401
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Grossman S, Rothstein A, Conway J, Gurin L, Galetta S. Clinical Reasoning: A 41-year-old man with thunderclap headache. Neurology 2018; 91:e87-e91. [DOI: 10.1212/wnl.0000000000005738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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402
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Karam C, Galetta S. Editors' note: Infliximab for the treatment of CNS sarcoidosis: A multi-institutional series. Neurology 2018. [DOI: 10.1212/wnl.0000000000005726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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403
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Alcauskas M, Galetta S. Editors' note: Serum neurofilament light is sensitive to active cerebral small vessel disease. Neurology 2018. [DOI: 10.1212/wnl.0000000000005674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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404
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Alcauskas M, Galetta S. Editors' note: Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life: A systematic review. Neurology 2018. [DOI: 10.1212/wnl.0000000000005673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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405
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Karam C, Galetta S. Editors' note: Smoking cessation and outcome after ischemic stroke or TIA. Neurology 2018. [DOI: 10.1212/wnl.0000000000005629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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406
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Karam C, Galetta S. Editors' note: Quinidine-associated skin discoloration in KCNT1-associated pediatric epilepsy. Neurology 2018. [DOI: 10.1212/wnl.0000000000005626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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407
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Alcauskas M, Galetta S. Editors' note: Pilocytic astrocytoma with anaplasia arising from the optic chiasm in a very elderly patient. Neurology 2018. [DOI: 10.1212/wnl.0000000000005594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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408
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Alcauskas M, Galetta S. Editors' note: ELAPSS score for prediction of risk of growth of unruptured intracranial aneurysms. Neurology 2018. [DOI: 10.1212/wnl.0000000000005599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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409
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Karam C, Galetta S. Editors' note: Blood pressure reduction and noncontrast CT markers of intracerebral hemorrhage expansion. Neurology 2018. [DOI: 10.1212/wnl.0000000000005568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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410
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Karam C, Galetta S. Editors' note: Anti-cytosolic 5′-nucleotidase 1A (cN1A) autoantibodies in motor neuron diseases. Neurology 2018. [DOI: 10.1212/wnl.0000000000005569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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411
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Alcauskas M, Galetta S. Editors' note: Teaching Video NeuroImages: Palsy of conjugate horizontal gaze and face due to isolated abducens nuclear infarction. Neurology 2018. [DOI: 10.1212/wnl.0000000000005510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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412
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Alcauskas M, Galetta S. Editors' note: Olfaction and incident Parkinson disease in US white and black older adults. Neurology 2018. [DOI: 10.1212/wnl.0000000000005514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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413
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Alcauskas M, Galetta S. Editors' note: Teaching NeuroImages: RCVS causing simultaneous convexity subarachnoid hemorrhage and hemimedullary infarction. Neurology 2018. [DOI: 10.1212/wnl.0000000000005407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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414
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Alcauskas M, Galetta S. Editors' note: Smoking cessation and secondary stroke prevention. Neurology 2018. [DOI: 10.1212/wnl.0000000000005403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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415
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Karam C, Galetta S. Editors' note: Utilization of rehabilitation therapy services in Parkinson disease in the United States. Neurology 2018. [DOI: 10.1212/wnl.0000000000005365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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416
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Karam C, Galetta S. Editors' note: High frequency of gastrointestinal manifestations in myotonic dystrophy type 1 and type 2. Neurology 2018. [DOI: 10.1212/wnl.0000000000005369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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417
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Alcauskas M, Galetta S. Editors' note: Teaching Video NeuroImages: Olivary enlargement and pharyngeal nystagmus. Neurology 2018. [DOI: 10.1212/wnl.0000000000005318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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418
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Karam C, Galetta S. Editors' note: Mystery Case: A case of fulminant encephalopathy in a 69-year-old woman. Neurology 2018. [DOI: 10.1212/wnl.0000000000005287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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419
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Karam C, Galetta S. Editors' note: Wrist sensor reveals sympathetic hyperactivity and hypoventilation before probable SUDEP. Neurology 2018. [DOI: 10.1212/wnl.0000000000005285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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420
