Journal of Clinical Neurology (Seoul, Korea)最新文献

{"title":"Correlation Between Neutrophil-to-Lymphocyte Ratio and Motoric Deterioration in Patients With Guillain-Barre Syndrome.","authors":"Felisitas Farica Sutantoyo,&nbsp;Fadil,&nbsp;Mudjiani Basuki,&nbsp;Fidiana,&nbsp;Muhammad Hamdan","doi":"10.3988/jcn.2022.18.6.671","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.6.671","url":null,"abstract":"Background and Purpose Guillain-Barre syndrome (GBS) is a common cause of inflammation-related acute flaccid paralysis, and is characterized by acute onset, rapid progression, and symmetrical weakness. GBS is an emergency with high morbidity and long-term disability rates. It is important to determine the prognostic factors for GBS in order to improve the disease outcomes. This study aimed to identify the correlation between the neutrophil-to-lymphocyte ratio (NLR) on day 1 of hospitalization (D1) and motor deterioration in GBS patients. Methods This observational analytical study applied a cross-sectional analysis to the medical records of GBS patients who were hospitalized at Dr. Soetomo General Hospital Surabaya from January 2018 to March 2020. The analysis used the chi-square bivariate test, multivariate analysis with logistic regression, and correlation analysis with the Spearman test. Results The study included 61 subjects. Statistical tests showed that there was no correlation between NLR and changes in the Medical Research Council sum scores (ΔMRC sum scores) during D1–D3, D1–D7, D1–D14, and D1 to the day of discharge (p>0.05). There was a significant correlation between NLR and the Erasmus GBS outcome score (EGOS) (p=0.006). NLR values differed significantly within each treatment group (p=0.001). Therefore, a subanalysis within each treatment group was conducted, which revealed a significant negative correlation (p<0.05) between NLR and the ΔMRC sum score during D1–D14 in the group treated without immunotherapy. Conclusions There was no correlation between NLR and motor deterioration in patients with GBS during hospitalization. However, NLR was significantly correlated with EGOS, and there was a negative correlation between NLR and motor deterioration during D1–D14 in GBS patients treated without immunotherapy.","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"671-680"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/dc/3c/jcn-18-671.PMC9669555.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40699595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-CoV Study: Autoimmune Encephalitis Associated With COVID-19 and Its Vaccines-A Systematic Review.","authors":"M M Samim,&nbsp;Debjyoti Dhar,&nbsp;Sheetal Goyal,&nbsp;Treshita Dey,&nbsp;Naznin Parvin,&nbsp;Rutul D Shah,&nbsp;Vikram Singh,&nbsp;Sampurna Chowdhury,&nbsp;Bhavesh Mohan Lal,&nbsp;Nibu Varghese,&nbsp;Abhishek Gohel,&nbsp;Abhishek Chowdhury,&nbsp;Aritra Chatterjee,&nbsp;Shahyan Siddiqui","doi":"10.3988/jcn.2022.18.6.692","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.6.692","url":null,"abstract":"<p><strong>Background and purpose: </strong>Autoimmune encephalitis (AIE) following coronavirus disease 2019 (COVID-19) is an underexplored condition. This study aims to systematically review the clinico-investigational and pathophysiologic aspects of COVID-19 and its vaccines in association with AIE, and identify the factors predicting neurological severity and outcomes.</p><p><strong>Methods: </strong>Relevant data sources were searched using appropriate search terms on January 15, 2022. Studies meeting the criteria for AIE having a temporal association with COVID-19 or its vaccines were included.</p><p><strong>Results: </strong>Out of 1,894 citations, we included 61 articles comprising 88 cases: 71 of COVID-19-associated AIE, 3 of possible Bickerstaff encephalitis, and 14 of vaccine-associated AIE.There were 23 definite and 48 possible seronegative AIE cases. Anti-NMDAR (N-methyl-D-aspartate receptor; <i>n</i>=12, 16.9%) was the most common definite AIE. Males were more commonly affected (sex ratio=1.63) in the AIE subgroup. The neurological symptoms included alteredmental state (<i>n</i>=53, 74.6%), movement disorders (<i>n</i>=28, 39.4%), seizures (<i>n</i>=24, 33.8%), behavioural (<i>n</i>=25, 35.2%), and speech disturbances (<i>n</i>=17, 23.9%). The median latency to AIE diagnosis was 14 days (interquartile range=4-22 days). Female sex and ICU admission had higherrisks of sequelae, with odds ratio (OR) of 2.925 (95% confidence interval [CI]=1.005-8.516)and 3.515 (95% CI=1.160-10.650), respectively. Good immunotherapy response was seen in42/48 (87.5%) and 13/13 (100%) of COVID-19-associated and vaccine-associated AIE patients, respectively. Sequelae were reported in 22/60 (36.7%) COVID-19 associated and 10/13 (76.9%) vaccine-associated cases.