111 results
Search Results
2. Zen and the Brain Towards an Understanding of Meditation and Consciousness. James H. Austin, MD, MIT Press, London, 5th printing 2000, 844 pp., UKL 20.50 (paper), ISBN 0-262-51109-6
- Author
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K A Jellinger
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Psychotherapist ,Neurology ,business.industry ,media_common.quotation_subject ,Medicine ,Neurology (clinical) ,Meditation ,Consciousness ,business ,media_common - Published
- 2001
3. European Federation of Neurological Societies (EFNS) Guideline Papers
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Jes Olesen
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Europe ,medicine.medical_specialty ,Neurology ,business.industry ,Family medicine ,Practice Guidelines as Topic ,Humans ,Medicine ,Neurology (clinical) ,Guideline ,business ,Societies, Medical - Published
- 1999
4. Update paper of the scientist panel on demyelinating diseases: is multiple sclerosis still a diagnostic and therapeutic enigma?
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M. Wender and J. Losy
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medicine.medical_specialty ,Pathology ,Natural course ,Neurology ,business.industry ,Multiple sclerosis ,medicine ,Alternative medicine ,Neurology (clinical) ,Disease ,medicine.disease ,Intensive care medicine ,business - Abstract
Despite great progress in the diagnosis and therapy of multiple sclerosis (MS) some problems remain unsolved. For example, should immunologically negative cases also be classified as multiple sclerosis? In addition, we are still waiting for medication which will have a definite impact on the natural course of the disease.
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- 1997
5. Systematic review of cases of acute myelitis in individuals with COVID‐19
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Alexander Kunz, Eva C. Schulte, Larissa Hauer, and Johann Sellner
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Male ,medicine.medical_specialty ,Myelitis ,Context (language use) ,Myelitis, Transverse ,Guillain-Barre Syndrome ,Acute motor axonal neuropathy ,neurological complication ,SARS‐CoV‐2 ,Covid-19 ,Sars-cov-2 ,Acute Transverse Myelitis ,Autoimmune ,Immune-mediated ,Neuroinfection ,Neurological Complication ,Cerebrospinal fluid ,COVID‐19 ,Internal medicine ,acute transverse myelitis ,medicine ,Humans ,neuroinfection ,medicine.diagnostic_test ,SARS-CoV-2 ,business.industry ,COVID-19 ,autoimmune ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Spinal cord ,Magnetic Resonance Imaging ,Regimen ,medicine.anatomical_structure ,Neurology ,Position Paper ,Neurology (clinical) ,business ,immune‐mediated - Abstract
Background and purpose An incremental number of cases of acute transverse myelitis (ATM) in individuals with ongoing or recent coronavirus disease 2019 (COVID-19) have been reported. Methods A systematic review was performed of cases of ATM described in the context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by screening both articles published and in preprint. Results Twenty cases were identified. There was a slight male predominance (60.0%) and the median age was 56 years. Neurological symptoms first manifested after a mean of 10.3 days from the first onset of classical, mostly respiratory symptoms of COVID-19. Overall, COVID-19 severity was relatively mild. Polymerase chain reaction of cerebrospinal fluid for SARS-CoV-2 was negative in all 14 cases examined. Cerebrospinal fluid findings reflected an inflammatory process in most instances (77.8%). Aquaporin-4 and myelin oligodendrocyte protein antibodies in serum (tested in 10 and nine cases, respectively) were negative. On magnetic resonance imaging, the spinal cord lesions spanned a mean of 9.8 vertebral segments, necrotic-hemorrhagic transformation was present in three cases and two individuals had additional acute motor axonal neuropathy. More than half of the patients received a second immunotherapy regimen. Over a limited follow-up period of several weeks, 90% of individuals recovered either partially or near fully. Conclusion Although causality cannot readily be inferred, it is possible that cases of ATM occur para- or post-infectiously in COVID-19. All identified reports are anecdotal and case descriptions are heterogeneous. Whether the condition and the observed radiological characteristics are specific to SARS-CoV-2 infection needs to be clarified.
- Published
- 2021
6. Sex and gender differences in Alzheimer’s disease: current challenges and implications for clinical practice
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Reinhold Schmidt, Maria Teresa Ferretti, A. Santuccione Chadha, G. Gialdini, V. Mantua, Ewelina Biskup, Zuzana Nedelska, Katrin Rauen, T. Benke, Dorota Religa, Jakub Hort, and Julie Martinkova
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medicine.medical_specialty ,Neurology ,tau Proteins ,Disease ,Analysis of clinical trials ,03 medical and health sciences ,Cognition ,0302 clinical medicine ,Alzheimer Disease ,medicine ,Humans ,Relevance (law) ,Dementia ,030212 general & internal medicine ,Clinical Trials as Topic ,Sex Characteristics ,Amyloid beta-Peptides ,business.industry ,medicine.disease ,Clinical trial ,Position paper ,Neurology (clinical) ,Cognition Disorders ,business ,Biomarkers ,030217 neurology & neurosurgery ,Clinical psychology - Abstract
Alzheimer's disease (AD) is characterized by high heterogeneity in disease manifestation, progression and risk factors. High phenotypic variability is currently regarded as one of the largest hurdles in early diagnosis and in the design of clinical trials; there is therefore great interest in identifying factors driving variability that can be used for patient stratification. In addition to genetic and lifestyle factors, the individual's sex and gender are emerging as crucial drivers of phenotypic variability. Evidence exists on sex and gender differences in the rate of cognitive deterioration and brain atrophy, and in the effect of risk factors as well as in the patterns of diagnostic biomarkers. Such evidence might be of high relevance and requires attention in clinical practice and clinical trials. However, sex and gender differences are currently seldom appreciated; importantly, consideration of sex and gender differences is not currently a focus in the design and analysis of clinical trials for AD. The objective of this position paper is (i) to provide an overview of known sex and gender differences that might have implications for clinical practice, (ii) to identify the most important knowledge gaps in the field (with a special regard to clinical trials) and (iii) to provide conclusions for future studies. This scientific statement is endorsed by the European Academy of Neurology.
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- 2020
7. The position of the neurologist in neuro-oncology1
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Wolfgang Grisold, Robin Grant, Riccardo Soffietti, J J Heimans, and T J Postma
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medicine.medical_specialty ,Neurology ,genetic structures ,business.industry ,Neuro oncology ,Cancer treatment ,Position (obstetrics) ,Quality of life (healthcare) ,Multidisciplinary approach ,medicine ,Position paper ,Medical physics ,Neurology (clinical) ,Psychiatry ,business - Abstract
Neuro-oncology is a growing new subspeciality with a strong interdisciplinary character. This position paper explains the role of neurology in the multidisciplinary field of neurosurgeons, radiotherapists and general oncologists, dealing with neuro-oncological patients. The paper delineates the varied spectrum of the field of neuro-oncology which expands from primary brain tumours, to metastatic and non-metastatic effects of systemic cancer on the central and peripheral nervous system, neurotoxicity due to cancer treatment and issues of quality of life. It has been written by the scientific neuro-oncology panel of the European Federation of Neurological Societies (EFNS) to delineate the situation of neuro-oncology in Europe, and facilitate the understanding and implementation of this subspeciality in the future.
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- 2002
8. Instructions for Authors.
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NEUROLOGY ,MEDICINE ,NEUROLOGICAL disorders ,PUBLISHING ,MANUSCRIPTS - Abstract
The article reports that the "European Journal of Neurology" will consider for publication papers in neurology and related areas in the following categories: original papers, short reports, reviews, letters to the editor, book reviews and short reports. The articles should be no more than 1500 words and two tables or figures. Letters to the editor should be no more than 500 words. It is to be noted that the journal will normally only accept case reports if they are submitted as letters to the editor.
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- 2005
- Full Text
- View/download PDF
9. Instructions for Authors.
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NEUROLOGY ,MEDICINE ,AUTHORS - Abstract
Presents an advisory for authors in the publication of papers in neurology and related areas in this field. Submission of manuscripts; Presentation of manuscripts; Manuscript acceptance.
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- 2005
- Full Text
- View/download PDF
10. Instructions for Authors.
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AUTHORS ,NEUROLOGY ,MEDICINE ,NEUROLOGICAL disorders ,PERIODICALS - Abstract
Provides instructions for authors on the publication of papers in neurology and related areas in the "European Journal of Neurology". Categories of publications; Submission of manuscripts; Author material archive policy.
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- 2005
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- View/download PDF
11. Instructions for Authors.
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PUBLISHING ,PERIODICALS ,NEUROLOGY ,NEUROLOGICAL disorders ,MEDICINE - Abstract
Presents instructions for authors who want to publish their papers in the "European Journal of Neurology." List of categories that are to be published in the journal; Submission of manuscripts; Presentation of manuscripts.
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- 2004
- Full Text
- View/download PDF
12. Instructions for Authors.
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PERIODICAL publishing ,NEUROLOGICAL disorders ,NEUROLOGY ,MEDICINE ,PUBLISHING - Abstract
The article presents instructions for contributing authors to the "European Journal of Neurology." Publication papers in neurology and related areas will be considered in five categories including original papers, short communications and book reviews. The journal prefers to receive all manuscript submissions electronically. All papers will be accepted on the understanding that these will not be published elsewhere.
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- 2007
- Full Text
- View/download PDF
13. EUROPEAN JOURNAL OF NEUROLOGY.
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Olsesen, Jes
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NEUROLOGY ,PERIODICALS ,SOCIETIES ,READERSHIP ,MEDICINE ,PERIODICAL circulation - Abstract
Comments on the success of the "European Journal of Neurology." Reasons the European Federation of Neurological Societies created the journal; Readership; Increase in submission of excellent papers.
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- 2001
14. Guillain Barré Syndrome associated with SARS‐CoV‐2 infection. A Systematic Review
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L. Viganò, Eduardo Nobile-Orazio, Pietro Emiliano Doneddu, P. De Sanctis, and C. Selmi
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Pediatrics ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,medicine.medical_treatment ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Clinical Neurology ,Coronavirus 2019 Disease ,Reviews ,SARS‐CoV‐2 ,Disease course ,03 medical and health sciences ,0302 clinical medicine ,COVID‐19 ,Medicine ,030212 general & internal medicine ,Mechanical ventilation ,Guillain-Barre syndrome ,business.industry ,Incidence (epidemiology) ,Outbreak ,medicine.disease ,Neurology ,Etiology ,Guillain‐Barré Syndrome ,neuropathy ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Background Guillain‐Barré syndrome (GBS) incidence can increase during outbreaks of infectious illnesses. A few cases of GBS associated with coronavirus disease 2019 (COVID‐19) infection have been reported. To identify specific clinical features of GBS associated with COVID‐19. Methods We searched Pubmed, EMBASE and Cochrane from November 1, 2019 to May 17, 2020 and included all papers with full text in English, Spanish, French, or Italian, reporting original data of patients with GBS and COVID‐19. Data were extracted according to a predefined protocol. Results A total of 18 patients reported in 14 papers were included in this review. All the patients were symptomatic for COVID‐19, with cough and fever as the most frequently reported symptoms. The interval between the onset of symptoms of COVID‐19 and the first symptoms of GBS ranged from ‐8 to 24 days (mean 9 days; median 10 days). Most of the patients had a typical GBS clinical form predominantly with a demyelinating electrophysiological subtype. Mechanical ventilation was necessary in 8 (44%) patients. Two (11%) patients died. Conclusions Published cases of GBS associated with COVID‐19 report a sensorimotor, predominantly demyelinating GBS with a typical clinical presentation. Clinical features and disease course seem similar to those observed in GBS related to other etiologies. These results should be interpreted with caution since only 18 cases have been heterogeneously reported so far.
