This article presents the different pharmacological classes and therapeutic strategies employed at the different stages of Parkinson's disease. To date, only symptomatic treatments exist. Levodopa remains the most effective treatment with the best benefit-risk ratio. It is the initial treatment of choice for most patients. In order to delay the onset of motor complications, such as dyskinesia or end-of-dose akinesia, dopamine agonists or monoamine oxidase B inhibitors may be proposed as first-line treatment to young patients with mild disability. Motor fluctuations can be improved by adjusting the levodopa dosing frequency or by adding a dopamine agonist, monoamine oxidase inhibitor, or catechol-O-methyltransferase inhibitor. Disabling dyskinesias can be improved by reducing the levodopa dose or using amantadine. Patients with severe motor complications may benefit from a treatment with Duodopa® or subcutaneous apomorphine.
Pietro Maggi, Antoine Guilmot, Sofia Maldonado Slootjes, Caroline Huart, Bernard Hanseeuw, Thierry Duprez, Julien De Greef, Leila Belkhir, Jean Cyr Yombi, Adrian Ivanoiu, Vincent van PeschPublished in the journal : May 2020Category : Neurology
A steadily increasing number of cases with neurological manifestations that are potentially related to COVID-19 are being reported in the literature. These most often include sudden anosmia, headache, encephalopathy, and stroke. The pathophysiological mechanisms underlying "Neuro-COVID" remain largely unknown, while the viral genome is very rarely detected in the cerebrospinal fluid. A study currently ongoing at the Cliniques universitaires Saint-Luc is aimed at investigating COVID-19 associated cerebrospinal fluid changes as well as immunohistochemical evidences of olfactory neuroepithelial cells direct viral infection and evidencing a direct infection of olfactory neuroepithelial cells.
Adrian Ivanoiu, Marianne de Tourtchaninoff, Susana Ferrao-Santos, Peter Y. K. Van den Bergh, Pietro Maggi, Bernard Hanseeuw, Louise-Amélie Cougnon, Olga Seminck, Nicolas DubuissonPublished in the journal : February 2020Category : Neurology
The year 2019 has seen a series of relevant advances in the diagnosis and management of neurological diseases. This edition offers a review of current developments, placing them in their clinical context. As the field is wide, only certain aspects will be presented in more detail, depending on their clinical significance or the involvement of our neurologist team at UCLouvain in the research in question. Thus, we will reflect on the latest guidelines in terms of diagnosis and treatment of migraine, risk of sudden death in epileptic patients, and diagnosis of inflammatory neuropathy. These diagnoses are often not established, whereas effective treatments are available. Some of our young clinical fellow researchers will share current research lines on multiple sclerosis imaging, early Alzheimer's disease diagnosis, and ultrasound as a means of diagnosing peripheral neuropathies.
Marie-Laure Oberweis(1), Laurent Houtekie(2), Jacques Louis(3)Published in the journal : November 2018Category : Neurology
Acute disseminated encephalomyelitis is an inflammatory and demyelinating disease of the central nervous system mainly affecting children. In its classical form, it is characterized by the acute or subacute occurrence of multifocal neurological symptoms and encephalopathy secondary to an infection. Although most children have a good prognosis with slow but complete healing, we here describe the case of a 25-month-old girl with a severe form of acute disseminated encephalomyelitis following a primary Epstein-Barr-Virus infection. Her case is particularly unusual, since it was characterized by a rapid and severe extension of the lesions that led to death.
CADASIL disease is a rare autosomal dominant hereditary angiopathy, primarily characterized by significant white matter damage on MRI. We have herein described a case of Cadasil disease discovered somewhat fortuitously, owing to its insidious symptom onset and the causal mutation 's strongly suspected transmission to the patient’s son.