</p><p><strong>Conclusions: </strong>The study has revealed diagnostic, therapeutic, and pathophysiological aspects of AIE associated with COVID-19 and its vaccines, and its differences from postinfectious AIE.</p><p><strong>Systematic review registration: </strong>PROSPERO registration number CRD42021299215.</p>","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"692-710"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2f/23/jcn-18-692.PMC9669562.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40699600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seborrheic Dermatitis Is Related to Motor Symptoms in Parkinson's Disease.","authors":"Svetlana Tomic,&nbsp;Igor Kuric,&nbsp;Tihana Gilman Kuric,&nbsp;Zvonimir Popovic,&nbsp;Jagoda Kragujevic,&nbsp;Tea Mirosevic Zubonja,&nbsp;Ines Rajkovaca,&nbsp;Sara Matosa","doi":"10.3988/jcn.2022.18.6.628","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.6.628","url":null,"abstract":"<p><strong>Background and purpose: </strong>Parkinson's disease (PD) patients present with numerous motor and nonmotor symptoms. Seborrheic dermatitis (SD) is reported in 18.6%-59% of PD patients. However, the etiology of SD in PD patients remains unknown. The aim of this study was to determine how motor and nonmotor symptoms, age, sex, and levodopa-equivalent daily dose (LEDD) influence the appearance and severity of SD in PD patients, and then discuss about SD possible etiology based on the obtained results.</p><p><strong>Methods: </strong>Motor symptoms were evaluated using the Unified Parkinson's Disease Rating Scale part III and nonmotor symptoms were evaluated using the Parkinson's Disease Sleep Scale, Scales for Outcomes in Parkinson's Disease-Autonomic Dysfunction, and Non-Motor Symptoms Questionnaire. LEDD was calculated and demographic data on age, sex, disease duration, and symptoms of SD prior to a PD diagnosis were collected. A dermatologist evaluated the skin for SD using the Seborrhea Area and Severity Index.</p><p><strong>Results: </strong>SD was present in 36.1% of the PD patients. There were positive correlations between age, motor-symptoms severity, and SD. After adjusting for age, disease duration, and sex, there remained a positive correlation between the severity of motor symptoms and SD. Patients with moderate-to-severe motor symptoms had more-severe SD symptoms, and their risk of developing SD was 1.8-fold higher. There was no correlation between SD and autonomic dysfunction, sleep disturbances, or other nonmotor symptoms, and no sex difference.</p><p><strong>Conclusions: </strong>In PD, SD is related to motor symptoms.</p>","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"628-634"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/de/15/jcn-18-628.PMC9669556.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40682970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Perampanel on Seizure Control, Cognition, Behavior, and Psychological Status in Patients With Epilepsy: A Systematic Review.","authors":"Yi-On Fong,&nbsp;Poyin Huang,&nbsp;Chung Yao Hsu,&nbsp;Yuan-Han Yang","doi":"10.3988/jcn.2022.18.6.653","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.6.653","url":null,"abstract":"<p><strong>Background and purpose: </strong>Thoroughly acquainting physicians with the effects of antiseizure medications (ASMs) is essential for developing appropriate therapeutic regimens for seizure management. This review summarizes the available evidence regarding patients receiving the antiseizure agent perampanel (PER) and its effects on the cognition, behavior, and psychological status of patients.</p><p><strong>Methods: </strong>The PubMed and Google Scholar databases were searched for all relevant articles published during 2015-2021 and without any other publication limitations, and also manually searched the reference lists in the identified articles. Outcomes of interest were changes in seizure frequency relative to baseline, 50% responder rate, seizure-free rate, and retention rate (proportion of participants continuing PER at study endpoints). Safety outcomes included adverse effects and the percentage of patients experiencing effects on cognitive, psychiatric, and behavioral symptoms.