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- 2020
15. Response to: SOD1 mutations in adult-onset distal spinal muscular atrophy
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Giorgio Tasca, Bjarne Udd, and Mario Sabatelli
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Adult ,Pathology ,medicine.medical_specialty ,Secondary myopathy ,SOD1 ,Distal spinal muscular atrophy ,Disease ,Muscular Atrophy, Spinal ,03 medical and health sciences ,0302 clinical medicine ,Superoxide Dismutase-1 ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Denervation ,Muscle biopsy ,medicine.diagnostic_test ,Blinking ,business.industry ,Neurology ,Mutation ,Neurology (clinical) ,Supranuclear Palsy, Progressive ,business ,030217 neurology & neurosurgery - Abstract
We thank Dr de Fuenmayor-Fernandez de la Hoz and colleagues for their interest in our paper and their comments. Clearly distinguishing neurogenic from myogenic disease processes is not always straightforward and we fully share the view that, to some extent, myopathic alterations on muscle biopsy may come along with long-standing denervation, thus configuring a so-called "secondary myopathy". This could in fact be the major contributing factor to explain the imaging and pathology features of patient 4 in our paper. However, we disagree that muscle biopsy findings in patient 1 resemble the picture reported in their patient.
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- 2020
16. Abstracts of the 5th International Conference of Stroke and 2nd Conference of the Mediterranean Stroke Society.
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MEDICINE , *HEART diseases , *CARDIAC arrest , *EPILEPSY - Abstract
Presents abstracts of several medical research papers on the heart and brain. `Intracardial haemodynamics disturbance in patients with ardioembolic stroke,' by O. Dubenko; `Impairment of cardiac activity during epileptic seizures: a relation to sudden death in epilepsy?,' by O. Mameli et al; `Clinical and prognostic significance of arrhythmogenesis factors at patients with myocardial infarction, evaluation of possibility of their correction,' by E. Gulaeva et al.
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- 2001
- Full Text
- View/download PDF
17. Advances and insights into neurological practice 2016-17
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Anthony H.V. Schapira
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medicine.medical_specialty ,Neurology ,business.industry ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Etiology ,Subject areas ,Humans ,030212 general & internal medicine ,Neurology (clinical) ,Nervous System Diseases ,Intensive care medicine ,business ,Stroke ,030217 neurology & neurosurgery ,Acute stroke - Abstract
Papers published by the European Journal of Neurology reflect the broad interest of practicing neurologists in advances in the aetiology, diagnosis and management of neurological disorders. As a general journal, the proportion of papers in the different subject areas reasonably reflects the case load of a practising neurologist. Stroke represents the largest proportion of papers published, including those on pathophysiology (1-23), acute stroke management (24-47) and the outcome of patients who have suffered stroke (48-72). This article is protected by copyright. All rights reserved.
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- 2017
18. Estimating the burden of early onset dementia; systematic review of disease prevalence
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Martin Prince, Dorota Frydecka, M. A. Lambert, Emma Reynish, Laura Fratiglioni, Jean Georges, Andrzej Kiejna, E. von Strauss, and Horst Bickel
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Gerontology ,medicine.medical_specialty ,education.field_of_study ,business.industry ,MEDLINE ,Population ,Prevalence ,medicine.disease ,Cost of Illness ,Neurology ,Epidemiology ,Humans ,Medicine ,Dementia ,Neurology (clinical) ,business ,education ,Pre-Senile Dementia ,Disease burden ,Frontotemporal dementia - Abstract
Dementia is more common in older age but a number of people develop symptoms at a younger age and are said to have early onset dementia (EOD). Those with EOD face different challenges to those with onset later in life. It has been difficult to quantify this disease burden. This is a systematic review of papers reporting on the prevalence of EOD. A search of Medline and Embase was performed. This was followed by a hand search of the references of these papers. Eleven suitable studies were included. All of the data was from more economically developed countries. The studies were heterogeneous in their design hindering direct comparison. The majority of the papers looked at all types of dementia although many gave a breakdown of the prevalence of different subgroups. A variety of diagnostic criteria was employed. Figures of 38 to 260 per 100,000 are quoted by papers looking at various different types of dementia together with an onset of between 30 and 64 or up to 420 per 100,000 for those aged 55-64. Prevalence rises as age approaches 65. Epidemiological data for prevalence rates for EOD are sparse. EOD remains a rare condition with low case numbers. Assimilation and comparison of results from existing studies is difficult due to methodological heterogeneity. Cross-national standardization of methodology should be a priority for future research in this area.
- Published
- 2014
19. EFNS-ENS guidelines for the use of PCR technology for the diagnosis of infections of the nervous system
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Erich Schmutzhard, Peter G. E. Kennedy, Israel Steiner, A. Chaudhuri, and Johann Sellner
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medicine.medical_specialty ,Tuberculosis ,Cns infections ,business.industry ,Context (language use) ,Infections ,medicine.disease ,Polymerase Chain Reaction ,Tuberculous meningitis ,law.invention ,Neurology ,Guidelines recommendations ,law ,Immunology ,medicine ,Humans ,Neurology (clinical) ,Nervous System Diseases ,Intensive care medicine ,business ,Meningitis ,Polymerase chain reaction - Abstract
Background Polymerase chain reaction (PCR) as a means to amplify nucleic acids has become an essential element in diagnosis of infections. It has evolved into a simple and rapid, easy- to- use approach. At present there are no published guidelines for the usage of PCR technology for the diagnosis of infections of the nervous system. Methods We reviewed the advantages and pitfalls of PCR in order to guide neurologists and infectious diseases experts in its application for the diagnosis of infections of the nervous system. Medical reference systems were searched, and original papers, meta-analyses, review papers, book chapters and guidelines recommendations were reviewed. The final literature search was performed in May 2012. Recommendations were reached by consensus. Recommendations The reliability of PCR technology for the diagnosis of neurological infections is currently based on the pathogens. The main contribution of PCR is to the diagnosis of viral infections followed by bacterial CNS infections with the notable exception of tuberculous meningitis. Efficacy for the diagnosis of protozoal infections and helminthic infestations has also been established in many instances. Unfortunately, current molecular PCR technology is far from becoming routine in resource-poor countries where such infections are prevalent. Despite the importance of fungal infections in the context of the immune-compromised host, there is not enough data to recommend the routine use of PCR. Conclusions PCR technology is currently a reliable method for the diagnosis of viral and bacterial (except tuberculosis) infections, and only for some protozoal infections and helminthic infestations.
- Published
- 2012
20. Neurophysiological tests and neuroimaging procedures in non-acute headache (2nd edition)
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Mark C. Kruit, Lars Friberg, Giorgio Sandrini, Rigmor Jensen, Jean Schoenen, David Russell, Gianluca Coppola, Trond Sand, M. Sanchez del Rìo, Philippe Rossi, and Wilfrid Jänig
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medicine.medical_specialty ,Pediatrics ,medicine.diagnostic_test ,business.industry ,Physical examination ,medicine.disease ,Palpation ,Transcranial Doppler ,Surgery ,Epilepsy ,Neurology ,Migraine ,Neuroimaging ,medicine ,Neurology (clinical) ,Differential diagnosis ,Trigeminal autonomic cephalalgia ,business - Abstract
Background and purpose: A large number of instrumental investigations are used in patients with non-acute headache in both research and clinical fields. Although the literature has shown that most of these tools contributed greatly to increasing understanding of the pathogenesis of primary headache, they are of little or no value in the clinical setting. Methods: This paper provides an update of the 2004 EFNS guidelines and recommendations for the use of neurophysiological tools and neuroimaging procedures in non-acute headache (first edition). Even though the period since the publication of the first edition has seen an increase in the number of published papers dealing with this topic, the updated guidelines contain only minimal changes in the levels of evidence and grades of recommendation. Results: (i) Interictal EEG is not routinely indicated in the diagnostic evaluation of patients with headache. Interictal EEG is, however, indicated if the clinical history suggests a possible diagnosis of epilepsy (differential diagnosis). Ictal EEG could be useful in certain patients suffering from hemiplegic or basilar migraine. (ii) Recording evoked potentials is not recommended for the diagnosis of headache disorders. (iii) There is no evidence warranting recommendation of reflex responses or autonomic tests for the routine clinical examination of patients with headache. (iv) Manual palpation of pericranial muscles, with standardized palpation pressure, can be recommended for subdividing patient groups but not for diagnosis. Pain threshold measurements and EMG are not recommended as clinical diagnostic tests. (v) In adult and pediatric patients with migraine, with no recent change in attack pattern, no history of seizures, and no other focal neurological symptoms or signs, the routine use of neuroimaging is not warranted. In patients with trigeminal autonomic cephalalgia, neuroimaging should be carefully considered and may necessitate additional scanning of intracranial/cervical vasculature and/or the sellar/orbital/(para)nasal region. In patients with atypical headache patterns, a history of seizures and/or focal neurological symptoms or signs, MRI may be indicated. (vi) If attacks can be fully accounted for by the standard headache classification (IHS), a PET or SPECT scan will normally be of no further diagnostic value. Nuclear medical examinations of the cerebral circulation and metabolism can be carried out in subgroups of patients with headache for the diagnosis and evaluation of complications, when patients experience unusually severe attacks or when the quality or severity of attacks has changed. (vii) Transcranial Doppler examination is not helpful in headache diagnosis.
- Published
- 2010
21. Dystonia. The paediatric perspective
- Author
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E. Fernández-Alvarez
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Dystonia ,medicine.medical_specialty ,business.industry ,Perspective (graphical) ,Paroxysmal dyskinesia ,medicine.disease ,nervous system diseases ,Physical medicine and rehabilitation ,Neurology ,Health care ,otorhinolaryngologic diseases ,medicine ,Life expectancy ,Neurology (clinical) ,Medical diagnosis ,Dopamine biosynthesis ,business ,Psychiatry - Abstract
Background and aims: This review focuses on some paediatric dystonias such as transient dystonias, new primary paediatric-onset dystonias, dopamine biosynthesis defects and new paroxysmal disorders. It is designed to provide practical help for neurologists and neuropediatricians to make appropriate diagnoses and plan the management of these disorders. Material and methods: Literature searches were performed and original papers, meta-analyses and review papers were reviewed. Conclusion: Paediatric onset dystonia is an increasingly interesting group of conditions that provides an expanding area of neuroscientific knowledge. Given the long life expectancy of children, appropriate treatment at the correct moment will have an important, lasting effect on the personal, social and healthcare domains.
