Role of B Cells in Relapsing-Remitting and Progressive Multiple Sclerosis and Long-Term Effects of B Cell Depletion
Depletion of circulating B lymphocytes using anti-CD20 monoclonal antibodies (mAbs) greatly reduces inflammatory activity in relapsing multiple sclerosis (RMS); it reduces progression to a lesser extent in nonrelapsing progressive MS. Mechanisms whereby anti-CD20 mAbs reduce MRI and clinical relapse activity in people with RMS are still being elucidated. Anti-CD20 agents do not fully protect from nonrelapsing disease progression, possibly due to their inability to cross the blood –brain barrier and inability to ameliorate the full extent of biology of MS progression. Anti-CD20 mAbs have a relatively favorable safety prof...
Source: Neurologic Clinics - July 23, 2023 Category: Neurology Authors: Afsaneh Shirani, Olaf Stuve, Anne H. Cross Source Type: research
Leveraging Real-World Evidence and Observational Studies in Treating Multiple Sclerosis
Randomized controlled trials (RCTs) are essential for regulatory approval of disease-modifying therapies (DMTs), yet their strict selection criteria often lead to limited generalizability. Observational studies using real-world data (RWD) allow for more inclusive heterogeneous cohorts resulting in higher external validity to inform treatment practices. As reviewed in this article, well-designed comparative effectiveness studies are an important application of RWD. Although, like RCTs, observational studies have their own set of limitations, including various biases that may confound results, advanced statistical methods ca...
Source: Neurologic Clinics - July 20, 2023 Category: Neurology Authors: Albert Aboseif, Izanne Roos, Stephen Krieger, Tomas Kalincik, Carrie M. Hersh Source Type: research
Setting up Functional Neurological Disorder Treatment Services
Functional neurologic disorder (FND) is commonly encountered across outpatient and inpatient medical settings. Given the potential for a high burden of disability in some patients and mounting evidence for the efficacy of FND-specific multidisciplinary treatment services, expanding clinical services for this population is a necessity. In this perspective article, we discuss considerations for creating FND services, including the types of services that exist, how to start, how to identify appropriate referrals, and how to develop and monitor individualized treatment plans. In addition, we discuss how this effort can be done...
Source: Neurologic Clinics - July 17, 2023 Category: Neurology Authors: Sara A. Finkelstein, Alan Carson, Mark J. Edwards, Kasia Kozlowska, Sarah C. Lidstone, David L. Perez, Ginger Polich, Jon Stone, Selma Aybek Source Type: research
Autologous Hematopoietic Stem Cell Transplantation to Treat Multiple Sclerosis
In aggregate, the available data suggest autologous hematopoietic stem cell transplantation (AHSCT) has potent, durable efficacy to treat relapsing multiple sclerosis (MS). Safety issues and financial costs are significant but largely associated with the procedure itself. AHSCT is a reasonable option for patients with highly active relapsing MS and an inadequate response to the available disease therapies. The key question is where to place AHSCT in the overall relapsing MS algorithm relative to other high-efficacy therapies. Ongoing randomized trials will better characterize the benefit and risk of AHSCT compared with cur...
