1,721,156 research outputs found
Evaluating dalfampridine for the treatment of relapsing-remitting multiple sclerosis: does it add to the treatment armamentarium?
No full textIntroduction: Multiple sclerosis (MS) is a demyelinating disease, causing axonal damage and disability. Dalfampridine (DAL) is an extended-release formulation of 4-aminopyridine (4AP) and broad-spectrum voltage-dependent potassium channel blocker that is reported to improve motor, visual and cognitive functions. Furthermore, it is presently the only approved drug for walking impairment in MS. Areas covered: Herein, the authors evaluate DAL as a relapsing-remitting MS treatment, reporting and commenting on all aspects of the drug including its chemistry, safety, pharmacokinetics, and cost-effectiveness. A bibliographic search was performed on PubMed using the terms 'dalfampridine OR fampridine OR 4-aminopyridine'. Expert opinion: Evidence from post-marketing studies suggests that DAL, consistent with the effects of 4AP, may not only improve walking speed, but also arm function, fatigue, mood and cognition through restored nerve conduction in central nervous system demyelinated areas. Long-term safety data confirm that the approved dose of 10 mg twice daily is generally well tolerated. However, despite the reported efficacy, the extent of the benefits is limited in real life activities, although significant improvements have been demonstrated in the clinical setting. Patients often complain of side effects (such as cramps and painful paraesthesia) or lack of efficacy. Also, its considerably higher pricing in comparison to 4AP represents an important limitation
Antithrombotic treatment of cervical arterial dissection: Big data needed to inform long-term management
No full textAuthor Response: Teaching NeuroImage: Partially Reversible Widespread Leukoencephalopathy Associated With Atypical Hemolytic Uremic Syndrome
No full textWe greatly appreciated the comment by Dr. Graber on our case.1 To date, kidney involvement associated with TREX1 sequence variations has been sparsely reported in the context of retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL-S). Specifically, different subtypes of kidney involvement have been described in RVCL-S, including thrombotic microangiopathy (TMA) and glomerulosclerosis.2-4
As for our case, unfortunately, TREX1 analysis was not included in the genetic panel. However, a diagnosis of RVCL-S was unlikely, given the optimal response to eculizumab. Indeed, TREX1-related TMA and leukoencephalopathy have been suggested to be driven by dysregulated type-1 interferon pathways.5 Therefore, the pathophysiologic association between TREX1 sequence variations and endothelial damage is supposed to be independent of complement and should not improve after anticomplement treatment. In addition, after 14 months from onset, no other episodes of leukoencephalopathy occurred in our patient, and she was totally weaned from hemodialysis.
To sum up, even if in our case RVCL-S was a remote possibility, we agree with Dr. Graber's suggestion to consider TREX-1 analysis in patients presenting with acute leukoencephalopathy and small vessel kidney disease. Close collaboration between neurologists and nephrologists remains the key point to promptly recognize such a critical condition
Teaching NeuroImage: Partially Reversible Widespread Leukoencephalopathy Associated With Atypical Hemolytic Uremic Syndrome
No full textA 43-year-old woman presented with altered mental status and hypertension. She had a 3-day history of oliguria. The blood test detected microangiopathic hemolytic anemia, thrombocytopenia, and severe kidney injury. The absence of shiga-like toxin, ADAMTS13 autoantibodies, and normal ADAMTS13 activity were consistent with a diagnosis of atypical hemolytic uremic syndrome (aHUS) and then confirmed by a renal biopsy. Genetic tests (CFH, CFHR1-5, MCP/CD46, CFI, C3, CFB, THBD, and DGKE) were unremarkable. Nevertheless, a history of anemia and kidney failure in her younger brother suggested a genetic etiology.
Brain MRI revealed extensive T2 FLAIR hyperintensities. Treatment with eculizumab and twice-weekly hemodialysis resulted in prompt mental recovery and improvement of MRI abnormalities. aHUS is an ultra-rare complement-mediated kidney disease occasionally associated with neurologic involvement.1 Less extensive T2 FLAIR abnormalities involving every CNS structure have also been reported in diarrhea-associated HUS.2 Here, we presented a case of aHUS-related widespread leukoencephalopathy partially reverting on treatment with eculizumab and hemodialysis
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Implementing Blood Biomarkers in Stroke Research and Clinical Practice
Full text linkBlood-based biomarkers reflecting the severity of brain injury showed manifold promising applications in the management of patients with stroke. To date, NfL (neurofilament light chain) and GFAP (glial fibrillary acidic protein) represent the markers with the most support from the literature, but novel biomarker candidates are emerging. In this commentary, we discuss the potential benefits that blood biomarkers would have as additional tools for physicians and stroke specialists in the assessment of stroke risk in the general population, in the acute and postacute phase of stroke management as well as during the longitudinal monitoring of patients during rehabilitation. Moreover, we present an overview of the current applications of blood biomarkers in ongoing clinical trials and debate the still unmet needs of biomarker research in stroke that future studies should target to ease their implementation in the routine care of patients
Prevention and treatment of ischaemic and haemorrhagic stroke in people with diabetes mellitus: a focus on glucose control and comorbidities
Full text linkDiabetes mellitus is a significant risk factor for both ischaemic and haemorrhagic stroke, affecting up to a third of individuals with cerebrovascular diseases. Beyond being a risk factor for stroke, diabetes and hyperglycaemia have a negative impact on outcomes after ischaemic and haemorrhagic stroke. Hyperglycaemia during the acute ischaemic stroke phase is associated with a higher risk of haemorrhagic transformation and poor functional outcome, with evidence in favour of early intervention to limit and manage severe hyperglycaemia. Similarly, intensive glucose control nested in a broader bundle of care, including blood pressure, coagulation and temperature control, can provide substantial benefit for clinical outcomes after haemorrhagic stroke. As micro- and macrovascular complications are frequent in people with diabetes, cardiovascular prevention strategies also need to consider tailored treatment. In this regard, the broader availability of sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists can allow tailored treatments, particularly for those with heart failure and chronic kidney disease as comorbidities. Here, we review the main concepts of hyperacute stroke management and CVD prevention among people with diabetes, capitalising on results from large studies and RCTs to inform clinicians on preferred treatments. Graphical Abstract
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