Neurology Alert
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Early Respiratory Decline in Amyotrophic Lateral Sclerosis
Hypercapnia, a manifestation of early respiratory dysfunction, can be challenging to detect in amyotrophic lateral sclerosis (ALS) patients. Pulmonary function tests are helpful, but their specificity in detecting hypercapnia is low and their use is limited in patients with bulbar weakness. Specific symptoms, such as dyspnea at rest, dyspnea while talking, and use of medications for sleep, can be more reliable in detecting hypercapnia among ALS patients.
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Atypical Presentations for Inclusion Body Myositis
Inclusion body myositis, the most common acquired myopathy, often is misdiagnosed or diagnosed after a delay of many years. Atypical presentations are not unusual, and clinicians should maintain a high degree of suspicion for this disorder when patients present with slowly progressive muscle weakness in an unusual pattern.
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Influence of Vitamin Intake on the Prevalence of Migraine
In a large population-based survey, 21.6% of participants reported having severe headaches or migraine. Those reporting severe headaches also reported a lower intake of thiamine and riboflavin, based on 24-hour recall of food intake. There also was an inverse relationship between thiamine intake and reports of severe headaches.
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Lipid Pathway Dysfunction in Parkinson’s Disease
In this large-scale study, the authors used a comprehensive untargeted lipidomic approach to determine the extent to which lipid dysregulation occurs in patients with Parkinson’s disease generally and in mutation carriers of one of the most common Parkinson’s disease risk genes, LRRK2. Further pathway analysis reveals sphingolipid metabolism, insulin signaling, and mitochondrial function as major metabolic pathways dysregulated in Parkinson’s disease.
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Persistent Asthma Patients Show More Plaque Buildup, Inflammation
Pulmonary ailment could speed carotid artery damage, create more inflammatory biomarkers.
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Scientists Are Worried About Air Quality and Dementia Risk
Traffic-related air pollution raises red flags for neurological health.
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Is IVIG Treatment Really Better than Natural Recovery in Patients with Guillain-Barré Syndrome?
In this controversial report comparing patients with Guillain-Barré syndrome treated with intravenous immunoglobulin vs. no treatment, the group that appears to have fared the best were patients who had an acute demyelinating syndrome, and not an axonal variant. This was an observational study and not a randomized treatment trial.
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Intravenous Immunoglobulin in Dermatomyositis
Treatment of dermatomyositis with intravenous immunoglobulin (IVIG) resulted in overall better clinical improvement after 16 weeks compared to patients treated with placebo. However, there was a significant number of thromboembolic adverse events in the treatment group. The group of patients treated was a heterogeneous group. However, IVIG now is U.S. Food and Drug Administration-approved for the treatment of dermatomyositis.
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Treatment of Progressive Multifocal Leukoencephalopathy
Progressive multifocal leukoencephalopathy, a rare opportunistic viral infection that occurs in patients who have chronic immunosuppression, has defied all attempts at treatment. This observational study, which pooled patient data from multiple centers around the world, showed that there is some benefit using checkpoint inhibitors to help reconstitute the immune system of these patients. However, survival, at best, is 50% of those treated.
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Long-Term Neurological Outcomes of Patients Treated with CAR-T Therapy
Chimeric antigen receptor (CAR)-T cell therapy is approved for the treatment of lymphoma, leukemia, and multiple myeloma, but its use is associated with early neurotoxicity in almost half of patients. Despite the incidence of neurotoxicity, long-term follow-up of patients after CAR-T infusion suggests that patients’ neurological examination, neuro-imaging studies, and cognition remain unaffected by this treatment.