Source: Neurologic Clinics - July 15, 2023 Category: Neurology Authors: Lindsay A. Ross, Lisa M. Stropp, Jeffrey A. Cohen Source Type: research
Medical Malpractice and the Neurologist: Specific Neurological Claims
This chapter highlights the most frequently encountered neurological malpractice claims. The format is designed to provide a rudimentary understanding of how lawsuits arise and thereby focus discussion on adapting practice patterns to improve patient care and minimize liability risk. (Source: Neurologic Clinics)
Source: Neurologic Clinics - July 4, 2023 Category: Neurology Authors: James C. Johnston, Thomas P. Sartwelle Source Type: research
Medicolegal and Ethical Issues in Neurology
The fundamental principles guiding the legal and ethical practice of neurology continue to evolve and grow more complex. For this issue of Neurologic Clinics, we have assembled a group of national experts in both ethical and medicolegal issues who discuss a range of topics of interest to clinicians caring for individuals with neurologic conditions. We begin with a discussion of informed consent and decision making in patients who have lost decision-making capacity and therefore require specific attention when developing treatment plans. (Source: Neurologic Clinics)
Source: Neurologic Clinics - July 4, 2023 Category: Neurology Authors: Joseph S. Kass, Michael A. Rubin Tags: Preface Source Type: research
Medicolegal and Ethical Issues in Neurology
NEUROLOGIC CLINICS (Source: Neurologic Clinics)
Source: Neurologic Clinics - July 4, 2023 Category: Neurology Authors: Joseph S. Kass, Michael A. Rubin Source Type: research
Copyright
ELSEVIER (Source: Neurologic Clinics)
Source: Neurologic Clinics - July 4, 2023 Category: Neurology Source Type: research
Contributors
RANDOLPH W. EVANS, MD (Source: Neurologic Clinics)
Source: Neurologic Clinics - July 4, 2023 Category: Neurology Source Type: research
Contents
Joseph S. Kass and Michael A. Rubin (Source: Neurologic Clinics)
Source: Neurologic Clinics - July 4, 2023 Category: Neurology Source Type: research
Forthcoming Issues
Functional Neurological Disorder (Source: Neurologic Clinics)
Source: Neurologic Clinics - July 4, 2023 Category: Neurology Source Type: research
Era of COVID-19 in Multiple Sclerosis Care
The unprecedented scope of the coronavirus disease 2019 (COVID-19) pandemic resulted in numerous disruptions to daily life, including for people with multiple sclerosis (PwMS). In this article, we review how disruptions in MS care prompted innovations in delivery of care (e.g., via telemedicine) and mobilized the global MS community to rapidly adopt safe and effective practices. We discuss how our understanding of the risks of COVID-19 in PwMS has evolved along with recommendations pertaining to disease-modifying therapies (DMTs) and vaccines. With lessons learned during the COVID-19 pandemic, we examine potential question...
Source: Neurologic Clinics - June 23, 2023 Category: Neurology Authors: Jonathan D. Krett, Amber Salter, Scott D. Newsome Source Type: research
Medical Malpractice and the Neurologist
This article provides an overview of current malpractice trends in neurology as well as non-malpractice and forensic liability concerns. It is more important for clinicians to recognize the common patient care scenarios that are likely to precipitate lawsuits rather than memorize arcane legal principles. Therefore, this article offers an introduction to malpractice jurisprudence as well as a general overview of current litigation trends and a review of the role and duties of a neurologist serving as an expert witness. The next article highlights mitigation strategies for the most prevalent neurologic misadventures. (Source...
Source: Neurologic Clinics - June 9, 2023 Category: Neurology Authors: James C. Johnston, Thomas P. Sartwelle Source Type: research
Counseling Patients with Neurologic Disabilities
People living with neurologic conditions have historically been among the most marginalized groups in society. Advances in science and medicine have helped prevent, manage, or even cure many of these disorders. The byproduct of these successes is an aging population and members of the population at large with neurologic diseases and their sequelae. These sequelae may be imperceptible to others but often include a loss of skills or independence, which negatively impact a person ’s psychosocial and socioeconomic status, particularly when either activities of daily living are compromised or the affected individuals possess ...
Source: Neurologic Clinics - June 9, 2023 Category: Neurology Authors: Sasha Alick-Lindstrom Source Type: research
Persistent Postural-Perceptual Dizziness
Persistent postural-perceptual dizziness (PPPD) is a functional neuro-otologic (vestibular) disorder manifesting dizziness, unsteadiness, or nonspinning vertigo lasting 3 months or more and exacerbated by upright posture, active or passive motion, and complex visual stimuli. PPPD is the most common cause of chronic vestibular symptoms. Early pathophysiologic models of PPPD emphasized the adverse effects of anxiety on postural control and spatial orientation. More r ecent concepts added predictive processing of sensory inputs and alterations in motion perception. Herein, a third-generation model incorporates prioritizatio...
Source: Neurologic Clinics - June 1, 2023 Category: Neurology Authors: Jeffrey P. Staab Source Type: research