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- 2010
22. EFNS guidelines on the molecular diagnosis of channelopathies, epilepsies, migraine, stroke, and dementias
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Hanne F. Harbo, Chantal M. E. Tallaksen, Bertrand Fontaine, T. Gasser, Massimo Zeviani, Z. Szolnoki, Antonella Spinazzola, Josef Finsterer, Caterina Mariotti, C. Van Broeckhoven, Ludger Schöls, Sarah J. Tabrizi, Jonathan Baets, J.-M. Burgunder, P. De Jonghe, Timothy Lynch, and S. Di Donato
- Subjects
medicine.medical_specialty ,Pediatrics ,medicine.diagnostic_test ,business.industry ,Frontotemporal lobar degeneration ,Evidence-based medicine ,medicine.disease ,Leukoencephalopathy ,Epilepsy ,Neurology ,medicine ,Dementia ,Myoclonic epilepsy ,Neurology (clinical) ,Psychiatry ,business ,Genetic testing ,Frontotemporal dementia - Abstract
Objectives: These EFNS guidelines on the molecular diagnosis of channelopathies, including epilepsy and migraine, as well as stroke, and dementia are designed to summarize the possibilities and limitations of molecular genetic techniques and to provide diagnostic criteria for deciding when a molecular diagnostic work-up is indicated. Search strategy: To collect data about planning, conditions, and performance of molecular diagnosis of these disorders, a literature search in various electronic databases was carried out and original papers, meta-analyses, review papers, and guideline recommendations were reviewed. Results: The best level of evidence for genetic testing recommendation (B) can be found for a small number of syndromes, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, severe myoclonic epilepsy of infancy, familial recurrent hemorrhages, familial Alzheimer’s disease, and frontotemporal lobar degeneration. Good practice points can be formulated for a number of other disorders. Conclusion: These guidelines are provisional, and the future availability of molecular genetic epidemiological data about the neurogenetic disorders under discussion in our article will allow improved recommendation with an increased level of evidence.
- Published
- 2010
23. EFNS guidelines on the molecular diagnosis of mitochondrial disorders
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Antonella Spinazzola, Josef Finsterer, Sarah J. Tabrizi, Massimo Zeviani, Caterina Mariotti, Jonathan Baets, Bertrand Fontaine, P. De Jonghe, C. Van Broeckhoven, Ludger Schöls, Hanne F. Harbo, Alexander Lossos, J.-M. Burgunder, Timothy Lynch, T. Gasser, Z. Szolnoki, Chantal M. E. Tallaksen, and S. Di Donato
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medicine.medical_specialty ,Task force ,business.industry ,MEDLINE ,Guideline ,Gene mutation ,Cochrane Library ,Diagnostic tools ,Appropriate use ,Neurology ,Physical therapy ,medicine ,Medical physics ,Neurology (clinical) ,business ,Genetic diagnosis - Abstract
Objectives: These European Federation of Neurological Sciences (EFNS) guidelines are designed to provide practical help for the general neurologist to make appropriate use of molecular genetics for diagnosing mitochondrial disorders (MIDs), which gain increasing attention and are more frequently diagnosed due to improved diagnostic tools. Background: Since the publication of the first EFNS guidelines on the molecular diagnosis of inherited neurological diseases in 2001, rapid progress has been made in this field, necessitating the creation of an updated version. Search strategy: To collect data about the molecular diagnosis of MIDs search for literature in various electronic databases, such as Cochrane library, MEDLINE, OMIM, GENETEST or Embase, were carried out and original papers, meta-analyses, review papers, and guideline recommendations were reviewed. Results: The guidelines summarise the possibilities and limitations of molecular genetic diagnosis of MIDs and provide practical recommendations and diagnostic criteria in accordance with the EFNS Scientific Committee to guide the molecular diagnostic work-up of MIDs. Recommendations: The proposed guidelines suggest an approach to the molecular diagnosis of MIDs in a manner accessible to general neurologists.
- Published
- 2009
24. A systematic review of the epidemiology of multiple sclerosis in South America
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Liliana Patrucco, Edgardo Cristiano, and Juan Ignacio Rojas
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medicine.medical_specialty ,Multiple Sclerosis ,Population ,Prevalence ,MEDLINE ,Disease ,Environment ,Hygiene hypothesis ,Environmental health ,Epidemiology ,Humans ,Medicine ,Vitamin D ,education ,Developing Countries ,education.field_of_study ,Traditional medicine ,business.industry ,Incidence ,Incidence (epidemiology) ,Phototherapy ,South America ,Epidemiologic Studies ,Neurology ,Neurology (clinical) ,business ,Developed country - Abstract
Hundreds of publications dealing with the prevalence of multiple sclerosis (MS) throughout the world exist, but little data have been published from South America. Epidemiological studies of MS vary according to environmental, racial and genetic factors; a better understanding of MS in South America would help us to elucidate the disease pattern in this population. The aim of this study is to review the evidence relevant to MS epidemiology in South America. We performed a systematic review of articles of MS epidemiology in South America, with special emphasis on those providing information on the incidence and prevalence of MS (population-based studies). Six papers provided information on MS epidemiology. One paper used the capture-recapture methodology, while the remainder employed traditional methods to collect the data. Population-based studies showed an MS prevalence rate ranging from 1.48 to 17 per 100 000 inhabitants. Available data suggest that the prevalence of MS is lower in South America than in developed countries. The reason for this observation is unknown. Some investigators suggest that certain environmental factors like sun exposure and vitamin D supplementation or the called 'hygiene hypothesis' may protect this population. Future studies will contribute to elucidate the etiology of that difference.
- Published
- 2008
25. Parkinson's disease, smoking and family history: meta-analysis
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Rafael Fernández-Crehuet Navajas, A. S. Del Castillo, and Mohamed Farouk Allam
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business.industry ,MEDLINE ,Disease ,Odds ratio ,Confidence interval ,Neurology ,Meta-analysis ,Medicine ,Observational study ,Neurology (clinical) ,Family history ,business ,Chi-squared distribution ,Demography - Abstract
To estimate the pooled risk of tobacco smoking for Parkinson's disease (PD) in patients with and without PD family history. We conducted systematic searches of Medline, PsycLIT, Embase, Current contents, Best Evidence, Nisc Mexico Biblioline, previous reviews, examination of cited reference sources and personal contact and discussion with several investigators expert in the field. Studies in all languages were considered. Published observational studies on PD and cigarette smoking stratified by PD family history were reviewed. When two or more papers were based on an identical study, the paper that principally investigated the relationship between PD, smoking stratified by PD family history or the paper that was published last was used. Three case-control studies were carried out between 1996 and 2000, of which one reported risk estimates. The risk of ever smoker in patients with positive PD family history was 0.82 (95% confidence interval 0.44-1.53). There was an obvious protective effect in the pooled estimate in patients with negative PD family history [odds ratio 0.77 (95% confidence interval 0.59-1.01)]. Although our pooled estimates show that smoking is inversely associated with the risk of PD only in patients with negative PD family history, further studies evaluating the interaction between smoking and PD family history are strongly needed.
- Published
- 2003
26. Weekday distribution of alcohol consumption in Norway: influence on the occurrence of epileptic seizures and stroke?
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Eylert Brodtkorb, Geir Bråthen, Gunnar Bovim, Trond Sand, and Grethe Helde
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Adult ,Male ,medicine.medical_specialty ,Pediatrics ,Time Factors ,Alcohol Drinking ,Binge drinking ,Electroencephalography ,Epilepsy ,Alcohol Withdrawal Seizures ,medicine ,Humans ,Medical history ,Psychiatry ,Alcohol Use Disorders Identification Test ,Ethanol ,medicine.diagnostic_test ,Norway ,business.industry ,Symptomatic seizures ,Middle Aged ,medicine.disease ,Stroke ,Neurology ,Female ,Neurology (clinical) ,Epileptic seizure ,medicine.symptom ,business - Abstract
The aims of this dissertation were to investigate alcohol-related seizures in clinical neurological practice. We wanted to assess the extent of this problem, to classify the seizures, and to investigate methods to improve the clinical diagnosis of such seizures. We propose an arbitrary but simple and reproducible way of diagnosing alcohol-related seizures and alcohol withdrawal seizures. Papers I and II relate to seizure classification and the extent of the problem in relation to the level and weekly pattern of alcohol use. Paper III investigates the performance of various biological markers as aids in the diagnosis of alcohol-related seizures. Paper IV explores pitfalls in the result interpretation for two methods for detection of CDT in patients with neurological disorders. Paper V investigates the utility of standard EEG for the identification of alcohol-related seizures. Even though the general alcohol consumption in our region is low, every third patient with an epileptic seizure leading to hospitalisation had hazardous alcohol consumption.Evidence of focal lesions or focal seizure start was found in a high proportion of alcohol-related seizures. All such seizures were secondarily generalized and thus, we challenge the establishment impression that the vast majority of alcohol-related seizures are primarily generalized. Binge drinking (more than six drinks for men or four drinks for women, in a single drinking occasion) was common, but had little influence on seizure susceptibility or timing of seizures. In contrast to prior knowledge, we found that in some patients there was no time lag from cessation of drinking to the occurrence of a seizure, but falling intake levels prior to withdrawal seizures were demonstrated. This indicates that a state of relative withdrawal while still drinking may be sufficient to induce a seizure. Carbohydrate-deficient transferring (CDT) is the most accurate biomarker for alcohol use and good adjunct to the diagnosis of alcohol-related seizures, but its accuracy does not compete with a good clinical investigation. Generally poor accuracy should be expected for fertile women. Women on enzyme-inducing antiepileptic drugs who drink no or little alcohol seem to be at risk of having false positive CDT. Other variables associated with increased CDT were low body mass index, or having total transferring levels outside normal range. A definitely abnormal EEG suggests epilepsy or symptomatic seizures unrelated to alcohol use. The predictive value of a normal EEG is limited, but the typical post-ictal finding in alcohol-related seizures is nevertheless a normal low-amplitude EEG record. The best method for identification of alcohol-related seizures is a clinical work-up based on a thorough medical history. The Alcohol Use Disorders Identification Test (AUDIT) provides a reliable measure of drinking habits. CDT is a good supplement to the clinical diagnosis when there is doubt, if factors associated with false-positive values are appreciated. The diagnostic value of EEG is limited.
