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Clinical Trial AND Neurology

Ian A Harris, Adrian Traeger, Ralph Stanford, Christopher G Maher, Rachelle Buchbinder
Lumbar spine fusion is a common procedure associated with a high cost burden and risk of serious complications. We aimed to summarise systematic reviews on the effectiveness of lumbar spine fusion for most diagnoses. We found no high-quality systematic reviews and the risk of bias of the randomised controlled trials in the reviews was generally high. The available evidence does not support a benefit from spine fusion compared to non-operative alternatives for back pain associated with degeneration. The available evidence does not support a clinical benefit from spine fusion compared to non-operative treatment or stabilisation without fusion for thoracolumbar burst fractures...
December 2018: Internal Medicine Journal
Susanne Muehlschlegel
PURPOSE OF REVIEW: This article reviews the epidemiology, clinical presentation, diagnosis, and management of patients with aneurysmal subarachnoid hemorrhage (SAH). SAH is a type of hemorrhagic stroke and is a neurologic emergency with substantial morbidity and mortality. This article reviews the most common and potentially life-threatening neurologic and medical complications to promote their early recognition and prevent secondary brain injury. RECENT FINDINGS: Over the past 30 years, the incidence of SAH has remained stable; yet, likely because of improved care in specialized neurocritical care units, discharge mortality has considerably decreased...
December 2018: Continuum: Lifelong Learning in Neurology
Bonnie M Kaas, Casey Jo Humbyrd, Alexander Pantelyat
Background: Functional movement disorders are common and disabling neurologic conditions. Patients with functional neurologic disorders represent a large proportion of neurology clinic referrals, and limited availability of subspecialty care creates a considerable burden for the healthcare system. These conditions are currently treated with a combination of physical therapy and cognitive behavioral therapy, with variable success. Methods: We searched the Medline database for studies on the epidemiology and physiology of functional movement disorders, as well as those on the placebo effect in movement disorders...
September 2018: Movement Disorders Clinical Practice
Hae-Ryeon Choi, Jinmin Kim, Hyojung Lim, Yoo Kyoung Park
The ketogenic diet has long been recommended in patients with neurological disorders, and its protective effects on the cardiovascular system are of growing research interest. This study aimed to investigate the effects of two-week of low-calorie ketogenic nutrition drinks in obese adults. Subjects were randomized to consume drinks either a ketone-to-non-ketone ratio of 4:1 (KD 4:1), a drink partially complemented with protein at 1.7:1 (KD 1.7:1), or a balanced nutrition drink (BD). Changes in body weight, body composition, blood lipid profile, and blood ketone bodies were investigated...
December 3, 2018: Nutrients
Sonia L Ramírez-Garza, Emily P Laveriano-Santos, María Marhuenda-Muñoz, Carolina E Storniolo, Anna Tresserra-Rimbau, Anna Vallverdú-Queralt, Rosa M Lamuela-Raventós
The effect of resveratrol (RV) intake has been reviewed in several studies performed in humans with different health status. The purpose of this review is to summarize the results of clinical trials of the last decade, in which RV was determined in biological samples such as human plasma, urine, and feces. The topics covered include RV bioavailability, pharmacokinetics, effects on cardiovascular diseases, cognitive diseases, cancer, type 2 diabetes (T2D), oxidative stress, and inflammation states. The overview of the recent research reveals a clear tendency to identify RV in plasma, showing that its supplementation is safe...
December 3, 2018: Nutrients
Ying Zhou, Jinhua Wen, Bei Hu, Hongyun Wang, Ji Jiang
HR7056 is a new benzodiazepine, showing more faster acting onset and recovery than currently available short-acting sedatives. To avoid inadequate anesthesia and predict return of cognition, allowing for immediate neurological evaluation, HR7056 pharmacokinetics and pharmacodynamics were characterized in Chinese healthy subjects. We report on modeling of the data and simulations of dosage regimens for future study. Up to 63 subjects were evaluated, using Bispectral Index (BIS) and Modified Observer's Assessment of Alertness/Sedation (MOAA/S) as pharmacodynamics endpoints...
2018: Frontiers in Pharmacology
Stephanie S L Cheung, Gary K K Lau, Koon-Ho Chan, Ian Y H Wong, Jimmy S M Lai, Wai Kiu Tang, Kendrick C Shih
BACKGROUND: Limbic encephalitis is characterized by rapid onset of working memory deficit, mood changes, and often seizures. The condition has a strong paraneoplastic association, but not all cases are invariably due to tumors. CASE PRESENTATION: We present a case of limbic encephalitis in a Chinese patient who initially presented to our hospital with optic neuritis and no other neurological symptoms. The diagnosis was made radiologically, and cognitive and neurological symptoms did not occur until 5 months later...
