(6):500.

    Article  PubMed  Google Scholar 

  • Pisters R, Lane DA, Nieuwlaat R, et al. A novel user-friendly score (HAS-BLED) to assess one-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138:1093–100.

    Article  PubMed  Google Scholar 

  • Pompili M, Girardi P, Tatarelli R. Death from suicide versus mortality from epilepsy in the epilepsies: a metaanalysis. Epilepsy Behav. 2006;9:641–8.

    Article  PubMed  Google Scholar 

  • Powers WJ, Clarke WR, Grubb Jr RL, et al. Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial. JAMA. 2011;306:1983–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Rhea J, Saver JL. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke. 2007;38:967–73.

    Article  Google Scholar 

  • Riedel CH, Zimmermann P, Jensen-Kondering U, et al. The importance of size: successful recanalization by intravenous thrombolysis in acute anterior stroke. Stroke. 2011;42:1775–7.

    Article  PubMed  Google Scholar 

  • Samuels MA, Ropper AH. Samuels’s manual of neurologic therapeutics. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2010.

    Google Scholar 

  • Sandset EC, Murray GD, Bath PM, et al. Scandinavian Candesartan Acute Stroke Trial (SCAST) Study Group. Relation between change in blood pressure in acute stroke and risk of early adverse events and poor outcome. Stroke. 2012;43:2108–14.

    Article  PubMed  Google Scholar 

  • Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372:2285–95.

    Article  CAS  PubMed  Google Scholar 

  • Schmidt R, Hofer E, Bouwman FH, et al. EFNS-ENS/EAN Guideline on concomitant use of cholinesterase inhibitors and memantine in moderate to severe Alzheimer’s disease. Eur J Neurol. 2015;22:889–98.

    Article  CAS  PubMed  Google Scholar 

  • Silbergleit R, Durkalski V, Lowenstein D, et al. Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med. 2012;366:591–600.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Skoglund TS, Eriksson-RitzĂ©n C, Sörbo A, et al. Health status and life satisfaction after decompressive craniectomy for malignant middle cerebral artery infarction. Acta Neurol Scand. 2008;117:305–10.

    Article  CAS  PubMed  Google Scholar 

  • Sorbi S, Hort J, Erkinjuntti T, Fladby T, et al. EFNS-ENS Guidelines on the diagnosis and management of disorders associated with dementia. Eur J Neurol. 2012;19:1159–79.

    Article  CAS  PubMed  Google Scholar 

  • Sorensen PS. Safety concerns and risk management of multiple sclerosis therapies. Acta Neurol Scand. 2016; doi:10.1111/ane.12712.

    PubMed  Google Scholar 

  • The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333:1581–7.

    Article  Google Scholar 

  • Vahedi K, Vicaut E, Mateo J, et al. Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke. 2007a;38:2506–17.

    Article  PubMed  Google Scholar 

  • Vahedi K, Hofmeijer J, Juettler E, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomized controlled trials. Lancet Neurol. 2007b;6:215–22.

    Article  PubMed  Google Scholar 

  • Wang Y, Zhao X, Liu L, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med. 2013;369:11–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Daniel Kondziella & Gunhild Waldemar

Authors
  1. Daniel Kondziella
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gunhild Waldemar
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Kondziella, D., Waldemar, G. (2017). Treatment of Neurological Disorders. In: Neurology at the Bedside. Springer, Cham. https://doi.org/10.1007/978-3-319-55991-9_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-55991-9_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-55990-2

  • Online ISBN: 978-3-319-55991-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation