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ISSN: Print -2349-0977, Online - 2349-4387
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   Table of Contents - Current issue
Coverpage
April-June 2018
Volume 5 | Issue 1
Page Nos. 1-85

Online since Monday, January 28, 2019

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EDITORIALS  

Clinical neurosciences: Where do we go from here? Highly accessed article p. 1
Yatish Agarwal, Rashmikant Dave
DOI:10.4103/2349-0977.250951  
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Unravelling the exciting new therapeutic pathways in clinical neurology p. 5
Majaz Moonis
DOI:10.4103/2349-0977.250926  
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CHRONICLES OF MEDICINE Top

The neurology timeline: Of demon holes, sacred pathways and great triumphs p. 10
Yatish Agarwal, Pranav Ish, Neera Chaudhry, Ravinder S Sethi
DOI:10.4103/2349-0977.250925  
The first chapter in neurology was composed in the prescience era. Chiseled with flint stones, grisly in nature, it was a narrative where men trephined human skull to treat such maladies as head injury, epilepsy, and disturbed mind. The ungodly practice survived from the late Stone Age until the renaissance. The first written reference to brain is found in the Edwin Smith surgical papyri. Written around 3000 BCE in Egypt, the papyri describe certain cognitive defects of head injuries. The first sapient exploration into the functions and diseases of brain opened in the sixth to fourth century BCE. It began with the Alexandrian anatomists and Hippocratic doctors, gathered steam in the classical era of science with Galen in the first century, and reached its peak with Vesalius during renaissance. Modern neurology, particularly the localization of brain functions, began with German physician Franz Joseph Gall's work on phrenology in the late 18th century and, over the next hundred years, was followed by the discovery of language, motor, and sensory cortical areas. The idea that the nervous system is made up of discrete nerve cells was born out of the neuroanatomical work of Camillo Golgi and a Spanish doctor, Santiago Ramón y Cajal, at the end of 19th century. Major 20th-century developments include advances in understanding of the frontal lobes, the role of visual cortex in perception, the function of hippocampus in memory, lateralization of cortical function, and the introduction of all revealing cross-sectional and functional imaging. While practitioners of medicine across the world unraveled the secrets of maladies that strike the seat of senses and intellect, other accomplished players struck sweet melodies of life by discovering potent molecules, devices, and surgical techniques which could work a remedy and cure.
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RECENT ADVANCES IN STROKE MEDICINE Top

Stroke in the young: Newer concepts in etiopathogenesis and risk factors p. 26
Man Mohan Mehndiratta, Prachi Mehndiratta
DOI:10.4103/astrocyte.astrocyte_48_18  
Background: Stroke in young has become one of the major causes of mortality & morbidity lately. Incidence of stroke in young is on the rise. Recent studies show young stroke being one of the important differential diagnoses for any kind of acute lateralised neurological deficits in younger population. Along with various traditional risk factors, there are some emerging vascular, genetic and others unidentified risk factors implicated in the etiopathogenesis of stroke in young. Burden of the disease along with major long term socioeconomic impacts at the patients, their family & society level are enormous. Objective: Recognition of underlying vascular & genetic risk factors may improve physician's awareness & optimise the outcomes in young stroke patients. Recent advances in the imaging technologies and genetic testing may help the experts to develop effective guidelines for the prevention and treatment of young stroke patients. Conclusion: Considering the increasing burden of the disease, standardised methodology along with more research works have become an imperative need of time in order to decrease the morbidity & mortality in young stroke patients.
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Current strategies in stroke therapy: Temporality, pharmacological agents and endovascular treatments p. 33
Yunis Mayasi, Brian Silver
DOI:10.4103/astrocyte.astrocyte_49_18  
Stroke, a leading cause of morbidity and mortality, remains an active venue for discovery. Advances in stroke neurology include prevention, treatment, and detection, in addition to rehabilitation. In terms of treatment, vast strides have been taken since the five major intra-arterial treatment trials, with extension of the treatment window in addition to the use of imaging for better patient selection. Treatment of hemorrhagic stroke has also improved in the past decade with better understanding of the pathophysiology of the disease, establishment of guidelines for blood pressure control and monitoring, treatment of coagulopathies in addition to surgical interventions. Several ongoing trials are being conducted to further elucidate the utility and efficacy of minimally invasive surgical options in deep intracranial hemorrhage.
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Post stroke restorative therapies: Drugs, devices and robotics p. 39
MV Padma Srivastava, Ashu Bhasin
DOI:10.4103/astrocyte.astrocyte_50_18  
Restorative therapies in neurology aim to improve outcome and function by promoting plasticity within a therapeutic time window between days to weeks to years. In this article, the mechanisms by which cell-based, pharmacological and robotic treatments stimulate endogenous brain remodeling after stroke, particularly neurogenesis, axonal plasticity, and white-matter integrity, are described with a brief outline of the potential of neuroimaging (functional magnetic resonance imaging) techniques. Stem cells aid stroke recovery through mechanisms depending on the type of cells used. Transplanted embryonic stem cells, induced pluripotent cells, and neural stem cells can replace the missing brain cells in the infarcted area, whereas adult stem cells, such as multipotent stromal cells and mononuclear cells, provide trophic support to enhance self-repair systems such as endogenous neurogenesis. Noninvasive brain stimulation provides a valuable tool for interventional neurophysiology by modulating brain activity in a specific distributed, corticosubcortical network. Elucidating the underlying mechanisms of cell-based, pharmacological and rehabilitative therapies is of primary interest and crucial for translation of treatments to clinical use. This will provide an impetus for the development of superior, advanced, and cost-effective neurorestorative interventions that will enhance stroke recovery.
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THE CHANGING LANDSCAPE Top