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- 2000
27. Clinical, pathological and genetic characteristics of Perry disease—new cases and literature review
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Jarosław Sławek, Zbigniew K. Wszolek, Alexa Kidd, Ana María Vanegas Monroy, Jolanta Pentela-Nowicka, Owen A. Ross, Jarosław Dulski, Audrey Strongosky, Lukasz M. Milanowski, Emilia J. Sitek, Catalina Cerquera-Cleves, and Dennis W. Dickson
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Pediatrics ,medicine.medical_specialty ,medicine.diagnostic_test ,Depression ,business.industry ,Parkinsonism ,Autopsy ,Dynactin Complex ,Hypoventilation ,Disease ,medicine.disease ,Article ,Parkinsonian Disorders ,Neurology ,Mutation ,medicine ,Etiology ,Humans ,Neurology (clinical) ,business ,Pathological ,Depression (differential diagnoses) ,Genetic testing ,Cause of death - Abstract
Background and purpose Perry disease (or Perry syndrome) is an autosomal dominant neurodegenerative disorder characterized by parkinsonism, neuropsychiatric symptoms, central hypoventilation, weight loss and distinct TDP-43 pathology. It is caused by mutations of the DCTN1 gene encoding an essential component of axonal transport. The objectives were to provide the current state of knowledge on clinical, pathological and genetic aspects of Perry disease, as well as practical suggestions for the management of the disease. Methods Data on new patients from New Zealand, Poland and Colombia were collected, including autopsy report. Also all of the published papers since the original work by Perry in 1975 were gathered and analyzed. Results Parkinsonism was symmetrical, progressed rapidly and was poorly responsive to L-Dopa; nonetheless, a trial with high doses of L-Dopa is warranted. Depression was severe, associated with suicidal ideations, and benefited from antidepressants and L-Dopa. Respiratory symptoms were the leading cause of death, and artificial ventilation or a diaphragm pacemaker prolonged survival. Weight loss occurred in most patients and was of multifactorial etiology. Autonomic dysfunction was frequent but underdiagnosed. There was a clinical overlap with other neurodegenerative disorders. An autopsy showed distinctive pallidonigral degeneration with TDP-43 pathology. Genetic testing provided evidence of a common founder for two families. There was striking phenotypic variability in DCTN1-related disorders. It is hypothesized that oligogenic or polygenic inheritance is at play. Conclusions Perry disease and other DCTN1-related diseases are increasingly diagnosed worldwide. Relatively effective symptomatic treatments are available. Further studies are needed to pave the way toward curative/gene therapy.
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- 2021
28. The facioscapulohumeral muscular dystrophy Rasch‐built overall disability scale (FSHD‐RODS)
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Nicol C. Voermans, Sabrina Sacconi, Corinne G.C. Horlings, Jeffrey Statland, Karlien Mul, Rabi Tawil, Ingemar S. J. Merkies, Alastair Corbett, Catharina G. Faber, Tatiana Hamadeh, Baziel G.M. van Engelen, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, Klinische Neurowetenschappen, and MUMC+: MA Med Staf Spec Neurologie (9)
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validity ,DISEASE ,Muscle and MNJ Disorders ,Disability Evaluation ,0302 clinical medicine ,Quality of life ,QUALITY-OF-LIFE ,Surveys and Questionnaires ,Facioscapulohumeral muscular dystrophy ,030212 general & internal medicine ,Reliability (statistics) ,EXAMPLE ,Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3] ,CLINICAL-TRIAL PREPAREDNESS ,Muscular Dystrophy, Facioscapulohumeral ,Neurology ,NATIONAL REGISTRY ,Scale (social sciences) ,Cohort ,Original Article ,musculoskeletal diseases ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,ENMC INTERNATIONAL WORKSHOP ,03 medical and health sciences ,ORDINAL SCALES ,medicine ,Humans ,Disabled Persons ,DRUG DEVELOPMENT ,FSHD ,reliability ,Rasch model ,business.industry ,Reproducibility of Results ,facioscapulohumeral dystrophy ,Rasch‐built disability scale ,OUTCOME MEASURES ,Interval Scale ,medicine.disease ,built disability scale ,Differential item functioning ,MEASUREMENT MODEL ,Physical therapy ,outcome research ,Rasch‐ ,Neurology (clinical) ,activity and participation ,business ,030217 neurology & neurosurgery - Abstract
Background and objectives Facioscapulohumeral muscular dystrophy (FHSD) is a debilitating inherited muscle disease for which various therapeutic strategies are being investigated. Thus far, little attention has been given in FSHD to the development of scientifically sound outcome measures fulfilling regulatory authority requirements. The aim of this study was to design a patient‐reported Rasch‐built interval scale on activity and participation for FSHD. Methods A pre‐phase FSHD‐Rasch‐built overall disability scale (pre‐FSHD‐RODS; consisting of 159 activity/participation items), based on the World Health Organization international classification of disease‐related functional consequences was completed by 762 FSHD patients (Netherlands: n = 171; UK: n = 287; United States: n = 221; France: n = 52; Australia: n = 32). A proportion of the patient cohort completed it twice (n = 230; interval 2–4 weeks; reliability studies). The pre‐FSHD‐RODS was subjected to Rasch analyses to create a model fulfilling its requirements. Validity studies were performed through correlation with the motor function measure. Results The pre‐FSHD‐RODS did not meet the Rasch model expectations. Based on determinants such as misfit statistics and misfit residuals, differential item functioning, and local dependency, we systematically removed items until a final 38‐inquiry (originating from 32 items; six items split) FSHD‐RODS was constructed achieving Rasch model expectations. Adequate test‐retest reliability and (cross‐cultural and external) validity scores were obtained. Conclusions The FSHD‐RODS is a disease‐specific interval measure suitable for detecting activity and participation restrictions in patients with FSHD with good item/person reliability and validity scores. The use of this scale is recommended in the near future, to determine the functional deterioration slope in FSHD per year as a preparation for the upcoming clinical intervention trials in FSHD., This paper presents the development and validation of a patient‐reported Rasch‐built interval scale on activity and participation for facioscapulohumeral muscular dystrophy (FSHD‐RODS). The final 38‐inquiry scale met Rasch model expectations and showed adequate discriminative power, test‐retest reliability and validity. The use of this scale is recommended in the near future to determine the functional deterioration slope in facioscapulohumeral muscular dystrophy (FSHD) per year as a preparation for the upcoming clinical intervention trials in FSHD.
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- 2021
29. EFNS guidelines on the clinical management of amyotrophic lateral sclerosis (MALS)--revised report of an EFNS task force
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EFNS Task Force on Diagnosis, Management of Amyotrophic Lateral Sclerosis, Andersen, Pm, Abrahams, S, Borasio, Gd, de Carvalho, M, Chio', Adriano, Van Damme, P, Hardiman, O, Kollewe, K, Morrison, Ke, Petri, S, Pradat, Pf, Silani, V, Tomik, B, Wasner, M, and Weber, M.
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medicine.medical_specialty ,Palliative care ,Evidence-Based Medicine ,business.industry ,Task force ,Advisory Committees ,Amyotrophic Lateral Sclerosis ,Evidence-based medicine ,medicine.disease ,Physical medicine and rehabilitation ,Neurology ,Physical therapy ,Terminal care ,Medicine ,Humans ,Neurology (clinical) ,Amyotrophic lateral sclerosis ,business - Abstract
The evidence base for the diagnosis and management of amyotrophic lateral sclerosis (ALS) is weak.To provide evidence-based or expert recommendations for the diagnosis and management of ALS based on a literature search and the consensus of an expert panel.All available medical reference systems were searched, and original papers, meta-analyses, review papers, book chapters and guidelines recommendations were reviewed. The final literature search was performed in February 2011. Recommendations were reached by consensus.Patients with symptoms suggestive of ALS should be assessed as soon as possible by an experienced neurologist. Early diagnosis should be pursued, and investigations, including neurophysiology, performed with a high priority. The patient should be informed of the diagnosis by a consultant with a good knowledge of the patient and the disease. Following diagnosis, the patient and relatives/carers should receive regular support from a multidisciplinary care team. Medication with riluzole should be initiated as early as possible. Control of symptoms such as sialorrhoea, thick mucus, emotional lability, cramps, spasticity and pain should be attempted. Percutaneous endoscopic gastrostomy feeding improves nutrition and quality of life, and gastrostomy tubes should be placed before respiratory insufficiency develops. Non-invasive positive-pressure ventilation also improves survival and quality of life. Maintaining the patient's ability to communicate is essential. During the entire course of the disease, every effort should be made to maintain patient autonomy. Advance directives for palliative end-of-life care should be discussed early with the patient and carers, respecting the patient's social and cultural background.
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- 2011
30. Systematic review of cognitive deficits in adult mitochondrial disease
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Douglass M. Turnbull, Alasdair P. Blain, Grainne S. Gorman, and Heather L. Moore
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Adult ,cognition ,impairment ,Mitochondrial Diseases ,MEDLINE ,Review Article ,PsycINFO ,memory ,Executive Function ,03 medical and health sciences ,0302 clinical medicine ,Functional neuroimaging ,Humans ,Medicine ,Dementia ,Cognitive Dysfunction ,030212 general & internal medicine ,Cognitive skill ,Cognitive decline ,10. No inequality ,Review Articles ,business.industry ,Cognition ,medicine.disease ,Executive functions ,3. Good health ,mitochondrial disease ,Neurology ,Disease Progression ,Neurology (clinical) ,Cognition Disorders ,business ,030217 neurology & neurosurgery ,Clinical psychology - Abstract
The profile and trajectory of cognitive impairment in mitochondrial disease are poorly defined. This systematic review sought to evaluate the current literature on cognition in mitochondrial disease, and to determine future research directions. A systematic review was conducted, employing PubMed, Medline, Psycinfo, Embase and Web of Science, and 360‐degree citation methods. English language papers on adult patients were included. The literature search yielded 2421 articles, of which 167 met inclusion criteria. Case reports and reviews of medical reports of patients yielded broad diagnoses of dementia, cognitive impairment and cognitive decline. In contrast, systematic investigations of cognitive functioning using detailed cognitive batteries identified focal cognitive rather than global deficits. Results were variable, but included visuospatial functioning, memory, attention, processing speed and executive functions. Conclusions from studies have been hampered by small sample sizes, variation in genotype and the breadth and depth of assessments undertaken. Comprehensive cognitive research with concurrent functional neuroimaging and physical correlates of mitochondrial disease in larger samples of well‐characterized patients may discern the aetiology and progression of cognitive deficits. These data provide insights into the pattern and trajectory of cognitive impairments, which are invaluable for clinical monitoring, health planning and clinical trial readiness.
