{"title":"Exploring neuropharmacokinetics: mechanisms, models, and clinical implications.","authors":"Seon-Jae Ahn","doi":"10.47936/encephalitis.2024.00080","DOIUrl":"https://doi.org/10.47936/encephalitis.2024.00080","url":null,"abstract":"<p><p>Neuropharmacokinetics is an emerging field dedicated to understanding the pharmacokinetics of drugs within the central nervous system (CNS), with a particular emphasis on overcoming the challenges posed by the blood-brain barrier. This paper reviews the latest advancements in drug delivery strategies, including nanoparticle-based systems, receptor-mediated transcytosis, and efflux transporter inhibition, which have been designed to enhance drug penetration into the brain. Additionally, the use of advanced imaging techniques such as positron emission tomography, functional magnetic resonance imaging, and magnetic resonance imaging with contrast agents has provided critical insights into drug distribution, receptor occupancy, and the functional impact of therapeutic agents within the CNS. These innovations not only enhance our understanding of CNS drug action but also pave the way for more effective treatments for neurological and psychiatric disorders.</p>","PeriodicalId":72904,"journal":{"name":"Encephalitis (Seoul, Korea)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acyclovir-induced sinus bradycardia: a case report and literature review.","authors":"Gregory Mikerov, Ilyse Darwish, Gail Goldman","doi":"10.47936/encephalitis.2024.00150","DOIUrl":"https://doi.org/10.47936/encephalitis.2024.00150","url":null,"abstract":"<p><p>In this report, we describe the case of a 51-year-old female who presented to our emergency department with varicella zoster infection. Her relevant medical history included rheumatoid arthritis which was treated with risankizumab. Intravenous acyclovir therapy was initiated due to concern for disseminated disease as she was experiencing T4 dermatomal involvement and new-onset scalp pain. On day 3 of antiviral therapy, the patient developed a sinus bradycardia of 35 beats/min. This persisted until 3 days after the discontinuation of acyclovir. This is the third reported case of sinus bradycardia potentially linked to acyclovir administration. Thus, clinicians should consider intravenous acyclovir as a possible cause of de novo sinus bradycardia.</p>","PeriodicalId":72904,"journal":{"name":"Encephalitis (Seoul, Korea)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"An interesting case of subacute sclerosing panencephalitis presenting with Balint's syndrome and dysautonomia.","authors":"Swati Parida, Nikhil Pandey, Anand Kumar, Varun Kumar Singh, Neetu Rani Dhiman, Niraj Kumar Srivastava, Deepika Joshi","doi":"10.47936/encephalitis.2024.00115","DOIUrl":"https://doi.org/10.47936/encephalitis.2024.00115","url":null,"abstract":"<p><p>Subacute sclerosing panencephalitis (SSPE) is a rare, progressive neurodegenerative disorder caused by persistent aberrant measles virus infection. It is characterized by behavioral changes, cognitive decline with deterioration in academic performance, visual dysfunction, focal or generalized seizures ,myoclonus, spasticity, mutism and akinesia ultimately leading to a vegetative state. Balint's syndrome, characterized by the triad of simultagnosia, optic ataxia, and oculomotor apraxia, as an initial presenting feature of SSPE is rare. Autonomic dysfunction in SSPE is attributed to central autonomic involvement, with decreased heart rate variability a predictor for arrhythmia and sudden cardiac death. We report an unusual case of a 22-year-old male presenting with features suggestive of Balint's syndrome. Myoclonus and cognitive decline appeared 6 months after the first onset of symptoms, along with autonomic dysfunction. Thereafter, rapid progression of symptoms was noted. Cerebrospinal fluid and electroencephalography after the first symptom onset were consistent with a diagnosis of SSPE. The patient ultimately succumbed to his illness. Thus we highlight atypical presentation of SSPE with autonomic dysfunction. A high index of suspicion is needed for prompt and timely intervention.</p>","PeriodicalId":72904,"journal":{"name":"Encephalitis (Seoul, Korea)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hyun Seung Kim, Seon-Jae Ahn, Han Sang Lee, Kon Chu
