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STENOSIS: Long-term single versus dual antiplatelet therapy in patients with ischaemic stroke due to intracranial atherosclerotic disease – a randomised trial BMJ Neurol. Open Pub Date : 2024-03-01 Rohit Bhatia, MV Padma Srivastava, Risha Sarkar, Saman Fatima, Imnameren Longkumer, Ajay Garg, Pooja Gupta, Jeyaraj Durai Pandian, Dheeraj Khurana, PN Sylaja, Shweta Jain, Deepti Arora, Aneesh Dhasan, Meenakshi Sharma
Rationale Intracranial atherosclerotic disease (ICAD) is a pathological process that causes progressive stenosis and cerebral hypoperfusion, leading to stroke occurrence and recurrence around the world. The exact duration of dual antiplatelet therapy (DAPT) for ICAD is unclear in view of long-term risk of bleeding complications. Aim The current study aims to study the efficacy and safety of long-term
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RE-OPEN: Randomised trial of biosimilar TNK versus TPA during endovascular therapy for acute ischaemic stroke due to large vessel occlusions BMJ Neurol. Open Pub Date : 2024-03-01 Rohit Bhatia, MV Padma Srivastava, Saman Fatima, Risha Sarkar, Imnameren Longkumer, Shailesh Gaikwad, Leve S Joseph Devaranjan, Ajay Garg, Jeyaraj Durai Pandian, Dheeraj Khurana, PN Sylaja, Shweta Jain, Deepti Arora, Aneesh Dhasan, Sanjith Aaron, Angel T Miraclin, Pamidimukkala Vijaya, Srijithesh P Rajendran, Jayanta Roy, Biman Kanti Ray, Vivek Nambiar, Paul J Alapatt, Meenakshi Sharma
Rationale Rapid and timely treatment with intravenous thrombolysis and endovascular treatment (EVT) in patients with acute ischaemic stroke (AIS) and large vessel occlusion (LVO) significantly improves patient outcomes. Bridging therapy is the current standard of care in these patients. However, an incompletely answered question is whether one thrombolytic agent is better than another during bridging
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The Lasting impact of the COVID-19 pandemic on outpatient neurology consultations BMJ Neurol. Open Pub Date : 2024-03-01 Sean YW Tan, Nushan Gunawardana, Rhys C Roberts
Background The COVID-19 pandemic prompted rapid changes in outpatient neurology services and there remain unanswered questions regarding its long-term impact. First, what are the lasting changes of the pandemic on demographics and outcomes of new referrals and patients reviewed at outpatient neurology clinics? Safety concerns about virtual consultations during the initial stages of the pandemic were
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Guillain-Barré syndrome and checkpoint inhibitor therapy: insights from pharmacovigilance data BMJ Neurol. Open Pub Date : 2024-03-01 Andre Abrahao, Pedro Henrique de Magalhães Tenório, Mariana Rodrigues, Monica Mello, Osvaldo José Moreira Nascimento
Background There are increasing reports of cases of Guillain-Barré syndrome (GBS), as an adverse event of an immune checkpoint inhibitor (ICI) but postmarket data on the incidence of this remains scarce. This study sought to conduct a comprehensive review of GBS events arising as a secondary outcome of ICI treatments in real-world patients, using the Food and Drug Administration Adverse Event Reporting
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Visual outcome measures in clinical trials of remyelinating drugs BMJ Neurol. Open Pub Date : 2024-02-01 Gioia Riboni-Verri, Benson S Chen, Christopher E McMurran, Gregory J Halliwell, J William L Brown, Alasdair J Coles, Nick G Cunniffe
One of the most promising approaches to delay, prevent or reverse disability progression in multiple sclerosis (MS) is to enhance endogenous remyelination and limit axonal degeneration. In clinical trials of remyelinating drugs, there is a need for reliable, sensitive and clinically relevant outcome measures. The visual pathway, which is frequently affected by MS, provides a unique model system to
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Estimating the cost of visiting hospital outpatient BMJ Neurol. Open Pub Date : 2024-02-01 Manoj Liyana Arachige, Wai Chung Tse, Roland Zhang, Henry Ma, Shaloo Singhal, Thanh Phan
Objectives This study aims to investigate the cost incurred by people travelling to the neurology outpatient clinic of a large metropolitan hospital. As outpatients are a substantial portion of a hospital’s demographic, we aimed to understand the patient experience of various commuters. Methods We conducted an observational study collecting demographic details and travel information for how people
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Non-invasive neuromodulation of the right temporoparietal junction using theta-burst stimulation in functional neurological disorder BMJ Neurol. Open Pub Date : 2024-02-01 Janine Bühler, Samantha Weber, Serafeim Loukas, Sebastian Walther, Selma Aybek
Background Disrupted sense of agency (SoA)—the sense of being the agent of one’s own actions—has been demonstrated in patients with functional neurological disorder (FND), and a key area of the corresponding neuronal network is the right temporoparietal junction (rTPJ). Several functional MRI (fMRI) studies have found hypoactivation as well as hyperactivation of the rTPJ in FND. In a proof-of-concept
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Incidence and prevalence of mtDNA-related adult mitochondrial disease in Southwest Finland, 2009–2022: an observational, population-based study BMJ Neurol. Open Pub Date : 2024-02-01 Mika H Martikainen, Kari Majamaa
Background Mitochondrial diseases are common inherited metabolic disorders. Due to improved case ascertainment and diagnosis methods, the detection of new diagnoses of mitochondrial disease can be expected to increase. In December 2009, the prevalence of mitochondrial DNA (mtDNA)-related mitochondrial disease was 4.6/100 000 (95% CI, 2.7 to 7.2) in the adult population of Southwest Finland. We investigated
