A 59‐years old Chinese woman presented with recurrent episodes of transient left hemiparesis for 1‐month. Each episode lasted 5‐10 minutes. She was on regular medications for hypertension and dyslipidemia.

With interest we read the article by Dos Santos et al. about a retrospective, multicenter study on the effect and safety of rituximab (RTX) in patients >18y with myasthenia gravis (MG) in 6 centers of Western France [1]. It was concluded that RTX is effective and safe for MG [1]. We have the following comments and concerns.

We thank Dr Finsterer and his colleagues for their interest in our paper (1) and for raising questions about it (2).

Unexpected stressful life events may alter immune function and affect susceptibility to autoimmune diseases including multiple sclerosis (MS). Current results from epidemiological investigations examining the role of stress in MS remain inconsistent. We aim to conduct the hitherto largest population‐based case‐control study on this topic.

The patient's perspective is becoming increasingly important for endpoints in studies on multiple sclerosis. However, relapse data generated from the patient's perspective in combination with independent documentation by the physician are scarce. Our objective was to compare self‐reported relapses by the patient to physician‐documented relapses within a routine clinical practice setting of quarterly

The existence of contraindications to intravenous thrombolysis (IVT) is considered a criterion for direct transfer of patients with suspected acute stroke to thrombectomy‐capable centers in the prehospital setting. Our aim was to assess the utility of this criterion in a setting where routing protocols are defined by the Madrid – Direct Referral to Endovascular Center (M‐DIRECT) prehospital scale.

Limited data are available in the literature for upper limb impairment in multiple sclerosis (MS). This study aimed to report the distribution of values of hand grip strength (HGS), of the box and block test (BBT) and of the nine‐hole peg test (9HPT) correlated with demographic and clinical data in subjects with MS.

“Stroke chameleons” refer to a group of syndromes that initially are not diagnosed as cerebrovascular events, but are then found to represent stroke. The objective of this study was to report on acute ischemic stroke (AIS) patients with chest or epigastric pain of central origin, clinically resembling an acute coronary syndrome (ACS).

In this issue of the European Journal of Neurology (pages to be completed) , Rebordão et al reported 5 cases of acute ischemic stroke (AIS) presenting with chest or epigastric pain leading to the misdiagnosis of acute coronary syndrome (ACS) on initial examination. All the cases were extracted from the prospective and consecutive cohort of AIS, the Acute Stroke registry and Analysis of Lausanne (ASTRAL)

Different amounts of cumulative exposure to the toxic mutant form of the huntingtin protein might underlie the distinctive pattern of striatal connectivity in pre‐manifest Huntington’s disease (pre‐HD). The aim of this study was to investigate disease‐burden‐dependent cortical‐striatal and subcortical‐striatal loops at different pre‐HD stages.

Advance care planning allows people to plan for their future care needs and can include medical, psychological and social aspects. However, little is known on the use, experience of and attitudes towards advance care planning in patients with parkinsonian disorders, their family carers and healthcare professionals.

This issue of the European Journal of Neurology is devoted to manuscripts on SARS‐CoV‐2 infection. Who could have expected this 1 year ago? The outbreak was first identified in Wuhan, China, in December 2019. The World Health Organization declared it a Public Health Emergency of International Concern on January 30, then a pandemic on March 11. Most people heard of this new viral infection for the first

The brain is not the central organ, isolated in its skull that we usually imagine. It is connected to many other organs including the liver. Brain‐liver relationships result from metabolic, hormonal, immunological or inflammatory pathways.

Basilar artery occlusion (BAO) leads to high rates of morbidity and mortality, despite successful recanalization. The discordance between flow restoration and long‐term functional status clouds clinical decision‐making regarding further aggressive care. We sought to develop and validate a practical, prognostic tool for the prediction of 3‐month favorable outcome after acute reperfusion therapy for

Three different sets of criteria have been proposed for the diagnosis of neuromyelitis optica spectrum disorder (NMOSD). The objective was to compare the specificity, sensitivity and diagnostic accuracy of the three different sets of NMOSD criteria in patients presenting with inflammatory disorders of the central nervous system suggestive of NMOSD.

