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Seigel CR, Martin H, Bastin G, Myers LJ, Taylor S, Pike F, Wilkinson J, Williams LS. Patient acceptance of teleneurology across neurologic conditions. J Neurol 2024; 271:2850-2858. [PMID: 38388928 DOI: 10.1007/s00415-024-12200-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Patient acceptability with outpatient teleneurology has been reported within specific conditions, but less is known about acceptability across neurologic conditions. The study objective was to compare the acceptability of teleneurology between patients with various neurological conditions and determine what other factors influence acceptability. METHODS This was a prospective study of Veterans who completed new outpatient teleneurology visits with the Department of Veterans Affairs National Teleneurology Program. Visits were conducted via video to home or video to the outpatient clinic. Patient acceptability was assessed via telephone interview two weeks post-visit. Acceptability was a summed score (3-21) of three 7-point Likert questions (higher = more acceptable). Clinical diagnosis categories were based on the neurologists' ICD10 diagnosis code. Acceptability score was modeled using a censored Tobit model controlling for demographics, type of tele-visit, medical comorbidity, and ICD10 category. RESULTS In FY 2021, 277 of 637 (43.5%) patients completed an interview with analyzable acceptability data. Of these 277, 70 (25.3%) had codes indicating headache, 46 (16.6%) movement disorder, 45 (16.2%) general symptoms, and 116 (41.9%) for all other categories. Mean patient acceptability was 18.3 (SD 3.2). There was no significant difference in scores between these groups. The only factor independently related to acceptability was medical comorbidity, with higher comorbidity associated with higher acceptability scores. DISCUSSION Patients find their outpatient teleneurology experience highly acceptable independent of neurologic condition. Those with more comorbidity report higher acceptability. Use of teleneurology may be useful and acceptable across many outpatient neurologic conditions including for more medically complex patients.
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Affiliation(s)
| | - Holly Martin
- Richard L. Roudebush VAMC HSR&D EXTEND QUERI, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Grace Bastin
- Richard L. Roudebush VAMC HSR&D EXTEND QUERI, Indianapolis, IN, USA
| | - Laura J Myers
- Indiana University School of Medicine, Indianapolis, IN, USA
- Richard L. Roudebush VAMC HSR&D EXTEND QUERI, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Stan Taylor
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Francis Pike
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jayne Wilkinson
- Corporal Michael J Crescenz VAMC, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Linda S Williams
- Richard L. Roudebush VAMC HSR&D EXTEND QUERI, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
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Alryalat SA, Al Deyabat O, Lee AG. Painful Eyes in Neurology Clinic: A Guide for Neurologists. Neurol Clin 2024; 42:559-571. [PMID: 38575266 DOI: 10.1016/j.ncl.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Eye pain is a common complaint among patients presenting to the neurology clinic. It can be related to neurologic diseases, but it can also be a localized eye condition. Such disorders can be misleading, as their benign appearance might mask more grave underlying conditions, potentially leading to misdiagnoses or delayed treatment. Clinicians should be aware of the specific neurologic or systemic disorders (eg, demyelinating diseases or vascular abnormalities) that might first manifest as eye pain. Formal ophthalmic consultation is recommended for patients presenting with eye pain as the predominant complaint especially when red flags for more serious pathology are present.
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Affiliation(s)
- Saif Aldeen Alryalat
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA; Department of Ophthalmology, The University of Jordan, Amman, Jordan
| | - Osama Al Deyabat
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA; Department of Ophthalmology, The University of Jordan, Amman, Jordan; Sam Houston State, Conroe, TX, USA; Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USA; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA; Department of Ophthalmology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Texas A&M College of Medicine, Bryan, TX, USA; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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Voigtlaender S, Pawelczyk J, Geiger M, Vaios EJ, Karschnia P, Cudkowicz M, Dietrich J, Haraldsen IRJH, Feigin V, Owolabi M, White TL, Świeboda P, Farahany N, Natarajan V, Winter SF. Artificial intelligence in neurology: opportunities, challenges, and policy implications. J Neurol 2024; 271:2258-2273. [PMID: 38367046 DOI: 10.1007/s00415-024-12220-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/19/2024]
Abstract
Neurological conditions are the leading cause of disability and mortality combined, demanding innovative, scalable, and sustainable solutions. Brain health has become a global priority with adoption of the World Health Organization's Intersectoral Global Action Plan in 2022. Simultaneously, rapid advancements in artificial intelligence (AI) are revolutionizing neurological research and practice. This scoping review of 66 original articles explores the value of AI in neurology and brain health, systematizing the landscape for emergent clinical opportunities and future trends across the care trajectory: prevention, risk stratification, early detection, diagnosis, management, and rehabilitation. AI's potential to advance personalized precision neurology and global brain health directives hinges on resolving core challenges across four pillars-models, data, feasibility/equity, and regulation/innovation-through concerted pursuit of targeted recommendations. Paramount actions include swift, ethical, equity-focused integration of novel technologies into clinical workflows, mitigating data-related issues, counteracting digital inequity gaps, and establishing robust governance frameworks balancing safety and innovation.