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Sialidosis type 1 without cherry-red spots: a case report and literature review BMJ Neurol. Open Pub Date : 2024-02-01 Congcong Zhang, Zhongkai Liao, Yanhui Zhou, Xiaohui Su
Background Sialidosis is a rare disorder caused by mutations in the NEU1 gene located on chromosome 6p21.3, constituting a group of autosomal recessive diseases. Enzyme activity analysis, electron microscopy examination and genetic testing are reliable methods for diagnosis. Despite previous reports on the disease, its rarity means that its clinical manifestations and prognosis still warrant attention
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Inflammatory markers and functional outcome score in different subgroups of ischaemic stroke: a prospective cohort study BMJ Neurol. Open Pub Date : 2024-02-01 Mohammad Sadegh Fakhari, Leila Poorsaadat, Amir Almasi-Hashiani, Mohsen Ebrahimi-Monfared
Background Acute ischaemic stroke (AIS) is a leading cause of disability and mortality worldwide. Determining subgroups and outcomes of AIS may lead to better treatment. We aimed to investigate the relationship between inflammatory markers and subgroups of AIS with further follow-up of patients in terms of functional outcome score. Methods In this prospective cohort study, we examined white cell count
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Mixed methods system for the assessment of post-exertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome: an exploratory study BMJ Neurol. Open Pub Date : 2024-02-01 Barbara Stussman, Brice Calco, Gina Norato, Angelique Gavin, Snigdha Chigurupati, Avindra Nath, Brian Walitt
Background A central feature of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is post-exertional malaise (PEM), which is an acute worsening of symptoms after a physical, emotional and/or mental exertion. Dynamic measures of PEM have historically included scaled questionnaires, which have not been validated in ME/CFS. To enhance our understanding of PEM and how best to measure it, we conducted
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Efficacy and safety of adjunctive oral therapy in Parkinson’s disease with motor complications: a systematic review and network meta-analysis BMJ Neurol. Open Pub Date : 2024-02-01 Vibuthi Sisodia, Lars Dubbeld, Rob M A De Bie, Gonçalo S Duarte, João Costa, Joke M Dijk
Background The aim of this manuscript is to review the evidence and compare the efficacy and safety of catechol-O-methyltransferase inhibitors (COMT-Is), dopamine receptor agonists (DRAs) and monoamine-oxidase B inhibitors (MAOB-Is) as adjunctive treatment to levodopa in patients with Parkinson’s disease (PD) experiencing motor complications. Methods In this systematic review and network meta-analysis
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Subthalamic stimulation has acute psychotropic effects and improves neuropsychiatric fluctuations in Parkinson’s disease BMJ Neurol. Open Pub Date : 2024-01-01 Andreia D Magalhães, Deborah Amstutz, Katrin Petermann, Ines Debove, Mário Sousa, Marie E Maradan-Gachet, Martin Lenard Lachenmayer, Julia Waskönig, Sandra Murcia-Carretero, Andreas Antonios Diamantaras, Gerd Tinkhauser, Andreas Nowacki, Claudio Pollo, Carmen Rodriguez-Blazquez, Pablo Martinez-Martin, Paul Krack
Background Subthalamic nucleus deep brain stimulation (STN-DBS) is a well-established treatment for motor complications in Parkinson’s disease (PD). However, its effects on neuropsychiatric symptoms remain disputed. The aim of this study was to evaluate the effects of STN-DBS on neuropsychiatric symptoms in PD. Methods We retrospectively assessed 26 patients with PD who underwent a preoperative levodopa
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Impaired mobility and MRI markers of vascular brain injury: Atherosclerosis Risk in Communities and UK Biobank studies BMJ Neurol. Open Pub Date : 2024-01-01 Richa Sharma, Adam de Havenon, Cyprien Rivier, Seyedmehdi Payabvash, Rachel Forman, Harlan Krumholz, Guido J Falcone, Kevin N Sheth, Walter N Kernan
Background Vascular brain injury (VBI) may be an under-recognised contributor to mobility impairment. We examined associations between MRI VBI biomarkers and impaired mobility. Methods We separately analysed Atherosclerosis Risk in Communities (ARIC) and UK Biobank (UKB) study cohorts. Inclusion criteria were no prevalent clinical stroke, and available brain MRI and balance and gait data. MRI VBI biomarkers
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Is there a temporal relationship between atrial fibrillation and stroke? A review BMJ Neurol. Open Pub Date : 2024-01-01 Jessica Dlima, Rooj Kitisarn, Han Lim, Vincent Thijs
Importance Atrial fibrillation (AF) is an established risk factor for ischaemic stroke. The introduction of continuous cardiac rhythm monitoring devices has enabled detection of brief and asymptomatic episodes of AF. Observations The search yielded 727 studies, 11 of which met the inclusion criteria. Four studies suggested a strong temporal association between episodes of AF and stroke, while seven
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Cognitive impairment and liver fibrosis in non-alcoholic fatty liver disease BMJ Neurol. Open Pub Date : 2024-01-01 Neal S Parikh, Farah Wahbeh, Christopher Tapia, Mallory Ianelli, Vanessa Liao, Abhishek Jaywant, Hooman Kamel, Sonal Kumar, Costantino Iadecola
Background Data regarding the prevalence and phenotype of cognitive impairment in non-alcoholic fatty liver disease (NAFLD) are limited. Objective We assessed the prevalence and nature of cognitive deficits in people with NAFLD and assessed whether liver fibrosis, an important determinant of outcomes in NAFLD, is associated with worse cognitive performance. Methods We performed a prospective cross-sectional
