Balancing efficacy and safety: The dual impact of antiseizure medications on the developing brain

The number of neurons in the developing brain is greater than typically found in adulthood, and the brain possesses delicate mechanisms to induce the death of excess cells and refine neural circuitry. The correct tuning between the processes of neuronal death and survival generates a mature and functional brain in its complexity and plastic capacity. Epilepsy is a highly prevalent neurological condition worldwide, including among young individuals. However, exposure to the main treatment approaches, the long-term use of Antiseizure Medication (ASM), during the critical period of development can induce a series of changes in this delicate balance. Acting by various mechanisms of action, ASMs may induce an increase in neuronal death, something that translates into deleterious neuropsychiatric effects in adulthood. Several investigations conducted in recent years have brought to light new aspects related to this dynamic, yet many questions, such as the cellular mechanisms of death and the pathophysiology of late effects, still have unresolved elements. In this review, we aimed to explore the mechanisms of action of the most widely used ASMs in the treatment of neonatal epilepsy, the broad aspects of neuronal death in the developing brain and the repercussions of this death and other effects in adulthood. We review the evidence indicating a relationship between exposure to ASMs and the manifestation of associated psychiatric comorbidities in adulthood and discuss some possible mechanisms underlying the induction of this process by morphological and physiological changes in the related behaviors.

Monte Carlo simulation of 133La/135La cyclotron production

The pair 133La/135La presents considerable potential for theranostic applications in nuclear medicine. Consequently, the implementation of a simulated production process for 133La/135La is crucial to identify a cost-efficient approach. This study utilized the Monte Carlo method to simulate and assess the bombardment parameters and production conditions for generating 133La/135La via a proton cyclotron. Three barium target materials, natBaCO3, natBa metal, and 135BaCO3, were examined for 133La/135La yields. The impact of proton energy, cooling time, and target thickness on the 133La/135La yields were assessed utilizing TALYS, FLUKA, and SRIM software. The results indicate that the proton energy range necessary for attaining elevated yields of 133La and 135La in natBaCO3 and natBa metal targets is 23-24 MeV, with the optimal energy being 23.9 MeV. For the 135BaCO3 target, the proton energies required for 133La and 135La are approximately 30.2 MeV and 12.8 MeV, respectively. A cooling time of 2-3 h is advised for the natural barium target, whereas 1-2 h is appropriate for the 135BaCO3 target. The highest yield is attained when the target thickness approaches the proton range. The practical and accurate application of this simulation for designing and optimizing radionuclide production is corroborated by the alignment of experimental and simulation results.

Kennedy's disease from India: An Indian Cohort with multisystemic manifestations

BackgroundKennedy's disease (KD) is a rare, insidiously progressive lower motor neuron syndrome characterised by amyotrophy involving the appendicular or bulbar musculature of adult males in their fourth to fifth decade. There are no large series from the Indian subcontinent describing the clinical-genetic and laboratory spectrum of KD.AimTo describe the clinical, electrophysiologic, metabolic and genetic profile of patients with KD.MethodsWe conducted a retrospective review of ten genetically confirmed KD patients.ResultsThe mean age of the cohort was 47 years, with a mean age of onset of illness at 41.3 ± 9.9 years. The median duration of symptoms before presentation was 5 (3-12) years. The most common referral diagnosis was ALS. The majority presented with symmetric proximal limb weakness with bulbar symptoms and were found to have gynecomastia, lower motor neuron (LMN) facial weakness, and facial and lingual fasciculations. Electrophysiology revealed sensory neuropathy in five patients and chronic neurogenic changes consistent with anterior horn cell disease in all. Metabolic profile showed impaired glycemia, hyperlipidemia and evidence of non-alcoholic fatty liver disease in the majority. All had elevated serum creatine kinase. Genetic testing revealed a median of 46 CAG repeats. The phenotypes of our patients aligned with global data that is predominantly derived from participants of European ancestry.ConclusionWe describe a series of patients with KD from India with significant multisystemic involvement.

Regional brain structural alterations in reward and salience networks in asthma

INTRODUCTION

Chronic systemic inflammation is highly prevalent and has deleterious effects on the brain, impacting both function and structure, and manifesting in elevations in psychological symptoms transdiagnostically. Asthma is a chronic inflammatory disease of the airway that affects more than 300 million people worldwide and is known to be highly comorbid with psychological and cognitive dysfunction. Though a growing corpus of work has identified functional brain abnormalities associated with asthma, limited research has investigated structural differences which may partially underlie functional changes. Identifying and characterizing asthma-related structural brain changes will shed light on the neurobiology through which asthma impacts mental function and has the potential to inform prophylaxis and treatment.

METHODS

We examined differences in regional brain volume, cortical thickness, and surface area, in 128 individuals with asthma compared to 134 non-asthma healthy controls. Five regions of interest were examined a priori, based on their previous implication in inflammation-related functional consequences (dorsal and ventral striatum, pallidum, and insula), or previous evidence of asthma-related structural impact (hippocampus and thalamus). We supplemented our region of interest approach with a voxel-wise whole-brain analysis. Additionally, we examined the association of brain structure with depression symptoms, asthma severity, degree of inflammation, and plasma biomarkers of neuroinflammation, neurodegeneration, and Alzheimer's disease specific pathology.

RESULTS

Compared to non-asthma control participants, those with asthma had smaller nucleus accumbens volumes, thicker orbitofrontal cortices, larger middle frontal cortex surface areas, and greater diencephalon volumes. Those with more severe asthma had smaller nucleus accumbens and dorsal striatal volumes, reduced anterior cingulate cortex surface area, and greater amygdala volume compared to those with mild asthma. In untreated asthma patients, greater depressive symptoms were associated with smaller striatal volume, suggesting a potential CNS-protective effect of medications that reduce airway inflammation in asthma. In addition, a plasma marker of astrogliosis was associated with larger diencephalon, cerebellum, brainstem, and thalamus volumes, but reduced insula thickness and surface area.

CONCLUSIONS

Patterns of structural brain changes in participants with asthma encompass key regions of reward and salience networks, which may in part give rise to the functional alterations in these networks characteristic of chronic systemic inflammation.

Toward a Mechanistic Understanding of Reading Difficulties: Deviant Audiovisual Learning Dynamics and Network Connectivity in Children with Poor Reading Skills

Mastering the associations between letters and their corresponding speech sounds (LSS) is pivotal in the early stages of reading development, requiring an effective reorganization of brain networks. Children with poor reading skills often show difficulties in LSS learning. To date, however, it remains unclear how the interaction of brain regions integral to the processing and integration of letters and speech sounds changes with LSS learning. Characterizing these changes and potential differences between children with typical (TR) or poor (PR) reading skills on both behavioral and neural levels is essential for a more comprehensive mechanistic understanding of reading impairments. In this study, we investigated brain network alterations underlying LSS learning and their association with reading skills using functional magnetic resonance imaging in 80 schoolchildren (6.9-10.8 years, 36 females, 27 PR) with a wide range of reading skills. We applied a reinforcement learning drift-diffusion model to LSS learning data and analyzed the corresponding effective connectivity and activation measures in the brain. While both groups learned well, PR showed slower adaptation of responses than TR as trials progressed. This could be explained by a slower adjustment of the drift rate and decision boundary while learning and longer nondecision times. Alongside deviant connectivity in the network of visual, auditory, and associative brain regions, PR also showed reduced striatal modulation of connectivity from visual to audiovisual association areas throughout learning. These findings indicate impaired information transfer to integrative areas, which aids to explain the difficulties in achieving proficient reading skills from a neuroscientific perspective.

Molecular Pathogenesis of the Histiocytic and Dendritic Cell Neoplasms

The histiocytic and dendritic cell neoplasms encompass a clinically heterogeneous group of disorders leading to tissue damage secondary to the accumulation and infiltration of pathologic cells thought to be derived from the dendritic or monocytic lineages with accompanying inflammation. The pathophysiology of these disorders is poorly understood. Studies over the past 15 y have identified a high-frequency of BRAFV600E, MAP2K1, and other kinase alterations in the histiocytic neoplasms. This review highlights the onslaught of molecular advancements and discusses the impact these insights have had on our understanding of the molecular pathophysiology and therapeutic targets of these rare, enigmatic diseases.

Evaluation of pressure-induced pain in patients with disorders of consciousness based on functional near infrared spectroscopy

Objective

This study aimed to investigate the brain's hemodynamic responses (HRO) and functional connectivity in patients with disorders of consciousness (DoC) in response to acute pressure pain stimulation using near-infrared spectroscopy (NIRS).

Methods

Patients diagnosed with DoC underwent pressure stimulation while brain activity was measured using NIRS. Changes in oxygenated hemoglobin (HbO) and deoxygenated hemoglobin (HbR) concentrations were monitored across several regions of interest (ROIs), including the primary somatosensory cortex (PSC), primary motor cortex (PMC), dorsolateral prefrontal cortex (dPFC), somatosensory association cortex (SAC), temporal gyrus (TG), and frontopolar area (FPA). Functional connectivity was assessed during pre-stimulation, stimulation, and post-stimulation phases.

