Lancet Neurology最新文献_第3页

RAB32 mutation in Parkinson's disease. 帕金森病中的 RAB32 基因突变。

IF 46.5 1区医学

Lancet Neurology Pub Date : 2024-10-01 DOI: 10.1016/S1474-4422(24)00324-7

Edoardo Monfrini, Raffaella Minardi, Franco Valzania, Giovanna Calandra-Buonaura, Paola Mandich, Alessio Di Fonzo

引用次数: 0

Targeting auto-antibodies for CIDP: hope and questions. 针对自身抗体治疗 CIDP：希望与问题。

IF 46.5 1区医学

Lancet Neurology Pub Date : 2024-10-01 DOI: 10.1016/S1474-4422(24)00362-4

Yusuf A Rajabally

引用次数: 0

Mexiletine versus lamotrigine in non-dystrophic myotonias: a randomised, double-blind, head-to-head, crossover, non-inferiority, phase 3 trial. 美西雷定与拉莫三嗪治疗非肌营养不良性肌张力障碍：随机、双盲、头对头、交叉、非劣效性三期试验。

IF 46.5 1区医学

Lancet Neurology Pub Date : 2024-10-01 DOI: 10.1016/S1474-4422(24)00320-X

Vinojini Vivekanandam, Iwona Skorupinska, Dipa L Jayaseelan, Emma Matthews, Richard J Barohn, Michael P McDermott, Michael G Hanna

{"title":"Mexiletine versus lamotrigine in non-dystrophic myotonias: a randomised, double-blind, head-to-head, crossover, non-inferiority, phase 3 trial.","authors":"Vinojini Vivekanandam, Iwona Skorupinska, Dipa L Jayaseelan, Emma Matthews, Richard J Barohn, Michael P McDermott, Michael G Hanna","doi":"10.1016/S1474-4422(24)00320-X","DOIUrl":"10.1016/S1474-4422(24)00320-X","url":null,"abstract":"Background: Non-dystrophic myotonias are skeletal muscle channelopathies caused by ion channel dysfunction. Symptom onset is frequently in the first decade of life, causing disability in a young cohort. Although there is no cure, symptomatic treatments exist. Previous trials provide evidence of the efficacy of mexiletine. More recently, lamotrigine has been shown to be effective. Both treatments have different profiles, including pharmacokinetics and adverse events. This trial aimed to investigate whether lamotrigine is non-inferior to mexiletine to directly inform clinical practice.Methods: We did a randomised, double-blind, crossover, non-inferiority, phase 3 trial at the National Hospital for Neurology and Neurosurgery (London, UK). Participants (aged ≥18 years) who had genetically confirmed symptomatic non-dystrophic myotonia were randomly assigned (1:1), by means of a block randomisation schedule created by a computer program, to receive either mexiletine for 8 weeks followed by lamotrigine for 8 weeks, or lamotrigine followed by mexiletine, with a 7-day washout period in between. Investigators and participants were masked to treatment allocation. The primary outcome measure was the mean interactive voice response (IVR) diary stiffness score (0-9 scale) over the participant's final 2 weeks of diary reporting in each treatment period. Non-inferiority was assessed using a mixed-effects model with a predefined margin of 0·5 and included all randomly assigned participants who contributed at least 7 days of IVR-diary data in either treatment period. The trial is registered at ClinicalTrials.gov, NCT05017155, and EudraCT, 2020-003375-17.Findings: Between Aug 1, 2021, and Dec 12, 2022, of 60 participants were screened (24 females and 36 males) and randomly assigned between Aug 1, 2021 and Dec 12, 2022, to either the mexiletine-lamotrigine sequence (n=30) or the lamotrigine-mexiletine sequence (n=30). 53 participants contributed data to the primary analysis. The mean IVR stiffness score after treatment with mexiletine was 2·54 (95% CI 1·98 to 3·10) versus 2·77 (2·21 to 3·32) with lamotrigine (mean mexiletine-lamotrigine difference -0·23 [95% CI -0·63 to 0·17]). The most common adverse event with both treatments was indigestion-reflux (eight participants, 208 participant-days receiving mexiletine; seven participants, 130 participant-days receiving lamotrigine). No serious adverse events were reported.Interpretation: We were unable to conclude that lamotrigine is non-inferior to mexiletine; however, improvements in all outcome measures from baseline were similar between lamotrigine and mexiletine. Lamotrigine is an important treatment consideration in non-dystrophic myotonias alongside mexiletine; we propose a treatment algorithm to guide clinical practice.Funding: Neuromuscular Study Group, Jon Moulton Charity Trust, UCLH BRC Fast Track","PeriodicalId":17989,"journal":{"name":"Lancet Neurology","volume":"23 10","pages":"1004-1012"},"PeriodicalIF":46.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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

The Yaoundé Declaration. 雅温得宣言

IF 46.5 1区医学

Lancet Neurology Pub Date : 2024-10-01 Epub Date: 2024-08-22 DOI: 10.1016/S1474-4422(24)00364-8

Alfred K Njamnshi, Agustin Ibanez, Gagandeep Singh, Mika Pyykko, Vladimir Hachinski, Harris A Eyre

引用次数: 0

Considerations for future trials in cerebral cavernous malformations - Authors' reply. 脑海绵畸形未来试验的考虑因素--作者回复。

IF 46.5 1区医学

Lancet Neurology Pub Date : 2024-10-01 DOI: 10.1016/S1474-4422(24)00352-1

引用次数: 0

Non-inferiority design for trials in multiple sclerosis. 多发性硬化症试验的非劣效性设计。

IF 46.5 1区医学