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Levodopa use in Australia: an analysis of Pharmaceutical Benefits Scheme 10% data BMJ Neurol. Open Pub Date : 2024-01-01 Andrew Evans, Benjamin J Waterhouse
Background Levodopa remains the mainstay of treatment of Parkinson’s disease, however, over time motor fluctuations and levodopa-induced dyskinesia develop, requiring add-on therapies to control emerging symptoms. To date, however, there is no clear consensus in Australia, or elsewhere, at which dose of levodopa that add-on therapies should be considered. Objectives The purpose of this study was to
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Sudden unilateral audiovestibular loss due to acute labyrinthine haemorrhage can be missed on early MRI brain sequences: case report BMJ Neurol. Open Pub Date : 2024-01-01 Patrick Harrison, John Blazak, Joshua Richmond, Kristy Fraser-Kirk, Aliese Hoffmann, Grant Collins, Benjamin K-T Tsang
Background Labyrinthine haemorrhage is a rare vascular disorder often presenting with the triad of acute vertigo, sudden sensorineural hearing loss and tinnitus. There are minimal reports on imaging progression over the acute period. Index case A woman in her mid-40s presented with acute vertigo, sudden left-sided hearing loss and tinnitus, consistent with acute unilateral audiovestibular loss. Left
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Peculiar aetiology for orbital apex syndrome: Wyburn-Mason syndrome as orbital apex lesion BMJ Neurol. Open Pub Date : 2024-01-01 Lívio Leite Barros, Pedro Lucas Grangeiro de Sá Barreto Lima, Pedro Helder de Oliveira Júnior, Daniel Aguiar Dias, Carolina de Figueiredo Santos, Pedro Braga-Neto, Paulo Ribeiro Nóbrega
Background Wyburn-Mason syndrome is a rare, non-hereditary congenital disease, belonging to the group of neurocutaneous syndromes with fewer than 100 cases reported since its first description in 1937. Case report A young adult man was initially evaluated at the age of 2 years for proptosis and progressive visual impairment of the right eye, followed by impairment in ocular abduction, adduction and
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Poor haemorrhagic stroke outcomes during the COVID-19 pandemic are driven by socioeconomic disparities: analysis of nationally representative data BMJ Neurol. Open Pub Date : 2024-01-01 Abdulaziz T Bako, Thomas Potter, Alan P Pan, Karim A Borei, Taya Prince, Gavin W Britz, Farhaan S Vahidy
Background Nationally representative studies evaluating the impact of the COVID-19 pandemic on haemorrhagic stroke outcomes are lacking. Methods In this pooled cross-sectional analysis, we identified adults (≥18 years) with primary intracerebral haemorrhage (ICH) or subarachnoid haemorrhage (SAH) from the National Inpatient Sample (2016–2020). We evaluated differences in rates of in-hospital outcomes
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Monash-Alfred protocol for assessment of atypical parkinsonian syndromes (MAP-APS) BMJ Neurol. Open Pub Date : 2024-01-01 Timothy P Siejka, Kelly L Bertram, Huiliang M Tang, Dominic Thyagarajan, Terence J O’Brien, Helmut Butzkueven, Lucy Vivash, Ian H Harding
Introduction Atypical parkinsonian syndromes (APS) are rare neurodegenerative syndromes for which parkinsonism is one significant feature. APS includes progressive supranuclear palsy (PSP), multiple system atrophy (MSA) and corticobasal syndrome (CBS). The diagnosis of APS remains reliant on clinical features with no available diagnostic or prognostic biomarker. Clinical scales remain the gold standard
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Cytotoxic lesions of the corpus callosum (CLOCCs) with a flow gap in straight sinus on magnetic resonance venography BMJ Neurol. Open Pub Date : 2024-01-01 Seung-Cheol Jeong, Seokwon Han, Jihye Hwang
Cytotoxic lesions of the corpus callosum (CLOCCs) are cytotoxic lesions observed in the splenium of the corpus callosum and are also called mild encephalitis or encephalopathy with reversible splenial lesions or reversible splenial lesion syndrome. It was first reported in patients with epilepsy and since then has been observed in a wide variety of diseases, including infections, trauma, metabolic
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Twelve-month efficacy of CGRP monoclonal antibodies and predictive value of short-term response: results of an Australian multicentre study BMJ Neurol. Open Pub Date : 2024-01-01 Jason Charles Ray, Linda Dalic, Josephine Baker, Shuli Cheng, Elspeth Jane Hutton, Manjit Matharu
Introduction Clinical trials show that calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are effective preventative treatments for chronic migraine. Their efficacy over longer time periods and in cohorts originally excluded from trials remains uncertain. This study aims to explore the impact of CGRP mAbs in an Australian real-life setting. Methods A multicentre cohort study was performed
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Detecting signatures of consciousness in acute brain injury after stimulation with apomorphine and methylphenidate: protocol for a placebo-controlled, randomized, cross-over study BMJ Neurol. Open Pub Date : 2024-01-01 Marwan H Othman, Kirsten Møller, Jesper Kjaergaard, Daniel Kondziella
Introduction Acute brain injury can lead to states of decreased consciousness, that is, disorder of consciousness (DoC). Detecting signs of consciousness early is vital for DoC management in the intensive care unit (ICU), neurorehabilitation and long-term prognosis. Our primary objective is to investigate the potential of pharmacological stimulant therapies in eliciting signs of consciousness among