Both optical coherence tomography (OCT) and magnetic resonance imaging (MRI) volumetric measures have been postulated as potential biomarkers of multiple sclerosis (MS)‐related disability. The aim of the study was to investigate the association between OCT and brain volume and spinal cord area (SCA) parameters in patients with relapsing MS and to assess their independent associations with disability

The frequency of infectious encephalitis and the distribution of causative pathogens in tropical areas are poorly known and may be influenced by emerging and rare infections. The aim was to characterize a large series of acute infectious encephalitis and myelitis in immunocompetent patients from the Caribbean island of Guadeloupe identifying clinical, biological and radiological features according

we read with interest recent paper written by Kleineberg and van der Meulen et al. [1] updating information on residency in Europe [2]. Since the current residency program in Slovenia has been reforming, and changes will be implemented soon, we would kindly provide up to date information for your valued readers.

Dementia is one of the most common disorders and is associated with increased morbidity, mortality and decreased quality of life. The present guideline addresses important medical management issues including systematic medical follow‐up, vascular risk factors in dementia, pain in dementia, use of antipsychotics in dementia and epilepsy in dementia.

Expectations of Africa having high rates of infection and death from COVID‐19 have, as yet, not materialized. At the time of writing (May 25, 2020), all 54 countries have officially reported COVID‐19 cases; 123 724 people have tested positive for the disease and 3668 people have died. The reasons for such low levels may be due, in part, to the rapid responses of countries. South Africa declared a national

Clinical use of continuous electrocardiography (cECG) for detecting atrial fibrillation (AF) after stroke is unclear. In a Danish nationwide cohort, we described post‐stroke time trends in outpatient cECG usage and AF incidence and characterized factors associated with cECG use.

Haemorrhagic transformation (HT) is one of the main risks of intravenous thrombolysis (IVT) for acute ischemic stroke. Contraindications serve to exclude patients at high risk of HT after IVT. One of these contraindications is a stroke within the preceding 3 months. It is unclear if this contraindication should include recent clinically silent infarcts (RSI). The aim of this study was to investigate

Hypomimia is a prominent clinical feature in people with Parkinson’s disease, though it remains under‐investigated. We aimed here to examine the clinical correlates of hypomimia in Parkinson's disease and to test if this is a levodopa‐responsive sign.

Very‐long‐chain acyl‐CoA dehydrogenase deficiency (VLCADD) is a hereditary disorder of mitochondrial long‐chain fatty acid oxidation that has variable presentations, including exercise intolerance, cardiomyopathy and liver disease. The aim of this study was to describe the clinical and genetic manifestations of six patients with adult‐onset VLCADD.

We are learning gradually about the neurological manifestations during the ongoing coronavirus disease (COVID‐19) pandemic, a respiratory disease related to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) [1]. As the clinical evidence is still limited, it makes sense to critically analyze the spectrum of neurological involvement caused by SARS‐CoV‐1 and Middle East respiratory syndrome

Visual snow manifests as a pan‐field, dynamic visual disturbance described as continuous television static‐like tiny flickering dots. Current diagnostic criteria further require at least two additional symptoms for visual snow syndrome (VSS) from: palinopsia (afterimages and trailing); entoptic phenomena (floaters, blue field entoptic phenomenon, photopsia, self‐light of the eye); photophobia and nyctalopia

Although the main clinical features of COVID‐19 infection are pulmonary, several associated neurological signs, symptoms and diseases are emerging. The incidence and characteristics of neurological complications are unclear. For this reason, the European Academy of Neurology (EAN) core COVID‐19 Task Force initiated a survey on neurological symptoms observed in patients with COVID‐19 infection.

Childhood‐onset autosomal dominant cerebellar ataxia type 7 (SCA7) is a severe disease which leads to premature loss of ambulation and death. Early diagnosis of SCA7 is of major importance for genetic counselling and still relies on specific genetic testing, driven by clinical expertise. However, the precise phenotype and natural history of paediatric SCA7 has not yet been fully described. Our aims

Neuromodulation is a promising approach to increase motor recovery in stroke. However, so far, there is a scarcity of evidence documenting the clinical potential of tDCS administered in the acute phase of stroke. The present study aims to examine the clinical effects of a treatment involving the application of tDCS in the acute stage post‐stroke.