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Affiliation(s)
- Sebastian Voigtlaender
- Systems Neuroscience Division, Max-Planck-Institute for Biological Cybernetics, Tübingen, Germany
- Virtual Diagnostics Team, QuantCo Inc., Cambridge, MA, USA
| | - Johannes Pawelczyk
- Faculty of Medicine, Ruprecht-Karls-University, Heidelberg, Germany
- Graduate Center of Medicine and Health, Technical University Munich, Munich, Germany
| | - Mario Geiger
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- NVIDIA, Zurich, Switzerland
| | - Eugene J Vaios
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Philipp Karschnia
- Department of Neurosurgery, Ludwig-Maximilians-University and University Hospital Munich, Munich, Germany
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Merit Cudkowicz
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jorg Dietrich
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ira R J Hebold Haraldsen
- Department of Neurology, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Mayowa Owolabi
- Center for Genomics and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, University of Ibadan, Ibadan, Nigeria
- Blossom Specialist Medical Center, Ibadan, Nigeria
- Lebanese American University of Beirut, Beirut, Lebanon
| | - Tara L White
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | | | | | | | - Sebastian F Winter
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Li Y, Ma R, Hao X. Therapeutic role of PTEN in tissue regeneration for management of neurological disorders: stem cell behaviors to an in-depth review. Cell Death Dis 2024; 15:268. [PMID: 38627382 PMCID: PMC11021430 DOI: 10.1038/s41419-024-06657-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Abstract
Phosphatase and tensin homolog deleted on chromosome 10 (PTEN) represents the initial tumor suppressor gene identified to possess phosphatase activity, governing various cellular processes including cell cycle regulation, migration, metabolic pathways, autophagy, oxidative stress response, and cellular senescence. Current evidence suggests that PTEN is critical for stem cell maintenance, self-renewal, migration, lineage commitment, and differentiation. Based on the latest available evidence, we provide a comprehensive overview of the mechanisms by which PTEN regulates activities of different stem cell populations and influences neurological disorders, encompassing autism, stroke, spinal cord injury, traumatic brain injury, Alzheimer's disease and Parkinson's disease. This review aims to elucidate the therapeutic impacts and mechanisms of PTEN in relation to neurogenesis or the stem cell niche across a range of neurological disorders, offering a foundation for innovative therapeutic approaches aimed at tissue repair and regeneration in neurological disorders. This review unravels novel therapeutic strategies for tissue restoration and regeneration in neurological disorders based on the regulatory mechanisms of PTEN on neurogenesis and the stem cell niche.
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Affiliation(s)
- Yue Li
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, 999078, Macau, China.
- Department of Pharmaceutical Sciences, Faculty of Health Sciences, University of Macau, 999078, Macau, China.
| | - Ruishuang Ma
- State Key Laboratory of Component-Based Chinese Medicine, Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China
| | - Xia Hao
- State Key Laboratory of Component-Based Chinese Medicine, Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China
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Kinnear EE, Beales D, Paton A, Challice S. Making a difference: neurological support in the community. Br J Community Nurs 2024; 29:190-194. [PMID: 38564446 DOI: 10.12968/bjcn.2024.29.4.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Nearly 3 million people in the UK have a neurological condition; stroke, traumatic brain injury, Parkinson's disease, multiple sclerosis, brain tumour, motor neurone disease, among others - all affecting the person for the rest of their life. The NHS provides treatment at the onset of a condition but after that, there is a huge need for ongoing support. Research shows that those who are supported and know more about their condition are less likely to have to call on further in-hospital and GP care. There is enormous scope for improving the quality of life for those with neurological conditions. The right support-therapeutic and social-makes all the difference. The book, which this article is based on, shows how those with neurological conditions benefit from integrated ongoing support provided in the local community and self-help, and how lives can be improved. It explains good practice and encouraging methods in the support and treatment of those with life changing conditions.
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Affiliation(s)
- Eleanor Ellie Kinnear
- Physiotherapist; Co-founder of the Medical Charity - Integrated Neurological Services
| | - David Beales
- Retired General Practitioner with Parkinson's Disease
| | | | - Sara Challice
- Carer for her husband with a brain tumour for 13 years; Author of 'Who Cares?'
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Chrzanowski S, Batra R. CRISPR-Based Gene Editing Techniques in Pediatric Neurological Disorders. Pediatr Neurol 2024; 153:166-174. [PMID: 38394831 DOI: 10.1016/j.pediatrneurol.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/15/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
The emergence of gene editing technologies offers a unique opportunity to develop mutation-specific treatments for pediatric neurological disorders. Gene editing systems can potentially alter disease trajectory by correcting dysfunctional mutations or therapeutically altering gene expression. Clustered regularly interspaced short palindromic repeats (CRISPR)-based approaches are attractive gene therapy platforms to personalize treatments because of their specificity, ease of design, versatility, and cost. However, many such approaches remain in the early stages of development, with ongoing efforts to optimize editing efficiency, minimize unintended off-target effects, and mitigate pathologic immune responses. Given the rapid evolution of CRISPR-based therapies, it is prudent for the clinically based child neurologist to have a conceptual understanding of what such therapies may entail, including both benefits and risks and how such therapies may be clinically applied. In this review, we describe the fundamentals of CRISPR-based therapies, discuss the opportunities and challenges that have arisen, and highlight preclinical work in several pediatric neurological diseases.
