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Literature review and meta-analysis of natalizumab therapy for the treatment of highly active relapsing remitting multiple sclerosis in the ‘suboptimal therapy’ patient population 纳他珠单抗疗法治疗 "次优疗法 "患者中高度活跃的复发缓解型多发性硬化症的文献综述和荟萃分析
IF 3.6 3区 医学
Journal of the Neurological Sciences Pub Date : 2024-08-06 DOI: 10.1016/j.jns.2024.123172
{"title":"Literature review and meta-analysis of natalizumab therapy for the treatment of highly active relapsing remitting multiple sclerosis in the ‘suboptimal therapy’ patient population","authors":"","doi":"10.1016/j.jns.2024.123172","DOIUrl":"10.1016/j.jns.2024.123172","url":null,"abstract":"<div><h3>Background</h3><p>Highly active (HA) relapsing remitting multiple sclerosis (RRMS) is associated with frequent relapses and high burden of disease/disability. Natalizumab is licensed for HA RRMS, including rapidly evolving severe (RES) (≥2 relapses in previous year) and sub-optimally treated (SOT) (≥1 relapse in previous year despite treatment) populations. However, there is limited RCT evidence in the SOT subpopulation.</p></div><div><h3>Objective</h3><p>To review the non-RCT evidence for natalizumab in SOT HA RRMS.</p></div><div><h3>Methods</h3><p>Databases were searched to January 2023 for non-randomised studies of natalizumab in HA RRMS. Studies in patients with ≥1 relapse during previous treatment were eligible for inclusion. Meta-analyses were conducted to compare natalizumab with platform and higher efficacy disease-modifying therapies, with sensitivity analysis restricted to studies of low risk of bias.</p></div><div><h3>Results</h3><p>Included comparative studies (<em>n</em> = 16) showed natalizumab had lower relapse rates, disease activity and MRI (radiological) outcomes compared with platform and higher efficacy therapy. Case series (<em>n</em> = 11) showed natalizumab was associated with high rates of freedom from relapse and clinical/radiological disease activity and reductions in annualised relapse rate and disability progression.</p></div><div><h3>Conclusions</h3><p>Literature reviewed indicates that natalizumab is more effective than other included treatments for SOT patients. Findings were consistent with studies in the broad HA RRMS population, suggesting that natalizumab may have similar efficacy for SOT and RES HA RRMS.</p></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0022510X24003071/pdfft?md5=379dd39647af789f9e6f1bf6fc079e7c&pid=1-s2.0-S0022510X24003071-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141978744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Environmental factors related to multiple sclerosis progression 与多发性硬化症进展有关的环境因素
IF 3.6 3区 医学
Journal of the Neurological Sciences Pub Date : 2024-08-06 DOI: 10.1016/j.jns.2024.123161
{"title":"Environmental factors related to multiple sclerosis progression","authors":"","doi":"10.1016/j.jns.2024.123161","DOIUrl":"10.1016/j.jns.2024.123161","url":null,"abstract":"<div><p>Multiple Sclerosis (MS) is a complex neurological disease which prevalence is increasing worldwide. The impact of environmental factors on MS susceptibility has already been defined and highlighted in many previous reports, particularly vitamin D or ultraviolet B light exposure, Epstein–Barr virus (EBV) infection, obesity, and smoking. There is increasing evidence that environmental and lifestyle factors are not only important in triggering MS but are also implicated in MS progression. Low sun exposure and vitamin D deficiency exhibit a strong relationship with disease progression in both animal and human studies. The gestational period seems also to impact long-term disease progression as January's babies had a higher risk of requiring walking assistance than those born in other months. The implication of EBV in neurodegeneration and MS progression was also suggested even though its specific targets and mechanisms are still unclear. Cigarette smoking is correlated with faster clinical progression. The association of obesity and smoking seems to be associated with a faster progression and an increased rate of brain atrophy. Although the effect of air pollution on MS pathogenesis remains not fully understood, exposure to polluted air can stimulate several mechanisms that might contribute to MS severity. People with MS with active disease have an altered microbiota compared to patients in the remission phase. Cardiovascular comorbidities, epilepsy, and depression are also associated with a more severe disability accrual. Knowledge about MS modifiable risk factors of progression need to be incorporated into everyday clinical practice in order to ameliorate disease outcomes.