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Alcauskas M, Galetta S. Editors' note: 25-Hydroxyvitamin D deficiency and risk of MS among women in the Finnish Maternity Cohort. Neurology 2018. [DOI: 10.1212/wnl.0000000000005248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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421
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Alcauskas M, Galetta S. Editors' note: Magnesium, hemostasis, and outcomes in patients with intracerebral hemorrhage. Neurology 2018. [DOI: 10.1212/wnl.0000000000005246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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422
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Gutman JM, Kupersmith M, Galetta S, Kister I. Anti-myelin oligodendrocyte glycoprotein (MOG) antibodies in patients with optic neuritis and seizures. J Neurol Sci 2018; 387:170-173. [DOI: 10.1016/j.jns.2018.01.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/02/2018] [Accepted: 01/31/2018] [Indexed: 10/18/2022]
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423
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Karam C, Galetta S. Editors' note: Sex-specific stroke incidence over time in the Greater Cincinnati/Northern Kentucky Stroke Study. Neurology 2018. [DOI: 10.1212/wnl.0000000000005201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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424
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Karam C, Galetta S. Editors' note: Expression of Concern: Does compensatory hyperparathyroidism predispose to ischemic stroke? Decreased bone mass and increased bone turnover with valproate therapy in adults with epilepsy; An alternative to vitamin D supplementation to prevent fractures in patients with MS; High prevalence of vitamin D deficiency and reduced bone mass in Parkinson's disease. Neurology 2018; 90:627. [DOI: 10.1212/wnl.0000000000005202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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425
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Alcauskas M, Galetta S. Editors' note: Swallowing-induced displacement of the carotid artery as a risk of stroke: Flip-flop phenomenon. Neurology 2018. [DOI: 10.1212/wnl.0000000000005153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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426
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Alcauskas M, Galetta S. Editors' note: Systematic review and statistical analysis of the integrity of 33 randomized controlled trials. Neurology 2018. [DOI: 10.1212/wnl.0000000000005154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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427
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Karam C, Galetta S. Editors' note: A new potential biomarker for dementia with Lewy bodies: Skin nerve α-synuclein deposits. Neurology 2018. [DOI: 10.1212/wnl.0000000000005099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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428
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Karam C, Galetta S. Editors' note: Underestimation of sudden deaths among patients with seizures and epilepsy. Neurology 2018. [DOI: 10.1212/wnl.0000000000005100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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429
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Alcauskas M, Galetta S. Editors' note: The state of academic neurology departments in the United States, 2016: A national survey. Neurology 2018. [DOI: 10.1212/wnl.0000000000005050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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430
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Alcauskas M, Galetta S. Editors' note: Sleep architecture and the risk of incident dementia in the community. Neurology 2018. [DOI: 10.1212/wnl.0000000000005052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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431
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Alcauskas M, Galetta S. Editors' note: Upgoing thumb sign: A sensitive indicator of brain involvement? Neurology 2018. [DOI: 10.1212/wnl.0000000000004979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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432
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Alcauskas M, Galetta S. Editors' note: Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology 2018. [DOI: 10.1212/wnl.0000000000004916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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433
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Alcauskas M, Galetta S. Editors' note: Blood pressure reduction and noncontrast CT markers of intracerebral hemorrhage expansion. Neurology 2018. [DOI: 10.1212/wnl.0000000000004846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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434
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Alcauskas M, Galetta S. Editors' note: Effects of increasing IV tPA-treated stroke mimic rates at CT-based centers on clinical outcomes. Neurology 2018. [DOI: 10.1212/wnl.0000000000004848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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435
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Alcauskas M, Galetta S. Editors' note: Olfaction and risk of dementia in a biracial cohort of older adults. Neurology 2018. [DOI: 10.1212/wnl.0000000000004786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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436
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Alcauskas M, Galetta S. Editors' note: Standard operating procedures improve acute neurologic care in a sub-Saharan African setting. Neurology 2018. [DOI: 10.1212/wnl.0000000000004791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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437