Results

No significant changes in HbO or HbR concentrations were observed during the stimulation vs. baseline or stimulation vs. post-stimulation comparisons, indicating minimal activation of the targeted brain regions in response to the pressure stimulus. However, functional connectivity between key regions, particularly the PSC, PMC, and dPFC, showed significant enhancement during the stimulation phase (r > 0.9, p < 0.001), suggesting greater coordination among sensory, motor, and cognitive regions. These changes in connectivity were not accompanied by significant activation in pain-related brain areas.

Conclusion

Although pain-induced brain activation was minimal in patients with DoC, enhanced functional connectivity during pain stimulation suggests that the brain continues to process pain information through coordinated activity between regions. The findings highlight the importance of assessing functional connectivity as a potential method for evaluating pain processing in patients with DoC.

Restless legs syndrome and ferritin levels in older adults with dementia: a cross-sectional study

In cases of dementia or major neurocognitive disorder, restless legs syndrome has not been extensively studied because the diagnosis relies on clinical assessments and self-reports from patients.

Objective

The aim of this study was to investigate the association between Willis-Ekbom disease/restless legs syndrome and iron-deficiency anemia in older adults with dementia.

Methods

A cross-sectional study was conducted with 70 older adults diagnosed with dementia and restless legs syndrome at a psychogeriatric clinic in the state of São Paulo, Brazil. The participants answered data collection instruments addressing sociodemographic characteristics, restless legs syndrome, neuropsychiatric symptoms, sleep quality, daytime sleepiness, and cognitive function. Creatinine, ferritin, red blood cells, hemoglobin, and hematocrit were determined by blood exams (the latter of which was collected from the patient records).

Results

The sample was composed predominantly of individuals with mixed dementia (i.e., Alzheimer's disease+vascular dementia). Women accounted for 55.7% of the sample, with a mean age of 77.80±9.36 years. The prevalence of restless legs syndrome among the participants was found to be 15.7%. Individuals with this syndrome had greater frequencies of neuropsychiatric symptoms, poor sleep quality, higher BMI, and lower ferritin levels (p<0.05).

Conclusion

The prevalence of restless legs syndrome among older adults with dementia was 15.7%, and individuals with this syndrome had ferritin deficiency.

Longitudinal trajectories of brain development from infancy to school age and their relationship to literacy development

Reading is one of the most complex skills that we utilize daily, and it involves the early development and interaction of various lower-level subskills, including phonological processing and oral language. These subskills recruit brain structures, which begin to develop long before the skill manifests and exhibit rapid development during infancy. However, how longitudinal trajectories of early brain development in these structures support long-term acquisition of literacy subskills and subsequent reading is unclear. Children underwent structural and diffusion MRI scanning at multiple timepoints between infancy and second grade and were tested for literacy subskills in preschool and decoding and word reading in early elementary school. We developed and implemented a reproducible pipeline to generate longitudinal trajectories of early brain development to examine associations between these trajectories and literacy (sub)skills. Furthermore, we examined whether familial risk of reading difficulty and children's home literacy environments, two common literacy-related covariates, influenced those trajectories. Results showed that individual differences in curve features (e.g., intercepts and slopes) for longitudinal trajectories of volumetric, surface-based, and white matter organization measures were linked directly to phonological processing and indirectly to first-grade decoding and word reading skills via phonological processing. Altogether, these findings suggest that the brain bases of phonological processing, previously identified as the strongest behavioral predictor of reading and decoding skills, may already begin to develop by birth but undergo further refinement between infancy and preschool. The present study underscores the importance of considering academic skill acquisition from the very beginning of life.

Synthetic MRI in Progressive MS: Associations with Disability

BACKGROUND AND PURPOSE

Synthetic MRI (SyMRI) is a short-time acquisition sequence that generates different contrast-weighted images based on the measurement of tissue properties and provides quantitative volumetric, relaxation, and myelin maps. It has been used as an alternative to conventional MRI sequences in relapsing-remitting MS for detecting focal lesions and volumetric analysis. This study aimed to find an SyMRI variable associated with an Expanded Disability Status Scale (EDSS) ≥ 6 in progressive patients.

MATERIALS AND METHODS

Twenty-four patients with progressive MS underwent SyMRI with a 2D axial QRAPMASTER pulse sequence. We analyzed volumetric parameters, global myelin fraction (MyCF), and quantitative values derived from maps of proton density, R1, R2, and myelin for the masks: normal-appearing white and gray matter, lesion, and corpus callosum. A t test compared SyMRI variables between groups, followed by univariate binary logistic regression for significant (P < .05) or trending results (P < .09).

RESULTS

Patients were categorized into 2 groups (EDSS < 6 versus ≥ 6). Variables with significant differences between groups were: brain parenchymal fraction (P = .05), white matter fraction (P = .05), MyCF (P = .04), and corpus callosum volume (P = .04). In the binary logistic regression analysis, the best predictor of the EDSS category was MyCF, with a P value of .08, and an OR of 0.59.

CONCLUSIONS

Our results confirm differences in volumetric parameters by EDSS by using a single MRI acquisition. Additionally, higher MyCF values were associated with lower disability, highlighting SyMRI and myelin quantification as potential tools for clinical practice.

Is migraine a common manifestation of CADASIL? Arguments Pros

BACKGROUND

Migraine with aura (MA) is a hallmark feature of CADASIL, a hereditary small-vessel disease caused by NOTCH3 mutations. While MA is prevalent in CADASIL, its underlying mechanisms remain unclear, and the links observed can be questioned or debated. This study examined the prevalence, clinical characteristics, and pathophysiology of MA in patients with CADASIL.

METHODS

Clinical and experimental data were reviewed to assess MA prevalence, aura characteristics, sex differences, and pathophysiological insights from CADASIL models to confirm the indisputable pathophysiological links between migraine and aura and this unique genetic model of cerebral small vessel disease.

RESULTS

MA was 10-20 times more prevalent in patients with CADASIL than in the general population, with frequent atypical and prolonged auras. The altered sex distribution and delayed onset suggest disease-specific mechanisms. Experimental data also revealed heightened susceptibility to cortical spreading depression (CSD) in preclinical CADASIL models, linked to greater fragility in maintaining cortical ionic homeostasis.

CONCLUSION

The high prevalence and distinct MA features, as well as the data obtained at the preclinical level, strongly support a causal relationship mediated by neurovascular dysfunction in CADASIL. Accumulating data in this condition sheds new light on the much-debated relationship between migraine and cerebrovascular diseases.

Abnormal Structural-Functional Coupling and MRI Alterations of Brain Network Topology in Progressive Supranuclear Palsy

BACKGROUND

Progressive supranuclear palsy (PSP) can cause structural and functional brain reconstruction. There is a lack of knowledge about the consistency between structural-functional (S-F) connection networks in PSP, despite growing evidence of anomalies in various single brain network parameters.

PURPOSE

To study the changes in the structural and functional networks of PSP, network's topological properties including degree, and the consistency of S-F coupling. The relationship with clinical scales was examined including the assessment of PSP severity, and so on.

STUDY TYPE

Retrospective.

SUBJECTS

A total of 51 PSP patients (70.04 ± 7.46, 25 females) and 101 healthy controls (64.58 ± 8.84, 58 females).

FIELD STRENGTH/SEQUENCE

3-T, resting-state functional MRI, diffusion tensor imaging, and T1-weighted images.

ASSESSMENT

A graph-theoretic approach was used to evaluate structural and functional network topology metrics. We used the S-F coupling changes to explore the consistency of structural and functional networks.

STATISTICAL TESTS

Independent samples t tests were employed for continuous variables, χ2 tests were used for categorical variables. For network analysis, two-sample t tests was used and implied an false discovery rate (FDR) correction. Pearson correlation analysis was used to explore the correlations. A P-value <0.05 was considered statistically significant.

RESULTS

PSP showed variations within and between modules. Specifically, PSP had decreased network properties changes (t = -2.0136; t = 2.5409; t = -2.5338; t = -2.4296; t = -2.5338; t = 2.8079). PSP showed a lower coupling in the thalamus and left putamen and a higher coupling in the visual, somatomotor, dorsal attention, and ventral attention network. S-F coupling was related to the number of network connections (r = 0.32, r = 0.22) and information transmission efficiency (r = 0.55, r = 0.28). S-F coupling was related to basic academic ability (r = 0.39) and disinhibition (r = 0.49).

DATA CONCLUSION

PSP may show abnormal S-F coupling and intramodular and intermodular connectome in the structural and functional networks.