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Affiliation(s)
- Stephen Chrzanowski
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts; Division of Neuromuscular Medicine, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts; Division of Neuromuscular Medicine, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts.
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7
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Bogetz JF, Oslin E, O’Donnell M, Barton KS, Yi-Frazier JP, Watson RS, Rosenberg AR. Meaning-Making Among Parents of Children With Severe Neurologic Impairment in the PICU. Pediatrics 2024; 153:e2023064361. [PMID: 38529567 PMCID: PMC10979294 DOI: 10.1542/peds.2023-064361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Parents and family caregivers of children with severe neurologic impairment (SNI) experience many stressors, especially during their child's critical illness. This study aimed to examine parent experiences around the time of their child's PICU care to explore ways parents make meaning in relation to these stressors. METHODS This qualitative study of data from a single center in the United States followed Consolidated Criteria for Reporting Qualitative Research guidelines. One to one semistructured interviews queried parents' psychosocial well-being around the time of their child's PICU care. Eligible participants had a child with an SNI condition for >3 months admitted to the PICU for >24 hours with an expected length of stay >1 week. RESULTS Data were analyzed by a research team with expertise in palliative care, psychology, critical care, and qualitative methods. Fifteen family caregivers of 15 children participated. Children were a median of 8 years old (interquartile range 4-11.5) and 80% (n = 12) had congenital/genetic conditions. Parent/family caregivers were a median age of 39 years old (interquartile range 36-42.5); 20% (n = 3) self-identified as fathers and 47% (n = 7) as having to a minority racial background. Parents discussed ongoing meaning-making that occurred through domains of comprehension and purpose, and themes of understanding of other people and the world around them. Subthemes focused on appreciation/acceptance, adaptability/accountability, valuing all lives, and learning/teaching about their child. CONCLUSIONS Meaning-making may be an opportunity for support in the PICU among parents/family caregivers of children with SNI.
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Affiliation(s)
- Jori F. Bogetz
- Divisions of Bioethics and Palliative Care
- Treuman Katz Center for Bioethics
| | | | | | - Krysta S. Barton
- Biostatistics Epidemiology and Analytics for Research (BEAR) Core, Seattle Children’s Research Institute; Seattle, Washington
| | | | - R. Scott Watson
- Division of Critical Care, Department of Pediatrics, University of Washington School of Medicine; Seattle, Washington
| | - Abby R. Rosenberg
- Division of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute; Department of Pediatrics, Boston Children’s Hospital; Department of Pediatrics, Harvard Medical School; Boston, Massachusetts
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8
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Teixeira L. Nursing assessment and care for a patient with a neurological disorder. Br J Nurs 2024; 33:252-255. [PMID: 38446514 DOI: 10.12968/bjon.2024.33.5.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
The previous article discussed the pathophysiology involved in disorders of the nervous system. Having considered some of the most prevalent disorders, this second part uses a case study to explore effective patient assessment and emphasise the importance of facilitating patient self-management for improved outcomes. By addressing these key aspects, nursing professionals can enhance the quality of care and the support provided to individuals experiencing neurological disorders.
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Affiliation(s)
- Luis Teixeira
- Lecturer in Adult Nursing Complex Care, King's College London
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9
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Nanetti L, Kearney M, Boesch S, Stovickova L, Ortigoza-Escobar JD, Macaya A, Gomez-Andres D, Roze E, Molnar MJ, Wolf NI, Darling A, Vasco G, Bertini E, Indelicato E, Neubauer D, Haack TB, Sagi JC, Danti FR, Sival D, Zanni G, Kolk A, Boespflug-Tanguy O, Schols L, van de Warrenburg B, Vidailhet M, Willemsen MA, Buizer AI, Orzes E, Ripp S, Reinhard C, Moroni I, Mariotti C. Child-to-adult transition: a survey of current practices within the European Reference Network for Rare Neurological Diseases (ERN-RND). Neurol Sci 2024; 45:1007-1016. [PMID: 37853291 DOI: 10.1007/s10072-023-07101-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Transition from child-centered to adult-centered healthcare is a gradual process that addresses the medical, psychological, and educational needs of young people in the management of their autonomy in making decisions about their health and their future clinical assistance. This transfer is challenging across all chronic diseases but can be particularly arduous in rare neurological conditions. AIM To describe the current practice on the transition process for young patients in centers participating in the European Reference Network for Rare Neurological Diseases (ERN-RND). METHODS Members of the ERN-RND working group developed a questionnaire considering child-to-adult transition issues and procedures in current clinical practice. The questionnaire included 20 questions and was sent to members of the health care providers (HCPs) participating in the network. RESULTS Twenty ERN-RND members (75% adult neurologists; 25% pediatricians; 5% nurses or study coordinators) responded to the survey, representing 10 European countries. Transition usually occurs between 16 and 18 years of age, but 55% of pediatric HCPs continue to care for their patients until they reach 40 years of age or older. In 5/20 ERN-RND centers, a standardized procedure managing transition is currently adopted, whereas in the remaining centers, the transition from youth to adult service is usually assisted by pediatricians as part of their clinical practice. CONCLUSIONS This survey demonstrated significant variations in clinical practice between different centers within the ERN-RND network. It provided valuable data on existing transition programs and highlighted key challenges in managing transitions for patients with rare neurological disorders.
