Assessing association of comorbidities with treatment choice and persistence in MS: A real-life multicenter study
Conclusions:
Comorbidities at diagnosis should be taken into account at the first treatment choice because they are associated with lower persistence on treatment. (Source: Neurology)
Source: Neurology - November 27, 2017 Category: Neurology Authors: Laroni, A., Signori, A., Maniscalco, G. T., Lanzillo, R., Russo, C. V., Binello, E., Lo Fermo, S., Repice, A., Annovazzi, P., Bonavita, S., Clerico, M., Baroncini, D., Prosperini, L., La Gioia, S., Rossi, S., Cocco, E., Frau, J., Torri Clerici, V., Signor Tags: Multiple sclerosis, All epidemiology ARTICLE Source Type: research
Increased relapse rate during pregnancy and postpartum in neuromyelitis optica
Neuromyelitis optica spectrum disorder (NMOSD) is a serious relapsing disease with a predilection for relapses in spinal cord and optic nerve. The presence of antibodies directed against the aquaporin-4 (AQP4) water channel has helped to distinguish NMOSD from multiple sclerosis (MS).1 A female preponderance exists in NMOSD and MS, although the overrepresentation of women in NMOSD is considerably greater, approaching a ratio of 8:1.2 The effect of pregnancy and the postpartum period on NMOSD disease expression and the effect of NMOSD on pregnancy outcomes are relatively unknown. In MS, reduced relapse rates during pregnanc...
Source: Neurology - November 27, 2017 Category: Neurology Authors: Banwell, B., Marrie, R. A. Tags: EDITORIALS Source Type: research
Comorbidities in MS are associated with treatment intolerance and disability
Since the 1990s, an increasing number of disease-modifying therapies (DMTs) have been approved to treat multiple sclerosis (MS), bringing increasing choice and efficacy. With this has come greater complexity for patients in what should be a shared decision-making process, involving oral treatment or injections, with varying frequency of administration and need for laboratory monitoring. Risks are variable, and efficacy may be also. The complexity increases for women in childbearing years. (Source: Neurology)
Source: Neurology - November 27, 2017 Category: Neurology Authors: McDonnell, G. V., Cohen, J. A. Tags: EDITORIALS Source Type: research
Spotlight on the November 28 issue
(Source: Neurology)
Source: Neurology - November 27, 2017 Category: Neurology Authors: Gross, R. A. Tags: IN FOCUS Source Type: research
How comorbid conditions affect the choice of treatment in multiple sclerosis
A person can have more than one medical illness at the same time. For instance, a person could have headaches and also have low thyroid. In some cases, the medical illnesses are unrelated. In other instances, the comorbid illnesses occur together more often than by chance alone. In medicine, comorbid illnesses are very common. Many prior Patient Pages have discussed some of these associations. For people with multiple sclerosis (MS), having a comorbid medical condition is common. In some studies, 40%–66% of people with MS will also have another, associated, medical condition. (Source: Neurology)
Source: Neurology - November 27, 2017 Category: Neurology Authors: Karceski, S. Tags: All Demyelinating disease (CNS), Multiple sclerosis PATIENT PAGES Source Type: research
Teaching NeuroImages: Brain imaging findings in acute methanol toxicity
A 35-year-old man presented to the hospital in status epilepticus. CT of the head revealed bilateral basal ganglia hemorrhage (figure, A). Serum osmolality was elevated at 372 mmol/kg and methanol level was 34 mmol/L. He was admitted to the intensive care unit. MRI of the brain (figure, B–D) demonstrated extensive white matter diffusion restriction and basal ganglia hemorrhage. Care was withdrawn on postadmission day 6, with the patient dying shortly thereafter. Methanol toxicity classically presents with putaminal necrosis, presumed secondary to cellular hypoxia from formate-induced cytochrome oxidase inhibition.1 R...