</p></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141964202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hippocampal atrophy and white matter lesions characteristics can predict evolution to dementia in patients with vascular mild cognitive impairment 海马体萎缩和白质病变特征可预测血管性轻度认知障碍患者向痴呆症的演变。
IF 3.6 3区 医学
Journal of the Neurological Sciences Pub Date : 2024-08-06 DOI: 10.1016/j.jns.2024.123163
{"title":"Hippocampal atrophy and white matter lesions characteristics can predict evolution to dementia in patients with vascular mild cognitive impairment","authors":"","doi":"10.1016/j.jns.2024.123163","DOIUrl":"10.1016/j.jns.2024.123163","url":null,"abstract":"<div><h3>Background</h3><p>Vascular mild cognitive impairment (VMCI) is a transitional condition that may evolve into Vascular Dementia(VaD). Hippocampal volume (HV) is suggested as an early marker for VaD, the role of white matter lesions (WMLs) in neurodegeneration remains debated.</p></div><div><h3>Objectives</h3><p>Evaluate HV and WMLs as predictive markers of VaD in VMCI patients by assessing: (i)baseline differences in HV and WMLs between converters to VaD and non-converters, (ii) predictive power of HV and WMLs for VaD, (iii) associations between HV, WMLs, and cognitive decline, (iv)the role of WMLs on HV.</p></div><div><h3>Methods</h3><p>This longitudinal multicenter study included 110 VMCI subjects (mean age:74.33 ± 6.63 years, 60males/50females) from the VMCI-Tuscany Study database. Subjects underwent brain MRI and cognitive testing, with 2-year follow-up data on VaD progression. HV and WMLs were semi-automatically segmented and measured. ANCOVA assessed group differences, while linear and logistic regression models evaluated predictive power<strong>.</strong></p></div><div><h3>Results</h3><p>After 2 years, 32/110 VMCI patients progressed to VaD. Converting patients had lower HV(<em>p</em> = 0.015) and higher lesion volumes in the posterior thalamic radiation (<em>p</em> = 0.046), splenium of the corpus callosum (<em>p</em> = 0.016), cingulate gyrus (<em>p</em> = 0.041), and cingulum hippocampus(<em>p</em> = 0.038). HV alone did not fully explain progression (<em>p</em> = 0.059), but combined with WMLs volume, the model was significant (<em>p</em> = 0.035). The best prediction model (<em>p</em> = 0.001) included total HV (<em>p</em> = 0.004) and total WMLs volume of the posterior thalamic radiation (<em>p</em> = 0.005) and cingulate gyrus (p = 0.005), achieving 80% precision, 81% specificity, and 74% sensitivity. Lower HV were linked to poorer performance on the Rey Auditory-Verbal Learning Test delayed recall (RAVLT) and Mini Mental State Examination (MMSE).</p></div><div><h3>Conclusions</h3><p>HV and WMLs are significant predictors of progression from VMCI to VaD. Lower HV correlate with worse cognitive performance on RAVLT and MMSE tests.</p></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0022510X24002983/pdfft?md5=35966eafc36f362559b78b91dc6ed0bf&pid=1-s2.0-S0022510X24002983-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Involvement of the nigrostriatal system in Gerstman–Sträussler–Scheinker disease with the PRNP-P102L mutation PRNP-P102L突变导致Gerstman-Sträussler-Scheinker病的黑质系统受累。
IF 3.6 3区 医学
Journal of the Neurological Sciences Pub Date : 2024-08-06 DOI: 10.1016/j.jns.2024.123166