</p><p><strong>Results: </strong>We identified 139 studies, of which 28 were included after screening. Most studies found reduced seizure frequencies and satisfactory responder and retention rates, demonstrating the effectiveness and tolerability of PER. No negative effects were found for cognitive function, but a nonnegligible impact on aggressive behavior was noted when compared with other ASMs. Patients with previous psychiatric comorbidities had a greater risk of psychiatric side effects under PER treatment. PER induces an overall improvement in quality of life.</p><p><strong>Conclusions: </strong>After synthesizing the study results, PER was a safe and effective choice as an additional therapy for patients with refractory epilepsy. A comprehensive evaluation of behavior and psychiatric risk is suggested before implementing PER.</p>","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"653-662"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8e/f8/jcn-18-653.PMC9669553.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40682973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vessel Wall Changes on Serial High-Resolution MRI and the Use of Cilostazol in Patients With Adult-Onset Moyamoya Disease.","authors":"Jae Youn Kim,&nbsp;Hyung Jun Kim,&nbsp;Eun-Hyeok Choi,&nbsp;Kwang Hyun Pan,&nbsp;Jong-Won Chung,&nbsp;Woo-Keun Seo,&nbsp;Gyeong-Moon Kim,&nbsp;Tae Keun Jee,&nbsp;Je Young Yeon,&nbsp;Jong-Soo Kim,&nbsp;Seung-Chyul Hong,&nbsp;Min-Jung Seong,&nbsp;Jihoon Cha,&nbsp;Keon Ha Kim,&nbsp;Pyoung Jeon,&nbsp;Oh Young Bang","doi":"10.3988/jcn.2022.18.6.610","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.6.610","url":null,"abstract":"<p><strong>Background and purpose: </strong>The natural course of adult-onset moyamoya disease (MMD) is unknown, and there is no medical treatment that halts its progression. We hypothesized that progressive shrinkage of large intracranial arteries occurs in adult-onset MMD, and that cilostazol inhibits this process.</p><p><strong>Methods: </strong>Serial high-resolution magnetic resonance imaging (HR-MRI) was performed on 66 patients with MMD: 30 patients received cilostazol, 21 received other antiplatelets, and 15 received no antiplatelets or had poor compliance to them. Serial HR-MRI was performed (interval between MRI scans: 29.67±18.02 months, mean±SD), and changes in outer diameter, luminal stenosis, and vascular enhancement were measured. Factors affecting HR-MRI changes were evaluated, including vascular risk factors and the ring finger protein 213 gene variant.</p><p><strong>Results: </strong>The progression of stenosis to occlusion, recurrent ischemic stroke, and the development of new stenotic segments were observed in seven, seven, and three patients, respectively. Serial HR-MRI indicated that the degree of stenosis increased with negative remodeling (outer diameter shrinkage). Patients who received cilostazol presented significantly larger outer diameters and lower degrees of stenosis compared with other groups (<i>p</i>=0.005 and <i>p</i>=0.031, respectively). After adjusting for clinical and genetic factors, only cilostazol use was independently associated with negative remodeling (odds ratio=0.29, 95% confidence interval=0.10-0.84, <i>p</i>=0.023). While vascular enhancement was observed in most patients (61 patients), the progression of enhancement or the occurrence of new vascular enhancement was rarely observed on follow-up HR-MRI (6 and 1 patients, respectively).</p><p><strong>Conclusions: </strong>Adult-onset MMD induces progressive shrinkage of large intracranial arteries, which cilostazol treatment may prevent. Further randomized clinical trials are warranted.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier NCT02074111.</p>","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"610-618"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/01/2a/jcn-18-610.PMC9669557.