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- 2019
31. Cognitive reserve as a useful variable to address robotic or conventional upper limb rehabilitation treatment after stroke: a multicentre study of the Fondazione Don Carlo Gnocchi
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Padua, L., Imbimbo, I., Aprile, I., Loreti, C., Germanotta, M., Coraci, D., Piccinini, G., Pazzaglia, C., Santilli, C., Cruciani, A., Carrozza, M. C., Pecchioli, C., Loreti, S., Lattanzi, S., Cortellini, L., Papadopoulou, D., Liberti, G., Panzera, F., Mitrione, P., Ruzzi, D., Rinaldi, G., Insalaco, S., De Santis, F., Spinelli, P., Marsan, S., Bastoni, I., Pellegrino, A., Petitti, T., Montesano, A., Castagna, A., Grosso, C., Ammenti, P., Cattaneo, D., Azzinnaro, L., Barbieri, D., Cassani, S., Corrini, C., Meotti, M., Parelli, R., Spedicato, A., Zocchi, M., Loffi, M., Manenti, D., Negri, L., Gramatica, F., Gower, V., Galeri, S., Noro, F., Medici, L., Garattini, R., Bariselli, F., Luli, M., Ricca, M., Negrini, S., Diverio, M., Giannini, E., Gabrielli, A., Deidda, B., Gnetti, B., Beatini, P., Callegari, S., Cabano, B., Converti, F., Pizzi, A., Falsini, C., Romanelli, A., De Luca, G., Vannetti, F., Simoncini, E., Martini, M., Peccini, E., Cecchi, F., Avila, L., Gabrielli, M. A., Barilli, M., Bertocchi, E., Giannarelli, G., Lerda, E., Vasoli, M., Rossi, P., Marsili, V., Tognoli, B., Bertolini, A., Vastola, G., Speranza, G., Colella, M., Mosca, R., Competiello, G., Chiusano, A., Della Vecchia, A., Soriano, P., Pagliarulo, M., Remollino, V., Langone, E., Santarsiero, R., Magliulo, M., Araneo, G., Galantucci, L., Lioi, N., Marrazzo, F., Larocca, S., Calia, R., Benevento, S., Toscano, O., and Lategana, M.
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medicine.medical_specialty ,Barthel index ,medicine.medical_treatment ,Cognitive Reserve Index ,rehabilitation ,Upper Extremity ,03 medical and health sciences ,0302 clinical medicine ,Cognitive Reserve ,Robotic Surgical Procedures ,medicine ,Humans ,030212 general & internal medicine ,Stroke ,Cognitive reserve ,robotics ,Rehabilitation ,business.industry ,personalized medicine ,stroke ,Stroke Rehabilitation ,Cognition ,Recovery of Function ,medicine.disease ,Settore MED/26 - NEUROLOGIA ,Treatment Outcome ,Neurology ,Physical therapy ,Neurology (clinical) ,Stroke recovery ,Upper limb rehabilitation ,business ,030217 neurology & neurosurgery ,Settore MED/34 - MEDICINA FISICA E RIABILITATIVA - Abstract
Background and purpose Rehabilitation plays a central role in stroke recovery. Besides conventional therapy, technological treatments have become available. The effectiveness and appropriateness of technological rehabilitation are not yet well defined; hence, research focused on different variables impacting recovery is needed. Results from the literature identified cognitive reserve (CR) as a variable impacting on the cognitive outcome. In this paper, the aim was to evaluate whether CR influences the motor outcome in patients after stroke treated with conventional or robotic therapy and whether it may influence one treatment rather than another. Methods Seventy-five stroke patients were enrolled in five Italian neurological rehabilitation centres. Patients were assigned either to a robotic group, rehabilitation by means of robotic devices, or to a conventional group, where a traditional approach was used. Patients were evaluated at baseline and after rehabilitation treatment of 6 weeks through the Action Research Arm Test (ARAT), the Motricity Index (MI) and the Barthel Index (BI). CR was assessed at baseline using the Cognitive Reserve Index (CRI) questionnaire. Results Considering all patients, a weak correlation was found between the CRI related to leisure time and MI evolution (r = 0.276; P = 0.02). Amongst the patients who performed a robotic rehabilitation, a moderate correlation emerged between the CRI related to working activities and MI evolution (r = 0.422; P = 0.02). Conclusions Our results suggest that CR may influence the motor outcome. For each patient, CR and its subcategories should be considered in the choice between conventional and robotic treatment.
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- 2019
32. Declining mortality of cerebral venous sinus thrombosis with thrombocytopenia after SARS-CoV-2 vaccination
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Katarzyna Krzywicka, Diana Aguiar de Sousa, Johanna A. Kremer Hovinga, Mayte Sánchez van Kammen, Anita van de Munckhof, Saskia Middeldorp, Jonathan M. Coutinho, Turgut Tatlisumak, Katarina Jood, José M. Ferro, Mirjam Rachel Heldner, Marcel Levi, Marcel Arnold, Erik Lindgren, Jukka Putaala, HUS Neurocenter, Neurologian yksikkö, Helsinki University Hospital Area, Neurology, Graduate School, ANS - Neurovascular Disorders, Vascular Medicine, ACS - Pulmonary hypertension & thrombosis, and ACS - Atherosclerosis & ischemic syndromes
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COVID-19 vaccines ,medicine.medical_specialty ,intracranial ,COVID-19 Vaccines ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Short Communication ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,610 Medicine & health ,thrombocytopenia ,030204 cardiovascular system & hematology ,3124 Neurology and psychiatry ,03 medical and health sciences ,Sinus Thrombosis, Intracranial ,0302 clinical medicine ,Immune system ,COVID‐19 vaccines ,Internal medicine ,ChAdOx1 nCoV-19 ,medicine ,Humans ,In patient ,Cerebral venous sinus thrombosis ,Ad26COVS1 ,business.industry ,SARS-CoV-2 ,High mortality ,Vaccination ,3112 Neurosciences ,COVID-19 ,medicine.disease ,mortality ,Confidence interval ,3. Good health ,Stroke ,sinus thrombosis ,Neurology ,Concomitant ,3121 General medicine, internal medicine and other clinical medicine ,Neurology (clinical) ,business ,cerebral venous sinus thrombosis ,030217 neurology & neurosurgery - Abstract
Background and purpose High mortality rates have been reported in patients with cerebral venous sinus thrombosis (CVST) due to vaccine‐induced immune thrombotic thrombocytopenia (VITT) after vaccination with adenoviral vector SARS‐CoV‐2 vaccines. The aim of this study was to evaluate whether the mortality of patients with CVST‐VITT has decreased over time. Methods The EudraVigilance database of the European Medicines Agency was used to identify cases of CVST with concomitant thrombocytopenia occurring within 28 days of SARS‐CoV‐2 vaccination. Vaccines were grouped based on vaccine type (adenoviral or mRNA). Cases with CVST onset until 28 March were compared to cases after 28 March 2021, which was the day when the first scientific paper on VITT was published. Results In total, 270 cases of CVST with thrombocytopenia were identified, of which 266 (99%) occurred after adenoviral vector SARS‐CoV‐2 vaccination (ChAdOx1 nCoV‐19, n = 243; Ad26.COV2.S, n = 23). The reported mortality amongst adenoviral cases with onset up to 28 March 2021 was 47/99 (47%, 95% confidence interval 37%–58%) compared to 36/167 (22%, 95% confidence interval 16%–29%) in cases with onset after 28 March (p < 0.001). None of the four cases of CVST with thrombocytopenia occurring after mRNA vaccination died. Conclusion The reported mortality of CVST with thrombocytopenia after vaccination with adenoviral vector‐based SARS‐CoV‐2 vaccines has significantly decreased over time, which may indicate a beneficial effect of earlier recognition and/or improved treatment on outcome after VITT., The EudraVigilance database of the European Medicines Agency was used to identify cases of cerebral venous sinus thrombosis (CVST) with concomitant thrombocytopenia occurring within 28 days of SARS‐CoV‐2 vaccination. The reported mortality of CVST with thrombocytopenia after vaccination with adenoviral vector‐based vaccines significantly decreased over time with a mortality rate of 47% (95% confidence interval 37%–58%) in cases with CVST onset prior to 28 March 2021 compared to 22% (95% confidence interval 16%–29%) in cases after 28 March (p < 0.001). This declining mortality may indicate a beneficial effect of earlier recognition and/or improved treatment on outcome after vaccine‐induced thrombotic thrombocytopenia.
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- 2021
33. Neurological manifestations and neuro‐invasive mechanisms of the severe acute respiratory syndrome coronavirus type 2
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Robrecht Raedt, Dimitri Hemelsoet, I. Garrez, Guy Laureys, Kristl Vonck, V. De Herdt, and Paul Boon
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medicine.medical_specialty ,Pediatrics ,Neurological injury ,Neurology ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Clinical Neurology ,Disease ,03 medical and health sciences ,0302 clinical medicine ,CEREBROSPINAL-FLUID ,INFECTION ,Medicine and Health Sciences ,medicine ,In patient ,030212 general & internal medicine ,SARS-CoV-2 ,business.industry ,COVID-19 ,Impaired consciousness ,neuro-invasive mechanism ,neurological manifestations ,VIRUS ,Neurology (clinical) ,Severe acute respiratory syndrome coronavirus ,business ,cerebrovascular diseases ,030217 neurology & neurosurgery - Abstract
Background and purpose Infections with coronaviruses are not always confined to the respiratory tract and various neurological manifestations have been reported. The aim of this study was to perform a review to describe neurological manifestations in patients with COVID-19 and possible neuro-invasive mechanisms of Sars-CoV-2. Methods PubMed, Web of Science and COVID-dedicated databases were searched for the combination of COVID-19 terminology and neurology terminology up to 10 May 2020. Social media channels were followed up between 15 March and 10 May 2020 for postings with the same scope. Neurological manifestations were extracted from the identified papers and combined to provide a useful summary for the neurologist in clinical practice. Results Neurological manifestations potentially related to COVID-19 have been reported in large studies, case series and case reports and include acute cerebrovascular diseases, impaired consciousness, cranial nerve manifestations and autoimmune disorders such as the Guillain-Barre syndrome often present in patients with more severe COVID-19. Cranial nerve symptoms such as olfactory and gustatory dysfunctions are highly prevalent in patients with mild to moderate COVID-19 even without associated nasal symptoms and often present in an early stage of the disease. Conclusion Physicians should be aware of the neurological manifestations in patients with COVID-19, especially when rapid clinical deterioration occurs. The neurological symptoms in COVID-19 patients may be due to direct viral neurological injury or indirect neuroinflammatory and autoimmune mechanisms. No antiviral treatments against the virus or vaccines for its prevention are available and the long-term consequences of the infection on human health remain uncertain especially with regard to the neurological system.
