Neurology
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Adverse Neurological Events from Immune Checkpoint Inhibitors
Immune checkpoint inhibitors have transformed the natural history of many metastatic cancers and now are widely used. However, the activation of killer T-cells also has caused serious, often fatal complications from the treatment. The central nervous system is a common victim of these complications.
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What Is the Best First-Line Treatment for Young Women with Generalized Epilepsy?
Valproate is a highly efficacious drug for treating idiopathic generalized epilepsy (IGE) but is not an option for many young women because of known teratogenic risks. This retrospective, multicenter study examined women with IGE who were treated initially with either levetiracetam or lamotrigine monotherapy, demonstrating superior efficacy of levetiracetam, although exclusively in women with juvenile myoclonic epilepsy.
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What Are F-Waves and What Do They Tell Us?
The presence or absence of F-waves is an important observation during the electrophysiological investigation of a patient with acute, progressive weakness. But the underlying physiological basis of F-waves has been elusive. This ex vivo animal study showed that F-waves are solely generated by motor nerves arising from the ventral horn of the spinal cord and require intact synapses.
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Safety and Efficacy of Mogalizumab in HTLV-1-Associated Myelopathy
Human T-cell leukemia virus type 1-associated myelopathy/tropical spastic paraparesis develops in a small number of carriers of this retrovirus as the result of infection and suppression of CD4+ T-cells. Therapy with steroids has been the mainstay but is not safe or effective for the long term. Mogalizumab shows promise as long-term therapy of this debilitating disease.
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Gut Microbiome Metabolites and Progression of Parkinson’s Disease
A Mendelian randomization study shows that trimethylamine N-oxide and its precursor metabolites are not associated with risk of Parkinson’s disease (PD) but have both positive and negative causal effects on some indicators of PD severity and progression.
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Slow-Wave Sleep and Risk of Dementia
In this long-term observational study of sleep efficiency in the Framingham Heart Study population, researchers found a strong correlation between a decline in duration of slow-wave sleep during aging and the risk of incident dementia from all causes. However, a direct cause-and-effect relationship cannot be determined from this observational study.
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Repetitive Head Impacts and Chronic Traumatic Encephalopathy in Young Contact Sport Athletes
In a first of its kind study, researchers found neuropathological markers suggestive of chronic traumatic encephalopathy (CTE) pathology in 41% (n = 152) of young contact sport athletes (< 30 years of age) at autopsy. Clinical measures (obtained retrospectively via informant report) assessing for cognitive and psychiatric/behavioral dysfunction, while elevated across most measures for the entire group, did not significantly differ between brain donors with and without a CTE diagnosis. Functional impairments also were not commonly found.
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Telestroke Facilitates Care for Rural Stroke Patients
In the year before the telestroke program was implemented, 11 of 15 eligible patients received thrombolytics in less than one hour, and there was a mean door-to-needle time of 61 minutes. After the telestroke program was implemented, 11 of 12 eligible patients received thrombolytics in less than one hour, with a mean door-to-needle time of just 38 minutes.
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Acute Vertigo Caused by Herpes Zoster Oticus
Herpes zoster oticus (HZO) and vestibular neuritis (VN) can be difficult to distinguish, but treatments may be different. Magnetic resonance imaging may help by showing inflammatory lesions in the vestibular nuclei or the proximal portions of the eighth nerves in HZO, but not VN.
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Autoimmune Encephalitis After Herpes Simplex Virus Encephalitis
A recent study showed that about 25% of patients with herpes simplex encephalitis develop neurological symptoms three to six weeks after the infection, pointing toward an autoimmune process with different neurological and psychiatric symptoms. Anti-neuronal antibodies, such as anti-N-methyl-D-aspartate receptor antibodies, have been found in this post-viral autoimmune encephalitis presentation.