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Alcauskas M, Galetta S. Editors' Note. Neurology 2017. [DOI: 10.1212/wnl.0000000000004735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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438
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Alcauskas M, Galetta S. Editors' Note. Neurology 2017. [DOI: 10.1212/wnl.0000000000004695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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439
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Alcauskas M, Galetta S. Editors' Note. Neurology 2017. [DOI: 10.1212/wnl.0000000000004653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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440
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Gutman JM, Levy M, Galetta S, Kister I. Clinical Reasoning: A patient with a history of encephalomyelitis and recurrent optic neuritis. Neurology 2017; 89:e231-e234. [PMID: 29109139 DOI: 10.1212/wnl.0000000000004628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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441
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Alcauskas M, Galetta S. Editors' Note. Neurology 2017. [DOI: 10.1212/wnl.0000000000004589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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442
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Karam C, Galetta S. Editors' Note. Neurology 2017. [DOI: 10.1212/wnl.0000000000004562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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443
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Alcauskas M, Galetta S. Editors' Note. Neurology 2017. [DOI: 10.1212/wnl.0000000000004510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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444
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Karam C, Galetta S. Editors' Note. Neurology 2017. [DOI: 10.1212/wnl.0000000000004479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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445
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Alcauskas M, Galetta S. Editors' Note. Neurology 2017. [DOI: 10.1212/wnl.0000000000004553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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446
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Alcauskas M, Galetta S. Editors' Note. Neurology 2017. [DOI: 10.1212/wnl.0000000000004401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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447
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Alcauskas M, Galetta S. Editors' Note. Neurology 2017. [DOI: 10.1212/wnl.0000000000004346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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448
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Meltzer E, Sguigna PV, Subei A, Beh S, Kildebeck E, Conger D, Conger A, Lucero M, Frohman BS, Frohman AN, Saidha S, Galetta S, Calabresi PA, Rennaker R, Frohman TC, Kardon RH, Balcer LJ, Frohman EM. Retinal Architecture and Melanopsin-Mediated Pupillary Response Characteristics: A Putative Pathophysiologic Signature for the Retino-Hypothalamic Tract in Multiple Sclerosis. JAMA Neurol 2017; 74:574-582. [PMID: 28135360 PMCID: PMC5822208 DOI: 10.1001/jamaneurol.2016.5131] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 10/21/2016] [Indexed: 12/19/2022]
Abstract
Importance A neurophysiologic signature of the melanopsin-mediated persistent constriction phase of the pupillary light reflex may represent a surrogate biomarker for the integrity of the retinohypothalamic tract, with potential utility for investigating alterations in homeostatic mechanisms associated with brain disorders and implications for identifying new treatments. Objective To characterize abnormalities of retinal architecture in patients with multiple sclerosis (MS) and corresponding alterations in the melanopsin-mediated sustained pupillary constriction response. Design, Setting, and Participants The case-control study was an experimental assessment of various stimulus-induced pupillary response characteristics and was conducted at a university clinical center for MS from September 6, 2012, to February 2015. Twenty-four patients with MS (48 eyes) and 15 individuals serving as controls (30 eyes) participated. The melanopsin-mediated, sustained pupillary constriction phase response following cessation of a blue light stimulus was compared with the photoreceptor-mediated pupillary constriction phase response following cessation of a red light stimulus. Optical coherence tomography was used to characterize the association between pupillary response characteristics and alterations in retinal architecture, specifically, the thickness of the retinal ganglion cell layer and inner plexiform layer (GCL + IPL). Main Outcomes and Measures Association of pupillary response characteristics with alterations in retinal architecture. Results Of 24 patients with MS included in the analysis, 17 were women (71%); mean (SD) age was 47 (11) years. Compared with eyes from individuals with MS who had normal optical coherence tomography-derived measures of retinal GCL + IPL thickness, eyes of patients who had GCL + IPL thickness reductions to less than the first percentile exhibited a correspondingly significant attenuation of the melanopsin-mediated sustained pupillary response (mean [SD] pupillary diameter ratios at a point in time, 0.18 [0.1] vs 0.33 [0.09]; P < .001, generalized estimating equation models accounting for age and within-patient intereye correlations). Conclusions and Relevance In this case-control study, attenuation of the melanopsin-mediated sustained pupillary constriction response was significantly associated with thinning of the GCL + IPL sector of the retina in the eyes of patients with MS, particularly those with a history of acute optic neuritis. Melanopsin-containing ganglion cells in the retina represent, at least in part, the composition of the retinohypothalamic tract. As such, our findings may signify the ability to elucidate a putative surrogate neurophysiologic signature that correlates with a constellation of homeostatic mechanisms in both health and illness.