{"title":"Rare manifestation of initial central nervous system involvement in severe fever with thrombocytopenia syndrome-associated encephalopathy/encephalitis: a case report.","authors":"Hyun Seung Kim, Seon-Jae Ahn, Han Sang Lee, Kon Chu","doi":"10.47936/encephalitis.2024.00108","DOIUrl":"https://doi.org/10.47936/encephalitis.2024.00108","url":null,"abstract":"<p><p>Severe fever with thrombocytopenia syndrome (SFTS) is a potentially fatal infectious disease if not diagnosed and treated promptly. Typical clinical features include fever, thrombocytopenia, and lymphadenopathy. However, we encountered a case of SFTS in a 60-year-old male who initially did not exhibit these hallmark symptoms. The patient presented with headache and myalgia, but fever did not develop until the 4th day of hospitalization. Initial neuroimaging and cerebrospinal fluid (CSF) analysis revealed no abnormalities. When the fever emerged, follow-up imaging revealed findings consistent with meningitis as a complication of SFTS. The patient was successfully treated with antibiotics and made a full recovery. This case underscores the challenges in diagnosing SFTS in patients who lack fever, CSF pleocytosis, or typical neuroimaging findings at presentation. Additionally, it highlights the importance of differentiating SFTS-related meningitis from other causes of encephalitis to avoid inappropriate treatments, such as immunosuppressive therapy, which could worsen viral infections.</p>","PeriodicalId":72904,"journal":{"name":"Encephalitis (Seoul, Korea)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Prognostic factors of subacute comprehensive encephalitis: a retrospective study.","authors":"Hiroshi Kataoka, Hitoki Nanaura, Kazuma Sugie","doi":"10.47936/encephalitis.2024.00136","DOIUrl":"10.47936/encephalitis.2024.00136","url":null,"abstract":"<p><strong>Purpose: </strong>The etiology of encephalitis is unknown in 40%-50% of cases, so a comprehensive examination of encephalitis would be significant and meaningful. The short-term outcomes in appropriately managed patients are also unknown. Short-term clinical outcomes following onset can provide clinicians with clues regarding the clinical course in the immediate future. We investigated cases of encephalitis, including viral and autoimmune encephalitis, to determine the predictable risk factors that can be assessed to determine a short-term prognosis.</p><p><strong>Methods: </strong>We studied 90 patients with encephalitis. Poor and good outcomes were defined as scores of ≥3 and ≤2 on the modified Rankin scale, respectively. Multivariate logistic regression analysis using 19 independent variables was performed.</p><p><strong>Results: </strong>Multivariate logistic regression analysis identified cranial magnetic resonance imaging (MRI) lesions (odds ratio [OR], 3.119; 95% confidence interval [CI], 1.166-8.344; p = 0.023) and the need for mechanical ventilation (OR, 4.461; 95% CI, 1.685-11.813; p = 0.003)) as being significantly associated with poor outcomes. In 57 patients with subacute encephalitis presenting with cranial MRI lesions, bilateral lesions on cranial MRI (OR, 5.078; 95% CI, 1.516-17.007; p = 0.008) and the need for mechanical ventilation (OR, 4.461; 95% CI, 1.135-13.584; p = 0.031) were significantly associated with poor outcomes.</p><p><strong>Conclusion: </strong>The location of brain lesions, lateral or bilateral, on the initial MRI during the acute phase of encephalitis may be a useful predictor of the outcome during the first 2 months after encephalitis onset, even in cases of encephalitis of unknown etiology.</p>","PeriodicalId":72904,"journal":{"name":"Encephalitis (Seoul, Korea)","volume":"5 1","pages":"6-14"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959758","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":"Influence of sleep on seizures and interictal epileptiform discharges in epilepsy.","authors":"Jun-Sang Sunwoo","doi":"10.47936/encephalitis.2024.00087","DOIUrl":"10.47936/encephalitis.2024.00087","url":null,"abstract":"<p><p>Sleep significantly influences seizure occurrence and interictal epileptiform discharges (IEDs) in patients with epilepsy. Sleep-related epilepsy, where seizures occur exclusively or predominantly during sleep, has been observed in various