{"title":"Involvement of the nigrostriatal system in Gerstman–Sträussler–Scheinker disease with the PRNP-P102L mutation","authors":"","doi":"10.1016/j.jns.2024.123166","DOIUrl":"10.1016/j.jns.2024.123166","url":null,"abstract":"<div><h3>Introduction</h3><p>Gerstmann–Sträussler–Scheinker disease (GSS) is an autosomal-dominant inherited prion disease most often associated with the human prion protein gene (<em>PRNP)</em>-P102L mutation. Although patients manifest considerable phenotypic heterogeneity, the involvement of the nigrostriatal system has not been well-studied.</p></div><div><h3>Methods</h3><p>We performed dopamine transporter single-photon emission computed tomography (DAT-SPECT) using <sup>123</sup>I-ioflupane to investigate the nigrostriatal system function in nine patients with the <em>PRNP</em>-P102L mutation. We also examined the pathological findings in another patient whose predominant feature was ataxia and who died 5 years after disease onset.</p></div><div><h3>Results</h3><p>Striatum uptake of <sup>123</sup>I-ioflupane indicated by specific binding ratio (SBR) values was significantly reduced in two patients. The DAT-SPECT examination was performed 6 months after disease onset in one of these patients who manifested rapidly developing cognitive decline mimicking Creutzfeldt–Jakob disease. DAT-SPECT was also performed 9 years after disease onset in another patient who manifested the conventional features of GSS involving ataxia and dementia in the initial phase but showed akinetic mutism at the examination time. Another patient examined 2 years after disease onset who predominantly manifested ataxia showed marginally abnormal SBR values. An autopsy case showed moderate neuronal loss in the substantia nigra, and the degree of neuronal loss was similar in most other parts of the brain.</p></div><div><h3>Conclusion</h3><p>Nigrostriatal system involvement may occur in patients with GSS associated with the <em>PRNP</em>-P102L mutation, even though parkinsonism is not the predominant feature.</p></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Serum phosphorus levels associated with nigrostriatal dopaminergic deficits in drug-naïve Parkinson's disease 血清磷水平与药物治疗无效帕金森病患者黑质纹状体多巴胺能缺陷有关。
IF 3.6 3区 医学
Journal of the Neurological Sciences Pub Date : 2024-08-05 DOI: 10.1016/j.jns.2024.123165
{"title":"Serum phosphorus levels associated with nigrostriatal dopaminergic deficits in drug-naïve Parkinson's disease","authors":"","doi":"10.1016/j.jns.2024.123165","DOIUrl":"10.1016/j.jns.2024.123165","url":null,"abstract":"<div><h3>Introduction</h3><p>A major component of Lewy bodies is phosphorylated α-synuclein. This post-translational modification of α-synuclein, phosphorylation, may consume a great amount of serum phosphorus. We aimed to investigate serum phosphorus levels and their associations with clinical phenotype and the degeneration of cardiac sympathetic and nigrostriatal dopaminergic neurons in patients with Parkinson's disease (PD).</p></div><div><h3>Materials and methods</h3><p>We examined serum phosphorus levels in 127 participants (drug-naïve PD, 97; age- and sex-matched controls, 30). Associations of serum phosphorus levels with clinical features, heart-to-mediastinum (H/M) ratio on cardiac <sup>123</sup>I-metaiodobenzylguanidine scintigraphy and striatal specific binding ratio of <sup>123</sup>I-2-carbomethoxy-3-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (<sup>123</sup>I-FP-CIT) were examined.</p></div><div><h3>Results</h3><p>Serum phosphorus levels were 3.4 ± 0.5 mg/dL in patients with PD and were not different from those in controls after controlling for age and sex (<em>p</em> = 0.850). Serum phosphorus levels were significantly lower in patients with PD and decreased H/M ratio than in those with PD and normal H/M ratio (3.3 ± 0.4 mg/dL vs. 3.6 ± 0.5 mg/dL, <em>p</em> = 0.003). Lower serum phosphorus levels were significantly associated with more severe degeneration of nigrostriatal dopaminergic neurons in patients with PD and decreased H/M ratio. However, this association was not observed in patients with PD and normal H/M ratio.</p></div><div><h3>Conclusions</h3><p>Serum phosphorus levels and their association with nigrostriatal dopaminergic degeneration are different between patients with decreased H/M ratio and those with normal H/M ratio. Serum phosphorus levels may reflect the degree of nigrostriatal dopaminergic degeneration in patients with decreased H/M ratio, namely, Body-First PD.</p></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cost of transport is a barrier to access to headache care in sub-Saharan Africa: An observational study in an HIV-positive population 交通费用是撒哈拉以南非洲地区获得头痛治疗的障碍:一项针对 HIV 阳性人群的观察性研究。