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Affiliation(s)
- Lorenzo Nanetti
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - Mary Kearney
- Patient Advocate at the European Reference Network Representing Individuals With Ataxia, and Neurology Research Fellow at the National Ataxia Centre, Tallaght University, Dublin, Ireland
| | - Sylvia Boesch
- Center for Rare Movement Disorders, Department of Neurology, Innsbruck, Austria
| | - Lucie Stovickova
- Centre of Hereditary Ataxias, Department of Pediatric Neurology, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | | | - Alfons Macaya
- Pediatric Neurology, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, and Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - David Gomez-Andres
- Pediatric Neurology, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, and Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Emmanuel Roze
- Sorbonne University, INSERM, CNRS, Paris Brain Institute, APHP Salpêtrière Hospital, Paris, France
| | - Maria-Judit Molnar
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Nicole I Wolf
- Amsterdam Leukodystrophy Center, Department of Child Neurology, Emma's Children's Hospital, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Cellular & Molecular Mechanisms, Amsterdam, The Netherlands
| | - Alejandra Darling
- Pediatric Neurology Department, Institut de Recerca Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Gessica Vasco
- Research Unit of Neurorehabilitation, IRCCS Bambino Gesù Children's Research Hospital, Rome, Italy
| | - Enrico Bertini
- Unit of Neuromuscular and Neurodegenerative Disease, IRCCS Bambino Gesù Children's Research Hospital, Rome, Italy
| | | | - David Neubauer
- UMCL, Children's Hospital Ljubljana and University of Ljubljana, Ljubljana, Slovenia
| | - Tobias B Haack
- Institute of Medical Genetics and Applied Genomics University of Tübingen, Tübingen, Germany
| | - Judit C Sagi
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
- Department of Paediatrics, Semmelweis University, Dept. of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Federica R Danti
- Department of Pediatric Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Deborah Sival
- Department of Paediatric Neurology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ginevra Zanni
- Unit of Neuromuscular and Neurodegenerative Disease, IRCCS Bambino Gesù Children's Research Hospital, Rome, Italy
| | - Anneli Kolk
- Tartu University Hospital Children's Clinic, Department of Pediatrics and Neurology, Tartu, Estonia
| | - Odile Boespflug-Tanguy
- APHP, Université Paris Cité, INSERM UMR1141, Hôpital Robert Debré, Service de Neuropédiatrie, Centre de Reference LEUKOFRANCE, Paris, France
| | - Ludger Schols
- Department of Neurology and Hertie Institute for Clinical Brain Research, University of Tübingen, and German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Bart van de Warrenburg
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marie Vidailhet
- Sorbonne University, INSERM, CNRS, Paris Brain Institute, APHP Salpêtrière Hospital, Paris, France
| | - Michèl A Willemsen
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Emma Children's Hospital, Amsterdam, Vrije Universiteit, Amsterdam, Amsterdam Movement Science, Rehabilitation and Development, Amsterdam, The Netherlands
| | - Enrico Orzes
- Osservatorio Malattie Rare - Rarelab S.R.L., Rome, Italy
| | - Sophie Ripp
- Centre for Rare Diseases and Institute of Medical Genetics and Applied Genomics, University Hospital Tübingen, Tübingen, Germany
| | - Carola Reinhard
- Centre for Rare Diseases and Institute of Medical Genetics and Applied Genomics, University Hospital Tübingen, Tübingen, Germany
| | - Isabella Moroni
- Department of Pediatric Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Caterina Mariotti
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy.
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Filosto M, Mancuso M, Federico A, Padovani A. Unravelling the mysteries: a reflection on rare neurological diseases. Neurol Sci 2024; 45:833-835. [PMID: 38302818 DOI: 10.1007/s10072-024-07374-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Affiliation(s)
- Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, Brescia, Italy.
| | - Michelangelo Mancuso
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy
| | - Antonio Federico
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Neurology, ASST Spedali Civili, Brescia, Italy
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Boon P, Lescrauwaet E, Aleksovska K, Konti M, Berger T, Leonardi M, Marson T, Kallweit U, Moro E, Toscano A, Rektorova I, Crean M, Sander A, Joyce R, Bassetti C. A strategic neurological research agenda for Europe: Towards clinically relevant and patient-centred neurological research priorities. Eur J Neurol 2024; 31:e16171. [PMID: 38085270 DOI: 10.1111/ene.16171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND AND PURPOSE Neurological disorders constitute a significant portion of the global disease burden, affecting >30% of the world's population. This prevalence poses a substantial threat to global health in the foreseeable future. A lack of awareness regarding this high burden of neurological diseases has led to their underrecognition, underappreciation, and insufficient funding. Establishing a strategic and comprehensive research agenda for brain-related studies is a crucial step towards aligning research objectives among all pertinent stakeholders and fostering greater societal awareness. METHODS A scoping literature review was undertaken by a working group from the European Academy of Neurology (EAN) to identify any existing research agendas relevant to neurology. Additionally, a specialized survey was conducted among all EAN scientific panels, including neurologists and patients, inquiring about their perspectives on the current research priorities and gaps in neurology. RESULTS The review revealed the absence of a unified, overarching brain research agenda. Existing research agendas predominantly focus on specialized topics within neurology, resulting in an imbalance in the number of agendas across subspecialties. The survey indicated a prioritization of neurological disorders and research gaps. CONCLUSIONS Building upon the findings from the review and survey, key components for a strategic and comprehensive neurological research agenda in Europe were delineated. This research agenda serves as a valuable prioritization tool for neuroscientific researchers, as well as for clinicians, donors, and funding agencies in the field of neurology. It offers essential guidance for creating a roadmap for research and clinical advancement, ultimately leading to heightened awareness and reduced burden of neurological disorders.