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Batoclimab as induction and maintenance therapy in patients with myasthenia gravis: rationale and study design of a phase 3 clinical trial BMJ Neurol. Open Pub Date : 2024-01-01 Michael Benatar, Heinz Wiendl, Richard Nowak, Yan Zheng, William Macias
Introduction Batoclimab, a fully human monoclonal antibody that inhibits the neonatal fragment crystallisable receptor, has shown promising phase 2 clinical trial results in patients with generalised myasthenia gravis (gMG). Methods and analysis In this phase 3, randomised, quadruple-blind, placebo-controlled study, adults with gMG will be randomised 1:1:1 to induction therapy with batoclimab 680 mg
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Relationship between emotion recognition and cognition in multiple sclerosis: a meta-analysis protocol BMJ Neurol. Open Pub Date : 2024-01-01 Béatrice Degraeve, Audrey Henry, Bruno Lenne
Introduction Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system characterised by a broad and unpredictable range of symptoms, including cognitive and socio-cognitive dysfunction. Alongside the well-known deficits in information processing speed (IPS), executive functioning and episodic memory, recent evidence also highlighted socio-cognitive
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ICAM-1 and CRP as biomarkers of 3-month outcome in acute ischaemic stroke BMJ Neurol. Open Pub Date : 2023-12-01 Gulnora Sattarovna Rakhimbaeva, Kutlibika Bakhtiyor kizi Abdurakhmonova
Background It is clear that, inflammation deteriorates cerebral injury during the acute phase of stroke. While this process is going on, intercellular adhesion molecule-1 (ICAM-1) has a crucial role to play in mediating migration of immune cells into the damaged area. Furthermore, C reactive protein (CRP) is an essential inflammatory molecule in human organism. This research aims to investigate the
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Weight management communications in idiopathic intracranial hypertension: challenges and recommendations from the patients’ perspective BMJ Neurol. Open Pub Date : 2023-12-01 Sally Abbott, Amanda Denton, Sui H Wong, Susan P Mollan, Kim CM Bul
Background Idiopathic intracranial hypertension (IIH) is a neurometabolic condition severely impacting the quality of life of people living with IIH (PwIIH). Most PwIIH are overweight or live with obesity, and weight loss is recommended by healthcare professionals (HCPs) as it is central to disease management. There is currently no research evaluating patient–clinician interactions when discussing
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Assessment of ChatGPT’s performance on neurology written board examination questions BMJ Neurol. Open Pub Date : 2023-11-01 Tse Chian Chen, Evan Multala, Patrick Kearns, Johnny Delashaw, Aaron Dumont, Demetrius Maraganore, Arthur Wang
Background and objectives ChatGPT has shown promise in healthcare. To assess the utility of this novel tool in healthcare education, we evaluated ChatGPT’s performance in answering neurology board exam questions. Methods Neurology board-style examination questions were accessed from BoardVitals, a commercial neurology question bank. ChatGPT was provided a full question prompt and multiple answer choices
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Cerebral venous sinus thrombosis secondary to acute cytomegalovirus infection BMJ Neurol. Open Pub Date : 2023-11-01 Andrew J Martin
Background Cerebral venous sinus thrombosis (CVST) is a potentially life-threatening disorder with a number of causes, including viral infections. Case presentation A 25-year-old female patient presented with a non-specific febrile illness, headache and hepatitis. She was found to have right transverse sinus and cortical venous thrombosis in addition to acute systemic Cytomegalovirus (CMV) infection
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Improving cognition in people with multiple sclerosis: study protocol for a multiarm, randomised, blinded trial of multidomain cognitive rehabilitation using a video-serious game (E-SEP cognition) BMJ Neurol. Open Pub Date : 2023-11-01 Bruno Lenne, Béatrice Degraeve, Jessy Davroux, Laurène Norberciak, Arnaud Kwiatkowski, Cécile Donze
Introduction Multiple sclerosis (MS) is a prevalent neurological disease characterised by disseminated areas of demyelination and atrophy within the central nervous system, inducing cognitive disorders in 45%–65% of persons with MS (PwMS). Neuropsychology and neuroimaging studies provide evidence of the effectiveness of cognitive rehabilitation interventions, including memory and attention. Recently
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Ambroxol as a disease-modifying treatment to reduce the risk of cognitive impairment in GBA-associated Parkinson’s disease: a multicentre, randomised, double-blind, placebo-controlled, phase II trial. The AMBITIOUS study protocol BMJ Neurol. Open Pub Date : 2023-11-01 Fabiana Colucci, Micol Avenali, Rosita De Micco, Marco Fusar Poli, Silvia Cerri, Mario Stanziano, Ana Bacila, Giada Cuconato, Valentina Franco, Diego Franciotta, Cristina Ghezzi, Matteo Gastaldi, Antonio Emanuele Elia, Luigi Romito, Grazia Devigili, Valentina Leta, Barbara Garavaglia, Nico Golfrè Andreasi, Federico Cazzaniga, Chiara Reale, Caterina Galandra, Giancarlo Germani, Pierfrancesco Mitrotti
Background Heterozygous mutations in the GBA gene, encoding the lysosomal enzyme β-glucocerebrosidase (GCase), are the most frequent genetic risk factor for Parkinson’s disease (PD). GBA -related PD (GBA-PD) patients have higher risk of dementia and reduced survival than non-carriers. Preclinical studies and one open-label trial in humans demonstrated that the chaperone ambroxol (ABX) increases GCase