epilepsy syndromes. Understanding the influence of sleep on seizures and IEDs is crucial in the diagnosis, classification, and management of epilepsy. Although there is a bidirectional relationship between sleep and epilepsy, this review focuses on the influence of sleep on seizures and IEDs in epilepsy. Seizures are more common during non-rapid eye movement (NREM) sleep, particularly during stage N2, and are suppressed during rapid eye movement (REM) sleep. Sleep also activates IEDs, increasing the diagnostic yield of EEG recordings. The rate of IEDs increases during NREM sleep, reaches its maximum during stage N3, and decreases during REM sleep. Sleep affects the electrical field of IEDs, with an increase of spiking fields during NREM sleep and a decrease during REM sleep. In the localization of epileptogenic foci, REM sleep is less sensitive but more specific than NREM sleep. Thalamocortical EEG synchronization during NREM sleep and desynchronization during REM sleep underlie their opposing effects on seizures and IEDs. Accumulating evidence has suggested an antiseizure effect of orexinergic antagonism in animal studies. Interventions that promote REM sleep, including orexinergic antagonists, should be studied in the future as novel treatment strategies for epilepsy.</p>","PeriodicalId":72904,"journal":{"name":"Encephalitis (Seoul, Korea)","volume":" ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634007","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}
Giuseppe Maria Andrea D'Arma, Rosario Francesco Balzano, Federica Masino, Giuseppe Guglielmi
{"title":"Progressive multifocal leukoencephalopathy, the role of the susceptibility-weighted imaging sequence in a case of immunosuppression of an initially unknown cause.","authors":"Giuseppe Maria Andrea D'Arma, Rosario Francesco Balzano, Federica Masino, Giuseppe Guglielmi","doi":"10.47936/encephalitis.2024.00094","DOIUrl":"10.47936/encephalitis.2024.00094","url":null,"abstract":"<p><p>We describe the case of a 47-year-old woman who was confused and complained about left-sided weakness when she presented to our institution. The patient underwent a head computed tomography that raised the suspicion of a recent-onset ischemic episode (subacute phase). The patient was admitted to the neurology department and underwent a magnetic resonance imaging (MRI) with contrast medium administration. The clinical and laboratory findings and the MRI features, particularly the presence of a hypointense rim in the susceptibility-weighted imaging (SWI) sequences, were consistent with a diagnosis of progressive multifocal leukoencephalopathy (PML). Immunosuppression was observed as a result of lymphopenia, and the patient was subsequently diagnosed with previously undocumented AIDS. Our aim is to present this rare case of PML in an immunocompromised patient with AIDS, describing the main MRI features and the possible role of SWI sequences.</p>","PeriodicalId":72904,"journal":{"name":"Encephalitis (Seoul, Korea)","volume":" ","pages":"15-20"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820204","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":"Multifocal disseminated necrotizing leukoencephalopathy as severe central nervous system toxicity from nivolumab therapy for Hodgkin lymphoma: a case report.","authors":"Hussein Algahtani, Bader Shirah, Mohamed Najm Aldeen Alameen, Abdulrahman Bin Saeed, Alwaleed Abdulhadi Alqahtani","doi":"10.47936/encephalitis.2024.00101","DOIUrl":"10.47936/encephalitis.2024.00101","url":null,"abstract":"<p><p>Nivolumab, a monoclonal antibody approved in 2014 as an immune checkpoint inhibitor, offers benefits in cancer treatment but can cause serious neurological complications, including multifocal disseminated necrotizing leukoencephalopathy. We report a case of severe central nervous system toxicity in a 13-year-old boy with Hodgkin lymphoma who was treated with nivolumab following an inadequate response to multiple lines of chemotherapy. After six cycles of nivolumab, the patient developed multifocal disseminated necrotizing leukoencephalopathy, presenting with altered mental status, seizures, and neurological deficits with magnetic resonance imaging (MRI) findings of extensive white matter involvement, rendering him completely disabled. This case highlights the potential for disabling neurological complications associated with immune checkpoint inhibitors, emphasizing the importance of early detection through regular neurological assessment and MRI surveillance. The case also underscores the need for careful patient selection and monitoring when using nivolumab to mitigate the risk of severe central nervous system toxicity.