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Clinical Trials and Neurology

Maria Landén Ludvigsson, Gunnel Peterson, Anneli Peolsson
Up to 90% of people with neurological deficits following a whiplash injury do not recover and cervical muscle dysfunction is common. The aim of this multicentre, randomized controlled trial was to examine whether two versions of neck-specific exercise or prescription of physical activity (PPA) can improve radiating arm pain and clinical signs that can be associated with neurological deficits in people with chronic whiplash associated disorders (WAD). Participants with chronic WAD, arm symptoms and signs associated with neurological deficits (n = 171) were randomized to: 12 weeks of neck-specific exercise without (NSE) or with a behavioural approach (NSEB), or PPA...
August 17, 2018: Scientific Reports
Matthew E Eagles, Michael K Tso, R Loch Macdonald
OBJECTIVE Fluctuations in patient serum sodium levels are common after aneurysmal subarachnoid hemorrhage (aSAH), but their effect on patient outcome is not well described in the literature. The goal of this work was to better characterize the relationship between fluctuations in serum sodium levels, outcome, and the development of delayed cerebral ischemia (DCI) after aSAH. METHODS The authors performed a post hoc analysis of data from the Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS-1) trial...
August 17, 2018: Journal of Neurosurgery
Nicola Disma, James D O'Leary, Andreas W Loepke, Ansgar M Brambrink, Karin Becke, Nicola G Clausen, Jurgen C De Graaff, Fang Liu, Tom G Hansen, Mary E McCann, Cynthia F Salorio, Sulpicio Soriano, Lena S Sun, Peter Szmuk, David O Warner, Laszlo Vutskits, Andrew J Davidson
All commonly used general anesthetics have been shown to cause neurotoxicity in animal models, including nonhuman primates. Opinion, however, remains divided over how cumulative evidence from preclinical and human studies in this field should be interpreted and its translation to current practices in pediatric anesthesia and surgery. A group of international experts in laboratory and clinical sciences recently convened in Genoa, Italy, to evaluate the current state of both laboratory and clinical research and discuss future directions for basic, translational, and clinical studies in this field...
August 16, 2018: Paediatric Anaesthesia
Babikir Kheiri, Mohammed Osman, Ahmed Abdalla, Tarek Haykal, Sahar Ahmed, Mustafa Hassan, Ghassan Bachuwa, Mohammed Al Qasmi, Deepak L Bhatt
Tenecteplase is a genetically mutated variant of alteplase with superior pharmacodynamic and pharmacokinetic properties. However, its efficacy and safety in acute ischemic strokes are limited. Hence, we conducted a study to evaluate the efficacy and safety of tenecteplase compared with alteplase in acute ischemic stroke. Electronic databases were searched for randomized clinical trials (RCTs) comparing tenecteplase with alteplase in acute ischemic stroke patients eligible for thrombolysis. We evaluated various efficacy and safety outcomes using random-effects models for both pairwise and Bayesian network meta-analyses along with meta-regression analyses...
August 16, 2018: Journal of Thrombosis and Thrombolysis
Changsong Xu, Bing Chen, Liujun Xue, Lei Xia, Xiu Yang, Ming Wei, Xiaobo Hui, Quan Chen, Jinlong Zheng, Zhengming Li, Xiangyang Tian, Guanliang Cheng, Feng Xiao, Min Lu
The present randomized controlled study investigated the differences in the curative effects of twist-drill craniotomy (TDC) and burr-hole craniotomy (BHC) in the treatment of chronic subdural hematoma (CSDH). A total of 40 patients diagnosed with CSDH via head computed tomography (CT) who required surgical decompression from January 2016 to January 2017 were enrolled in the present study, and were randomly divided into a TDC group (n=20) and a BHC group (n=20). The modified Rankin scale (mRS) scores of patients were recorded prior to the operation, and at 48 h and 3 months after the operation...
August 2018: Experimental and Therapeutic Medicine
Elisabet Guillamó, Álvaro Cobo-Calvo, Guillermo R Oviedo, Noémie Travier, Juan Álamo, Oscar A Niño-Mendez, Antonio Martínez-Yelamos, Sergio Martínez-Yelamos, Casimiro Javierre
Multiple sclerosis (MS) is a chronic neurological disease which affects young adults at a time of maximum personal, professional and social growth. Recent guidelines on physical activity have established that exercise is an essential component of the clinical management of people with MS with mild or moderate degree of disability. The main purpose of this study was to test the feasibility and the effects of two different 40-week structured physical exercise interventions (a supervised high intensity interval training plus home exercise program and a self-applied home-based exercise program) on clinical evolution, psychological wellbeing, quality of life, fatigue, cardiorespiratory fitness, strength and balance of people with MS...