LEVEL OF EVIDENCE

3 TECHNICAL EFFICACY: Stage 3.

Pathomechanisms of neuropsychiatric disturbances in atypical parkinsonian disorders: a current view

Multiple system atrophy (MSA), corticobasal degeneration (CBD) and progressive supranuclear palsy (PSP) are the most common atypical parkinsonisms. These adult-onset and lethal neurodegenerative disorders of unknown etiology are clinically characterized by varying combinations of autonomic, levodopa-poorly responsive parkinsonsm, motor, non-motor, cerebellar syndromes, behavioral, cognitive and other neuropsychiatric disorders. Although their pathological hallmarks are different-MSA α-synucleinopathy, CBD and PSP 4-repeat (4R) tauopathies-their neuropsychiatric disturbances include anxiety, depression, agitations, attention-executive dysfunctions, less often compulsive and REM sleep behavior disorders (RBD), which may contribute to disease progression and reduced quality of life (QoL) of patients and caregivers. The present paper reviews the prevalence and type of neuropsychiatric profile in these atypical parkinsonian syndromes, their neuroimaging, and pathogenic backgrounds based on extensive literature research. MSA patients show anxiety, apathy (depression), initial RBD, attentional and executive dysfunction; PSP patients present with apathy, depression, disinhibition, and to a lesser extent, anxiety and agitation; CBD patients are featured by executive and visuospatial dysfunctions, irritability, alien limb phenomena, sleep and language disorders. Neuropsychiatric disorders in these syndromes are often similar, due to disruption of prefronto-subcortical (limbic) and striato-thalamo-cortical circuitries or default mode and attention network disorder. This supports the concept that they are brain network disorders due to complex pathogenic mechanisms related to the basic proteinopathies that are still poorly understood. Psychotic symptoms, hallucinations and delusions are rare. Neuropsychiatric changes in these disorders are often premature and anticipate motor dysfunctions; their assessment and further elucidation of their pathogenesis are warranted as a basis for early diagnosis and adequate treatment of these debilitating comorbidities.

A patient with Eradheim-Chester disease presenting with progressive cystic lung lesions and confirmed pulmonary artery hypertension: a case report

BACKGROUND

Erdheim-Chester disease (ECD), a rare type of non-Langerhans cell histiocytosis, was classified as a haematopoietic tumour by the World Health Organization (WHO) in 2016. It involves multiple systems and is challenging to diagnose due to its broad spectrum of clinical manifestations. The pulmonary manifestations of ECD lack specificity. We present a case of ECD with pronounced cystic lung abnormalities to increase awareness of the disease among pulmonologists and expedite diagnosis and treatment.

CASE PRESENTATION

We report the case of a 44-year-old male who presented with intermittent fever, cough, bilateral leg pain, extensive xanthomas on his face, and extensive pulmonary cystic changes noted on imaging following a pulmonary stab wound incident. Thoracoabdominal enhanced computed tomography (CT) revealed progressive cystic changes in the lungs, notably in the upper lungs and subpleural areas; thickened interlobular septa; circumferential wall thickening of the left subclavian artery; uneven thickening of the aortic wall; and soft tissue shadows in the right atrium of the heart. Bone scintigraphy revealed bilateral symmetric long-bone uptake. Despite his advanced lung abnormalities, he exhibited no hypoxia. Notably, echocardiography indicated severe pulmonary artery hypertension, and right heart catheterization confirmed increased mean pulmonary artery pressure at 37 mmHg and elevated pulmonary vascular resistance. Pathology examination of transbronchial lung biopsy and the facial xanthomas confirmed the presence of ECD-characteristic histiocytes, and genetic testing revealed a BRAF V600E mutation. Treatment with dabrafenib improved respiratory symptoms and facial xanthomas, although some symptoms persisted. Follow-up CT showed reduced interstitial lesions but more pronounced cystic changes.

CONCLUSIONS

This case of ECD illustrates rare pulmonary cystic changes alongside pulmonary arterial hypertension, challenging typical presentations of ECD. This is the first documented instance of pulmonary hypertension associated with ECD, broadening the understanding of its potential complications. These findings emphasize the need for considering ECD in the differential diagnosis of atypical cystic lung lesions, especially when accompanied by systemic symptoms such as xanthomas and bone pain.

Real-time optimization to enhance noninvasive cortical excitability assessment in the human dorsolateral prefrontal cortex

OBJECTIVE

We currently lack a robust noninvasive method to measure prefrontal excitability in humans. Concurrent TMS and EEG in the prefrontal cortex is usually confounded by artifacts. Here we asked if real-time optimization could reduce artifacts and enhance a TMS-EEG measure of left prefrontal excitability.

METHODS

This closed-loop optimization procedure adjusts left dlPFC TMS coil location, angle, and intensity in real-time based on the EEG response to TMS. Our outcome measure was the left prefrontal early (20-60 ms) and local TMS-evoked potential (EL-TEP).

RESULTS

In 18 healthy participants, this optimization of coil angle and brain target significantly reduced artifacts by 63 % and, when combined with an increase in intensity, increased EL-TEP magnitude by 75 % compared to a non-optimized approach.

CONCLUSIONS

Real-time optimization of TMS parameters during dlPFC stimulation can enhance the EL-TEP.

SIGNIFICANCE

Enhancing our ability to measure prefrontal excitability is important for monitoring pathological states and treatment response.

Imaging insights of FDG-PET from neonates to infants

In pediatric oncology, 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) is valuable as a tool for noninvasive imaging and monitoring. While many reports have reviewed the use of PET and PET/CT in pediatrics, considerable variations in age, body size, and metabolism are seen during different stages of childhood development. Neonates (from birth to one month old) and infants (from 1 month to 1 year) present unique challenges for FDG-PET/CT examination due to their small body size, the immaturity of organs, the need for specialized patient preparation, and support requirements during scanning. In addition, differences in metabolic activity can lead to distinct differences in patterns of physiological FDG uptake on PET/CT imaging between neonates and infants. These factors differ significantly from those encountered in older children, who may be treated similarly to adults during imaging procedures. This review, based on both the literature and clinical experience, explores the specific characteristics, challenges, and considerations for FDG-PET/CT imaging from neonates to infants, with a focus on optimizing imaging protocols and interpreting physiological variations in this growth period.

Preclinical evaluation of [13xLa]La-FAP-2286 as a novel theranostic agent for tumors expressing fibroblast activation protein

In this study, a novel theranostic radiopharmaceutical, [13xLa]La-FAP-2286, for targeting Fibroblast Activation Protein (FAP)-positive tumors. The theranostic pair of 132La (half-life: 4.59 h, 42.1% β⁺) and 135La (half-life: 18.91 h, 100% EC) was produced via proton bombardment of natural barium in a 30 MeV cyclotron, achieving high radionuclidic purity (99.9%) and radiochemical purity (RCP > 99%). Stability tests revealed the RCP greater than 91% over 24 h in human serum and PBS buffer. Cellular studies confirmed high binding affinity (KD = 0.51 ± 0.12 nM) and effective internalization of [13xLa]La-FAP-2286 in FAP + tumor cells. Distribution coefficient (log D) measurements demonstrated high hydrophilicity of the complex with a value of - 3.21 ± 0.14. Imaging and biodistribution studies in tumor-bearing mice further confirmed tumor targeting, with significant uptake observed up to 48 h post-injection. These results suggest [13xLa]La-FAP-2286 can be considered a candidate for theranostic applications, offering both practical PET imaging and targeted Auger-electron therapy for cancer treatment.

A direct comparison in diagnostic performance of CDUS, FDG-PET/CT and MRI in patients suspected of giant cell arteritis

OBJECTIVES

This study directly compares the diagnostic performance of colour duplex ultrasound (CDUS), fluor-18-deoxyglucose positron emission tomography computed tomography (FDG-PET/CT) and magnetic resonance imaging (MRI) in patients suspected of giant cell arteritis (GCA).

METHODS

Patients with suspected GCA were included in a nested-case control pilot study. CDUS, whole body FDG-PET/CT and cranial MRI were performed within 5 working days after initial clinical evaluation. Clinical diagnosis after six months follow-up by experienced rheumatologists in the field of GCA, blinded for imaging, was used as reference standard. Diagnostic performance of the imaging modalities was determined. Stratification for GCA subtype was performed and imaging results were evaluated in different risk stratification groups.

RESULTS

In total, 23 patients with GCA and 19 patients suspected of but not diagnosed with GCA were included. Sensitivity was 69.6% (95%CI 50.4%-88.8%) for CDUS, 52.2% (95%CI 31.4%-73.0%) for FDG-PET/CT and 56.5% (95%CI 35.8%-77.2%) for MRI. Specificity was 100% for CDUS, FDG-PET/CT and MRI. FDG-PET/CT was negative for GCA in all isolated cranial GCA patients (n = 8), while MRI was negative in all isolated extracranial GCA patients (n = 4). In four GCA patients with false-negative (n = 2; intermediate and high risk) or inconclusive (n = 2; low and intermediate risk) CDUS results, further imaging confirmed diagnosis.