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Efficacy of exercises in early-stage Parkinson’s disease (PARK-EASE trial): single-blind, randomised, controlled trial BMJ Neurol. Open Pub Date : 2023-11-01 Raktim Swarnakar, Sanjay Wadhwa, Srikumar Venkataraman, Vinay Goyal, Sreenivas Vishnubhatla
Objectives To assess the efficacy of exercises in early-stage Parkinson’s disease (PD). Design Single-blind, randomised controlled trial. Setting Tertiary rehabilitation care centre. Participants Forty individuals (≥18 years, either gender) with newly diagnosed PD (Hoehn and Yahr stage ≤2) on a stable dose of PD medications were randomised (1:1) to the intervention group (IG) and control group (CG)
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Oculomotor palsy and drowsiness due to post-thrombectomy subarachnoid haemorrhage falsely suggesting transtentorial herniation BMJ Neurol. Open Pub Date : 2023-10-01 Logesh Palanikumar, Joshua Mahadevan, Timothy Kleinig
Introduction Post-thrombectomy subarachnoid haemorrhage (SAH) can result in oculomotor palsy and drowsiness, which may falsely suggest transtentorial herniation. Case presentation We present a case of right oculomotor nerve palsy presenting after endovascular thrombectomy (EVT) for a right middle cerebral artery (MCA) stroke. The patient presented with a significant right MCA syndrome and a National
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Physical exercise for treating non-motor symptoms assessed by general Parkinson’s disease scales: systematic review and meta-analysis of clinical trials BMJ Neurol. Open Pub Date : 2023-10-01 Valton Costa, Alice de Oliveira Barreto Suassuna, Thanielle Souza Silva Brito, Thalita Frigo da Rocha, Anna Carolyna Gianlorenco
Introduction Parkinson’s disease is a movement disorder that also manifests non-motor symptoms (NMS). Physical exercise is a prominent strategy that can have an impact on NMS; however, the evidence is limited. Our aim was to verify the effects of exercise on NMS, as assessed using general NMS scales. Methods This study is a systematic review and meta-analysis. Two searches were conducted on the PubMed
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STAREE-Mind Imaging Study: a randomised placebo-controlled trial of atorvastatin for prevention of cerebrovascular decline and neurodegeneration in older individuals BMJ Neurol. Open Pub Date : 2023-10-01 Ian H Harding, Joanne Ryan, Stephane Heritier, Simone Spark, Zachary Flanagan, Richard McIntyre, Craig S Anderson, Sharon L Naismith, Trevor T-J Chong, Michael O'Sullivan, Gary Egan, Meng Law, Sophia Zoungas
Introduction Cerebrovascular disease and neurodegeneration are causes of cognitive decline and dementia, for which primary prevention options are currently lacking. Statins are well-tolerated and widely available medications that potentially have neuroprotective effects. The STAREE-Mind Imaging Study is a randomised, double-blind, placebo-controlled clinical trial that will investigate the impact of
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Evaluation of the efficacy and safety of MRI-guided focused ultrasound (MRgFUS) for focal hand dystonia: study protocol for an open-label non-randomised clinical trial BMJ Neurol. Open Pub Date : 2023-10-01 Joel Maamary, James Peters, Kain Kyle, Diane Ruge, Benjamin Jonker, Yael Barnett, Stephen Tisch
Introduction MRI-guided focused ultrasound (MRgFUS) thalamotomy provides an exciting development in the field of minimally invasive stereotactic neurosurgery. Current treatment options for focal hand dystonia are limited, with potentially more effective invasive stereotactic interventions, such as deep brain stimulation or lesional therapies, rarely used. The advent of minimally invasive brain lesioning
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Oral cladribine treatment and idiosyncratic drug-induced liver injury in multiple sclerosis BMJ Neurol. Open Pub Date : 2023-09-01 Florian Rakers, Almut Fritsch, Andreas Herrmann, Andrea Tannapfel, Matthias Schwab
Background Oral cladribine (OC) is approved for the treatment of highly active relapsing multiple sclerosis. Postmarketing safety assessments have reported rare, but occasionally severe cases of liver injury in temporal association with OC, with pathophysiologic mechanisms still unknown. In the only detailed case report on this topic, idiosyncratic drug-induced liver injury (iDILI) during OC treatment
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Myths and facts about functional neurological disorders: a cross-sectional study of knowledge and awareness among medical students and healthcare professionals in Iraq BMJ Neurol. Open Pub Date : 2023-09-01 Essam M Al-Sibahee, Ahmed Hashim, Sajjad Al-Badri, Nabeel Al-Fatlawi
Background Functional neurological disorder (FND) is a complex condition with neurological symptoms but no clear structural or biochemical explanation. Myths and misconceptions about FND can lead to misdiagnosis and inappropriate treatment. This study aimed to assess knowledge and common myths about FND among medical students and practitioners. Methods Data were collected from 324 participants using
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Music medicine to improve the tolerability of onabotulinumtoxinA injections for chronic migraine: an open-label prospective cohort study BMJ Neurol. Open Pub Date : 2023-09-01 Jason Ray, Subahari Raviskanthan
Introduction OnabotulinumtoxinA for migraine involves 31 injected repeated every 12 weeks. Tolerability is a significant factor impacting discontinuation. Music medicine has not been studied previously as an intervention to improve the tolerability of injections. Methodology A single-centre prospective cohort study was undertaken. Following baseline, patients had music played during the procedure.