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Affiliation(s)
- Paul Boon
- Department of Neurology and 4Brain, Ghent University Hospital, Ghent, Belgium
- Eindhoven University of Technology, Eindhoven, the Netherlands
- European Academy of Neurology, Vienna, Austria
| | - Emma Lescrauwaet
- Department of Neurology and 4Brain, Ghent University Hospital, Ghent, Belgium
- Eindhoven University of Technology, Eindhoven, the Netherlands
| | | | - Maria Konti
- European Academy of Neurology, Vienna, Austria
| | - Thomas Berger
- Department of Neurology and Comprehensive Centre of Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit and Coma Research Centre, Fondazione IRCCS Instituto Neurologico C. Besta, Milan, Italy
| | - Tony Marson
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Ulf Kallweit
- Centre for Narcolepsy and Hypersomnolence Disorders, Professorship for Narcolepsy and Hypersomnolence Research, Department of Medicine, Witten/Herdecke University, Witten, Germany
- Centre for Biomedical Education and Research, Witten/Herdecke University, Witten, Germany
| | - Elena Moro
- Department of Psychiatry, Neurology and Neurological Rehabilitation of CHU, Grenoble, France
| | - Antonio Toscano
- ERN-NMD Centre for Neuromuscular Disorders of Messina, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Irena Rektorova
- Brain and Mind Research, Central European Institute of Technology, Masaryk University, Brno, Czechia
- First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czechia
| | | | - Anja Sander
- European Academy of Neurology, Vienna, Austria
| | - Robert Joyce
- Discipline of Occupational Therapy, School of Health Sciences, National University of Ireland, Galway, Ireland
| | - Claudio Bassetti
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
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Goebel HH, Koch A, Radbruch H, Schmid S, Friebel E, Stenzel W, Heppner FL, Capper D. Meeting report of the 20th International Congress of Neuropathology (ICN) 2023 in Berlin. Brain Pathol 2024; 34:e13249. [PMID: 38417806 PMCID: PMC10901616 DOI: 10.1111/bpa.13249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/09/2024] [Indexed: 03/01/2024] Open
Affiliation(s)
- Hans H. Goebel
- Department of NeuropathologyCharité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Arend Koch
- Department of NeuropathologyCharité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Helena Radbruch
- Department of NeuropathologyCharité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Simone Schmid
- Department of NeuropathologyCharité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Ekaterina Friebel
- Department of NeuropathologyCharité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Werner Stenzel
- Department of NeuropathologyCharité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Frank L. Heppner
- Department of NeuropathologyCharité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - David Capper
- Department of NeuropathologyCharité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ)HeidelbergGermany
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13
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Omori N, Nagai A. [Hematologic Diseases and Neurological Complications]. Brain Nerve 2024; 76:221-229. [PMID: 38514103 DOI: 10.11477/mf.1416202592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Many hematologic diseases can be complicated by neurological symptoms during the disease course. Hematologic diseases can contribute to strokes and neuropathies; thus, neurologists should be aware of them. Recent reports have increased of neurological side effects associated with new anticancer therapies such as immune checkpoint inhibitors and chimeric antigen receptor-T cell therapy. The relationship between hematologic diseases and neurological complications is expected to become more prevalent.
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Affiliation(s)
- Naoki Omori
- Department of Neurology, Shimane Prefectural Central Hospital
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14
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Wu W. Symptom Management in Children Who Are Neurologically Impaired for the Primary Care Medical Home. Pediatr Ann 2024; 53:e82-e87. [PMID: 38466328 DOI: 10.3928/19382359-20240108-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Children with neurologic impairment are a growing population of pediatric patients who require care from a large team of physicians to maintain their health. These children often have similar clinical patterns and symptoms that occur because of their neurologic impairment. Families often seek care first from their primary care home to identify and guide initial steps in management. Identifying the symptoms outlined in the 4 cases in this article will help alleviate consequences of delayed care for these patients and provide opportunities for shared decision-making with the family's goals of care for their child. [Pediatr Ann. 2024;53(3):e82-e87.].