IF 3.6 3区 医学
Journal of the Neurological Sciences Pub Date : 2024-08-05 DOI: 10.1016/j.jns.2024.123162
{"title":"Cost of transport is a barrier to access to headache care in sub-Saharan Africa: An observational study in an HIV-positive population","authors":"","doi":"10.1016/j.jns.2024.123162","DOIUrl":"10.1016/j.jns.2024.123162","url":null,"abstract":"<div><h3>Introduction</h3><p>Headache disorders are the largest contributor to all years lived with disability attributed to neurological disorders. In sub-Saharan Africa (SSA), with 1.2 billion inhabitants, headache prevalence is similar to that of Western countries but with widely inadequate access to care. Cost of transport to healthcare facilities hampers access to care, leading to abandonment and low retention. The aim of this observational study in Malawi was to investigate cost of transport and its likely impact on implementation of WHO's-Intersectoral Global Action Plan (IGAP) in an HIV+ population also complaining of, and requiring treatment for, an active headache disorder.</p></div><div><h3>Methods</h3><p>The study was conducted at the Disease Relief through Excellent and Advanced Means (DREAM) centre in Blantyre, Malawi, in collaboration with the Global Campaign against Headache as an extension of a previous study. Enquiries about distance and costs of travel were added to the previously published questionnaire.</p></div><div><h3>Results</h3><p>We included 495 consecutive HIV+ patients aged 6–65 years who had been followed for at least 1 year. One-year prevalence of any headache was 76.6%; 28.7% missed at least one appointment because of transport costs. Higher costs of transport were associated with higher probability of missing visits (<em>p</em> &lt; 0.001), while costs were higher for those living in rural areas than for those in urban (p &lt; 0.001).</p></div><div><h3>Conclusions</h3><p>Awareness of cost and affordability of transport in SSA may suggest strategies to improve access to headache care. Given the disability attributable to headache, this is necessary if the IGAP strategic objectives and targets are to be achieved.</p></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Biomarkers of neural integrity and immunoglobulin genes influence neurodegeneration in Alzheimer's disease 神经完整性生物标记物和免疫球蛋白基因影响阿尔茨海默病的神经退行性变
IF 3.6 3区 医学
Journal of the Neurological Sciences Pub Date : 2024-08-05 DOI: 10.1016/j.jns.2024.123167
{"title":"Biomarkers of neural integrity and immunoglobulin genes influence neurodegeneration in Alzheimer's disease","authors":"","doi":"10.1016/j.jns.2024.123167","DOIUrl":"10.1016/j.jns.2024.123167","url":null,"abstract":"<div><p>Compelling evidence has been presented in favor of herpes simplex virus type 1 (HSV1) being one of the causative agents of Alzheimer's disease (AD). The success of HSV1 as a pathogen relates to its sophisticated strategies to evade host immunosurveillance. One strategy involves encoding a decoy Fcγ receptor (FcγR) that thwarts the Fcγ-mediated effector functions, such as antibody-dependent cellular cytotoxicity (ADCC), a potent host immunosurveillance mechanism against virally infected cells. The decoy FcγR binds to antibodies of all IgG subclasses, except IgG3; therefore, IgG3 would be expected to play an important role in viral clearance by neutralization and ADCC, and thus contribute to protection from HSV1-spurred diseases. Previous studies have shown significant association between anti-HSV1 IgG3 antibodies and cortical thinning of the areas of the brain typically altered in AD and also targeted by HSV1. The aim of the present investigation was to determine whether GM (γ marker) 5 and GM 21 allotypes, hereditary allelic determinants expressed on IgG3, together with brain biomarkers of neural integrity, contributed to neurodegeneration—as measured by mini-mental state examination (MMSE) score—in patients with AD. Multiple regression analyses showed that the homozygous GM 5/5 genotype, preserved right hippocampus, and right insula thickness were associated with higher MMSE scores (<em>p</em> &lt; 0.001), whereas the opposite pattern and GM 5/21 genotype were associated with worse clinical profiles. Influence of GM 5/21-expressing IgG3 antibodies on the ADCC of HSV1-infected neurons could, at least partially, explain these results.