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40682968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Memorial Tribute to Kyoung-Min Lee: An Outstanding Behavioral Neurologist and Cognitive Neuroscientist.","authors":"Sung-Ho Woo,&nbsp;Hyeon-Ae Jeon,&nbsp;Soyoung Kang,&nbsp;Hyeyeon Joo,&nbsp;Min-Hee Seo,&nbsp;Eunbeen Lee,&nbsp;Jae-Hyeok Heo,&nbsp;Jeong-In Cha,&nbsp;Jeh-Kwang Ryu,&nbsp;Min-Jeong Kim","doi":"10.3988/jcn.2022.18.6.603","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.6.603","url":null,"abstract":"of the neural mechanisms underlying visual perception, eye movement, and response selection throughout his life. His initial studies on visual information processing and eye movement in nonhuman primates were conducted with renowned neurophysiologist Professor Schiller during his Ph.D studies at MIT. In their earliest paper published in Science in 1991","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"603-609"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/89/e6/jcn-18-603.PMC9669554.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40682967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resting Heart Rate and Cognitive Decline: A Meta-Analysis of Prospective Cohort Studies.","authors":"Hong-Bae Kim,&nbsp;Young Hee Jung,&nbsp;Hyun Jeong Han","doi":"10.3988/jcn.2022.18.6.619","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.6.619","url":null,"abstract":"<p><strong>Background and purpose: </strong>Several previous meta-analyses have identified an association between cognitive decline and heart rate variability, which reflects autonomic nerve activity. This systematic review and meta-analysis investigated the impact of increased resting heart rate (RHR) on the incidence of cognitive decline, including dementia.</p><p><strong>Methods: </strong>The PubMed, Embase, and PsycInfo databases were searched for relevant prospective cohort studies published before April 18, 2022. A methodological quality assessment of the included studies was conducted using the Newcastle-Ottawa Scale. Summary estimates of the incidence of cognitive decline, including dementia, were generated using a random-effects model. Potential publication bias was evaluated using Begg's funnel plots and Egger's regression tests.</p><p><strong>Results: </strong>The meta-analysis included 7 prospective cohort studies comprising 53,621 participants. A weak significant association was observed between RHR and the risk of cognitive decline, although the analysis indicated high heterogeneity among the studies (relative risk=1.18, 95% confidence interval=1.04-1.33, I²=82.5%). Significant associations were determined between RHR and all combined types of dementia except for Alzheimer's disease and mild cognitive impairment. There was also a dose-response association between increased RHR and cognitive decline. The meta-estimate of the cognitive decline risk associated with a 10 beat-per-minute increase in RHR was 1.06, and it was 1.10 for dementia.</p><p><strong>Conclusions: </strong>This study found that a higher RHR was associated with an increased cognitive decline risk. Due to study limitations such as publication bias and high heterogeneity, additional studies are required to validate this finding.</p><p><strong>Systematic review registration: </strong>PROSPERO registration number CRD42021282912.</p>","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"619-627"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a4/ce/jcn-18-619.PMC9669550.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40682969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the Characteristics of Patients With Newly Diagnosed Dementia Before and After 2008 in Seoul, South Korea: A Population-Based Study.","authors":"Hyuk Sung Kwon,&nbsp;Yong Whi Jeong,&nbsp;Sojeong Park,&nbsp;Dae Ryong Kang,&nbsp;Hojin Choi","doi":"10.3988/jcn.2022.18.6.711","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.6.711","url":null,"abstract":"Dear Editor, The burden of dementia is growing as the South Korean population ages.1 The South Korean government declared a “war on dementia” in 2008, and 25 dementia support centers (DSCs) were established between 2007 and 2009 in Seoul, South Korea. We previously reported that the dementia incidence in Seoul increased rapidly after 2007 and then stabilized after 2011.2 In the current study, we investigated the characteristics of patients with newly diagnosed dementia before and after 2008, and considered variables such as age, comorbidities, income, and