December 3, 2018: Journal of Medical Case Reports
Junhong Wang, Qingbian Ma, Hua Zhang, Shaoyu Liu, Yaan Zheng
BACKGROUND: This systemic review aimed to explore the predictors of discharge and neurologic outcome of adult extracorporeal cardiopulmonary resuscitation (ECPR) to provide references for patient selection. METHODS: Electronically searching of the Pubmed, Embase, Cochrane Library, and manual retrieval were done for clinical trials about predictors for adult ECPR which were published between January 2000 and January 2018 and included predictors for discharge and neurologic outcome...
November 2018: Medicine (Baltimore)
Steve S Cho, Sung-Eun Kim, Heung Cheol Kim, Won Jin Kim, Jin Pyeong Jeon
OBJECT: Clazosentan, an endothelin-receptor-antagonist, reduced vasospasm and delayed-ischemic-neurological-deficit (DIND) but did not improve outcome following subarachnoid hemorrhage (SAH) in clinical trials. However, a lack of dose-dependent analysis and potential overestimation of clazosentan's effect are concerning. We employ stratified analysis and trial-sequential-analysis (TSA) of existing data to investigate the effects of clazosentan on SAH outcome. METHODS: Studies from PubMed, EMBASE, and Cochrane were reviewed for eligibility...
November 30, 2018: World Neurosurgery
Reza Rikhtegar, Mehdi Yousefi, Sanam Dolati, Hosein Delavar Kasmaei, Saeid Charsouei, Mohammad Nouri, Seyed Kazem Shakouri
Neurological disorders, such as stroke, are triggered by a loss of neurons and glial cells. Ischemic stroke remains a substantial problem for industrialized countries. Over the previous few decades our understanding about the pathophysiology of stroke has enhanced, nevertheless, more awareness is required to advance the field of stroke recovery. Existing therapies are incapable to adequately relief the disease outcome and are not appropriate to all patients. Meanwhile, the majority of patients continue to show neurological deficits even subsequent effective thrombolysis, recuperative therapies are immediately required that stimulate brain remodeling and repair once stroke damage has happened...
December 2, 2018: Journal of Cellular Biochemistry
Jonathan T Yamaguchi, Wellington K Hsu
Intervertebral disc herniations are a common cause of neck and back pain in athletes. It is thought to be more prevalent in athletes than in the general population due to the consistent pressure placed on the spine and concurrent microtraumas that are unable to heal. Prevention focuses on neck and trunk stability and flexibility, training on proper technique, and rule changes to minimize catastrophic injuries. The evaluation for athletes includes a full neurologic exam and imaging. The imaging modality of choice is MRI, but CT myelography can be a useful alternative...
December 1, 2018: International Orthopaedics
Riley M Bove, Gillian Rush, Chao Zhao, William Rowles, Priya Garcha, John Morrissey, Adrian Schembri, Titi Alailima, Dawn Langdon, Katherine Possin, Adam Gazzaley, Anthony Feinstein, Joaquin Anguera
INTRODUCTION: Self-administered in-home digital therapeutics could expand access to cognitive rehabilitation for individuals with multiple sclerosis (MS), over half of whom experience cognitive impairment (CI). However, feasibility in an MS population must be clarified. This study was conducted to assess the feasibility of deploying a videogame-like digital treatment for CI in MS, including initial efficacy and barriers to adherence. METHODS: In this pilot study, 21 participants with MS completed an in-clinic baseline neurological evaluation...
November 30, 2018: Neurology and Therapy
Sabrina Guzzetti, Francesca Mancini, Alessandra Caporali, Luigi Manfredi, Roberta Daini
INTRODUCTION: The cognitive reserve (CR) theory has been proposed to account for the mismatch between the degree of neuropathological changes and clinical outcome in dementias. Recently, it has also been applied to Parkinson's disease (PD) with promising results, but mostly just focusing on separate proxy measures of CR, such as education, working and leisure time activities, instead of adopting a more comprehensive approach. Using the Cognitive Reserve Index questionnaire (CRIq), this study examined the association of CR with motor functions and cognition in patients with medium-low (1-9 years) and medium-high (>9 years) PD duration...
November 28, 2018: Experimental Gerontology
Cathrine K Fog, Paola Zago, Erika Malini, Lukasz M Solanko, Paolo Peruzzo, Claus Bornaes, Raffaella Magnoni, Arnela Mehmedbasic, Nikolaj H T Petersen, Bruno Bembi, Johannes F M G Aerts, Andrea Dardis, Thomas Kirkegaard
BACKGROUND: Gaucher Disease is caused by mutations of the GBA gene which encodes the lysosomal enzyme acid beta-glucosidase (GCase). GBA mutations commonly affect GCase function by perturbing its protein homeostasis rather than its catalytic activity. Heat shock proteins are well known cytoprotective molecules with functions in protein homeostasis and lysosomal function and their manipulation has been suggested as a potential therapeutic strategy for GD. The investigational drug arimoclomol, which is in phase II/III clinical trials, is a well-characterized HSP amplifier and has been extensively clinically tested...