Multiple sclerosis: Newer concepts on pathophysiology, diagnostic criteria and therapeutics p. 43
Rohit Bhatia, Nishita Singh
DOI:10.4103/astrocyte.astrocyte_51_18  
Multiple sclerosis (MS) is a challenging and disabling demyelinating disorder, presumed to be of autoimmune origin. Various environmental and genetic risk factors have now been implicated in the etiopathogenesis of this disorder. Early and precise diagnosis is critical and is supported by use of recent revision of diagnostic criteria, incorporating imaging and spinal fluid abnormalities. Notably, the treatment armamentarium for MS has expanded substantially over the last two decades with approval of newer drugs and many other drugs in terminal stages of development. However, some of these therapies are associated with long-term effects on immune system and/or severe adverse events which can complicate ensuing therapies. The customisation of treatment requires consideration of many factors like safety, efficacy, patient related factors and finally a comprehensive risk-benefit assessment for an individual patient. This article is intended to help make informed ecisions, keep realistic goals and raising cognizance of multiple factors involved in treating patients with MS.
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Movement disorders: Current understanding of pathophysiology and management p. 55
Madhuri Behari, Abhilekh Srivastava
DOI:10.4103/astrocyte.astrocyte_52_18  
In the last four decades, great strides have been made in understanding the pathophysiology and management of movement disorders. Several new molecules and methods of their delivery have made management of these disorders free of complications. New discoveries of genetic abnormalities have helped in better classification of these disorders along with improved prognostication. Improved imaging techniques that help in better localization of target for deep brain stimulation, refinement of stereotactic procedure, and development of safer anesthetic procedure have together encouraged more patients opting for deep brain stimulation for treatment. In the near future, it is expected that more genetic varieties of disorders will be known which may help in genetic intervention for therapy.
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THE INTIMATE CONNECTION Top

Cross linkage between quality of sleep and neurologic conditions in age-diverse populations p. 63
Anne Marie Morse, Sanjeev V Kothare
DOI:10.4103/astrocyte.astrocyte_53_18  
Sleep medicine is inextricably interwoven with neurological health, be it in the young, adult, or geriatric population. Recent studies have highlighted its clinical benefit in autism, attention deficit hyperactivity disorder, traumatic brain injury, headache, epilepsy, multiple sclerosis, neuromuscular disease, stroke, and Alzheimer's disease. The tool of sleep health optimization may provide significant benefit and transform outcome and prognosis, and may also help yield a greater insight into many of these neurologic conditions.
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THE THERAPEUTIC BOX Top

The antiepileptics: Drug choice in newly diagnosed epilepsy p. 74
Felicia Chu
DOI:10.4103/astrocyte.astrocyte_54_18  
Numerous anti-epileptic drugs now exist worldwide for the treatment of epilepsy. With the availability of second- and third-generation antiepileptic medications, many factors may need to be considered in choosing the most appropriate treatment for an individual based on the tolerability, efficacy, and cost. This review highlights the treatment options and provides insights into how to choose among the various medications available.
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Neuromuscular diseases: Recent advances in antisense oligonucleotide therapy p. 81
Ashok Verma
DOI:10.4103/astrocyte.astrocyte_55_18  
Genetic neuromuscular diseases are caused by defective expression of nuclear or mitochondrial genes. Toxic mutant protein may cause cell death, and thus, strategies that reduce mutant gene expression may provide therapeutic benefit. Synthetic antisense oligonucleotide (ASO) has been known to recognize cellular RNA and control gene expression. In recent years, advances in ASO chemistry, creation of designer ASO molecules to enhance their delivery and safety, and design of clinical trials to judge therapeutic efficacy have ushered into an era of plausible application of ASO technology to treat currently incurable neuromuscular diseases. The US Food and Drug Administration has recently approved two ASO therapies in genetic neuromuscular diseases. This brief overview examines the recent advances in ASO technology, evolution, and use of synthetic ASOs as therapeutic platform, and the mechanism of ASO action by exon-inclusion in spinal muscular atrophy and exon-skipping in Duchenne muscular dystrophy, with attention to their advantages and limitations.
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