September 2018: Journal of Sports Science & Medicine
Mario Cortina-Borja, Danielle Te Vruchte, Eugen Mengel, Yasmin Amraoui, Jackie Imrie, Simon A Jones, Christine I Dali, Paul Fineran, Thomas Kirkegaard, Heiko Runz, Robin Lachmann, Tatiana Bremova-Ertl, Michael Strupp, Frances M Platt
BACKGROUND: Niemann-Pick disease type C (NPC) is a lysosomal storage disease with a heterogeneous neurodegenerative clinical course. Multiple therapies are in clinical trials and inclusion criteria are currently mainly based on age and neurological signs, not taking into consideration differential individual rates of disease progression. RESULTS: In this study, we have evaluated a simple metric, denoted annual severity increment score (ASIS), that measures rate of disease progression and could easily be used in clinical practice...
August 16, 2018: Orphanet Journal of Rare Diseases
Jordan W Squair, Ian A Ruiz, Aaron A Phillips, Mei Mz Zheng, Zoe Sarafis, Rahul Sachdeva, Rayshad Gopaul, Jie Liu, Wolfram Tetzlaff, Christopher R West, Andrei V Krassioukov
Spinal cord injury (SCI) is a devastating neurological condition for which there is no effective treatment to restore neurological function. The development of new treatments for SCI may be hampered by the insensitivity of clinical tools to assess motor function in humans. Treatments aimed at preserving neuronal function through anti-inflammatory pathways (i.e., neuroprotection) have been a mainstay of pre-clinical SCI research for decades. Minocycline, a clinically available antibiotic with anti-inflammatory properties, has demonstrated promising neuroprotective effects in a variety of animal models and improved motor recovery in a Phase-2 human trial...
August 16, 2018: Journal of Neurotrauma
Laszlo Kiss, Alexandre Beliaev, Humberto S Ferreira, Carla P Rosa, Maria Joao Bonifacio, Ana I Lourerio, Nuno M Pires, Nuno P Palma, Patricio Soares-da-Silva
Fatty acid amide hydrolase (FAAH) enzyme can be targeted for the treatment of pain associated with various medical conditions. Herein, we report the design and synthesis of a novel series of heterocyclic-N-carboxamide FAAH inhibitors that achieve good alignment of potency, metabolic stability and selectivity over monoacylglycerol lipase (MAGL) and carboxylesterases (CEs) enzymes. Lead optimization efforts carried out with benzotriazolyl- and imidazolyl-N-carboxamide series led to the discovery of clinical candidate 8l (BIA 10-2474) as a potent and long acting inhibitor of FAAH...
August 16, 2018: ChemMedChem
Abdul Sami Shaikh, Xi Guo, Yi Li, Lili Cao, Xuewu Liu, Pingli Li, Rui Zhang, Ruichen Guo
BACKGROUND: The impact of antiepileptics on serum vitamin levels is controversial and uncertain. With no clear conclusions on the impact of antiepileptics on serum levels of vitamins, there is a need for further clinical studies in order to ascertain the impact of old and newer antiepileptic drugs on serum levels of vitamins in epileptic patients, thus accomplishing a suitable usage of vitamins supplementation. OBJECTIVE: The intention of the present research is to confirm the hypothesis of whether or not vitamin levels are altered with antiepileptic drugs...
August 15, 2018: Current Pharmaceutical Biotechnology
Mercè Pineda, Mark Walterfang, Marc C Patterson
OBJECTIVE: Niemann-Pick disease type C (NP-C) is a rare, autosomal recessive, neurodegenerative disease associated with a wide variety of progressive neurological manifestations. Miglustat is indicated for the treatment of progressive neurological manifestations in both adults and children. Since approval in 2009 there has been a vast growth in clinical experience with miglustat. The effectiveness of miglustat has been assessed using a range of measures. METHODS: Comprehensive review of published data from studies of cellular neuropathological markers and structural neurological indices in the brain, clinical impairment/disability, specific clinical neurological manifestations, and patient survival...
August 15, 2018: Orphanet Journal of Rare Diseases
Antti Lindgren, Mervyn DI Vergouwen, Irene van der Schaaf, Ale Algra, Marieke Wermer, Mike J Clarke, Gabriel Je Rinkel
BACKGROUND: Around 30% of people who are admitted to hospital with aneurysmal subarachnoid haemorrhage (SAH) will rebleed in the initial month after the haemorrhage if the aneurysm is not treated. The two most commonly used methods to occlude the aneurysm for prevention of rebleeding are microsurgical clipping of the neck of the aneurysm and occlusion of the lumen of the aneurysm by means of endovascular coiling. This is an update of a systematic review that was previously published in 2005...
August 15, 2018: Cochrane Database of Systematic Reviews
Elena Bruzzesi, Irini Sereti
The introduction of combination antiretroviral therapy (cART) in the 1990s has dramatically changed the course of HIV infection, decreasing the risk for both AIDS- and non-AIDS-related events. Cancers, cardiovascular disease (CVD), liver and kidney disease, neurological disorders and frailty have become of great importance lately in the clinical management as they represent the principal cause of death in people living with HIV who receive cART (Kirk et al. in Clin Infect Dis 45(1):103-10, 2007; Strategies for Management of Antiretroviral Therapy Study et al...
August 14, 2018: Current Topics in Microbiology and Immunology
Gregory S Day, Alexander Rae-Grant, Melissa J Armstrong, Tamara Pringsheim, Stacey S Cofield, Ruth Ann Marrie
Background: Persons with multiple sclerosis (MS) may now choose from a broad array of approved disease-modifying treatments (DMTs). The priority that patients and practitioners assign to specific clinical outcomes is likely to influence the MS DMT selection process. Methods: We invited 9,126 participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry and 18 members of the American Academy of Neurology MS DMT guideline development panel to complete a brief survey prioritizing outcomes of importance to MS DMT selection...
June 2018: Neurology. Clinical Practice
Fiona Costello, Jodie M Burton
Multiple sclerosis (MS) is a progressive neurological disorder characterized by both inflammatory and degenerative components that affect genetically susceptible individuals. Currently, the cause of MS remains unclear, and there is no known cure. Commonly used therapies tend to target inflammatory aspects of MS, but may not halt disease progression, which may be governed by the slow, subclinical accumulation of injury to neuroaxonal structures in the central nervous system (CNS). A recognized challenge in the field of MS relates to the need for better methods of detecting, quantifying, and ameliorating the effects of subclinical disease...
2018: Eye and Brain
Joseph J Titano, Marcus Badgeley, Javin Schefflein, Margaret Pain, Andres Su, Michael Cai, Nathaniel Swinburne, John Zech, Jun Kim, Joshua Bederson, J Mocco, Burton Drayer, Joseph Lehar, Samuel Cho, Anthony Costa, Eric K Oermann
Rapid diagnosis and treatment of acute neurological illnesses such as stroke, hemorrhage, and hydrocephalus are critical to achieving positive outcomes and preserving neurologic function-'time is brain'1-5 . Although these disorders are often recognizable by their symptoms, the critical means of their diagnosis is rapid imaging6-10 . Computer-aided surveillance of acute neurologic events in cranial imaging has the potential to triage radiology workflow, thus decreasing time to treatment and improving outcomes...
August 13, 2018: Nature Medicine
Thomas J Sorenson, Harry Cloft, Alejandro Rabinstein, Giuseppe Lanzino
While revascularization of the acutely or chronically occluded internal carotid artery has become commonplace with modern endovascular techniques, revascularization of an acutely occluded common carotid artery (CCA) is a controversial procedure with unique challenges. These challenges can be related to the lack of observable markers for identifying vessels during navigation or for identifying the exact location and extent of occlusion within the CCA, in addition to wide-ranging treatment risks. In this video, we illustrate the controversial revascularization of a 68-yr-old woman with an acute CCA occlusion who presented with fluctuating neurological symptoms...
August 7, 2018: Operative Neurosurgery (Hagerstown, Md.)
Darin D Dougherty
Deep brain stimulation has been used for decades in neurology to treat movement disorders. More recent work has focused on developing applications for deep brain stimulation in psychiatric illness. Initial studies have demonstrated positive results for treatment-refractory obsessive-compulsive disorder. Initial open-label studies of deep brain stimulation at targets for treatment-resistant depression have been encouraging. However, the only 2 published controlled trials that were conducted for potential FDA approval for treatment-resistant depression were both negative...
September 2018: Psychiatric Clinics of North America
Pavlina Lenga, Christian Hohaus, Bujung Hong, Adisa Kursumovic, Nicolai Maldaner, Jan-Karl Burkhardt, Philippe Bijlenga, Daniel A Rüfenacht, Nils O Schmidt, Peter Vajkoczy, Julius Dengler
OBJECTIVE Giant posterior circulation aneurysms (GPCirAs) usually cause substantial mass effect on the brainstem, which may lead to neurological deficits. So far, there has been no systematic investigation of factors associated with such deficits in GPCirA. The authors aim to examine the risk factors for cranial nerve deficit (CND), motor deficit, and disability in patients with GPCirA. METHODS Using MR images obtained in 30 patients with unruptured GPCirA, the authors examined GPCirA volume, presence of hydrocephalus or partial thrombosis (PT) of the aneurysm, and the degree of brainstem displacement measured by the distance between the McRae line and the tip of the GPCirA (∆MT)...
August 10, 2018: Journal of Neurosurgery
Na Young Jung, Chang Kyu Park, Minsoo Kim, Phil Hyu Lee, Young Ho Sohn, Jin Woo Chang
OBJECTIVE Recently, MR-guided focused ultrasound (MRgFUS) has emerged as an innovative treatment for numerous neurological disorders, including essential tremor, Parkinson's disease (PD), and some psychiatric disorders. Thus, clinical applications with this modality have been tried using various targets. The purpose of this study was to determine the feasibility, initial effectiveness, and potential side effects of unilateral MRgFUS pallidotomy for the treatment of parkinsonian dyskinesia. METHODS A prospective, nonrandomized, single-arm clinical trial was conducted between December 2013 and May 2016 at a single tertiary medical center...
August 10, 2018: Journal of Neurosurgery
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