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Leukoaraiosis and stroke severity scores in post-rtPA intracerebral haemorrhage BMJ Neurol. Open Pub Date : 2023-09-01 Arunnit Boonrod, Prompan Tangsakul, Narongrit Kasemsap, Nisa Vorasoot, Somsak Tiamkao, Kittisak Sawanyawisuth, Kannikar Kongbunkiat
Introduction Post thrombolytic symptomatic intracerebral haemorrhage (sICH) is a major concern in patients who had acute ischaemic stroke. Leukoaraiosis (LA) is reported to be related with sICH after intravenous thrombolytic treatment. However, the influence of LA and stroke neurological and imaging severity scores is still debated. Objective To evaluate if LA or severity scores are related with sICH
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Out-of-hospital multimodal seizure detection: a pilot study BMJ Neurol. Open Pub Date : 2023-08-01 Jonas Munch Nielsen, Ástrós Eir Kristinsdóttir, Ivan Chrilles Zibrandtsen, Paolo Masulli, Martin Ballegaard, Tobias Søren Andersen, Troels Wesenberg Kjær
Background Out-of-hospital seizure detection aims to provide clinicians and patients with objective seizure documentation in efforts to improve the clinical management of epilepsy. In-patient studies have found that combining different modalities helps improve the seizure detection accuracy. In this study, the objective was to evaluate the viability of out-of-hospital seizure detection using wearable
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Validation of a comorbidity questionnaire in patients with neurological disorders BMJ Neurol. Open Pub Date : 2023-08-01 Nirosen Vijiaratnam, Shree Vadera, Katharina Lefringhausen, Christine Girges, Anette Schrag
Rational Several tools exist to assess comorbidities in neurological disorders, the most widely used being the Charlson Comorbidity Index (CCI), but it has several limitations. The Comorbidity and General Health Questionnaire (CGHQ) is a newly designed tool, which includes additional comorbidities associated with health-related quality of life (HR-QOL) and outcomes in neurological disorders. Aims and
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Novel IRF2BPL gene mutation manifesting as a broad spectrum of neurological disorders: a case report BMJ Neurol. Open Pub Date : 2023-08-01 Wardah Javed Khan, Hamza Maqsood, Shifa Younus
Background IRF2BPL (interferon regulatory factor 2-binding protein-like) gene is an intronless gene present ubiquitously in the human body, including the brain. Pathogenic variants lead to neurodegeneration and present with phenotypic features of a neurological disorder, including dyslexia, dyscalculia, epilepsy, dystonia, neurodevelopmental regression, loss of motor skills and cerebellar ataxia. Case
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Cost-effectiveness of ticagrelor plus aspirin versus aspirin in acute ischaemic stroke or transient ischaemic attack: an economic evaluation of the THALES trial BMJ Neurol. Open Pub Date : 2023-08-01 Amarjeet Tank, S Claiborne Johnston, Ritika Jain, Pierre Amarenco, Carl Mellström, Klas Rikner, Hans Denison, Per Ladenvall, Mikael Knutsson, Anders Himmelmann, Scott R Evans, Stefan James, Carlos A Molina, Yongjun Wang, Mario Ouwens
Objective THALES demonstrated that ticagrelor plus aspirin reduced the risk of stroke or death but increased bleeding versus aspirin during the 30 days following a mild-to-moderate acute non-cardioembolic ischaemic stroke (AIS) or high-risk transient ischaemic attack (TIA). There are no cost-effectiveness analyses supporting this combination in Europe. To address this, a cost-effectiveness analysis
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Dilated fixed pupils and respiratory failure: a rare clinical course of Lambert-Eaton myasthenic syndrome BMJ Neurol. Open Pub Date : 2023-08-01 Michelle FM ten Brinck, Inge WH Verheijen, Jaron van de Wardt, Gert W van Dijk, Frouke AP Nijhuis, Aad Verrips
Background Lambert-Eaton myasthenic syndrome (LEMS) is a neuromuscular junction disorder and the clinical triad consists of proximal muscle weakness, autonomic symptoms and reduced tendon reflexes. Sluggish pupillary reflexes are common but dilated fixed pupils are rare. Case presentation We report a patient with a rare clinical course of LEMS. The patient was hospitalised due to progressive dyspnoea
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Blood pressure medication and acute kidney injury after intracerebral haemorrhage: an analysis of the ATACH-II trial BMJ Neurol. Open Pub Date : 2023-07-01 Andrew M Naidech, Hanyin Wang, Meghan Hutch, Julianne Murphy, James Paparello, Philip Bath, Anand Srivastava, Yuan Luo
Background Acute blood pressure (BP) reduction is standard of care after acute intracerebral haemorrhage (ICH). More acute BP reduction is associated with acute kidney injury (AKI). It is not known if the choice of antihypertensive medications affects the risk of AKI. Methods We analysed data from the ATACH-II clinical trial. AKI was defined by the Kidney Disease: Improving Global Outcomes criteria