</p></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141978743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical and molecular predictors of survival among atypical parkinsonian syndromes in a North African tertiary referral center 北非三级转诊中心非典型帕金森综合征患者存活率的临床和分子预测因素。
IF 3.6 3区 医学
Journal of the Neurological Sciences Pub Date : 2024-07-31 DOI: 10.1016/j.jns.2024.123155
{"title":"Clinical and molecular predictors of survival among atypical parkinsonian syndromes in a North African tertiary referral center","authors":"","doi":"10.1016/j.jns.2024.123155","DOIUrl":"10.1016/j.jns.2024.123155","url":null,"abstract":"<div><h3>Introduction</h3><p>Atypical Parkinsonian Syndromes(APS) are challenging neurodegenerative disorders due to their heterogeneous phenotypic overlaps.So far,there are no validated biomarkers that can accurately predict disease progression,and survival studies were highly different and contradictory.</p></div><div><h3>Aim</h3><p>To investigate clinical and molecular survival factors among Tunisian APS patients.</p></div><div><h3>Methods</h3><p>A retrospective study included Tunisian APS-patients.Using clinical and molecular parameters,survival was explored by Kaplan-Meier analysis.</p></div><div><h3>Results</h3><p>We included 409-APS patients divided into 166-DLB,112-PSP,81-MSA and 50-CBS.Survival rate was similar in synucleinopathies, while it differed in tauopathies,being shorter in PSP compared to CBS.Median survival in DLB was different according to gender(<em>p</em> = 0.0048),early parkinsonism and cognitive disorders. Among MSA, prognosis was worse in MSA-C-patients(<em>p</em> = 0.012) and those with stridor(<em>p</em> = 0.0049),oculomotor and neuropsychiatric disorders. For tauopathies, survival was shorter in PSP-RS(<em>p</em> = 0.027),cerebellar phenotype, those with tremor and swallowing problems at onset, early parkinsonism and memory impairment. For CBS,prognosis was worse in patients with tremor,swallowing and cognitive problems.Significant differences were noted in terms of survival across APS non-carriers of <em>APOE-</em>ε4(<em>p</em> &lt; 0.001) as well APS patients carriers of <em>MAPT-</em>H1.PSP patients had lower survival rate according to <em>MAPT</em> haplotype carriage. Moreover, the number of copies had an influence as patients with H1/H2-<em>MAPT</em> profile had better prognosis than those with H1/H1.</p></div><div><h3>Conclusion</h3><p>This study determined survival rates in APS subgroups,which were comparable across synucleinopathies but shorter in PSP and longer in CBS.It also characterized demographic,phenotypic,and genetic profiles identifying more aggressive forms within APS subgroups.These findings address clinical gaps,aiding counseling for patients and families and guiding clinical management.Furthermore,they could facilitate patient stratification in clinical trials where mortality is an outcome measure.</p></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Worsening of myasthenic symptoms associated with statins 他汀类药物导致肌无力症状加重
IF 3.6 3区 医学
Journal of the Neurological Sciences Pub Date : 2024-07-31 DOI: 10.1016/j.jns.2024.123154
{"title":"Worsening of myasthenic symptoms associated with statins","authors":"","doi":"10.1016/j.jns.2024.123154","DOIUrl":"10.1016/j.jns.2024.123154","url":null,"abstract":"<div><h3>Introduction/Aims</h3><p>The common presentations of statin intolerance are muscle-specific symptoms. Although statins are one type of drug reported to cause myasthenic worsening, myasthenic worsening has not been recognized as statin intolerance. The purpose of the present study is to investigate in a large cohort the safety profiles of statins in patients with myasthenia gravis (MG).</p></div><div><h3>Methods</h3><p>A total of 1710 consecutive patients with MG who visited sites associated with the Japan MG registry 2021 group between April and October 2021 were reviewed. Statin-associated myasthenic worsening was defined as worsening of any myasthenic symptoms on statin use and improvement of the symptom by stopping the statin or by undertaking additional treatment with patient and doctor confirmation.</p></div><div><h3>Results</h3><p>Among the 400 patients who used statins, 8 (2%) patients experienced statin intolerance and 6 (1.5%) patients experienced myasthenic worsening. No patients developed MG on the statin. Ptosis was a main symptom of myasthenic worsening in 4 (67%) patients. Atorvastatin was used in all patients with statin-associated myasthenic worsening. The symptoms of statin intolerance and statin-associated myasthenic worsening were improved within 2 months and 3 months, respectively, in all patients by cessation of statin use.</p></div><div><h3>Discussion</h3><p>Regarding statin-associated myasthenic worsening, prevalence was low, and severity was mild; with cessation of statin use, symptoms improved within a few months, and outcomes were generally good. Although statins can be used in MG patients with little concern, statin-associated myasthenic worsening should be noted in addition to the classical statin intolerance associated with statin use.</p></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141978741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Story recall performance and AT classification via positron emission tomography: A comparison of logical memory and Craft Story 21 通过正电子发射断层扫描进行故事回忆和 AT 分类:逻辑记忆与 Craft Story 21 的比较。
IF 3.6 3区 医学
Journal of the Neurological Sciences Pub Date : 2024-07-31 DOI: 10.1016/j.jns.2024.123148
{"title":"Story recall performance and AT classification via positron emission tomography: A comparison of logical memory and Craft Story 21","authors":"","doi":"10.1016/j.jns.2024.123148","DOIUrl":"10.1016/j.jns.2024.123148","url":null,"abstract":"<div><h3>Background</h3><p>Early detection of Alzheimer's disease (AD) is one of the critical components of the global response to the growing dementia crisis. Analysis of serial position performance in story recall tests has yielded sensitive metrics for the prediction of AD at low cost. In this study, we examined whether serial position markers in two story recall tests (the logical memory test, LMT, and the Craft Story 21 test, CST) were sensitive to cross-sectional biomarker-based assessment of in vivo neuropathology.</p></div><div><h3>Methods</h3><p>Participants were selected from the Wisconsin Registry of Alzheimer's Prevention (<em>n</em> = 288; WRAP) and the Alzheimer's Disease Research Center (<em>n</em> = 156; ADRC), both from the University of Wisconsin–Madison. Average age at PET was 68.9 (6.7) and 67.0 (8.0), respectively. Data included tau and PiB PET, and LMT for WRAP participants and CST for ADRC participants. Two sets of Bayesian analyses (logistic regressions and ANCOVAs) were conducted within each cohort, separately.</p></div><div><h3>Results</h3><p>Results indicated that the A+T+ classification was best predicted, cross-sectionally, by the recency ratio (Rr), indexing how much of the end of the story was forgotten between initial learning and delayed assessment. Rr outperformed traditional scores and discriminated between A+T+ and A+T−/A-T-, in both cohorts.</p></div><div><h3>Conclusions</h3><p>Overall, this study confirms that serial position analysis of LMT and CST data, and particularly Rr as an index of recency loss, is a valuable tool for the identification of in vivo tau pathology in individuals free of dementia. Diagnostic considerations are discussed.</p></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0022510X24002831/pdfft?md5=223b11f2df052645d049d536c64f0784&pid=1-s2.0-S0022510X24002831-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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