Source: Neurology - November 27, 2017 Category: Neurology Authors: Anderson, D., Beecher, G., Emery, D., Khadaroo, R. G. Tags: CT, MRI, All Toxicology, Alcohol, Other toxicology RESIDENT & amp;amp; FELLOW SECTION Source Type: research
Mystery Case: A 61-year-old woman with lower extremity paralysis and sensory loss
A 61-year-old woman presented to the hospital with acute onset of numbness and weakness in the lower extremities. Her symptoms rapidly progressed, reaching maximal intensity within hours. She developed acute urinary retention but without bulbar or upper extremity involvement. There was no constitutional symptom or preceding trauma. Prior medical conditions included hypertension, hyperlipidemia, left-sided sciatica, and low back pain. Family history was unremarkable. (Source: Neurology)
Source: Neurology - November 27, 2017 Category: Neurology Authors: Manners, J., Jadhav, A. P., Xia, Z. Tags: All Clinical Neurology, All Spinal Cord, Arteriovenous malformation, Transverse myelitis RESIDENT AND FELLOW SECTION Source Type: research
The rest of the iceberg
The easily recognizable motor symptoms of Parkinson disease (PD) are just the tip of the iceberg. Beneath the surface lurk over 20 nonmotor symptoms ranging from nuisance to life-threatening. As anyone familiar with the fate of the Titanic can tell you, these are game changers. (Source: Neurology)
Source: Neurology - November 27, 2017 Category: Neurology Authors: Cook, D. G., Hall, K. W., Hall, L. L., Schmidt, T. A., Sumrall, M. A., Tuck, K. K. Tags: Parkinson's disease/Parkinsonism REFLECTIONS: NEUROLOGY AND THE HUMANITIES Source Type: research
Author response: Dementia risk in renal dysfunction: A systematic review and meta-analysis of prospective studies
We thank Prof. Kawada for the interest in our article,1 and agree that the exact mechanisms underlying the relationship between renal dysfunction and cognitive impairment or dementia are not fully understood. In our article, we discussed several suggested potential mechanisms.1 These might work additively, or synergistically, and include shared vascular risk factors or a direct effect of uremic toxins.1,2 (Source: Neurology)
Source: Neurology - November 20, 2017 Category: Neurology Authors: Deckers, K., Camerino, I., van Boxtel, M. P. J., Verhey, F. R. J., Irving, K., Brayne, C., Kivipelto, M., Starr, J. M., Yaffe, K., de Leeuw, P. W., Köhler, S. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Letter re: Dementia risk in renal dysfunction: A systematic review and meta-analysis of prospective studies
Deckers et al.1 conducted random effects meta-analyses on the prospective association between potential markers of renal dysfunction and development of cognitive impairment or dementia. Pooled odds ratios (95% confidence intervals) of albuminuria and estimated glomerular filtration rate <60 mL/min/1.73 m2 for cognitive impairment or dementia were 1.35 (1.06–1.73) and 1.28 (0.99–1.65), respectively.1 As the number of studies was not sufficient, meta-analyses could not be done for serum creatinine, creatinine clearance, or cystatin C.1 The authors concluded that albuminuria was a useful marker of renal dysfunc...
Source: Neurology - November 20, 2017 Category: Neurology Authors: Kawada, T. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Author response: Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society
We wholeheartedly agree with the comments of Stanton et al. on our sudden unexpected death in epilepsy guideline article.1 (Source: Neurology)
Source: Neurology - November 20, 2017 Category: Neurology Authors: Gloss, D., French, J. A., Hesdorffer, D. C., Smithson, W. H., Harden, C. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Letter re: Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society
The new guideline by the American Academy of Neurology (AAN) and the American Epilepsy Society (AES) on sudden unexpected death in epilepsy (SUDEP) is a landmark.1 The communication between medical professionals and patients about SUDEP risk remains unacceptably low. Tragically, family members often first learn about SUDEP after their loved one's death. Every patient and parent deserves to know the risks of epilepsy. For the first time, the AAN and AES recommend that neurologists inform them about SUDEP, the most common cause of epilepsy-related death.1 (Source: Neurology)
Source: Neurology - November 20, 2017 Category: Neurology Authors: Stanton, T., Harding, R., Gattone, P., Friedman, D., Geiger, A., Devinsky, O., Rosbeck, K. L., Vogel-Farley, V., Meskis, M. A., Singer, A., Miller, A. B., Miller, I. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Editors' Note
: In the American Academy of Neurology and the American Epilepsy Society practice guideline on sudden unexpected death in epilepsy (SUDEP) incidence rates and risk factors, Harden et al. made recommendations to clinicians caring for people with epilepsy including the need to inform their patients about SUDEP, the most common cause of epilepsy-related death. Commenting on the guideline, Stanton et al. note that certain pediatric populations (children with Dravet syndrome, Dup15q syndrome) face a significantly higher risk of SUDEP. (Source: Neurology)
Source: Neurology - November 20, 2017 Category: Neurology Authors: Karam, C., Griggs, R. C. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Quinidine-associated skin discoloration in KCNT1-associated pediatric epilepsy
A 9-month-old boy with migrating partial seizures of infancy due to a de novo KCNT1 mutation c.2278A>T (p.Ile760Phe) developed bluish discoloration of the hands, feet, and lips (figure) during a 9-month trial of quinidine (40 mg/kg/d; level 3.4 μg/mL).1 There was no exposure to other medications that cause pigmentary changes. Given minimal improvement in seizures and development, quinidine was stopped. Discoloration persisted at 3 months but markedly improved by the 6-month follow-up. Though common with other potassium channel blockers (ezogabine and quinine), such discoloration has only rarely been reported with qui...
Source: Neurology - November 20, 2017 Category: Neurology Authors: Baumer, F. M., Sheehan, M. Tags: Antiepileptic drugs NEUROIMAGES Source Type: research
TRMT5 mutations are associated with features of complex hereditary spastic paraparesis
Mitochondrial DNA (mtDNA) encodes for 22 tRNAs (mt-tRNA) that undergo posttranscriptional modification.1,2 A specific nucleotide adjacent to the anticodon of mt-tRNA (position 37) is methylated (m1G37) to enhance translational efficiency/fidelity.3 The gene tRNA methyltransferase 5 (TRMT5) encodes a protein involved in m1G37 formation for some mitochondrial tRNAs3,4 and has been associated with combined oxidative phosphorylation deficiency 26 (COXPD26) (OMIM 616539). (Source: Neurology)
Source: Neurology - November 20, 2017 Category: Neurology Authors: Tarnopolsky, M. A., Brady, L., Tetreault, M., For the Care4Rare Canada Consortium Tags: Spastic paraplegia, Muscle disease, Mitochondrial disorders CLINICAL/SCIENTIFIC NOTES Source Type: research