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Valproate pregnancy prevention scheme: what are the barriers to enrolling patients and how do we meet them? BMJ Neurol. Open Pub Date : 2023-07-01 Musa Mamman Watila, Alistair James, Karen Milne, Graham Mackay
Background The UK Medicines Health products Regulation Agency instructs that valproate prescriptions should be restricted in women of childbearing age to those consenting to the Pregnancy Prevention Programme (PPP). We assessed the compliance and barriers to the valproate PPP. Methods We retrospectively audited NHS Grampian’s compliance with PPP guidelines among women of childbearing potential prescribed
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Anatomical distribution and clinical significance of middle cerebral artery M2 segment vessel occlusions and its cortical branches in acute ischaemic stroke patients BMJ Neurol. Open Pub Date : 2023-07-01 Philipp Gruber, Paola Valbuena, Renske Sassenburg, Javier Anon, Lukas Andereggen, Jatta Berberat, Luca Remonda
Background Characterisation of anatomical distribution and the clinical impact of middle cerebral artery M2 (MCA-M2) segment occlusion and its subsequent cortical branches (CBs) in acute ischaemic stroke patients (AIS). Methods Retrospective, monocentric study analysing radiological and clinical data of AIS patients with MCA-M2 segment occlusion with regard to the anatomic distribution of MCA-M2 occlusion
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Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): effects on outcomes at day 365 in a randomised, sham-controlled, blinded, phase III, superiority ambulance-based trial BMJ Neurol. Open Pub Date : 2023-06-01 Lisa J Woodhouse, Jason P Appleton, Sandeep Ankolekar, Timothy J England, Grant Mair, Keith Muir, Christopher I Price, Stuart Pocock, Marc Randall, Thompson G Robinson, Christine Roffe, Else C Sandset, Jeffrey L Saver, Aloysius Niroshan Siriwardena, Nikola Sprigg, Joanna M Wardlaw, Philip M Bath
Background The Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke Trial-2 (RIGHT-2) reported no overall treatment difference between glyceryl trinitrate (GTN) and sham at day 90. Here we assess participants’ outcomes 1 year after randomisation. Methods RIGHT-2 was an ambulance-based prospective randomised controlled trial where patients with presumed stroke and systolic blood pressure
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Opsoclonus myoclonus ataxia syndrome, ovarian teratoma and anti-NMDAR antibody: an ‘unresolved’ mystery BMJ Neurol. Open Pub Date : 2023-06-01 Angel T Miraclin, Arun Mathai Mani, Ajith Sivadasan, Aditya Nair, Munagapati Christina, Abigail Ruth Gojer, Sharon Milton, John A Jude Prakash, Rohit N Benjamin, Appaswamy Thirumal Prabhakar, Vivek Mathew, Sanjith Aaron
Background Opsoclonus–myoclonus–ataxia syndrome (OMAS) is characterised by the combination of opsoclonus and arrhythmic action myoclonus with axial ataxia and dysarthria. In adults, a majority are paraneoplastic secondary to solid organ tumours and could harbour antibodies against intracellular epitopes; however, certain proportions have detectable antibodies to various neuronal cell surface antigens
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Characteristics of hypersomnia due to inflammatory demyelinating diseases of the central nervous system BMJ Neurol. Open Pub Date : 2023-06-01 Hideaki Ishido, Shigeru Chiba, Hana Takahashi, Megumi Isa, Yasuhiro Ogawa, Hiroki Kubota, Aya Imanishi, Yuki Omori, Taisuke Ono, Ko Tsutsui, GoEun Han, Hideaki Kondo, Hiroshi Tsuji, Kiyotaka Nakamagoe, Akiko Ishii, Keiko Tanaka, Akira Tamaoka, Tetsuo Shimizu, Seiji Nishino, Tomoyuki Miyamoto, Takashi Kanbayashi
Background Neuromyelitis optica spectrum disorder (NMOSD) diagnostic criteria for inflammatory demyelinating central nervous system diseases included symptomatic narcolepsy; however, no relevant case‐control studies exist. We aimed to examine the relationship among cerebrospinal fluid orexin‐A (CSF‐OX) levels, cataplexy and diencephalic syndrome; determine risk factors for low-and-intermediate CSF‐OX
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Evaluating the limits of AI in medical specialisation: ChatGPT’s performance on the UK Neurology Specialty Certificate Examination BMJ Neurol. Open Pub Date : 2023-06-01 Panagiotis Giannos
Background Large language models such as ChatGPT have demonstrated potential as innovative tools for medical education and practice, with studies showing their ability to perform at or near the passing threshold in general medical examinations and standardised admission tests. However, no studies have assessed their performance in the UK medical education context, particularly at a specialty level