Urinary liver‐type fatty‐acid binding protein (L‐FABP), which is a biomarker of kidney tubule injury, has been studied extensively and established as a risk marker of acute kidney injury (AKI). However, no evidence has indicated whether kidney tubule injury is associated with the development of AKI and mortality in patients with acute ischemic stroke.

Blood pressure (BP) variability has been associated with worse neurologic outcomes in acute ischemic stroke (AIS) patients receiving treatment with intravenous thrombolysis (IVT). However, no study to date has investigated whether pulse pressure (PP) variability may be a superior indicator of the total cardiovascular risk, as measured by clinical outcomes.

We aimed to define the radiological picture of Facioscapulohumeral muscular dystrophy 2 (FSHD2) in comparison with FSHD1, and to explore correlations between imaging and clinical/molecular data.

Dementia disorders predispose for lethal complications and decrease life expectancy. A more profound knowledge regarding end‐stage conditions in dementia could therefore ameliorate treatment and care of these patients.

With much interest we read the article by Wagner et al.,1 however, their claim that “patients with breakthrough tick‐borne encephalitis suffer a more severe clinical course” is not supported by their data as the scientific evidence necessary to substantiate this claim would generally be a double‐blind randomized study, not a retrospective case series from a tertiary care center. Specifically:

Most recurrent cervical artery dissection (CeAD) events occur shortly after the acute first CeAD. This study compared the characteristics of recurrent and first CeAD events and searched for associations between subsequent events of an individual person.

The COVID‐19 pandemic is seriously affecting the lives of billions of people around the world, especially in the healthcare systems [1]. Although the impact of the pandemic on health services is mostly negative, there is still a chance to use this situation as an opportunity for positive changes. Neurosonological examination involves direct contact between the patient and the sonographer, often for

Clinical trials (CTs) aimed at vulnerable groups, such as patients with mental disorders, create ethical complexity. The patient information sheet (PIS) should provide all of the information about the CT that is relevant to the subject's decision to participate. After being informed, the subject will decide freely whether to take part in the CT and will read and sign the informed consent form (ICF)

Liver fibrosis, a common yet often subclinical manifestation of chronic liver disease, may have an unrecognized role in cognitive impairment. We evaluated the association between a validated liver fibrosis index and cognitive measures among older adults.

Individuals with radiologically isolated syndrome (RIS) are at increased risk of converting to multiple sclerosis (MS). Early identification of later converters is crucial for optimal treatment decisions. The purpose of this study was to assess the predictive potential of optical coherence tomography (OCT) measures in individuals with RIS regarding conversion to MS.

In cervical dystonia, the accuracy of botulinum neurotoxin (BoNT) injections may influence the response to the treatment.

The objective of this study is to assess the neurological manifestations in a series of consecutive SARS‐CoV‐2 positive patients, comparing their frequency with a population hospitalized in the same period for flu/respiratory symptoms, finally not related to SARS‐CoV‐2.

As severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), the virus that causes COVID‐19, is highly infectious and variable, and given that we now understand a large proportion of asymptomatic carriers can be still infectious [1], it is expected that a normalization of epidemic prevention and control measures will be required for a long time worldwide. Our neurology department at Xuanwu Hospital

Primitive reflexes (PR) may reoccur in various neurodegenerative diseases. However, little is known about their structural and functional correlates in the human brain. Notably, the neural mechanisms underlying a positive palmomental reflex (PMR) are poorly understood. As recent studies link Alzheimer’s disease (AD)‐related PRs to a dysfunction of the corticostriatal motor circuit, we here investigated

Post‐viral olfactory dysfunction is well established and has been shown to be a key symptom of the Coronavirus diseases 2019 with more than 66% European and U.S patients reporting some degree of loss of smell. Persistent olfactory dysfunction appears to be commonplace and will drive the demand for General Practitioner, Otolaryngology or Neurology consultation in the next months ‐ evidence regarding

Soluble ST2 (sST2) is a promising biomarker in inflammation, atherosclerosis and cardiovascular diseases. We investigated the association between serum sST2 and poor outcome in patients with transient ischaemic attack (TIA)/ischaemic stroke.