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Rossmann T, Veldeman M, Oulasvirta E, Nurminen V, Rauch PR, Gruber A, Lehecka M, Niemelä M, Numminen J, Raj R. Long-term treatment outcomes and natural course of low-grade intracranial dural arteriovenous fistulas. Neurosurg Focus 2024; 56:E2. [PMID: 38428004 DOI: 10.3171/2024.1.focus23767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/02/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE In contrast to high-grade dural arteriovenous fistula (dAVF), low-grade dAVF is mainly associated with tinnitus and carries a low risk of morbidity and mortality. It remains unclear whether the benefits of active interventions outweigh the associated risk of complications in low-grade dAVF. METHODS The authors conducted a retrospective single-center study that included all consecutive patients diagnosed with an intracranial low-grade dAVF (Cognard type I and IIa) during 2012-2022 with DSA. The authors analyzed symptom relief, symptomatic angiographic cure, treatment-related complications, risk for intracerebral hemorrhage (ICH), and mortality. All patients were followed up until the end of 2022. RESULTS A total of 81 patients were diagnosed with a low-grade dAVF. Of these, 48 patients (59%) underwent treatment (all primary endovascular treatments), and 33 patients (41%) did not undergo treatment. Nine patients (19%) underwent retreatments. Angiographic follow-up was performed after median (IQR) 7.7 (6.1-24.1) months by means of DSA (mean 15.0, median 6.4 months, range 4.5-83.4 months) or MRA (mean 29.3, median 24.7 months, range 5.9-62.1 months). Symptom control was achieved in 98% of treated patients after final treatment. On final angiographic follow-up, 73% of patients had a completely occluded dAVF. There were 2 treatment-related complications resulting in 1 transient (2%) and 1 permanent (2%) neurological complication. One patient showed recurrence and progression of a completely occluded low-grade dAVF to an asymptomatic high-grade dAVF. No cases of ICH- or dAVF-related mortality were found in either treated patients (median [IQR] follow-up 5.1 [2.0-6.8] years) or untreated patients (median [IQR] follow-up 5.7 [3.2-9.0] years). CONCLUSIONS Treatment of low-grade dAVF provides a high rate of symptom relief with small risks for complications with neurological sequela. The risks of ICH and mortality in patients with untreated low-grade dAVF are minimal. Symptoms may not reveal high-grade recurrence, and radiological follow-up may be warranted in selected patients with treated low-grade dAVF. An optimal radiographic follow-up regimen should be developed by a future prospective multicenter registry.
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Affiliation(s)
- Tobias Rossmann
- Departments of1Neurosurgery and
- 2Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Linz, Austria
- 3Johannes Kepler University, Linz, Austria; and
| | - Michael Veldeman
- Departments of1Neurosurgery and
- 4Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | | | | | - Philip-Rudolf Rauch
- 2Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Linz, Austria
- 3Johannes Kepler University, Linz, Austria; and
| | - Andreas Gruber
- 2Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Linz, Austria
- 3Johannes Kepler University, Linz, Austria; and
| | | | | | - Jussi Numminen
- 5Radiology, Helsinki University Hospital, University of Helsinki, Finland
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16
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Dan B. Advancing definitions of paediatric neurological disorders: Lessons from adult neurology. Dev Med Child Neurol 2024; 66:270-271. [PMID: 37990477 DOI: 10.1111/dmcn.15818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
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17
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Hediyal TA, Vichitra C, Anand N, Bhaskaran M, Essa SM, Kumar P, Qoronfleh MW, Akbar M, Kaul-Ghanekar R, Mahalakshmi AM, Yang J, Song BJ, Monaghan TM, Sakharkar MK, Chidambaram SB. Protective effects of fecal microbiota transplantation against ischemic stroke and other neurological disorders: an update. Front Immunol 2024; 15:1324018. [PMID: 38449863 PMCID: PMC10915229 DOI: 10.3389/fimmu.2024.1324018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/01/2024] [Indexed: 03/08/2024] Open
Abstract
The bidirectional communication between the gut and brain or gut-brain axis is regulated by several gut microbes and microbial derived metabolites, such as short-chain fatty acids, trimethylamine N-oxide, and lipopolysaccharides. The Gut microbiota (GM) produce neuroactives, specifically neurotransmitters that modulates local and central neuronal brain functions. An imbalance between intestinal commensals and pathobionts leads to a disruption in the gut microbiota or dysbiosis, which affects intestinal barrier integrity and gut-immune and neuroimmune systems. Currently, fecal microbiota transplantation (FMT) is recommended for the treatment of recurrent Clostridioides difficile infection. FMT elicits its action by ameliorating inflammatory responses through the restoration of microbial composition and functionality. Thus, FMT may be a potential therapeutic option in suppressing neuroinflammation in post-stroke conditions and other neurological disorders involving the neuroimmune axis. Specifically, FMT protects against ischemic injury by decreasing IL-17, IFN-γ, Bax, and increasing Bcl-2 expression. Interestingly, FMT improves cognitive function by lowering amyloid-β accumulation and upregulating synaptic marker (PSD-95, synapsin-1) expression in Alzheimer's disease. In Parkinson's disease, FMT was shown to inhibit the expression of TLR4 and NF-κB. In this review article, we have summarized the potential sources and methods of administration of FMT and its impact on neuroimmune and cognitive functions. We also provide a comprehensive update on the beneficial effects of FMT in various neurological disorders by undertaking a detailed interrogation of the preclinical and clinical published literature.