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Muscle spindles as pain receptors BMJ Neurol. Open Pub Date : 2023-06-01 Juhani V Partanen, Hanna-Reetta Lajunen, Sara K Liljander
Background Muscle membranes have a sensation of pain, but within the muscle tissue, the origin of pain is unclear. We present a hypothesis that the pain receptors of the muscle tissue are situated principally in the muscle spindles. A recent report reintroduced that ‘end plate spikes’ in needle electromyography (EMG) are fusimotor unit potentials of the intrafusal muscle fibres, and thus represent
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Effects of blood pressure and tranexamic acid in spontaneous intracerebral haemorrhage: a secondary analysis of a large randomised controlled trial BMJ Neurol. Open Pub Date : 2023-06-01 Jason Philip Appleton, Zhe Kang Law, Lisa Jane Woodhouse, Rustam Al-Shahi Salman, Maia Beridze, Hanne Christensen, Robert A Dineen, Juan José Egea Guerrero, Timothy J England, Michal Karlinski, Kailash Krishnan, Ann Charlotte Laska, Philippe Lyrer, Serefnur Ozturk, Christine Roffe, Ian Roberts, Thompson G Robinson, Polly Scutt, David J Werring, Philip M Bath, Nikola Sprigg
Background Tranexamic acid reduced haematoma expansion and early death, but did not improve functional outcome in the tranexamic acid for hyperacute spontaneous intracerebral haemorrhage-2 (TICH-2) trial. In a predefined subgroup, there was a statistically significant interaction between prerandomisation baseline systolic blood pressure (SBP) and the effect of tranexamic acid on functional outcome
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Assessing and managing medication overuse headache in Australian clinical practice BMJ Neurol. Open Pub Date : 2023-05-01 Tissa Wijeratne, Bronwyn Jenkins, Richard J Stark, Christina Sun-Edelstein
More than 3 million Australians are estimated to have migraine disorders, and over a quarter of a million Australians are estimated to have medication overuse headache (MOH). The personal, societal and economic burden of MOH is high. MOH impacts an individual’s ability to work or study, care for family or themselves, culminating in poor quality of life. Accurate and timely diagnosis and treatment of
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The 8 January 2020 theatre ballistic missile attack on US soldiers stationed at Al Asad Air Base, Iraq: case series using a concussion subtypes framework to approach a real-world, chaotic blast-related TBI mass casualty event BMJ Neurol. Open Pub Date : 2023-05-01 Jeffrey Brian Hainsworth, Alan Johnson, Shana Godfred-Cato, George J Smolinski, Kendra Jorgensen-Wagers
Objectives This study aims to describe which concussion subtype(s) result specifically from the explosions of theatre ballistic missiles (TBMs) blast waves, an extremely rare occurrence in modern warfare. We provide feedback from using the US military’s standard acute concussion screening tool, the Military Acute Concussion Examination version 2, in a deployed, chaotic, real-world environment. Background
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Correction: Modelling accessibility of adult neurology care in Australia, 2020–2034 BMJ Neurol. Open Pub Date : 2023-05-01 BMJ Publishing Group Ltd
Simpson-Yap S, Frascoli F, Harrison L On behalf of the Australian & New Zealand Association of Neurologists Workforce Committee, et al . Modelling accessibility of adult neurology care in Australia, 2020–2034. BMJ Neurol Open 2023;5:e000407 This article has been corrected since it was first
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Retinal vascular density in CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) BMJ Neurol. Open Pub Date : 2023-05-01 Valérie Krivosic, Michel Paques, Dominique Hervé, Cedric Duliére, Abbas Taleb, Nathalie Gastellier, Eric Jouvent, Jessica Lebenberg, Ramin Tadayoni, Hugues Chabriat
Background and objective Retinal vascular density (VD) measured using optical coherence tomography with angiography (OCTA) has been suggested as a potential marker of intracerebral vascular changes in Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL). We aimed to determine whether VD is related to the clinical and imaging manifestations of the disease
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Modelling accessibility of adult neurology care in Australia, 2020–2034 BMJ Neurol. Open Pub Date : 2023-04-01 Steve Simpson-Yap, Federico Frascoli, Lucinda Harrison, Charles Malpas, James Burrell, Nicholas Child, Lauren P Giles, Christian Lueck, Merrilee Needham, Benjamin Tsang, Tomas Kalincik
Introduction In 2015/2016, annual national expenditure on neurological conditions exceeded $A3 billion. However, a comprehensive study of the Australian neurological workforce and supply/demand dynamics has not previously been undertaken. Methods Current neurological workforce was defined using neurologist survey and other sources. Workforce supply modelling used ordinary differential equations to