</p>","PeriodicalId":72904,"journal":{"name":"Encephalitis (Seoul, Korea)","volume":" ","pages":"21-26"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142560343","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":"Tandem repeat disorders: from diagnosis to emerging therapeutic strategies.","authors":"Jangsup Moon","doi":"10.47936/encephalitis.2024.00122","DOIUrl":"https://doi.org/10.47936/encephalitis.2024.00122","url":null,"abstract":"<p><p>Tandem repeat disorders (TRDs) are genetic conditions characterized by the abnormal expansion of repetitive DNA sequences within specific genes. The growing number of identified TRDs highlights their complexity, with varied molecular mechanisms ranging from toxic protein production and repeat-associated non-AUG translation to RNA toxicity and epigenetic modifications. TRDs also exhibit unique clinical features such as reduced penetrance, anticipation, and repeat motif changes. Advances in molecular diagnostics such as long-read sequencing have significantly improved the detection of TRDs, especially for large or complex repeat expansions. Additionally, emerging therapeutic strategies, particularly antisense oligonucleotides (ASOs) and gene editing technologies, are showing great promise. ASOs in particular have demonstrated success through mechanisms like allele-specific knockdown and splice modulation. In this review, we explore the classification of TRDs, advances in diagnostics, molecular mechanisms, clinical features, and innovative therapeutic strategies, highlighting the need for further research to refine treatments and improve outcomes.</p>","PeriodicalId":72904,"journal":{"name":"Encephalitis (Seoul, Korea)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kevser Erdogan, Nermin Tepe, Gülay Turan, Musa Öztürk
{"title":"Immunoglobulin G4-related disease in an elderly patient with treatment-resistant headache: a case report.","authors":"Kevser Erdogan, Nermin Tepe, Gülay Turan, Musa Öztürk","doi":"10.47936/encephalitis.2024.00073","DOIUrl":"https://doi.org/10.47936/encephalitis.2024.00073","url":null,"abstract":"<p><p>Immunoglobulin G4 (IgG4)-related disease is an immune-mediated, fibroinflammatory condition that causes multisystemic contrast enhancement and is predominantly observed in elderly male patients. The most prominent features of IgG4-related disease are systemic involvement affecting from two to six systems. In the central nervous system, these contrast enhancements are typically found in the meninges and orbit. This case study describes a 78-year-old female patient with persistent headaches and constant diarrhea who underwent treatment for IgG4-related disease. Despite two months of treatment with non-steroidal and opioid analgesics, the patient remained unresponsive and continued to experience diarrhea for 4 months. Brain magnetic resonance imaging revealed contrast enhancement in the leptomeningeal surfaces, and a biopsy of the gastrointestinal mucosa confirmed the diagnosis of IgG4-related disease, showing widespread plasma cell infiltration and IgG4 expression on plasma cells. The patient was initially treated with 1.0 g/day of pulse therapy for 5 days, followed by a maintenance dose of 1.0 mg/kg oral azathioprine. When azathioprine caused significant pancytopenia, rituximab therapy was initiated. The patient's headaches resolved completely, and the diarrheal attacks were controlled. This case highlights the importance of considering IgG4-related disease as a potential cause of headache or multiorgan symptoms in elderly patients with new-onset headache unresponsive to conventional analgesics. IgG4-related disease can often be effectively treated with steroids and monoclonal antibodies.</p>","PeriodicalId":72904,"journal":{"name":"Encephalitis (Seoul, Korea)","volume":"4 4","pages":"87-90"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482282","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}