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Affiliation(s)
- Tousif Ahmed Hediyal
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, KA, India
- Centre for Experimental Pharmacology and Toxicology, JSS Academy of Higher Education & Research, Mysuru, KA, India
| | - C. Vichitra
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, KA, India
- Centre for Experimental Pharmacology and Toxicology, JSS Academy of Higher Education & Research, Mysuru, KA, India
| | - Nikhilesh Anand
- Department of Pharmacology, American University of Antigua, College of Medicine, Saint John’s, Antigua and Barbuda
| | - Mahendran Bhaskaran
- College of Pharmacy and Pharmaceutical Sciences, Frederic and Mary Wolf Centre University of Toledo, Health Science, Toledo, OH, United States
| | - Saeefh M. Essa
- Department of Computer Science, Northwest High School, Bethesda, MD, United States
| | - Pravir Kumar
- Molecular Neuroscience and Functional Genomics Laboratory, Department of Biotechnology, Delhi Technological University (Formerly DCE), Delhi, India
| | - M. Walid Qoronfleh
- Q3CG Research Institute (QRI), Research and Policy Division, Ypsilanti, MI, United States
| | - Mohammed Akbar
- Division of Neuroscience and Behavior, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
| | - Ruchika Kaul-Ghanekar
- Symbiosis Centre for Research and Innovation (SCRI), Cancer Research Lab, Symbiosis School of Biological Sciences (SSBS), Symbiosis International University (SIU), Pune, Maharashtra, India
| | - Arehally M. Mahalakshmi
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, KA, India
- Centre for Experimental Pharmacology and Toxicology, JSS Academy of Higher Education & Research, Mysuru, KA, India
| | - Jian Yang
- Drug Discovery and Development Research Group, College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Byoung-Joon Song
- Section of Molecular Pharmacology and Toxicology, Laboratory of Membrane Biochemistry and Bio-physics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, MD, United States
| | - Tanya M. Monaghan
- National Institute for Health Research Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Meena Kishore Sakharkar
- Drug Discovery and Development Research Group, College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Saravana Babu Chidambaram
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, KA, India
- Centre for Experimental Pharmacology and Toxicology, JSS Academy of Higher Education & Research, Mysuru, KA, India
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18
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Graessner H, Reinhard C, Bäumer T, Baumgärtner A, Brockmann K, Brüggemann N, Bültmann E, Erdmann J, Heise K, Höglinger G, Hüning I, Kaiser FJ, Klein C, Klopstock T, Krägeloh-Mann I, Kraemer M, Luedtke K, Mücke M, Musacchio T, Nadke A, Osmanovic A, Ritter G, Röse K, Schippers C, Schöls L, Schüle R, Schulz JB, Sproß J, Stasch E, Wunderlich G, Münchau A. Recommendations for optimal interdisciplinary management and healthcare settings for patients with rare neurological diseases. Orphanet J Rare Dis 2024; 19:62. [PMID: 38347616 PMCID: PMC10863275 DOI: 10.1186/s13023-024-03023-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/11/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND In 2017, the German Academy for Rare Neurological Diseases (Deutsche Akademie für Seltene Neurologische Erkrankungen; DASNE) was founded to pave the way for an optimized personalized management of patients with rare neurological diseases (RND) in all age groups. Since then a dynamic national network for rare neurological disorders has been established comprising renowned experts in neurology, pediatric neurology, (neuro-) genetics and neuroradiology. DASNE has successfully implemented case presentations and multidisciplinary discussions both at yearly symposia and monthly virtual case conferences, as well as further educational activities covering a broad spectrum of interdisciplinary expertise associated with RND. Here, we present recommendation statements for optimized personalized management of patients with RND, which have been developed and reviewed in a structured Delphi process by a group of experts. METHODS An interdisciplinary group of 37 RND experts comprising DASNE experts, patient representatives, as well as healthcare professionals and managers was involved in the Delphi process. First, an online collection was performed of topics considered relevant for optimal patient care by the expert group. Second, a two-step Delphi process was carried out to rank the importance of the selected topics. Small interdisciplinary working groups then drafted recommendations. In two consensus meetings and one online review round these recommendations were finally consented. RESULTS 38 statements were consented and grouped into 11 topics: health care structure, core neurological expertise and core mission, interdisciplinary team composition, diagnostics, continuous care and therapy development, case conferences, exchange / cooperation between Centers for Rare Diseases and other healthcare partners, patient advocacy group, databases, translation and health policy. CONCLUSIONS This German interdisciplinary Delphi expert panel developed consented recommendations for optimal care of patients with RND in a structured Delphi process. These represent a basis for further developments and adjustments in the health care system to improve care for patients with RND and their families.
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Affiliation(s)
- Holm Graessner
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.