dementia type. Using customized research data from the National Health Insurance Service (NHIS) database, data of patients with dementia diagnosed during 2005–2007 and 2009–2011 were analyzed and compared. We compared time periods between before the DSCs were established and those when dementia incidence increased rapidly after they were established. The data source and method of identifying patients with dementia have been described in detail previously.2 In brief, patients with dementia were defined by dementia-related diagnostic codes from the Korean Standard Classification of Diseases (F00, F01, F02, F03, G30, G31.00, G31.01, G31.02, G31.03, G31.04, and G31.82) or by the use of antidementia drugs (donepezil, galantamine, rivastigmine, and memantine). In order to only include patients with newly diagnosed dementia, those who had visited the hospital previously and were diagnosed with a dementia-related code were excluded. The International Classification of Diseases (ICD-10) version of the Charlson Comorbidity Index (CCI) was used.3,4 The patients were divided into groups according to age (six groups: 60–64, 65–69, 70–74, 75–79, 80–84, and ≥85 years old), sex, CCI (four groups: 0, 1, 2, and ≥3), income (quintiles), and dementia type (unspecified dementia [F03], Alzheimer’s disease dementia [F00, G30], vascular dementia [F01], and other [F02, G31.00–04, G31.82]). Patients with dementia who were first diagnosed during 2005–2007 or 2009–2011 were compared using t-test and chi-square test. This study evaluated 35,271 patients with incident dementia. The total number (age-adjusted incidence per 100,000 person-years) of patients with newly diagnosed dementia was 9,980 (273.21) during 2005–2007 and 25,291 (576.01) during 2009–2011 (p&lt;0.0001). The age at first diagnosis increased from 76.45±7.64 years (mean±SD) to 77.89±7.78 years (p&lt;0.0001). The percentage of females with dementia increased slightly from 67.02% to 67.11% (p&lt;0.0001). A comparison of the patients who were diagnosed with dementia during 2005–2007 versus those diagnosed during 2009–2011 indicated significant differences between age groups (p&lt;0.0001), CCI groups (p&lt;0.001), income groups (p&lt;0.0001), and dementia types (p&lt;0.0001) (Fig. 1). Specifically, the proportions of patients aged ≥85 years, with a CCI of 0, in the lowest income group, and with unspecified dementia increased from 14.86% (n=6,689) to 21.29% (n=5,383) (Fig. 1A), from 76","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"711-713"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7b/f1/jcn-18-711.PMC9669552.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40699597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated Bone Resorption Markers in Patients With Migraine: A Case Series.","authors":"Alberto Lerario","doi":"10.3988/jcn.2022.18.6.720","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.6.720","url":null,"abstract":"Dear Editor, Migraine is a debilitating headache characterized by pulsating quality, and is often on one side of the head and aggravated by movement. Excessive bone resorption due to osteoclast activity can lead to diminished bone strength. Although it may appear ambiguous, a recent study by Wu et al.1 suggested a pathophysiological link between osteoporosis and migraine. Magnesium and vitamin D levels are known to be vital for proper bone function, while they may regulate the frequency of migraines2 by shaping nociceptive processes in unmyelinated calcitonin gene-related peptide (CGRP)-positive neurons, a process also influenced by ovarian hormones.3 Inflammatory mediators such as certain interleukins and tumor necrosis factor-α contribute to endothelial dysfunction and pain pathways in migraine,4 and exerts a significant influence on bone turnover that induces osteoporosis. Moreover, inflammatory mediators play roles in activating the trigeminovascular system, which in turn releases proinflammatory substances, particularly CGRP. Elevated CGRP levels have also been found in subjects with osteoporosis and may indirectly regulate osteoclast activity.5 Furthermore, both of these diseases include high prevalence rates of migraine and osteoporosis in patients with inflammatory bowel disease,6 possibly due to multiple factors such as gut microbiota profile, stress hormones, nutrients, and neuropeptides that affect