CONCLUSIONS

Sensitivity of CDUS was highest, while specificity was excellent in all imaging modalities. Nevertheless, confidence intervals of all imaging modalities were overlapping. Following EULAR recommendations, CDUS can be used as a first test to diagnose GCA. With insufficient evidence for GCA, further testing considering GCA subtype is warranted.

Alpha Atlas: Mapping global production of α-emitting radionuclides for targeted alpha therapy

Targeted Alpha Therapy has shown great promise in cancer treatment, sparking significant interest over recent decades. However, its broad adoption has been impeded by the scarcity of alpha-emitters and the complexities related to their use. The availability of these radionuclides is often constrained by the intricate production processes and purification, as well as regulatory and logistical challenges. Moreover, the high cost and technical difficulties associated with handling and applying alpha-emitting radionuclides pose additional barriers to their clinical implementation. This Alpha Atlas provides an in-depth overview of the leading alpha-particle emitting radionuclide candidates for clinical use, focusing on their production processes and supply chains. By mapping the current facilities that produce and supply these radionuclides, this atlas aims to assist researchers, clinicians, and industries in initiating or scaling up the applications of alpha-emitters. The Alpha Atlas aspires to act as a strategic guide, facilitating collaboration and driving forward the integration of these potent therapeutic agents into cancer treatment practices.

Sensory Dysfunction in ALS and Other Motor Neuron Diseases: Clinical Relevance, Histopathology, Neurophysiology, and Insights from Neuroimaging

Background: The clinical profiles of MNDs are dominated by inexorable motor decline, but subclinical proprioceptive, nociceptive and somatosensory deficits may also exacerbate mobility, dexterity, and bulbar function. While extra-motor pathology and frontotemporal involvement are widely recognised in motor neuron diseases (MNDs), reports of sensory involvement are conflicting. The potential contribution of sensory deficits to clinical disability is not firmly established and the spectrum of sensory manifestations is poorly characterised. Methods: A systematic review was conducted to examine the clinical, neuroimaging, electrophysiology and neuropathology evidence for sensory dysfunction in MND phenotypes. Results: In ALS, paraesthesia, pain, proprioceptive deficits and taste alterations are sporadically reported and there is also compelling electrophysiological, histological and imaging evidence of sensory network alterations. Gait impairment, impaired dexterity, and poor balance in ALS are likely to be multifactorial, with extrapyramidal, cerebellar, proprioceptive and vestibular deficits at play. Human imaging studies and animal models also confirm dorsal column-medial lemniscus pathway involvement as part of the disease process. Sensory symptoms are relatively common in spinal and bulbar muscular atrophy (SBMA) and Hereditary Spastic Paraplegia (HSP), but are inconsistently reported in primary lateral sclerosis (PLS) and in post-poliomyelitis syndrome (PPS). Conclusions: Establishing the prevalence and nature of sensory dysfunction across the spectrum of MNDs has a dual clinical and academic relevance. From a clinical perspective, subtle sensory deficits are likely to impact the disability profile and care needs of patients with MND. From an academic standpoint, sensory networks may be ideally suited to evaluate propagation patterns and the involvement of subcortical grey matter structures. Our review suggests that sensory dysfunction is an important albeit under-recognised facet of MND.

The effect of calcitonin gene-related peptide monoclonal antibodies on restless legs syndrome in patients with migraine

BACKGROUND

Calcitonin gene-related peptide monoclonal antibody (CGRP mAb) effects on restless legs syndrome (RLS) are unclear.

METHODS

Fifteen migraine patients (aged 49.1 ± 5.8 years; 14 women) with concomitant RLS who received CGRP mAbs (2 erenumab, 3 galcanezumab, and 10 fremanezumab) were retrospectively studied. Number of monthly migraine days (MMDs) was obtained from headache diaries. The primary outcome is changes in RLS severity as assessed by the International RLS Group Rating Scale (IRLS). Headache-related disability was assessed using the Migraine Disability Assessment (MIDAS). The severity of headache and RLS was rated using the Patient Global Impression of Change (PGIC) scale. Central sensitization was evaluated with the Central Sensitization Inventory (CSI).

RESULTS

At 1, 2, and 3 months, the percentages of patients with ≥ 50% improvement in number of MMDs were 53.3%, 66.6%, and 60.0%, respectively. From baseline to 3 months, there were significant reductions in the MIDAS (25.1 ± 23.2 vs. 19.7 ± 22.8, p = 0.005) and CSI scores (36.3 ± 12.9 vs. 29.1 ± 12.3, p = 0.001). IRLS scores decreased significantly from baseline to 1 month (-8.8 ± 2.1 points) and 3 months (-11.6 ± 2.3 points) after CGRP mAb treatment. On the PGIC scale, 86.7% and 73.3% of patients reported at least "minimal improvement" in migraine and RLS severity, respectively, with 46.7% and 26.7% reporting "very much improvement". Among those with a < 50% reduction in number of MMDs at 3 months, 66.6% reported at least "minimal improvement", with 33.3% reporting "very much improvement".

CONCLUSION

Our study revealed that 3-month CGRP mAb treatment significantly alleviated RLS symptoms, central sensitization and headache-related disability in patients with comorbid migraine and RLS.

Low prevalence of CWH43 variants among Finnish and Norwegian idiopathic normal pressure hydrocephalus patients: a cohort-based observational study

BACKGROUND

Heterozygous CWH43 loss-of-function (LOF) variants have been identified as iNPH risk factors, with 10-15% of iNPH patients carrying these variants in cohorts from the US. Mouse model harboring CWH43 LOF variants display a hydrocephalic phenotype with ventricular cilia alterations. Our aim was to study the effect of CWH43 variants on disease risk and clinical phenotype in Finnish and Norwegian iNPH cohorts.

METHODS

We analyzed CWH43 LOF frameshift deletions (4:49032652 CA/C, Leu533Ter and 4:49061875 CA/C, Lys696AsnfsTer23) in Finnish iNPH patients from the Kuopio NPH registry (n = 630) and FinnGen (iNPH n = 1 131, controls n = 495 400), and Norwegian iNPH patients from EADB (n = 306). The Kuopio and Norwegian cohorts included possible and probable iNPH patients based on the American-European iNPH guidelines. FinnGen cohort included iNPH patients based on ICD-10 G91.2 with the exclusion of secondary etiologies, and controls having no diagnosis of hydrocephalus.

RESULTS

In the Kuopio cohort of Finnish iNPH patients, 2.9% carried CWH43 variants (Leu533Ter 2.1%, Lys696AsnfsTer23 0.8%), with one homozygous Leu533Ter carrier. In FinnGen, 3.1% of iNPH patients carried heterozygous variants (Leu533Ter 2.6%, Lys696AsnfsTer23 0.5%) compared to 2.5% of controls (p = 0.219, OR = 1.23, 95% CI 0.85-1.72), with no effect on disease risk or onset age. Importantly in the FinnGen cohort, none of the 23 compound heterozygote or 59 homozygote individuals had hydrocephalus diagnosis. In the Norwegian iNPH cohort, 5.2% of patients were heterozygous variant carriers (Leu533Ter 3.3%, Lys696AsnfsTer23 2.0%). No differences in clinical phenotype (age, triad symptoms, shunt response, vascular comorbidities) were found between carriers and noncarriers in any cohort. However, 74% of variant-carrying iNPH patients in FinnGen were female, compared to 47% of noncarriers (p = 0.002). Pedigrees indicated no autosomal dominant co-inheritance of iNPH and the CWH43 variants.

CONCLUSIONS

We studied the iNPH-associated CWH43 LOF variants for the first time on a population-scale. Contrary to previously reported findings in smaller cohorts, our study revealed a low prevalence of these variants in the population-scale Finnish iNPH cohort, with no effect on disease risk of iNPH. The prevalence in the Norwegian iNPH cohort was also low compared to previous studies.

The Use of [11C]C-Methionine in Diagnostics of Endocrine Disorders with Focus on Pituitary and Parathyroid Glands

The rapid development of nuclear medicine offers vast opportunities for diagnosing neoplasms, particularly in endocrinology. The use of the [11C]C-methionine radiotracer is currently limited due to its physical properties and the complex production process. However, studies conducted so far have demonstrated its utility in PET imaging, helping to detect lesions that often remain elusive with other modalities. This systematic review focuses on [11C]C-methionine in diagnosing hyperparathyroidism and pituitary tumors, highlighting its high effectiveness, which can be crucial in diagnosis. Despite some disadvantages, it should be considered when available, especially when other modalities or radiotracers fail.