- Centre for Rare Diseases, University Hospital Tübingen, Tübingen, Germany.
| | - Carola Reinhard
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- Centre for Rare Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
- Center for Rare Diseases, University of Lübeck and University Hospital Medical Center, Schleswig-Holstein, Germany
| | | | - Knut Brockmann
- Interdisciplinary Pediatric Center for Children With Developmental Disabilities and Severe Chronic Disorders, Department of Pediatrics and Adolescent Medicine, University Medical Center, Göttingen, Germany
| | - Norbert Brüggemann
- Center for Rare Diseases, University of Lübeck and University Hospital Medical Center, Schleswig-Holstein, Germany
- Department of Neurology, University Hospital Medical Center Schleswig-Holstein, Schleswig-Holstein, Germany
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Eva Bültmann
- Institute of Diagnostic Und Interventional Neuroradiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jeanette Erdmann
- Institute for Cardiogenetics, DZHK (German Research Centre for Cardiovascular Research), Partner Site Hamburg/Lübeck/Kiel, and University Heart Center Lübeck, University of Lübeck, Lübeck, Germany
| | - Kirstin Heise
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, USA
- Department of Movement Sciences, Movement Control and Neural Plasticity Research Group, KU Leuven, Louvain, Belgium
| | - Günter Höglinger
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
- Department of Neurology, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Feodor-Lynen-Straße 17, 81377, Munich, Germany
| | - Irina Hüning
- Institute of Human Genetics, University of Lübeck, Lübeck, Germany
| | - Frank J Kaiser
- Essen Center for Rare Diseases (Essener Zentrum Für Seltene Erkrankungen, EZSE), University Hospital Essen, Essen, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck and University Hospital Medical Center , Schleswig-Holstein, Germany
| | - Thomas Klopstock
- Friedrich Baur Institute at the Department of Neurology, University Hospital, LMU , Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Ingeborg Krägeloh-Mann
- Department of Pediatric and Developmental Neurology, Social Pediatrics, University of Tübingen, Tübingen, Germany
| | - Markus Kraemer
- Department of Neurology, Alfried Krupp Hospital Essen, Essen, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Kerstin Luedtke
- Department of Physiotherapy, Institute of Health Sciences, University of Lübeck, Lübeck, Germany
| | - Martin Mücke
- Institute for Digitalization and General Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
- Center for Rare Diseases Aachen (ZSEA), RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Thomas Musacchio
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
- Center for Rare Diseases, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Andreas Nadke
- Deutsche Heredo-Ataxie-Gesellschaft E.V., Stuttgart, Germany
| | - Alma Osmanovic
- Essen Center for Rare Diseases (Essener Zentrum Für Seltene Erkrankungen, EZSE), University Hospital Essen, Essen, Germany
| | - Gabriele Ritter
- Klinikum Ameos, 23774 Heiligenhafen Friedrich Ebertstrrasse 100 Huntington Zentrum Nord, Heiligenhafen, Germany
| | - Katharina Röse
- Institute of Health Sciences, University of Lübeck, Lübeck, Germany
| | | | - Ludger Schöls
- Centre for Rare Diseases, University Hospital Tübingen, Tübingen, Germany
- Department of Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Rebecca Schüle
- Division of Neurodegenerative Diseases, Department of Neurology, Heidelberg University Hospital and Faculty of Medicine, Heidelberg, Germany
- Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Jörg B Schulz
- Department of Neurology and Center for Rare Diseases, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Joachim Sproß
- Deutsche Gesellschaft Für Muskelkranke e.V. Im Moos 4, 79112, Freiburg, Germany
| | - Eveline Stasch
- Deutsche PSP-Gesellschaft e.V. Weingartenstr. 28a, 61231, Bad Nauheim, Germany
| | - Gilbert Wunderlich
- Faculty of Medicine and University Hospital, Department of Neurology, University of Cologne, Cologne, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
- Center for Rare Diseases, University of Lübeck and University Hospital Medical Center, Schleswig-Holstein, Germany
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Roganovic M, Erakovic J, Radulovic L, Perunicic S, Milikic D, Vujovic B, Idrizovic Z, Vujovic S, Debeljevic M, Gluscevic S. Plasma exchange in neurology patients-experience from single center in Montenegro. Ther Apher Dial 2024; 28:125-130. [PMID: 37641163 DOI: 10.1111/1744-9987.14062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Plasma exchange (PE) is widely used in many immune-based neurological diseases. Our aim is to analyze characteristics of PE in neurological patients at the Clinical Center of Montenegro. METHODS Our study involved neurological patients treated with PE between January 2020 and April 2022. RESULTS In total, 246 PEs were performed in 43 patients. We divided patients into 4 groups according to indications. In 8/9 multiple sclerosis (MS) patients a decrease of Expanded Dysability Status Scale at least 0.5 was verified. In 14/20 Guillain Barre syndrome patients reduction of Hughes was observed. Four patients with myasthenia gravis (MG) were treated with PE. The most heterogeneous group (4) consisted of patients in whom the mechanism of disease development is assumed to be immune system dysregulation. Fourteen patients had any adverse event. CONCLUSION Our results show that PE is widely used and safe in the treatment of neurological diseases.
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Affiliation(s)
- Milovan Roganovic
- Clinic for Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Jevto Erakovic
- Clinic for Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Ljiljana Radulovic
- Clinic for Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Slavisa Perunicic
- Clinic for Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Dragica Milikic
- Clinic for Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Balsa Vujovic
- Clinic for Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Zilha Idrizovic
- Clinic for Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Sandra Vujovic
- Clinic for Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Mladen Debeljevic
- Clinic for Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Sanja Gluscevic
- Clinic for Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro
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20
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Maida E, Bresciamorra V, Triassi M, