[Comment] Global burden of neurological disease: what's in a name?
We are living in a rapidly changing landscape in terms of global public health. On one hand, the immense increase in and ageing of the world's population, mass migration of people from rural to urban areas, and unhealthy lifestyles —either by choice or by circumstance—are negatively affecting the overall health of the planet. On the other hand, medical advances such as vaccines, antibiotics, and new medications, and renewed emphasis on workplace safety, have benefitted global health. These balancing influences perhaps have the most effect on neurological diseases, which affect many different daily functions and therefo...
Source: Lancet Neurology - September 17, 2017 Category: Neurology Authors: James J Sejvar Tags: Comment Source Type: research
[Personal View] Exercise in patients with multiple sclerosis
Exercise can be a beneficial rehabilitation strategy for people with multiple sclerosis to manage symptoms, restore function, optimise quality of life, promote wellness, and boost participation in activities of daily living. However, this population typically engages in low levels of health-promoting physical activity compared with adults from the general population, a fact which has not changed in the past 25 years despite growing evidence of the benefits of exercise. To overcome this challenge, the main limitations to promoting exercise through the patient –clinician interaction must be addressed. (Source: Lancet Neurology)
Source: Lancet Neurology - September 13, 2017 Category: Neurology Authors: Robert W Motl, Brian M Sandroff, Gert Kwakkel, Ulrik Dalgas, Anthony Feinstein, Christoph Heesen, Peter Feys, Alan J Thompson Tags: Personal View Source Type: research
[Review] Therapies targeting DNA and RNA in Huntington's disease
No disease-slowing treatment exists for Huntington's disease, but its monogenic inheritance makes it an appealing candidate for the development of therapies targeting processes close to its genetic cause. Huntington's disease is caused by CAG repeat expansions in the HTT gene, which encodes the huntingtin protein; development of therapies to target HTT transcription and the translation of its mRNA is therefore an area of intense investigation. Huntingtin-lowering strategies include antisense oligonucleotides and RNA interference targeting mRNA, and zinc finger transcriptional repressors and CRISPR-Cas9 methods aiming to re...
Source: Lancet Neurology - September 13, 2017 Category: Neurology Authors: Edward J Wild, Sarah J Tabrizi Tags: Review Source Type: research
[Review] Prediction of motor recovery after stroke: advances in biomarkers
Stroke remains a leading cause of adult disability, and the recovery of motor function after stroke is crucial for the patient to regain independence. However, making accurate predictions of a patient's motor recovery and outcome is difficult when based on clinical assessment alone. Clinical assessment of motor impairment within a few days of stroke can help to predict subsequent recovery, while neurophysiological and neuroimaging biomarkers of corticomotor structure and function can help to predict both motor recovery and motor outcome after stroke. (Source: Lancet Neurology)
Source: Lancet Neurology - September 13, 2017 Category: Neurology Authors: Cathy M Stinear Tags: Review Source Type: research
[Series] The chronic and evolving neurological consequences of traumatic brain injury
Traumatic brain injury (TBI) can have lifelong and dynamic effects on health and wellbeing. Research on the long-term consequences emphasises that, for many patients, TBI should be conceptualised as a chronic health condition. Evidence suggests that functional outcomes after TBI can show improvement or deterioration up to two decades after injury, and rates of all-cause mortality remain elevated for many years. Furthermore, TBI represents a risk factor for a variety of neurological illnesses, including epilepsy, stroke, and neurodegenerative disease. (Source: Lancet Neurology)
Source: Lancet Neurology - September 13, 2017 Category: Neurology Authors: Lindsay Wilson, William Stewart, Kristen Dams-O'Connor, Ramon Diaz-Arrastia, Lindsay Horton, David K Menon, Suzanne Polinder Tags: Series Source Type: research
[Articles] Retinal layer segmentation in multiple sclerosis: a systematic review and meta-analysis
The largest and most robust differences between the eyes of people with multiple sclerosis and control eyes were found in the peripapillary RNFL and macular GCIPL. Inflammatory disease activity might be captured by the INL. Because of the consistency, robustness, and large effect size, we recommend inclusion of the peripapillary RNFL and macular GCIPL for diagnosis, monitoring, and research. (Source: Lancet Neurology)
Source: Lancet Neurology - September 13, 2017 Category: Neurology Authors: Axel Petzold, Laura J Balcer, Peter A Calabresi, Fiona Costello, Teresa C Frohman, Elliot M Frohman, Elena H Martinez-Lapiscina, Ari J Green, Randy Kardon, Olivier Outteryck, Friedemann Paul, Sven Schippling, Patrik Vermersch, Pablo Villoslada, Lisanne J Tags: Articles Source Type: research
[In Context] Biomarkers, bioprediction, and ethics
“Foresight! Foresight!, which takes us ceaselessly beyond ourselves and often places us where we shall never arrive.” This quote by Jean-Jacques Rousseau appears on the opening page of Matthew L. Baum's book The Neuroethics of Biomarkers. Rousseau pinpoints the problem physicians are constantly grappling with, when trying to synthesise medical history, clinical signs, and results from investigations to make a diagnosis and ultimately a prognosis, and decide the interventions that may best serve our patients. (Source: Lancet Neurology)
Source: Lancet Neurology - September 13, 2017 Category: Neurology Authors: Henrik Zetterberg Tags: In Context Source Type: research
[In Context] Gian Lorenzo Bernini's 17th century white noise machine
For centuries, people have sought relief from insomnia through a wide assortment of methods. Studies in young adults and children, which investigated non-pharmacological approaches in sleep induction, found that white noise triggered sleep and reduced night-waking behaviours.1 –2 Nowadays, different kinds of white noise devices are available for insomnia relief, which can sound like rushing waterfalls or wind blowing through trees. It is less well known that one of the most ancient insomnia treatment machines—which used the principles of white noise—was invented in the 17th century by the illustrious architect and sc...