different intestinal bacterial strains.7 Finally, migraine causes social withdrawal with a consequent reduction in motor activity, and less exposure to light due to a reaction from photophobia. We present 19 patients with migraine who presented pathological bone turnover. In our private clinic, we evaluated 19 Italian adult patients (15 fertile females and 4 males) aged between 20 and 40 years over the course of 1 year. These patients were suffering from migraine with aura or migraine without aura according to the third edition of the International Classification of Headache Disorders (ICHD-3), or one or more migraine attacks per month for at least 6 months. All subjects did not show associated comorbidities or present a history of fragility fracture. All patients were not sedentary, followed a Mediterranean diet, and had body mass indices of 18.42–25.12 kg/m2 (Table 1). However, we did not further detail exercise capacity, smoking, or alcohol consumption in detail. None of the patients had taken prophylactic or contraceptive therapies within the past 5 years, and they utilized nonsteroidal anti-inflammatory drugs or triptans for symptomatic therapy. The sex, age, and migraine frequency distributions are listed in Table 1. The findings of physical and neurological examinations were unremarkable for all patients. Considering the frequent vitamin D deficiency in patients with migraine, we also performed bone profile laboratory tests. Serological tests were performed under fasting conditions and without taking into account the menstrual cycle f","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"720-722"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/be/da/jcn-18-720.PMC9669558.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40699601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Temporal Pattern of the Lymphocyte Count During Fingolimod Therapy in Patients With Multiple Sclerosis: Real-World Korean Experience.","authors":"So-Young Huh,&nbsp;Su-Hyun Kim,&nbsp;Ki Hoon Kim,&nbsp;Young Nam Kwon,&nbsp;Sung-Min Kim,&nbsp;Seung Woo Kim,&nbsp;Ha Young Shin,&nbsp;Yeon Hak Chung,&nbsp;Ju-Hong Min,&nbsp;Jungmin So,&nbsp;Young-Min Lim,&nbsp;Kwang-Kuk Kim,&nbsp;Nam-Hee Kim,&nbsp;Tai-Seung Nam,&nbsp;Sa-Yoon Kang,&nbsp;Jeeyoung Oh,&nbsp;Seong-Il Oh,&nbsp;Eunhee Sohn,&nbsp;Ho Jin Kim","doi":"10.3988/jcn.2022.18.6.663","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.6.663","url":null,"abstract":"Background and Purpose Fingolimod (FTY) inhibits lymphocyte egress from lymphoid organs to cause lymphopenia, but the clinical implications of FTY-induced lymphopenia are not fully understood. We aimed to determine the frequency and severity of lymphopenia during FTY treatment among Korean patients with multiple sclerosis (MS), and its association with infections. Methods We retrospectively reviewed the medical records of patients with MS treated using FTY from 12 referral centers in South Korea between March 2013 and June 2021. Patients were classified according to their nadir absolute lymphocyte count (ALC) during treatment: grade 1, 800–999/µL; grade 2, 500–799/µL; grade 3, 200–499/µL; and grade 4, <200/µL. Results FTY treatment was administered to 69 patients with a median duration of 18 months (range=1–169 months), with 11 patients being treated for ≥7 years. During FTY treatment, mean ALCs were reduced after the first month (653.0±268.9/µL, mean±standard deviation) (p<0.0001) and remained low during treatment lasting up to 84 months. During follow-up, 41 (59.4%) and 7 (10.1%) patients developed grade-3 and grade-4 lymphopenia, respectively. No significant difference was found in age at FTY initiation, sex, baseline ALC, body mass index, or prior disease-modifying treatment between patients with and without grade-4 lymphopenia. Infections were observed in 11 (15.9%) patients, and the frequencies of patients with and without grade-4 lymphopenia were similar. Conclusions FTY treatment induced grade-4 lymphopenia in 10% of South Korean patients with MS, but did not appear to be associated with an increased infection risk.","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"663-670"},"PeriodicalIF":3.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ad/4d/jcn-18-663.PMC9669559.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40699596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}