November 26, 2018: EBioMedicine
(no author information available yet)
OBJECTIVEGranulocyte-colony stimulating factor (G-CSF) is a major cytokine that has already been clinically verified for chronic traumatic spinal cord injuries (TSCIs). In this study, the authors set out to determine the safety and efficacy of G-CSF administration for neurological and functional improvement in subacute, incomplete TSCI.METHODSThis phase II/III, prospective, double-blind, placebo-controlled, parallel randomized clinical trial was performed in 60 eligible patients (30 treatment, 30 placebo). Patients with incomplete subacute TSCIs with American Spinal Injury Association Impairment Scale (AIS) grades B, C, and D were enrolled...
October 1, 2018: Journal of Neurosurgery. Spine
(no author information available yet)
OBJECTIVEIntracranial pressure (ICP), outflow resistance (Rout), and amplitude of cardiac-related ICP pulsations (AMPs) are established parameters to describe the CSF hydrodynamic system and are assumed, but not confirmed, to be disturbed in idiopathic normal pressure hydrocephalus (INPH). The aim of this study was to compare the CSF hydrodynamic profile between patients with INPH and healthy volunteers.METHODSSixty-two consecutive INPH patients (mean age 74 years) and 40 healthy volunteers (mean age 70 years) were included...
November 1, 2018: Journal of Neurosurgery
Jie Song, Yue-Qin Xue, Yan-Ju Wang, Peng Xu, De-Ke Sun, Wei Chen
AIMS: The present meta-analysis was conducted to provide an update on the efficacy and safety profile of clazosentan with different doses in aSAH. METHODS: We performed a comprehensive and electronic search of the following databases updated to September, 2018: the Cochrane library, Embase and PubMed, to identify relevant clinical trials. Trials of the effectiveness of clazosentan in treating cerebral vasospasm after aSAH were studied, of which the main outcomes included new cerebral infarction (NCI), delayed ischemic neurological deficit (DIND), vasospasm associated with morbidity/mortality (M/M), angiographic vasospasm, rescue therapy and adverse events...
November 26, 2018: World Neurosurgery
Martin Niethammer, Chris C Tang, An Vo, Nha Nguyen, Phoebe Spetsieris, Vijay Dhawan, Yilong Ma, Michael Small, Andrew Feigin, Matthew J During, Michael G Kaplitt, David Eidelberg
Gene therapy is emerging as a promising approach for treating neurological disorders, including Parkinson's disease (PD). A phase 2 clinical trial showed that delivering glutamic acid decarboxylase ( GAD ) into the subthalamic nucleus (STN) of patients with PD had therapeutic effects. To determine the mechanism underlying this response, we analyzed metabolic imaging data from patients who received gene therapy and those randomized to sham surgery, all of whom had been scanned preoperatively and at 6 and 12 months after surgery...
November 28, 2018: Science Translational Medicine
Asheebo Rojas, Di Chen, Thota Ganesh, Nicholas H Varvel, Raymond Dingledine
Introduction:A robust neuroinflammatory response is a prevalent feature of multiple neurological disorders, including epilepsy and acute status epilepticus. One component of this neuroinflammatory reaction is the induction of cyclooxygenase-2 (COX-2), synthesis of several prostaglandins and endocannabinoid metabolites, and subsequent activation of prostaglandin and related receptors. Neuroinflammation mediated by COX-2 and its downstream effectors has received considerable attention as a potential target class to ameliorate the deleterious consequences of neurological injury...
November 28, 2018: Expert Opinion on Therapeutic Targets
Giorgio Lambru, Anna P Andreou, Martina Guglielmetti, Paolo Martelletti
Migraine is a very frequent and disabling neurological disorder. The current treatment options are old, generally poorly tolerated and not migraine-specific, reflecting the low priority of migraine research and highlighting the vast unmet need in its management. Areas covered: Advancement in the understanding of migraine pathophysiological mechanisms and identification of novel potentially meaningful targets have resulted in a multitude of emerging acute and preventive treatments. Here we review the known putative migraine pathophysiological mechanisms in order to understand the rationale of the most promising novel treatments targeting the Calcitonin-Gene-Related Peptide (CGRP) receptor and ligand and the 5 hydroxytryptamine (5-HT)1F receptor...
November 28, 2018: Expert Opinion on Emerging Drugs
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