Treatment for Trigeminal Neuralgia, CSF lactate as a diagnostic marker, cancers behind brain metastases, and the link between comorbidities and a common neuropathy; here are 4 advances set to change the field of neurology in 2018.

In India, the prevalence rate of neurological diseases in the last four decades has increased. As per statistics, it is reported that out of 1.27 billion population in India, about 30 million people were diagnosed with neurological disorders in 2014. The common neurological disorders include epilepsy, stroke, Parkinson's disease, and tremors.

Here’s a round-up of four recent advances in the field of neurology.

Microvascular decompression – a better treatment method for Trigeminal Neuralgia

Microvascular decompression (MVD) has emerged as a better treatment option for trigeminal neuralgia (TN) than Gamma knife therapy (GKT). Medical therapy with carbamazepine is the first line treatment for TN; surgical interventions, including MVD, percutaneous destructive procedures, and stereotactic radiosurgery are reserved for the refractory cases.

A recent meta-analysis, comparing the efficacy and complications of MVD and GKT as primary treatment for medically refractory TN, found the initial success rates for MVD and GKT to be 96% and 71.8% respectively. Patients who underwent MVD had a lower rate of facial numbness and dysesthesia. MVD has the potential to become the primary treatment modality in TN.

Article: Microvascular decompression versus stereotactic radiosurgery as primary treatment modality for trigeminal neuralgia: A systematic review and meta‑analysis of prospective comparative trials. Sharma R, Phalak M, Katiyar V, et al. Neurology India. 2018

Prognostic role of CSF lactate in post-operative meningitis

Cerebrospinal fluid (CSF) lactate levels can be a reliable prognostic and and diagnostic marker in postoperative bacterial meningitis (POBM) when compared to the standard CSF markers. CSF lactate is elevated in many conditions such as seizures, meningitis, encephalitis, and cerebral ischaemia. The rate of incidence of POBM is low (1-2%) but is a serious complication of neurosurgery.

A study that investigated the prognostic importance of CSF lactate and its optimal diagnostic cut-off value to determine POBM in neurosurgical patients, found correlation of CSF lactate levels with meningeal infection. Once the antibiotic was started, the CSF lactate levels dropped, and was associated with improvement in patients condition, such as decrease in fever, reduction in neck rigidity and improvement in sensorium. Thus, CSF lactate testing should be considered as a diagnostic marker in the clinical practice.

Article: Prognostic value of cerebrospinal fluid lactate in meningitis in postoperative neurosurgical patients. Kumar S, Sahu BP, Kumar A. Neurology India. 2018

Lung and breast cancers are the primary reasons for brain metastasis

Brain metastasis arises due to primary malignancies of lung, breast, skin and gastrointestinal tract; the lung tumour being the most common primary cancer. But, in nearly 5 to 10% of patients the primary site of cancer is not detected. Brain metastases occurs in about 25% of cancer patients and has high morbidity and mortality rate among the cancer patients.

Analysis of a four-year recorded data revealed that 48.4% of primary malignancies were lung cancer, followed by breast, colorectal and skin cancer (in the descending order). These results regarding the lung and breast cancers as primary sites for BM, are similar to the Western countries, however, incidence of colorectal cancers causing BM is relatively higher.

Article: Spectrum of metastatic neoplasms of the brain: A clinicopathological study in a tertiary care cancer centre. Singh S, Amirtham U, P Chennagiri, et al. Neurology India. 2018

Female gender, comorbidities like diabetes and hypertension are risk factors of Carpel tunnel syndrome

Carpel tunnel syndrome (CTS), is a common peripheral entrapment neuropathy, caused by compression of the median nerve at the writs. A study was conducted to determine the risk factors, symptom severity, as well as the functional status of carpel tunnel syndrome in patients. It was found that females, especially those doing household chores, are more prone than the males.

Co-morbidities such as diabetes mellitus, hypertension, and hypothyroidism can increase the risk for developing CTS. In patients with CTS, the functional status decreased with increasing symptom severity. The knowledge of risk factors can help in providing education to the high-risk groups, to help adopt preventive measures.

Article: Risk factors, symptom severity and functional status among patients with carpal tunnel syndrome. F Sharief, J Kanmani, S Kumar. Neurology India. 2018

Each of these advancements in neurology takes us one-step ahead in better disease management and in prevention.

References:

1. Sharma R, Phalak M, Katiyar V, et al. Microvascular decompression versus stereotactic radiosurgery as primary treatment modality for trigeminal neuralgia: A systematic review and meta‑analysis of prospective comparative trials. Neurology India. 2018; 66
2. Kumar S, Sahu BP, Kumar A. Prognostic value of cerebrospinal fluid lactate in meningitis in postoperative neurosurgical patients. Neurology India. 2018; 66
3. Singh S, Amirtham U, P Chennagiri, et al. Spectrum of metastatic neoplasms of the brain: A clinicopathological study in a tertiary care cancer centre. Neurology India. 2018; 66
4. F Sharief, J Kanmani, S Kumar. Risk factors, Symptom severity and functional status among patients with carpal tunnel syndrome. Neurology India. 2018; 66