Source: Lancet Neurology - September 13, 2017 Category: Neurology Authors: Michele Augusto Riva, Vincenzo Cimino, Stefano Sanchirico Tags: In Context Source Type: research
[In Context] Ed Wild
Ed Wild is a Medical Research Council clinician scientist and principal research associate at University College London (UCL, London, UK). He studied medicine at Cambridge University (Cambridge, UK) and did his PhD at UCL. His research, including the multinational HDClarity study, focuses on studying human biofluids to develop biomarkers to help test innovative therapies for Huntington's disease. (Source: Lancet Neurology)
Source: Lancet Neurology - September 13, 2017 Category: Neurology Tags: In Context Source Type: research
[In Context] David Menon: the incredible, incurable, clinical rationalist
“I have this urge to find explanations, and I can't seem to get rid of it”, confesses David Menon, Professor of Anaesthesia at University of Cambridge (Cambridge, UK), referring to his Twitter profile that neatly labels him as an incurable clinical rationalist. Menon suggests that, for him, evid ence alone is not quite enough; “why have we got this result—this is the question that consumes me”, he explains. There is something particularly reassuring about a doctor who is a self-confessed knowledge-addict—this may well be the essence of Menon. (Source: Lancet Neurology)
Source: Lancet Neurology - September 13, 2017 Category: Neurology Authors: Jules Morgan Tags: In Context Source Type: research
[Correspondence] Obesity and the nervous system: more questions – Authors' reply
We appreciate the insightful comments pertaining to our Review1 on the neurological consequences of obesity. Our Review focused on the increasing medical literature supporting an association between obesity and CNS and peripheral nervous system (PNS) injury. Several observational and intervention studies have provided consistent evidence substantiating a potential causal link. The two letters raise important issues pertaining to the strength of the current evidence for other associations involving obesity and CNS outcomes. (Source: Lancet Neurology)
Source: Lancet Neurology - September 13, 2017 Category: Neurology Authors: Brian C Callaghan, Phillipe D O'Brien, Lucy M Hinder, Eva L Feldman Tags: Correspondence Source Type: research
[Correspondence] Obesity and the nervous system: more questions
In their excellent Review, Phillipe O'Brien and colleagues1 describe the neurological consequences of obesity. However, the authors did not mention migraine, which is a common, chronic, disabling neurological disorder.2 Epidemiological research shows a link between migraine and obesity that is further substantiated by putative pathophysiological mechanisms.3 A body of evidence supports a role for adipokines (such as leptin, adiponectin, interleukin 6, and TNF- α, among others), which are mediators of inflammatory processes, in the onset, persistence, and progression of migraines. (Source: Lancet Neurology)
Source: Lancet Neurology - September 13, 2017 Category: Neurology Authors: Ane M ínguez-Olaondo, Pablo Irimia, Gema Frühbeck Tags: Correspondence Source Type: research
[Correspondence] Obesity and the nervous system: more questions
In their Review, Phillipe O'Brien and colleagues1 concluded that, although extensive data exist to indicate that obesity —a component of the metabolic syndrome—is a mediator of CNS and peripheral nervous system (PNS) injury, the ideal intervention to prevent the associated cognitive impairment, autonomic neuropathy, and polyneuropathy is not yet known. (Source: Lancet Neurology)
Source: Lancet Neurology - September 13, 2017 Category: Neurology Authors: Jannis Kountouras, Stergios A Polyzos, Panagiotis Katsinelos, Georgios Kotronis, Michael Doulberis Tags: Correspondence Source Type: research
[Correspondence] Edaravone for treatment of early-stage ALS – Authors' reply
We thank Jes ús Mora for allowing us to provide clarifications on our study.1 The protocol2 required all investigators to receive ALSFRS-R video training and to be certified to meet the same evaluation standards. One patient's ALSFRS-R score at cycle 2 was evaluated by an investigator who did not meet this stan dard, and this cycle 2 score was therefore excluded from analyses. Nonetheless, since the cycle 6 endpoint data were available and adequate, this exclusion did not affect our primary analysis. (Source: Lancet Neurology)
Source: Lancet Neurology - September 13, 2017 Category: Neurology Authors: Makoto Akimoto, Kazue Nakamura, Writing Group on behalf of the Edaravone (MCI-186) ALS 19 Study Group Tags: Correspondence Source Type: research
[Correspondence] Edaravone for treatment of early-stage ALS
The Edaravone (MCI-186) ALS 19 Study Group1 reported on the safety and efficacy of edaravone in a phase 3 study of patients with early-stage amyotrophic lateral sclerosis. The primary endpoint was change in the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) scores from baseline to 24 weeks after randomisation. Before randomisation, patients entered a 12-week observation period, and those patients with a decrease in ALSFRS-R score of 1 –4 points were randomly assigned to receive edaravone or placebo. (Source: Lancet Neurology)
Source: Lancet Neurology - September 13, 2017 Category: Neurology Authors: Jes ús S Mora Tags: Correspondence Source Type: research