Vascular amyloidβ load in the meningeal arterial network correlates with loss of cerebral blood flow and pial collateral vessel enlargement in the J20 murine model of Alzheimer's disease

INTRODUCTION

Global reduction in cerebral blood flow (CBF) is an early pathology in Alzheimer's disease, preceding significant plaque accumulation and neurological decline. Chronic reduced CBF and subsequent reduction in tissue oxygenation and glucose may drive neurodegeneration, yet the underlying cause of globally reduced CBF remains unclear.

METHODS

Using premortem delivery of Methoxy-XO4 to label Aβ, and arterial vascular labeling, we assessed Aβ burden on the pial artery/arteriole network and cerebral blood flow in aged male and female WT and J20 AD mice.

RESULTS

The pial artery/arteriole vascular network selectively displayed extensive vascular Aβ burden. Pial collateral arteriole vessels, the by-pass system that reroutes blood flow during occlusion, displayed significant enlargement in J20 mice. Despite this, CBF was decreased by approximately 15% in 12-month J20 mice when compared to WT littermates.

DISCUSSION

Significant Aβ burden on the meningeal arterial network may contribute to the restriction of CBF. Redistribution of CBF through enlarged pial collateral vessels may serve as a compensatory mechanism to alter CBF during disease progression in cases of CAA.

Consensus review and considerations on TMS to treat depression: A comprehensive update endorsed by the National Network of Depression Centers, the Clinical TMS Society, and the International Federation of Clinical Neurophysiology

This article updates the prior 2018 consensus statement by the National Network of Depression Centers (NNDC) on the use of transcranial magnetic stimulation (TMS) in the treatment of depression, incorporating recent research and clinical developments. Publications on TMS and depression between September 2016 and April 2024 were identified using methods informed by PRISMA guidelines. The NNDC Neuromodulation Work Group met monthly between October 2022 and April 2024 to define important clinical topics and review pertinent literature. A modified Delphi method was used to achieve consensus. 2,396 abstracts and manuscripts met inclusion criteria for review. The work group generated consensus statements which include an updated narrative review of TMS safety, efficacy, and clinical features of use for depression. Considerations related to training, roles/responsibilities of providers, and documentation are also discussed. TMS continues to demonstrate broad evidence for safety and efficacy in treating depression. Newer forms of TMS are faster and potentially more effective than conventional repetitive TMS. Further exploration of targeting methods, use in special populations, and accelerated protocols is encouraged. This article provides an updated overview of topics relevant to the administration of TMS for depression and summarizes expert, consensus opinion on the practice of TMS in the United States.

Synthesis and in vitro evaluation of novel compounds and discovery of a promising iodine-125 radioligand for purinergic P2X7 receptor (P2X7R)

The purinergic P2X ligand-gated ion channel 7 receptor (P2X7R) plays a critical role in various inflammatory processes and other diseases. Fast determination of compounds P2X7R binding potency and discovery of a promise PET radiotracer for imaging P2X7R require a P2X7R suitable radioligand for radioactive competitive binding assay. Herein, we designed and synthesized thirteen new P2X7R ligands and determined the in vitro binding potency. The fluorescence screening assay identified the iodide compound 1c with high potency and specificity toward P2X7R with an IC50 of 0.25 ± 0.05 nM. Therefore, 1c was 125I-labeled to afford [125I]1c with a good radiochemical yield (44 ± 12 %, n = 3) and high radiochemical purity (>95 %). Radioligand saturation binding assay showed that [125I]1c specifically bound to human P2X7R with high affinity (Kd = 1.68 nM and Bmax = 94 fmol/mg). A radioactive high throughput binding assay using [125I]1c for our new compounds demonstrated that the imidazole compounds 1b, 1c, and 1d exhibited high inhibition for >70 %, while the analogues of GSK314181A exhibited low inhibition for <35 %. In addition, our radioligand competitive binding assays using [125I]1c demonstrated that 1b, 1c, and 1d have high potency with IC50 values of 7.91 ± 0.22, 7.06 ± 1.68, and 7.16 ± 0.41 nM toward P2X7R, respectively.Together, compounds 1b, 1c, and 1d are highly potent for P2X7R, and [125I]1c has great potential to be a radioligand for screening P2X7R binding potency of the new compounds and investigating the P2X7R expression in animal models of human disease.

Erdheim-Chester disease: Comprehensive insights from genetic mutations to clinical manifestations and therapeutic advances

Erdheim-Chester disease (ECD) is an extremely rare non-Langerhans cell disorder that is believed to include both inflammatory and neoplastic characteristics. It is caused due to genetic mutations in proto-oncogenes like BRAF and MEK, while immunological pathways have an essential role in the onset and progression of the disease. Despite its rarity, ECD poses significant diagnostic and therapeutic challenges due to its heterogeneous clinical presentation and limited understanding of its underlying pathophysiology. Multiple organs can be affected, with the most frequent being long bones, central nervous system and retro-orbital abnormalities, pericardial and myocardial infiltration, interstitial lung disease, retroperitoneal fibrosis, and large blood vessel aberrations. Here, in this review, we comprehensively underline the current knowledge of ECD, including its epidemiology, clinical manifestations, genetics, pathophysiology, diagnostic modalities, and treatment options. By synthesizing existing literature and highlighting areas of ongoing research, this review aims to provide clinicians and researchers with a comprehensive understanding of ECD and guide future directions for improved patient care and outcomes.

The spectrum of behavioral disorders in amyotrophic lateral sclerosis: current view

Behavioral disorders, with an average prevalence of 30-60% are important non-motor symptoms in amyotrophic lateral sclerosis (ALS) that have a negative impact on prognosis, management and quality of life, yet the underlying neurobiology is poorly understood. Among people with ALS, apathy, fatigue, anxiety, irritability and other behavioral symptoms are the most prominent, although less frequent than cognitive impairment. The present review explores the current understanding of behavioral changes in ALS with particular emphasis on our current knowledge about their structural and functional brain correlates, substantiating a multisystem degeneration with particular dysfunction of frontal-subcortical circuits and dysfunction of fronto-striatal, frontotemporal and other essential brain systems. The natural history of behavioral dysfunctions in ALS and their relationship to frontotemporal lobe degeneration (FTLD) are not fully understood, although they form a clinical continuum, suggesting a differential vulnerability of non-motor brain networks, ALS being considered a brain network disorder. An assessment of risks or the early detection of brain connectivity signatures before structural changes may be helpful in investigating the pathophysiological mechanisms of behavioral impairment in ALS. Treatment of both ALS and co-morbid behavioral disorders is a multidisciplinary task, but whereas no causal or disease-modifying therapies for ALS are available, symptomatic treatment of a variety of behavioral symptoms plays a pivotal role in patient care, although the management of behavioral symptoms in clinical care still remains limited.

The Spectrum of Cognitive Impairment in Atypical Parkinsonism Syndromes: A Comprehensive Review of Current Understanding and Research

Multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD) are the most common atypical parkinsonism (AP) syndromes. They are clinically characterized by varying combinations of levodopa-poorly responsive parkinsonism, motor, cerebellar, and other signs. They are associated with a wide spectrum of non-motor symptoms, including prominent cognitive impairment such as global cognitive deficits, memory, executive, attentional, visuospatial, language, and non-verbal reasoning dysfunctions. Within the APs, their cognitive functioning is distributed along a continuum from MSA with the least impaired cognitive profile (similar to Parkinson's disease) to PSP and CBD with the greatest decline in global cognitive and executive domains. Although their pathological hallmarks are different-MSA α-synucleinopathy, CBD, and PSP 4-repeat tauopathies-cognitive dysfunctions in APs show both overlaps and dissimilarities. They are often preceding and anticipate motor dysfunctions, finally contributing to reduced quality of life of patients and caregivers. The present paper will review the current evidence of the prevalence and type of cognitive impairment in these AP syndromes, their neuroimaging, pathogenic backgrounds, and current management options based on extensive literature research. Cognitive dysfunctions in APs are due to disruption of prefronto-subcortical and striato-thalamo-cortical circuitries and multiple essential brain networks. This supports the concept that they are brain network disorders due to complex pathogenic mechanisms related to the basic proteinopathies that are still poorly understood. Therefore, the pathophysiology and pathogenesis of cognitive impairment in APs deserve further elucidation as a basis for early diagnosis and adequate treatment of these debilitating comorbidities.

Early-onset sleep alterations found in patients with amyotrophic lateral sclerosis are ameliorated by orexin antagonist in mouse models

Sleep alterations have been described in several neurodegenerative diseases yet are currently poorly characterized in amyotrophic lateral sclerosis (ALS). This study investigates sleep macroarchitecture and related hypothalamic signaling disruptions in ALS. Using polysomnography, we found that both patients with ALS as well as asymptomatic C9ORF72 and SOD1 mutation carriers exhibited increased wakefulness and reduced non-rapid eye movement sleep. Increased wakefulness correlated with diminished cognitive performance in both clinical cohorts. Similar changes in sleep macroarchitecture were observed in three ALS mouse models (Sod1G86R, FusΔNLS/+, and TDP43Q331K). A single oral administration of a dual-orexin receptor antagonist or intracerebroventricular delivery of melanin-concentrating hormone (MCH) through an osmotic pump over 15 days partially normalized sleep patterns in mouse models. MCH treatment did not extend the survival of Sod1G86R mice but did decrease the loss of lumbar motor neurons. These findings suggest MCH and orexin signaling as potential targets to treat sleep alterations that arise in early stages of the disease.