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- 2020
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34. COVID-19-related encephalopathy: a case series with brain FDG-positron-emission tomography/computed tomography findings
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Gaëlle Bruneteau, Pauline Shambrook, Loïc Le Guennec, Bruno Millet, Valérie Pourcher, Adèle Hesters, Philippe Fossati, S. Bombois, Nagisa Godefroy, Vincent Navarro, Aurélie Kas, Olivier Paccoud, Diana Doukhi, Sophie Demeret, Augustin Boullet, Cécile Delorme, and Redwan Maatoug
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Male ,Myoclonus ,medicine.medical_specialty ,Short Communication ,encephalitis ,FDG‐PET/CT ,Encephalopathy ,Clinical Neurology ,Status epilepticus ,Neuropsychological Tests ,SARS‐CoV‐2 ,03 medical and health sciences ,0302 clinical medicine ,Status Epilepticus ,Cerebellar Diseases ,Fluorodeoxyglucose F18 ,Positron Emission Tomography Computed Tomography ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Covid‐19 ,Brain Diseases ,medicine.diagnostic_test ,Lumbar puncture ,business.industry ,Mental Disorders ,COVID-19 ,Cognition ,Middle Aged ,medicine.disease ,encephalopathy ,Magnetic Resonance Imaging ,Frontal Lobe ,Treatment Outcome ,Neurology ,Frontal lobe ,Hypermetabolism ,Female ,Neurology (clinical) ,Radiology ,Immunotherapy ,medicine.symptom ,Radiopharmaceuticals ,business ,Cognition Disorders ,030217 neurology & neurosurgery ,Encephalitis - Abstract
The aim of this paper is to describe the clinical features of COVID-19-related encephalopathy and their metabolic correlates using brain 2-desoxy-2-fluoro-D-glucose (FDG)-positron-emission tomography (PET)/computed tomography (CT) imaging.A variety of neurological manifestations have been reported in association with COVID-19. COVID-19-related encephalopathy has seldom been reported and studied.We report four cases of COVID-19-related encephalopathy. The diagnosis was made in patients with confirmed COVID-19 who presented with new-onset cognitive disturbances, central focal neurological signs, or seizures. All patients underwent cognitive screening, brain magnetic resonance imaging (MRI), lumbar puncture, and brain 2-desoxy-2-fluoro-D-glucose (FDG)-positron-emission tomography (PET)/computed tomography (CT) (FDG-PET/CT).The four patients were aged 60 years or older, and presented with various degrees of cognitive impairment, with predominant frontal lobe impairment. Two patients presented with cerebellar syndrome, one patient had myoclonus, one had psychiatric manifestations, and one had status epilepticus. The delay between first COVID-19 symptoms and onset of neurological symptoms was between 0 and 12 days. None of the patients had MRI features of encephalitis nor significant cerebrospinal fluid (CSF) abnormalities. SARS-CoV-2 RT-PCR in the CSF was negative for all patients. All patients presented with a consistent brain FDG-PET/CT pattern of abnormalities, namely frontal hypometabolism and cerebellar hypermetabolism. All patients improved after immunotherapy.Despite varied clinical presentations, all patients presented with a consistent FDG-PET pattern, which may reflect an immune mechanism.
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- 2020
35. Maternal myasthenia gravis represents a risk for the child through autoantibody transfer, immunosuppressive therapy and genetic influence
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Yu Hong and Nils Erik Gilhus
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Adult ,0301 basic medicine ,Pediatrics ,medicine.medical_specialty ,Azathioprine ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Intensive care ,Myasthenia Gravis ,medicine ,Humans ,Family ,Receptors, Cholinergic ,Autoantibodies ,business.industry ,Infant, Newborn ,Autoantibody ,Immunoglobulins, Intravenous ,Receptor Protein-Tyrosine Kinases ,Muscle weakness ,Neuromuscular Diseases ,medicine.disease ,Myasthenia gravis ,030104 developmental biology ,Neurology ,Pyridostigmine ,Prenatal Exposure Delayed Effects ,Prednisolone ,Female ,Neurology (clinical) ,medicine.symptom ,business ,Immunosuppressive Agents ,030217 neurology & neurosurgery ,Pyridostigmine Bromide ,medicine.drug - Abstract
Females with myasthenia gravis (MG) worry about their disease having negative consequences for their children. Autoimmune disease mechanisms, treatment and heredity could all have an impact on the child. This is a subject review where Web of Science was searched for relevant keywords and combinations. Controlled and prospective studies were included, and also results from selected and unselected patient cohorts, guidelines, consensus papers and reviews. Neonatal MG with temporary muscle weakness occurs in 10% of newborn babies where the mother has MG, due to transplacental transfer of antibodies against acetylcholine receptor (AChR), muscle-specific kinase (MuSK) or lipoprotein receptor-related protein 4 (LRP4). Arthrogryposis and fetal AChR inactivation syndrome with contractures and permanent myopathy are rare events caused by mother's antibodies against fetal type AChR. The MG drugs pyridostigmine, prednisolone and azathioprine are regarded as safe during pregnancy and breastfeeding. Methotrexate, mycophenolate mofetil and cyclophosphamide are teratogenic. Mother's MG implies at least a 10-fold increased risk for MG and other autoimmune diseases in the child. MG females should receive specific information about pregnancy and giving birth. First-line MG treatments should usually be continued during pregnancy. Intravenous immunoglobulin and plasma exchange represent safe treatments for exacerbations. Neonatal MG risk means that MG women should give birth at hospitals experienced in neonatal intensive care. Neonatal MG needs supportive care, rarely also acetylcholine esterase inhibition or intravenous immunoglobulin. Women with MG should be supported in their wish to have children.
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- 2018
36. How often is the diagnosis of the permanent vegetative state incorrect? A review of the evidence
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Derick T Wade
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Coma ,medicine.medical_specialty ,business.industry ,Persistent Vegetative State ,Minimally conscious state ,medicine.disease ,03 medical and health sciences ,Neurological assessment ,0302 clinical medicine ,Systematic review ,Neurology ,Neurological Damage ,Acute injury ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Neurology (clinical) ,Diagnostic Errors ,medicine.symptom ,Intensive care medicine ,business ,030217 neurology & neurosurgery ,Recovery phase - Abstract
Some research suggests that 40% of people in the vegetative state are misdiagnosed. This review investigates the frequency, nature and causes of reported misdiagnosis of patients in the vegetative state, focusing on the nature of the error. It is a systematic review of all relevant literature, using references from key papers identified. The data are summarized in tables. Five clinical studies of the rate of misdiagnosis in practice were identified, encompassing 236 patients in the vegetative state of whom 80 (34%) were reclassified as having some awareness, often minimal. The studies often included patients in the recovery phase after acute injury, and were poorly reported. Five systematic reviews of signs and technologically based neurophysiological tests were identified, and they showed that most studies were small, lacked accurate or important details, and were subject to bias. Studies were not replicated. Many signs and tests did not differ between people in the vegetative state and in the minimally conscious state, and those that did were unable to diagnose an individual patient. The few single case reports suggest that failure to ensure an accurate diagnosis of the underlying neurological damage and dysfunction could, rarely, lead to significant misdiagnosis usually in patients who had brain-stem damage with little thalamic or cortical damage. Significant misdiagnosis of awareness, with an apparently 'vegetative' patient having good awareness, is rare. Careful neurological assessment of the cause and routine measurement of awareness using the Coma Recovery Scale - Revised should further reduce mistakes.
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- 2018
37. Anticipation of age at onset in familial multiple sclerosis.
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Romero-Pinel, L., Martínez-Yélamos, S., Gubieras, L., Matas, E., Bau, L., Kremenchutzky, M., and Arbizu, T.
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MULTIPLE sclerosis ,GENETIC disorders ,AGE ,DEMYELINATION ,MEDICINE - Abstract
Background and objective: Anticipation of age at onset in the younger generations is a widely known characteristic of many diseases with genetic inheritance. This study was performed to assess whether there is anticipation of age at onset in younger generations of familial multiple sclerosis (MS) in a Spanish population and to compare clinical characteristics of familial and sporadic MS. Methods: We studied a cohort of 1110 patients diagnosed with MS and followed-up in our MS Unit. Patients were considered as familial MS if they had in their family at least one relative of first or second degree diagnosed with MS. Otherwise, patients were considered to have sporadic MS. We compared the age at onset between relatives from different generations, and we also compared the age at onset of familial and sporadic MS. Results: A lower age at onset in the younger generations was found (median 22 years vs. 30 years, P < 0.001) and a significant lower age at onset of the disease in familial MS comparing to sporadic MS (median 25 years vs. 29 years, P = 0.042). Conclusions: There is an anticipation of the age at onset of MS in the younger generations of patients with familial MS. There is also a lower age at onset in familial versus sporadic MS. [ABSTRACT FROM AUTHOR]
- Published
- 2010
- Full Text
- View/download PDF
38. One Europe, one neurologist?
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Grisold, W., Galvin, R., Lisnic, V., Lima, J. Lopes, Mueller, E., Oberndorfer, St., and Vodusek, D. B.
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NEUROLOGY ,MEDICAL education ,NEUROLOGICAL disorders ,HEALTH policy ,MEDICINE - Abstract
In recent years, there has been a major shift in emphasis within neurology from being a largely diagnostic discipline to one much more actively involved in treating disease. There have been major scientific advances leading to new and effective treatments. There is also a much greater awareness of the burden of neurological disease (Olesen J, Leonardi M. European Journal of Neurology 2003; 10: 471) and informed sufferers are requesting specific intervention. There is wide variation in the delivery of neurological services throughout Europe. This is reflected in manpower levels, the place of neurology related to other medical specialties and different mixes of hospital and private office practice. These differences have been thrown into sharper focus by the recent expansion of the European Union (EU). Initial training in neurology is given to undergraduate/pre-graduate students. Post-graduate education is delivered within a residency program leading to specialist qualification and certification. We now recognize that this is only the beginning of a life long program of continuous education and development (CME/CPD). National and international exchange programs facilitate the growth of knowledge and promote professional harmony and cooperation. The free migration of medical specialists has been an aspiration but remains limited by cultural, linguistic, personal, professional, political and economic factors. Two bodies, the European Board of Neurology (EBN–UEMS) (Union Européenne des Médecins Spécialistes) and the European Federation of Neurological Societies (EFNS) are actively involved in harmonising and developing neurology at the European level. [ABSTRACT FROM AUTHOR]
- Published
- 2007
- Full Text
- View/download PDF
39. EUROPEAN JOURNAL OF NEUROLOGY.
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Olesen, Jes
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NEUROLOGY ,PERIODICALS ,SOCIETIES ,MEDICINE ,JOURNALISM - Abstract
Discusses developments in the "European Journal of Neurology" in Europe. Integration of the national neurological societies of Europe with the European Federation of Neurological Societies; Aims and scope of the periodical; Support to the journal.
- Published
- 2001
40. Neuroimaging correlates of neuropsychiatric symptoms in Alzheimer's disease: a review of 20 years of research
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N. Boublay, Pierre Krolak-Salmon, and Anne-Marie Schott
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Apathy ,Neuroimaging ,PsycINFO ,Disease ,Delusions ,03 medical and health sciences ,0302 clinical medicine ,Alzheimer Disease ,medicine ,Humans ,Anterior cingulate cortex ,Cerebral Cortex ,Depression ,business.industry ,medicine.disease ,030227 psychiatry ,medicine.anatomical_structure ,Neurology ,Frontal lobe ,Neurology (clinical) ,Alzheimer's disease ,medicine.symptom ,business ,Neuroscience ,Insula ,030217 neurology & neurosurgery - Abstract
Assessing morphological, perfusion and metabolic brain changes preceding or associated with neuropsychiatric symptoms (NPSs) will help in the understanding of pathophysiological underlying processes in Alzheimer's disease (AD). This review aimed to highlight the main findings on significant associations between neuroimaging and NPSs, the pathophysiology to elucidate possible underlying mechanisms, and methodological issues to aid future research. Research papers published from January 1990 to October 2015 were identified in the databases PsycInfo, Embase, PubMed and Medline, using key words related to NPSs and imaging techniques. In addition to a semi-systematic search in the databases, we also performed hand searches based on reported citations identified to be of interest. Delusions, apathy and depression symptoms were particularly associated with brain changes in AD. The majority of studies disclosed an association between frontal lobe structural and/or metabolic changes and NPSs, implicating, interestingly, for all 12 NPSs studied, the anterior cingulate cortex although temporal, subcortical and parietal regions, and insula were also involved. Given the high degree of connectivity of these brain areas, frontal change correlates of NPSs may help in the understanding of neural network participation. This review also highlights crucial methodological issues that may reduce the heterogeneity of results to enable progress on the pathophysiological mechanisms and aid research on NPS treatments in AD. Based on a broad review of the current literature, a global brain pattern to support the huge heterogeneity of neuroimaging correlates of NPSs in AD and methodological strategies are suggested to help direct future research.