The single simple question (SSQ) is a simple and validated question asking what percentage of normal a patient feels with respect to their myasthenia gravis (MG), with 100% being normal. Patient acceptable symptom states (PASS) are based on a dichotomous ‘Yes’ or ‘No’ response, asking whether a patient is satisfied overall with their current status and thus measures holistic satisfaction with their

The detection rate of diffusion‐weighted (DWI) hyperintense lesions varies widely in patients with transient global amnesia (TGA). The aim was to examine the association of hyperintense lesions on DWI magnetic resonance imaging (MRI) with patient characteristics, precipitating factors, clinical presentation and MRI settings in patients with TGA.

Migraine is a complex and disabling neurological disorder, the exact neurological mechanisms of which remain unclear. The thalamus is considered to be the hub of the central processing and integration of nociceptive information, as well as the modulation of these processes.

Severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) causes a highly contagious respiratory disease referred to as COVID‐19. However, emerging evidence indicates that a small, but a growing number of COVID‐19 patients also manifest neurological symptoms, suggesting that SARS‐CoV‐2 may infect the nervous system under some circumstances. SARS‐CoV‐2 primarily enters the body through the epithelial

The incidence of Moyamoya disease (MMD) in Europe is not well known. In those affected, the risk of brain hemorrhage is considered low. The present study aimed to investigate the incidence and clinical presentation of MMD in the Danish population.

Before the European Academy of Neurology: the roots The first international Neurological Congress took place in Bern, Switzerland, in 1931 with the participation of 42 countries from four continents [1]. The World Federation of Neurology was founded in 1957, whereas the European Neurological Society (ENS) (1986) and the European Federation of Neurological Societies (EFNS) (1991) came much later [2]

Nerve tissue alterations have rarely been quantified in Charcot–Marie–Tooth type 1A (CMT1A) patients. The aim of the present study was to quantitatively assess the magnetic resonance imaging (MRI) anomalies of the sciatic and tibial nerves in CMT1A disease using quantitative neurography MRI. It was also intended to seek for correlations with clinical variables.

Systematic research on the effect of Charcot–Marie–Tooth (CMT) disease on the outcome of pregnancy and conversely the effect of pregnancy on neuropathy is still sparse.

A wide variety of metabolic changes, including an increased incidence of diabetes mellitus (DM) and dyslipidaemia, has been described in amyotrophic lateral sclerosis (ALS). The aim of this study was to investigate the associations of statin use and history of DM with onset of disease and survival in patients with ALS.

The aim was to investigate whether female reproductive factors are associated with dementia.

The diagnosis of rare movement disorders is difficult and specific management programmes are not well defined. Thus, in order to capture and assess care needs, the European Reference Network for Rare Neurological Diseases has performed an explorative care need survey across all European Union (EU) countries.

Essential tremor (ET) is a movement disorder primarily characterized by upper limb postural and kinetic tremor. Although still under‐investigated, bradykinesia may be part of the phenotypic spectrum of ET. The aim was to evaluate bradykinesia features in ET through clinical examination and kinematic analysis of repetitive finger movements. Data collected in ET patients were compared with those recorded

Patients with severe, progressive multiple sclerosis (MS) have complex physical and psychosocial needs, typically over several years. Few treatment options are available to prevent or delay further clinical worsening in this population. The objective was to develop an evidence‐based clinical practice guideline for the palliative care of patients with severe, progressive MS.

Data on rates of newly diagnosed depression after multiple sclerosis (MS) diagnosis are sparse. Here, incident, treated depression in MS patients after diagnosis compared with matched non‐MS patients is described.

Infections with coronaviruses are not always confined to the respiratory tract and various neurological manifestations have been reported. The aim of this study was to perform a review to describe neurological manifestations in patients with COVID‐19 and possible neuro‐invasive mechanisms of Sars‐CoV‐2.