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449
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Cadavid D, Balcer L, Galetta S, Aktas O, Ziemssen T, Vanopdenbosch L, Frederiksen J, Skeen M, Jaffe GJ, Butzkueven H, Ziemssen F, Massacesi L, Chai Y, Xu L, Freeman S. Safety and efficacy of opicinumab in acute optic neuritis (RENEW): a randomised, placebo-controlled, phase 2 trial. Lancet Neurol 2017; 16:189-199. [PMID: 28229892 DOI: 10.1016/s1474-4422(16)30377-5] [Citation(s) in RCA: 175] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 11/29/2016] [Accepted: 11/29/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND The human monoclonal antibody opicinumab (BIIB033, anti-LINGO-1) has shown remyelinating activity in preclinical studies. We therefore assessed the safety and tolerability, and efficacy of opicinumab given soon after a first acute optic neuritis episode. METHODS This randomised, double-blind, placebo-controlled, phase 2 study (RENEW) was done at 33 sites in Australia, Canada, and Europe in participants (aged 18-55 years) with a first unilateral acute optic neuritis episode within 28 days from study baseline. After treatment with high-dose methylprednisolone (1 g/day, intravenously, for 3-5 days), participants were assigned with a computer-generated sequence with permuted block randomisation (1:1) using a centralised interactive voice and web response system to receive 100 mg/kg opicinumab intravenously or placebo once every 4 weeks (six doses) and followed up to week 32. All study participants and all study staff, including the central readers, were masked to treatment assignment apart from the pharmacist responsible for preparing the study treatments and the pharmacy monitor at each site. The primary endpoint was remyelination at 24 weeks, measured as recovery of affected optic nerve conduction latency using full-field visual evoked potential (FF-VEP) versus the unaffected fellow eye at baseline. Analysis was by intention-to-treat (ITT); prespecified per-protocol (PP) analyses were also done. This study is registered with ClinicalTrials.gov, number NCT01721161. FINDINGS The study was done between Dec 21, 2012, and Oct 21, 2014. 82 participants were enrolled, and 41 in each group comprised the ITT population; 33 participants received opicinumab and 36 received placebo in the PP population. Adjusted mean treatment difference of opicinumab versus placebo was -3·5 ms (17·3 vs 20·8 [95% CI -10·6 to 3·7]; 17%; p=0·33) in the ITT population, and -7·6 ms in the PP population (14·7 vs 22·2 [-15·1 to 0·0]; 34%; p=0·050) at week 24 and -6·1 ms (15·1 vs 21·2 [-12·7 to 0·5]; 29%; p=0·071) in the ITT population and -9·1 ms (13·2 vs 22·4 [-16·1 to -2·1]; 41%; p=0·011) in the PP population at week 32. The overall incidence (34 [83%] of 41 in each group) and severity of adverse events (two [5%] of 41 severe adverse events with placebo vs three [7%] of 41 with opicinumab) were similar between groups and no significant effects on brain MRI measures were noted in either group (mean T2 lesion volume change, 0·05 mL [SD 0·21] for placebo vs 0·20 mL [0·52] with opicinumab; 27 [77%] of 35 participants with no change in gadolinium-enhancing [Gd+] lesion number with opicinumab vs 27 [79%] of 34 with placebo; mean 0·4 [SD 0·79 for the placebo group and 0·85 for the opicinumab group] new Gd+ lesions per participant in both groups). Treatment-related serious adverse events were reported in three (7%) of 41 participants in the opicinumab group (hypersensitivity [n=2], asymptomatic increase in transaminase concentrations [n=1]) and none of the participants in the placebo group. INTERPRETATION Remyelination did not differ significantly between the opicinumab and placebo groups in the ITT population at week 24. However, results from the prespecified PP population suggest that enhancing remyelination in the human CNS with opicinumab might be possible and warrant further clinical investigation. FUNDING Biogen.
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450
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Wilson MA, Guld K, Galetta S, Walsh RD, Kharlip J, Tamhankar M, McGettigan S, Schuchter LM, Fecher LA. Acute visual loss after ipilimumab treatment for metastatic melanoma. J Immunother Cancer 2016; 4:66. [PMID: 27777775 PMCID: PMC5067900 DOI: 10.1186/s40425-016-0170-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 09/29/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Ipilimumab, a humanized CLTA-4 antibody is a standard therapy in the treatment of advanced melanoma. While ipilimumab provides an overall survival benefit to patients, it can be associated with immune related adverse events (IrAEs). CASE PRESENTATION Here we describe a patient treated with ipilimumab who experienced known IrAEs, including hypophysitis, as well as a profound vision loss due to optic neuritis. There are rare reports of optic neuritis occurring as an adverse event associated with ipilimumab treatment. Furthermore, the patient experienced multiple complications from high dose steroids used to manage his IrAEs. CONCLUSIONS This case highlights the need for recognition of atypical immune mediated processes associated with newer checkpoint inhibitor therapies including ipilimumab.
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