Structural and functional alterations in the brain gray matter among Tourette syndrome patients: a multimodal meta-analysis of fMRI and VBM studies

BACKGROUND

Tourette syndrome (TS) is a prevalent neurodevelopmental disorder with an uncertain etiology. Numerous neuroimaging studies have investigated patients with TS, but their conclusions remain inconsistent. The current study attempted to provide an unbiased statistical meta-analysis of published neuroimaging studies of TS.

METHODS

A comprehensive literature search was conducted to identify voxel-based whole-brain morphology (VBM) and functional magnetic resonance imaging (fMRI) studies related to TS. Two separate meta-analyses of neurofunctional activation and gray matter volume (GMV) were performed using a seed-point-based d-mapping software package, followed by joint and subgroup analyses.

RESULTS

11 VBM studies and 18 fMRI studies were included in this study. We found that grey matter volumes were significantly decreased in the right anterior cingulate/paracingulate gyri and the left postcentral gyrus; while the cerebellum, bilateral cortico-spinal projections, and striatum showed increased GMV in patients with TS. In fMRI studies, patients with TS showed overactivation in the right superior frontal gyrus and right superior temporal gyrus, and significant hypoactivation in left SMA. In the multimodal studies, TS patients showed that there was an overlap between decreased GMV and hypoactivation in the right median cingulate/paracingulate gyri.

CONCLUSION

Abnormal alterations in the structure and function of the brain regions may play a role in the pathogenesis of TS in patients, and may be used as an imaging indicator for patients with TS to be diagnosed.

Spatial Distribution Dynamics of Sensory Disturbances in the Treatment of Obesity-Related Meralgia Paresthetica Using Transcutaneous Electrical Nerve Stimulation

Background: To date, there have been no studies on the dynamics of areas of pain, paraesthesia and hypoesthesia after the use of various transcutaneous electrical nerve stimulation in the treatment of meralgia paresthetica. Methods: In this pilot study, we observed 68 patients with obesity-related bilateral meralgia paresthetica. Pain syndrome, paraesthesia symptoms, and hypoesthesia were evaluated using 10-point scores. In addition, pain drawing (PD) was used to determine the area of the spatial distribution of pain syndrome and paraesthesia symptoms, and body drawing was used to determine the area of hypoesthesia. Sham TENS was performed in the control group, and effective TENS was performed in the treatment group. The treatment group consisted of two subgroups. One subgroup underwent HF-LA TENS, and the second subgroup underwent LF-HA TENS. Results: Despite the greatest analgesic effect observed from HF-LA TENS, which was assessed using scoring methods, during and after treatment, the reduction in the area of pain and paraesthesia symptoms and the area of hypoesthesia was moderate, short-term, and reversible. In contrast, LF-HA TENS had a pronounced analgesic and sustained anti-paraesthesia effect, manifested by a noticeable decrease in pain and paraesthesia symptoms area in PD, gradually increasing during the first 2 months of follow-up and accompanied by an irreversible prolonged decrease in the area of hypoesthesia. Conclusion: The areas of paraesthesia and hypoesthesia correlate with affective reactions to long-term chronic pain, which noticeably regress under the influence of LF-HA TENS compared to HF-LA TENS.

Unraveling the pathophysiology of restless legs syndrome from multimodal MRI techniques: A systematic review

BACKGROUND

Restless Legs Syndrome (RLS) is a common neurological disorder currently diagnosed based on clinical features only, and characterized by a compulsive urge to move the legs triggered by rest or diminished arousal. This systematic review aimed at integrating all current brain magnetic resonance imaging (MRI) modalities for a convergent pathophysiological understanding of RLS phenomenology.

METHODS

We performed a MEDLINE (PubMed)-based systematic review for research articles in patients with primary RLS published in English from 2010 till November 2023. Studies meeting the inclusion criteria according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria were systematically assessed for quality using modality-specific checklists, bias using AXIS tool and a narrative synthesis of the results was conducted.

RESULTS

A total of 49 studies (22 structural, 12 DTI, 7 iron-imaging, 4 spectroscopy with 10 datasets combining multiple approaches) involving 1273 patients (414 males) and 1333 healthy controls (478 males) met the eligibility criteria. Despite participant, technical/device-related and statistical heterogeneity, most agree that patients with primary RLS have structural and metabolite alterations, changes in multiple white matter tract architectures, and disrupted functional connectivity within multiple brain areas. Most of the studies (n = 43, 88 %) have a low-risk of bias on the AXIS scale. Scores on the modality-specific checklist ranged from 46 to 92 %, 70-93 % and 54-92 % for structural MRI, DTI and MRS Datasets, respectively.

CONCLUSIONS

Notwithstanding the large heterogeneity in the methods employed, global connectivity alterations suggest the utility of casting RLS within a system-level perspective rather than viewing it as related to the dysfunction of a single or particular brain region. A holistic approach and its integration within the framework of molecular vulnerability and neurotransmitter alterations are warranted to disentangle the complex pathophysiology of RLS and to identify new therapeutic targets.

Brain-Derived Neurotrophic Factor (BDNF) in Huntington's Disease: Neurobiology and Therapeutic Potential

Huntington's disease is a hereditary neurodegenerative disorder marked by severe neurodegeneration in the striatum and cortex. Brain-derived neurotrophic factor (BDNF) is a member of the neurotrophin family of growth factors. It plays a crucial role in maintaining the survival and proper function of striatal neurons. Depletion of BDNF has been linked to impairment and death of striatal neurons, leading to the manifestation of motor, cognitive, and behavioral dysfunctions characteristic of Huntington's disease. This review highlights the current update on the neurobiology of BDNF in the pathogenesis of Huntington's disease. The molecular evidence and the affected signaling pathways are also discussed. In addition, the impact of experimental manipulation of BDNF levels and its pharmaceutical potential for Huntington's disease treatment are explicitly reviewed.

Grading and staging for pituitary neuroendocrine tumors

Pituitary adenoma/pituitary neuroendocrine tumors (PitNETs) are the second most common primary intracranial tumor and the most frequent neuroendocrine tumors/neoplasms of the human body. Thus, they are one of the most frequent diagnoses in neuropathologist's practise. 2022 5th edition WHO Classification of Endocrine and Neuroendocrine Tumors does not support a grading and/or staging system for PitNETs and argues that histological typing and subtyping are more robust than proliferation rate and invasiveness to stratify tumors. Numerous studies suggest the existence of clinically relevant molecular subgroups encouraging an integrated histo-molecular approach to the diagnosis of PitNETs to deepen the understanding of their biology and overcome the unresolved problem of grading system. The present review illustrates the main issues involved in establishing a grading and a staging system, as well as alternative systems validated by independent series to date. The state of art of the current histological and molecular markers is detailed, demonstrating that a standardized and reproducible clinico-pathological approach, combined with the integration of molecular data may help build a workflow to refine the definition of PitNETs with 'malignant potential' and most importantly, avoid delay in patient treatment. Next molecular studied are needed to validate an integrated histo-molecular grading for PitNETs.

Structural changes in early-stage Parkinson's disease with resting tremor at node, edge and network level

BACKGROUND

Resting tremor in Parkinson's disease (PD) is associated with the activity in the basal ganglia and cerebello-thalamo-cortical circuits/network. However, most insights stem from functional MRI research, and structural studies, which can provide basis for and constrain functional activity, remains limited.

METHODS

We investigated the structural change in PD patients with resting tremor (PD-WR) from a network perspective. 42 early-stage PD-WR, 27 PD patients without resting tremor (PD-NR), and 56 healthy controls (HC) were included.

RESULTS

PD-WR showed lower cortical thickness in several motor-related lobules. Compared to HC, significant atrophy was found in right lobule VIIA (t = -3.076, p = 0.016, Cohen's d = 0.627), left lobule VI (t = -3.323, p = 0.007, Cohen's d = 0.678), and right lobule VI (t = -3.052, p = 0.017, Cohen's d = 0.623) in PD-WR. Compared to PD-NR, left lobule V also had a significant reduction (t = -2.958, p = 0.023, d = -0.657). PD-WR had higher fractional anisotropy in cerebello-cortical connection compared to HC (t = 3.209, p = 0.009, d = 0.926), with reduced radial (t = -2.561, p = 0.046, d = 0.739) and mean (t = 2.614, p = 0.046, d = 0.871) diffusivity compared to PD-NR. At the network level, better hierarchy (rho = 0.598, p = 0.004), small-worldness (rho = 0.621, p = 0.003), and increased nodal involvement of the thalamus (rho = 0.718, p = 0.031) and motor cortex (rho = 0.660, p = 0.055) were positively correlated with tremor amplitude.