- Published
- 2016
41. Unusual presentations in patients with E200K familial Creutzfeldt−Jakob disease
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Esther Kahana, Itzhak Kimiagar, Zeev Nitsan, Joab Chapman, Shmuel Appel, Oren S. Cohen, Chen Hoffmann, Hanna Rosenmann, and Amos D. Korczyn
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Male ,0301 basic medicine ,Pediatrics ,medicine.medical_specialty ,Movement disorders ,Auditory agnosia ,Disease ,Article ,Creutzfeldt-Jakob Syndrome ,Prion Proteins ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Animals ,Humans ,Prospective Studies ,Cognitive decline ,Alien hand syndrome ,Aged ,Genetic testing ,Movement Disorders ,medicine.diagnostic_test ,business.industry ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Surgery ,030104 developmental biology ,Neurology ,Jews ,Mutation ,Familial Creutzfeldt-Jakob ,Female ,Neurology (clinical) ,Symptom Assessment ,medicine.symptom ,Cognition Disorders ,business ,030217 neurology & neurosurgery - Abstract
Background and propose Familial Creutzfeldt−Jakob disease (fCJD) in Jews of Libyan ancestry is caused by an E200K mutation in the PRNP gene. The typical presenting symptoms include cognitive decline, behavioral changes and gait disturbances; however, some patients may have an unusual presentation such as a stroke-like presentation, alien hand syndrome or visual disturbances. The aim of this paper is to describe uncommon presentations in our series of consecutive patients with E200K fCJD. Methods The study group included consecutive fCJD patients followed up as part of a longitudinal prospective study ongoing since 2003 or hospitalized since 2005. The clinical diagnosis of probable CJD was based on accepted diagnostic criteria and supported by typical magnetic resonance imaging, electroencephalographic findings, elevated cerebrospinal fluid tau protein levels and by genetic testing for the E200K mutation. Disease symptoms and signs were retrieved from the medical files. Results The study population included 77 patients (42 men) with a mean age of disease onset of 60.6 ± 7.2 years. The most prevalent presenting symptoms were cognitive decline followed by gait impairment and behavioral changes. However, six patients had an unusual presentation including auditory agnosia, monoparesis, stroke-like presentation, facial nerve palsy, pseudobulbar syndrome and alien hand syndrome. Conclusions Our case series illustrates the wide phenotypic variability of the clinical presentation of patients with fCJD and widens the clinical spectrum of the disease. A high level of clinical suspicion may prove useful in obtaining early diagnosis and therefore avoiding costly and inefficient diagnostic and therapeutic strategies.
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- 2016
42. Gait phenotype from mild cognitive impairment to moderate dementia: results from the <scp>GOOD</scp> initiative
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Michele L. Callisaya, Jean-Paul Steinmetz, A.‐M. De Cock, Joe Verghese, Gilles Allali, Velandai Srikanth, Cédric Annweiler, Helena M. Blumen, Olivier Beauchet, Reto W. Kressig, Albert Einstein College of Medicine [New York], Geneva University Hospital (HUG), Laboratoire de Psychologie des Pays de la Loire (LPPL), Université d'Angers (UA)-Université de Nantes - UFR Lettres et Langages (UFRLL), Université de Nantes (UN)-Université de Nantes (UN), Department of Computer Science and Engineering [San Diego] (CSE-UCSD), University of California [San Diego] (UC San Diego), and University of California-University of California
- Subjects
Male ,Aging ,Quantitative gait parameters ,Amnesia/complications/physiopathology ,0302 clinical medicine ,Gait (human) ,Neurologic/etiology/physiopathology ,80 and over ,030212 general & internal medicine ,Cognitive decline ,Gait ,Aged, 80 and over ,Cognition ,Alzheimer's disease ,Research Personnel ,Phenotype ,Neurology ,[SCCO.PSYC]Cognitive science/Psychology ,Cohort studies ,Female ,Cohort study ,medicine.medical_specialty ,Cognitive Dysfunction/complications/physiopathology ,Gait disorders ,Article ,Dementia/complications/physiopathology ,03 medical and health sciences ,Physical medicine and rehabilitation ,Alzheimer Disease ,Motor control ,mental disorders ,medicine ,Humans ,Dementia ,Cognitive Dysfunction ,Gait Disorders ,Gait Disorders, Neurologic ,Aged ,Surrogate endpoint ,business.industry ,Alzheimer Disease/complications/physiopathology ,Mild cognitive impairment ,medicine.disease ,ddc:616.8 ,Institutional repository ,Cross-Sectional Studies ,Physical therapy ,Human medicine ,Amnesia ,Neurology (clinical) ,Cognition Disorders ,business ,human activities ,030217 neurology & neurosurgery - Abstract
Background and purposeThe differences in gait abnormalities from the earliest to the later stages of dementia and in the different subtypes of dementia have not been fully examined. This study aims to compare spatiotemporal gait parameters in cognitively healthy individuals, patients with amnestic mild cognitive impairment (MCI) and non-amnestic MCI, and patients with mild and moderate stages of Alzheimer's disease (AD) and non-Alzheimer's disease (non-AD). MethodsBased on a cross-sectional design, 1719 participants (77.4 7.3 years, 53.9% female) were recruited from cohorts from seven countries participating in the Gait, Cognition and Decline (GOOD) initiative. Mean values and coefficients of variation of spatiotemporal gait parameters were measured during normal pace walking with the GAITRite system at all sites. ResultsPerformance of spatiotemporal gait parameters declined in parallel with the stage of cognitive decline from MCI status to moderate dementia. Gait parameters of patients with non-amnestic MCI were more disturbed compared to patients with amnestic MCI, and MCI subgroups performed better than demented patients. Patients with non-AD dementia had worse gait performance than those with AD dementia. This degradation of gait parameters was similar between mean values and coefficients of variation of spatiotemporal gait parameters in the earliest stages of cognitive decline, but different in the most advanced stages, especially in the non-AD subtypes. ConclusionsSpatiotemporal gait parameters were more disturbed in the advanced stages of dementia, and more affected in the non-AD dementias than in AD. These findings suggest that quantitative gait parameters could be used as a surrogate marker for improving the diagnosis of dementia. Click to view the accompanying paper in this issue.
- Published
- 2015
43. Practical recommendations for the process of proposing, planning and writing a neurological management guideline by EAN task forces
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Antonio Federico, Anthony H.V. Schapira, Günther Deuschl, Maurizio Leone, and Magdalena Keindl
- Subjects
medicine.medical_specialty ,Process (engineering) ,Management guideline ,Task (project management) ,medicine ,Humans ,neurological societies ,Obligation ,Psychiatry ,Societies, Medical ,Protocol (science) ,Structure (mathematical logic) ,GRADE ,clinical practice guideline ,conflict of interests ,grading evidence ,neurological diseases ,recommendations ,Timeline ,Guideline ,Europe ,Neurology ,Practice Guidelines as Topic ,Engineering ethics ,Neurology (clinical) ,Nervous System Diseases ,Psychology - Abstract
The European Academy of Neurology (EAN), founded in 2014 after the merging of the two previously active European Neurological Societies, considers the production of neurological guidelines a major obligation, as this is a major tool to improve clinical practice in neurology. This paper updates practical suggestions to develop guidelines about the treatment and diagnosis of neurological diseases within the framework of the EAN. Its aim is to make uniform, traceable and explicit the path from the decision to write an EAN guideline to its publication. We explain the protocol structure, handling of conflicts of interest, format, timeline and process of revision and acceptance. It provides the view of the Scientific Committee and the Board of the EAN. We hope to make easier a larger involvement of the EAN scientific community in producing guidelines.
- Published
- 2015
44. Comment on 'Efficacy and feasibility of antidepressants for the prevention of migraine in adults: a meta-analysis'
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Kamyar Mansori and Salman Khazaei
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Adult ,medicine.medical_specialty ,Neurology ,business.industry ,Migraine Disorders ,030209 endocrinology & metabolism ,medicine.disease ,Placebo ,Antidepressive Agents ,03 medical and health sciences ,0302 clinical medicine ,Migraine ,Sample size determination ,Strictly standardized mean difference ,Meta-analysis ,Statistical significance ,medicine ,Humans ,Neurology (clinical) ,business ,Psychiatry ,030217 neurology & neurosurgery - Abstract
have read the paper entitled ‘Efficacy and feasibility of antidepressants for the prevention of migraine in adults: a meta-analysis’ [1] written by Xu et al. which was published in the European Journal of Neurology in May 2017 [1]. The authors reported that antidepressants had a significant advantage over placebo in reducing the migraine frequency or index of adults with a standardized mean difference (SMD) of −0.79 (−1.13, −0.45) and they concluded that antidepressants are effective in the prophylaxis of migraine in adults. Although the data reported by Xu et al. are interesting, it is important to emphasize that, although an SMD of −0.79 is statistically significant, clinically these differences may be unimportant. The reader should distinguish the difference between statistical significance and clinical importance. A larger sample size, higher standard deviation and bigger means difference can increase the chance of finding a statistically significant SMD [2, 3]. In meta-analyses, the larger sample size arising from pooling individual studies can easily lead to a significant P value. Therefore, these conclusions should be interpreted with caution because clinical judgements have been overlooked.