CONCLUSION

Our study supports the alternation of the cerebello-thalamo-cortical circuit in PD-WR. However, further research with other forms of PD, a wide range of disease stage and larger sample size is needed.

PET Imaging in Dementia: Mini-Review and Canadian Perspective for Clinical Use

PET imaging is increasingly recognized as an important diagnostic tool to investigate patients with cognitive disturbances of possible neurodegenerative origin. PET with 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG), assessing glucose metabolism, provides a measure of neurodegeneration and allows a precise differential diagnosis among the most common neurodegenerative diseases, such as Alzheimer's disease, frontotemporal dementia or dementia with Lewy bodies. PET tracers specific for the pathological deposits characteristic of different neurodegenerative processes, namely amyloid and tau deposits typical of Alzheimer's Disease, allow the visualization of these aggregates in vivo. [18F]FDG and amyloid PET imaging have reached a high level of clinical validity and are since 2022 investigations that can be offered to patients in standard clinical care in most of Canada.This article will briefly review and summarize the current knowledge on these diagnostic tools, their integration into diagnostic algorithms as well as perspectives for future developments.

An examination of cortical thickness relationships within the reading network of adults

Much brain imaging work has underscored the functional connections among the inferior frontal gyrus (IFG; articulation), supramarginal gyrus (SMG; letter-sound correspondence), superior temporal gyrus (STG; sound) and fusiform gyrus (FFG; print) during basic reading processes. This reading network supports and coordinates the complex processes that contribute to successful reading. In line with the Hebbian notion that 'neurons that fire together, wire together' we examined cortical thickness among these regions and the extent to which these regions showed structural relationships in average and impaired readers. Structural high resolution brain scans from 87 adult participants including average (N = 56; 51 right-handed; females = 29; mean age = 20.5; SD = 2.14) and impaired (N = 31; 27 right-handed; females = 24; mean age = 23.1; SD = 4.23) readers were collated. Cortical thickness measurements of the left and right IFG, SMG, STG, and FFG were extracted. Average readers had significantly greater cortical thickness in the right IFG and right SMG compared to impaired readers. Within each group, similarly strong relationships between the left and right structures were observed. Average readers had a significantly stronger connection between the left IFG-FFG compared to impaired readers (p = 0.012). In contrast, the impaired readers had a significantly stronger connection between the left STG-FFG compared to average readers (p = 0.027). In conclusion, the findings suggest that structural relationships within the reading network may contribute to variations in reading proficiency, with average readers exhibiting distinct patterns of cortical thickness and relationships compared to impaired readers. Further exploration of these structural differences could offer valuable insights into the neural mechanisms underlying reading abilities and disabilities.

Validation of the SIMIND simulation code using the myocardial phantom HL

Introduction. Monte Carlo simulation codes simulating medical imaging nuclear detectors (SIMIND) are notable tools used to model nuclear medicine experiments.This study aimed to confirm the usability of SIMIND as an alternative method for nuclear medicine experiments with a cardiac phantom HL, simulating human body structures, by comparing the actual experiment data.Methods. A cardiac phantom HL that simulates myocardial scintigraphy using123I-meta-iodobenzylguanidine was developed, and single-photon emission computed tomography/computed tomography imaging was performed using Discovery NM/CT 670 scanner. Aside from the main-energy window(159 keV ± 10%), additional windows were set on the low(137.5 keV ± 4% ) and high(180.5 keV ± 3%)-energy sides. The simulations were performed under the same conditions as the actual experiments. Regions of interest (ROIs) were set in each organ part of the experiments and simulated data, and a polar map for the myocardial part was developed. The mean, maximum (max), and minimum (min) counts within each ROI, as well as the relative errors of each segment in the polar map, were calculated to evaluate the accuracy of the simulation.Results. Overall, the results were favorable with relative errors of <10% except in some areas based on the data from the main-energy window and postreconstruction. On the other hand, relative errors of >10% were found in both the low and high subenergy windows. The smallest error occurred when assessing using mean values within the ROIs. The relative error was high at the cardiac base in the polar map evaluation; however, it remained <10% from the mid to apical heart sections.Conclusion. SIMIND is considered an alternative method for nuclear medicine experiments using a myocardial phantom HL that closely resembles human body structures. However, caution is warranted as accuracy may decrease under specific conditions.

Functional connectivity abnormalities in clinical variants of progressive supranuclear palsy

Progressive supranuclear palsy (PSP) can present with different clinical variants which show distinct, but partially overlapping, patterns of neurodegeneration and tau deposition in a network of regions including cerebellar dentate, superior cerebellar peduncle, midbrain, thalamus, basal ganglia, and frontal lobe. We sought to determine whether disruptions in functional connectivity within this PSP network measured using resting-state functional MRI (rs-fMRI) differed between PSP-Richardson's syndrome (PSP-RS) and the cortical and subcortical clinical variants of PSP. Structural MRI and rs-fMRI scans were collected for 36 PSP-RS, 25 PSP-cortical and 34 PSP-subcortical participants who met the Movement Disorder Society PSP clinical criteria. Ninety participants underwent flortaucipir-PET scans. MRIs were processed using CONN Toolbox. Functional connectivity between regions of the PSP network was compared between each PSP group and 83 healthy controls, and between the PSP groups, covarying for age. The effect of flortaucipir uptake and clinical scores on connectivity was assessed. Connectivity was reduced in PSP-RS compared to controls throughout the network, involving cerebellar dentate, midbrain, basal ganglia, thalamus, and frontal regions. Frontal regions showed reduced connectivity to other regions in the network in PSP-cortical, particularly the thalamus, caudate and substantia nigra. Disruptions in connectivity in PSP-subcortical were less pronounced, with the strongest disruption between the pallidum and striatum. There was moderate evidence that elevated subcortical flortaucipir uptake correlated with both increased and reduced connectivity between regions of the PSP network. Lower connectivity within the PSP network correlated with worse performance on clinical tests, including PSP rating scale. Patterns of disrupted functional connectivity revealed both variant-specific and shared disease pathways within the PSP network among PSP clinical variants, providing insight into disease heterogeneity.

Current potential diagnostic biomarkers of amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) currently lacks the useful diagnostic biomarkers. The current diagnosis of ALS is mainly depended on the clinical manifestations, which contributes to the diagnostic delay and be difficult to make the accurate diagnosis at the early stage of ALS, and hinders the clinical early therapeutics. The more and more pathogenesis of ALS are found at the last 30 years, including excitotoxicity, the oxidative stress, the mitochondrial dysfunction, neuroinflammation, the altered energy metabolism, the RNA misprocessing and the most recent neuroimaging findings. The findings of these pathogenesis bring the new clues for searching the diagnostic biomarkers of ALS. At present, a large number of relevant studies about the diagnostic biomarkers are underway. The ALS pathogenesis related to the diagnostic biomarkers might lessen the diagnostic reliance on the clinical manifestations. Among them, the cortical altered signatures of ALS patients derived from both structural and functional magnetic resonance imaging and the emerging proteomic biomarkers of neuronal loss and glial activation in the cerebrospinal fluid as well as the potential biomarkers in blood, serum, urine, and saliva are leading a new phase of biomarkers. Here, we reviewed these current potential diagnostic biomarkers of ALS.

Patterns of the left thalamus embedding into the connectome associated with reading skills in children with reading disabilities

We examined how thalamocortical connectivity structure reflects children's reading performance. Diffusion-weighted MRI at 3 T and a series of reading measures were collected from 64 children (33 girls) ages 8-14 years with and without dyslexia. The topological properties of the left and right thalamus were computed based on the whole-brain white matter network and a hub-attached reading network, and were correlated with scores on several tests of children's reading and reading-related abilities. Significant correlations between topological metrics of the left thalamus and reading scores were observed only in the hub-attached reading network. Local efficiency was negatively correlated with rapid automatized naming. Transmission cost was positively correlated with phonemic decoding, and this correlation was independent of network efficiency scores; follow-up analyses further demonstrated that this effect was specific to the pulvinar and mediodorsal nuclei of the left thalamus. We validated these results using an independent dataset and demonstrated that that the relationship between thalamic connectivity and phonemic decoding was specifically robust. Overall, the results highlight the role of the left thalamus and thalamocortical network in understanding the neurocognitive bases of skilled reading and dyslexia in children.

Neuroimaging markers and disability scales in multiple sclerosis: A systematic review and meta-analysis

BACKGROUND

Multiple sclerosis (MS) is a central nervous system disorder marked by progressive neurological impairments. Magnetic resonance imaging (MRI) parameters are key paraclinical measures that play a crucial role in the diagnosis, prognosis, and monitoring of MS-related disability. This study aims to analyze and summarize the existing literature on the correlation between MRI parameters and disability in people with MS (pwMS).