- Published
- 2017
45. Intravenous thrombolysis for acute ischaemic stroke in patients on direct oral anticoagulants
- Author
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Pierre Sié, Isabelle Gouin-Thibault, Emmanuel Touzé, Laurent Derex, S. Susen, E. de Maistre, and Yves Gruel
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Administration, Oral ,030204 cardiovascular system & hematology ,Antithrombins ,Dabigatran ,Brain Ischemia ,03 medical and health sciences ,0302 clinical medicine ,Fibrinolytic Agents ,Rivaroxaban ,Atrial Fibrillation ,Coagulation testing ,Medicine ,Humans ,Thrombolytic Therapy ,Stroke ,Retrospective Studies ,Prothrombin time ,medicine.diagnostic_test ,business.industry ,Anticoagulants ,Idarucizumab ,Thrombolysis ,medicine.disease ,Neurology ,Emergency medicine ,Administration, Intravenous ,Neurology (clinical) ,Blood Coagulation Tests ,business ,030217 neurology & neurosurgery ,Partial thromboplastin time ,medicine.drug ,Factor Xa Inhibitors - Abstract
BACKGROUND AND PURPOSE Whereas intravenous thrombolysis (IVT) is allowed for acute ischaemic stroke in patients on vitamin K antagonists with international normalized ratio ≤1.7, there are no similar recommendations for patients on direct oral anticoagulants (DOACs), notably due to the lack of coagulation tests to assess the therapeutic effects. Although the literature is scarce, consisting of small case series and retrospective studies, considering the frequency of this situation the French Vascular Neurology Society and the French Study Group on Haemostasis and Thrombosis have worked on a joint position paper to provide a practical position regarding the emergency management of ischaemic stroke in patients on DOACs. METHOD Based on a review of the literature, the authors wrote a first text that was submitted to a broad panel of members from the two societies. The text was then amended by the authors to address experts' comments and to reach a consensus. RESULTS In patients with normal renal function and who stopped the DOAC for at least 48 h, the management should not differ from that in patients without oral anticoagulant. In patients who are still on DOACs, mechanical thrombectomy is encouraged preferentially when applicable in first line. Otherwise, when specific tests are available, values
- Published
- 2017
46. Impaired sexual activity in young ischaemic stroke patients: an observational study
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C. Legrand, C. Lamy, Sandrine Canaple, O. Hamy, and Jean-Marc Bugnicourt
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Adult ,Male ,medicine.medical_specialty ,Sexual Behavior ,Hospital Anxiety and Depression Scale ,Cohort Studies ,Surveys and Questionnaires ,Internal medicine ,medicine ,Humans ,Stroke ,Depression (differential diagnoses) ,business.industry ,Odds ratio ,Middle Aged ,Stepwise regression ,medicine.disease ,Confidence interval ,Sexual Dysfunction, Physiological ,Neurology ,Cohort ,Physical therapy ,Female ,Neurology (clinical) ,Sexual function ,business - Abstract
Background and purpose The present study sought to determine the impact of stroke on sexual function and well-being in a cohort of young ischaemic stroke patients and identify factors associated with impairment. Methods Over a 2-year period, all patients aged 60 or under with ischaemic stroke or transient ischaemic attack (n = 156) were included. Information on sexual function and well-being was obtained by means of a paper questionnaire mailed to participants 1 year after their stroke. Impaired sexual activity (ISA) was defined as a decline in sexual function and/or satisfaction. Psychological well-being was evaluated on the Hospital Anxiety and Depression Scale (HADS). Results The response rate was 67% (n = 104). Thirty of these responders (29%) reported ISA. Patients with ISA had a higher HADS score (19.7 vs. 11.2 in patients with no impairment; P
- Published
- 2013
47. The European Association of Young Neurologists and Trainees in 2013: striking a blow for European junior neurologists
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Antonella Macerollo, Johann Sellner, O. Györfi, Ross W. Paterson, Xenia Kobeleva, and Edina Timea Varga
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Medical education ,medicine.medical_specialty ,Neurology ,medicine ,Neurology (clinical) ,Personal experience ,Association (psychology) ,Psychology ,Psychiatry ,Clinical neurology - Abstract
Background and purpose The main objective of the European Association of Young Neurologists and Trainees (EAYNT), an independent Brussels-based association of junior neurologists, is to represent and promote the interests of European junior neurologists. Methods and results A wide variety of projects and activities are ongoing, carried out by members of the organization in close collaboration with major European and National Neurology bodies. Most recently, we surveyed European junior neurologists about their views on the European Board of Neurology Examination, the status of e-learning in postgraduate neurology training and migration patterns of young neurologists. Conclusions The aim of this paper is to outline the current and future activities of the EAYNT. We run a series of lectures (‘EAYNT special sessions’) at the major European conferences and disseminate information to young neurologists at the EAYNT booth. We provide information about travel grants, fellowships as well as sharing personal experiences of working abroad. EAYNT members have the opportunity to sit on the scientific subcommittees of the European Federation of Neurological Societies (EFNS) and European Neurological Society (ENS), to chair poster sessions and review abstracts. Furthermore, we continue to provide a forum for young neurologists from all over Europe to network and socialize by means of get-together events and hospital visits.
- Published
- 2013
48. Multiple sclerosis and restless legs syndrome: a systematic review and meta-analysis
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M. Schürks and P. Bussfeld
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medicine.medical_specialty ,Multiple Sclerosis ,Cross-sectional study ,Medizin ,Restless Legs Syndrome ,Internal medicine ,mental disorders ,Odds Ratio ,Prevalence ,medicine ,Humans ,Restless legs syndrome ,business.industry ,Multiple sclerosis ,Case-control study ,Odds ratio ,medicine.disease ,Confidence interval ,Cross-Sectional Studies ,Pooled analysis ,Neurology ,Case-Control Studies ,Data Interpretation, Statistical ,Meta-analysis ,Physical therapy ,Neurology (clinical) ,business - Abstract
Background and purpose Restless legs syndrome (RLS) has been reported to occur more frequently in patients with multiple sclerosis (MS) than in people without MS. Methods Systematic review and meta-analysis of studies investigating RLS in patients with MS published through April 2012. We calculated the prevalences and 95% confidence intervals (CIs) of RLS in patients with MS and people without MS as well as odds ratios (ORs) and 95% CIs of the association between MS and RLS based on data from the publications. We then calculated pooled effect estimates for the association between MS and RLS. Results We identified 24 studies. RLS prevalence amongst patients with MS ranged from 12.12% to 57.50% and from 2.56% to 18.33% amongst people without MS. Heterogeneity amongst studies was high (RLS prevalence in patients with MS I2 = 94.4%; RLS prevalence amongst people without MS I2 = 82.2%). Hence, we did not pool the prevalence data for meta-analysis. Heterogeneity amongst studies investigating the association between MS and RLS was moderate (I2 = 53.6%). Pooled analysis indicates that MS is associated with a fourfold increased odds for RLS (pooled OR = 4.19, 95% CI 3.11–5.66). This association was smaller amongst studies published as full papers (pooled OR = 3.94, 95% CI 2.81–5.54) than amongst studies published as abstracts only (pooled OR = 6.23, 95% CI 3.25–11.95). Conclusion This systematic review indicates that RLS prevalence amongst patients with MS ranges from 12.12% to 57.50% in different populations. Pooled analysis further indicates that the odds of RLS amongst patients with MS are fourfold higher compared to people without MS.
- Published
- 2012
49. What should we expect from multiple sclerosis therapy? Results of an integrated analysis of delayed-release dimethyl fumarate pivotal trials
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Roberta Lanzillo and Lanzillo, Roberta
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Multiple Sclerosis ,disease monitoring ,Pharmacology ,03 medical and health sciences ,chemistry.chemical_compound ,Multiple Sclerosis, Relapsing-Remitting ,0302 clinical medicine ,medicine ,Humans ,magnetic resonance imaging ,no evidence of disease activity ,dimethyl fumarate ,Dimethyl fumarate ,business.industry ,Multiple sclerosis ,relapsing–remitting multiple sclerosis ,Glatiramer Acetate ,Original Articles ,Delayed release (linguistics) ,clinical relapse ,medicine.disease ,disability progression ,030104 developmental biology ,Neurology ,chemistry ,Physical therapy ,Original Article ,Neurology (clinical) ,business ,Immunosuppressive Agents ,030217 neurology & neurosurgery - Abstract
Background and purpose Significant effects on clinical/neuroradiological disease activity have been reported in patients with relapsing–remitting multiple sclerosis treated with delayed‐release dimethyl fumarate (DMF) in phase III DEFINE/CONFIRM trials. We conducted a post hoc analysis of integrated data from DEFINE/CONFIRM to evaluate the effect of DMF on achieving no evidence of disease activity (NEDA) in patients with relapsing–remitting multiple sclerosis. Methods The analysis included patients randomized to DMF 240 mg twice daily, placebo or glatiramer acetate (CONFIRM only) for ≤2 years. A time‐to‐event method was used to estimate the percentage of patients achieving NEDA. Clinical NEDA (no relapses/no 12‐week confirmed disability progression) was analysed in the intention‐to‐treat (ITT) population. Neuroradiological (no new/newly enlarging T2 hyperintense lesions/no gadolinium‐enhancing lesions) and overall NEDA (clinical and neuroradiological NEDA) were analysed in the magnetic resonance imaging (MRI) cohort. Results The ITT and MRI populations comprised 1540 and 692 patients, respectively. The percentage of patients with clinical NEDA (ITT population) and neuroradiological NEDA (MRI cohort) was higher with DMF versus placebo over 2 years [clinical NEDA: 38.9% relative reduction; hazard ratio (HR), 0.61; 95% confidence interval (CI), 0.52‐0.72; P < 0.0001; neuroradiological NEDA: 40.0% relative reduction; HR, 0.60; 95% CI, 0.49–0.73; P < 0.0001]. The percentage of patients achieving overall NEDA (MRI cohort) was also higher with DMF (26%) versus placebo (12%) over 2 years, with a relative risk reduction of 42.7% (HR, 0.57; 95% CI, 0.48–0.69; P < 0.0001). Conclusions A significantly higher percentage of patients treated with DMF achieved NEDA status over 2 years compared with placebo., Click here to view the accompanying paper in this issue.
- Published
- 2017
50. Five‐year experience with incobotulinumtoxinA (Xeomin ® ): the first botulinum toxin drug free of complexing proteins
- Author
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Dirk Dressler
- Subjects
Hypersalivation ,Dystonia ,business.industry ,Blepharospasm ,Pharmacology ,medicine.disease ,Botulinum toxin ,Drug Stability ,Neuromuscular Agents ,Neurology ,Anesthesia ,medicine ,Animals ,Humans ,Potency ,Neurology (clinical) ,Cervical dystonia ,Spasticity ,Botulinum Toxins, Type A ,medicine.symptom ,business ,Hemifacial spasm ,medicine.drug - Abstract
In 2005, incobotulinumtoxinA (Xeomin(®) ), a new botulinum toxin (BT) type A drug without complexing proteins (CPs), became available. This paper reviews the specific features of Xeomin(®) and the experience gathered with it during the last 5 years. Compared with conventional BT drugs, Xeomin(®) 's extended shelf live and its simplified temperature restrictions indicate that CPs are not necessary for BT drug stability. Its reduced molecular size does not translate into diffusion differences, and its potency labelling is identical to that of onabotulinumtoxinA (Botox(®) ). With a reduced content of inactivated botulinum neurotoxin, Xeomin(®) should have reduced antigenicity. Lack of CP's may further reduce antigenicity. Xeomin(®) 's therapeutic efficacy against cervical dystonia, blepharospasm and spasticity has been proven in large randomised, double-blind and placebo-controlled studies leading to registrations in many countries. Additional successful clinical use in axillary hyperhidrosis, hemifacial spasm, re-innervation synkinesias and hypersalivation as well as in dystonia and spasticity in extended doses and throughout extended observation periods has been documented meanwhile. Lack of reported cases of antibody-induced therapy failure (ABF), as to date, support the hypothesis of an improved antigenicity.
- Published
- 2011
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