METHODS

The PubMed/MEDLINE, Embase, Scopus, and Web of Science databases were searched from inception to July 19, 2024, and a meta-analysis was carried out using R software version 4.4.0 and the random effects model used to determine the pooled correlation coefficient, with its 95% confidence interval (CI), between MRI measurements and disability scales.

RESULTS

Among 5741 studies, 383 studies with 39707 pwMS were included. The meta-analysis demonstrated that Expanded Disability Status Scale (EDSS) had significant correlations with cervical cord volume (r = -0.51, 95% CI: -0.62 to -0.38, I2 = 0%, p-heterogeneity = 0.86, p-value<0.01), cortical lesion volume (r = 0.45, 95% CI: 0.36 to 0.53, I2 = 68%, p-heterogeneity<0.01, p-value<0.01), brain volume (r = -0.40, 95% CI: -0.47 to -0.33, I2 = 41%, p-heterogeneity = 0.05, p-value<0.05), and grey matter volume (GMV) (r = -0.36, 95% CI: -0.49 to -0.21, I2 = 0%, p-heterogeneity = 0.53, p-value<0.01), respectively.

CONCLUSION

This study offers evidence suggesting that cortical lesion volume, brain volume, GMV, and MRI measurements of the spinal cord may constitute reliable indicators for assessing disability in pwMS.

Mental health variables affecting Quality of Life (QOL) among healthcare workers during the COVID-19 pandemic in Jazan City, Saudi Arabia

Background

Health workers directly involved in the diagnosis, treatment, and care of patients with COVID-19 are at risk of developing mental health symptoms.

Objective

The study aimed to assess the quality of life (QoL) of healthcare workers at Prince Mohammed bin Nasser Tertiary Hospital in Jazan during the COVID-19 pandemic, with a focus on the relationship between QoL and stress, anxiety, and depression. Pandemic.

Methods

This was a cross-sectional study conducted among healthcare workers at Prince Mohammed bin Nasser Hospital in the Jazan. The study included a sample of 352 healthcare workers. Data was collected through a self-administered questionnaire pertaining to sociodemographic characteristics and the 21-item Depression Anxiety Stress Scale questionnaire, SF-36, for QoL. Descriptive statistics, frequencies, and percentages were used. A chi-squared test was performed to compare categorical data. A one-way ANOVA was performed to compare the effect of disorder variables on QoL. Multiple linear regression analyses were carried out to discern the differences between the different groups of participants in QoL measures.

Results

Our results showed a poor QoL among those with a chronic disease (p = 0.002), who worked in the COVID-19 department (p = 0.030) and those who experienced the death of relatives or friends due to COVID-19 (p = 0.003).

Conclusion

Healthcare workers, particularly those with chronic diseases or who had lost relatives to COVID-19, exhibited significantly lower QoL levels, especially those working directly in COVID-19 departments.

Neurovascular complications of antiphospholipid syndrome: a narrative review

BACKGROUND

 Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by thrombosis, pregnancy complications, and other nonthrombotic manifestations in the presence of antiphospholipid antibodies. Neurovascular complications, including ischemic stroke, cerebral venous thrombosis and cognitive impairment, pose significant challenges in management.

OBJECTIVE

 To comprehensively review relevant and updated clinical aspects of neurovascular manifestations of APS.

METHODS

 We conducted a narrative review using the PubMed, EMBASE, and Cochrane Library databases with medical terms related to APS and its neurovascular manifestations. English-language studies, published between January 1, 2015, and March 2024, were included. Key publications outside this timeframe were also considered. Studies with higher levels of evidence, such as randomized controlled trials and meta-analyses, were prioritized for inclusion.

RESULTS

 Stroke is a prevalent complication in APS, with arterial thrombosis being a predominant mechanism. Despite recent trials, direct oral anticoagulants (DOACs) have not shown superiority over vitamin K antagonists (VKAs) for secondary prevention in this population. Cerebral venous thrombosis (CVT), although rare, can also occur in APS, and while DOACs have shown promise as a treatment in a general population, caution is warranted due to potential harm. Cognitive impairment affects a considerable proportion of APS patients, with thrombotic and nonthrombotic mechanisms contributing to its pathophysiology. Future research should focus on optimal management strategies for cognitive impairment and the efficacy of anticoagulation and immunosuppression.

CONCLUSION

 Understanding the complex interplay of neurovascular manifestations in APS is essential for guiding clinical decisions and improving patient outcomes. Despite advancements, some challenges remain in establishing effective preventive and treatment measures, highlighting the need for further research in this field.

Control energy detects discrepancies in good vs. poor readers' structural-functional coupling during a rhyming task

Neuroimaging studies have identified functional and structural brain circuits that support reading. However, much less is known about how reading-related functional dynamics are constrained by white matter structure. Network control theory proposes that cortical brain dynamics are linearly determined by the white matter connectome, using control energy to evaluate the difficulty of the transition from one cognitive state to another. Here we apply this approach to linking brain dynamics with reading ability and disability in school-age children. A total of 51 children ages 8.25 -14.6 years performed an in-scanner rhyming task in visual and auditory modalities, with orthographic (spelling) and phonological (rhyming) similarity manipulated across trials. White matter structure and fMRI activation were used conjointly to compute the control energy of the reading network in each condition relative to a null fixation state. We then tested differences in control energy across trial types, finding higher control energy during non-word trials than word trials, and during incongruent trials than congruent trials. ROI analyses further showed a dissociation between control energy of the left fusiform and superior temporal gyrus depending on stimulus modality, with higher control energy for visual modalities in fusiform and higher control energy for auditory modalities in STG. Together, this study highlights that control theory can explain variations on cognitive demands in higher-level abilities such as reading, beyond what can be inferred from either functional or structural MRI measures alone.

Correlating clinical course with baseline subcortical shape in provisional tic disorder

OBJECTIVE

This study examined children at the onset of tic disorder (tics for less than 9 months: NT group), a population on which little research exists. Here, we investigate relationships between the baseline shape and volume of subcortical nuclei, diagnosis, and tic symptom outcomes.

METHODS

187 children were assessed at baseline and a 12-month follow-up: 88 with NT, 60 tic-free healthy controls (HC), and 39 with chronic tic disorder/Tourette syndrome (TS), using T1-weighted MRI and total tic scores (TTS) from the Yale Global Tic Severity Scale to evaluate symptom change. Subcortical surface maps were generated using FreeSurfer-initialized large deformation diffeomorphic metric mapping. Linear regression models correlated baseline structural shapes with follow-up TTS while accounting for covariates, with relationships mapped onto structure surfaces.

RESULTS

We found that the NT group had a larger right hippocampus compared to HC. Surface maps illustrate distinct patterns of inward deformation in the putamen and outward deformation in the thalamus for NT compared to controls. We also found patterns of outward deformation in almost all studied structures when comparing the TS group to controls. The NT group also showed consistent outward deformation compared to TS in the caudate, accumbens, putamen, and thalamus. Subsequent analyses including clinical symptoms revealed that a larger pallidum and thalamus at baseline correlated with less improvement of tic symptoms at follow-up.

CONCLUSION

These observations constitute some of the first prognostic biomarkers for tic disorders and suggest that these subregional shape and volume differences may be associated with the outcome of tic disorders.

Rasch Analysis of the Chinese Version of the Nociception Coma Scale-Revised in Patients with Prolonged Disorders of Consciousness

OBJECTIVES

The aim of this study was to analyze the Chinese version of the Nociception Coma Scale-Revised in patients with prolonged disorders of consciousness within the framework of Rasch modeling, including investigating the invariance of total scores across different etiologies of disorders of consciousness.

DESIGN

Prospective psychometric study.

PARTICIPANTS

Patients with prolonged disorders of consciousness from the Rehabilitation and Neurology units in hospital.

INTERVENTIONS

None.

MAIN OUTCOME MEASURE

The Nociception Coma Scale-Revised was undertaken by trained raters and the Coma Recovery Scale-Revised was used to assess patients' consciousness. The psychometric properties within the Rasch model including item-person targeting, reliability and separation, item fit, unidimensionality, and differential item functioning were assessed.

RESULTS

84 patients with prolonged disorders of consciousness (mean age 53 years; mean injury 5 months; 42 with Minimally Conscious State and 42 with Unresponsive Wakefulness Syndrome) of 252 observations were enrolled in the study. Through the procedure of repeated assessment and differential item function, a lower item bias Rasch set was purified. The Rasch model assumptions were examined and met, with item reliability and validity meeting the recommended threshold.

CONCLUSIONS

The Chinese version of the Nociception Coma Scale-Revised demonstrated unidimensionality, good reliability and separation, and good item fit, but dissatisfied person fit and item-person targeting. The verbal subscale showed a notable discrepancy between person responses and the difficulty of the items, suggesting limited clinical significance.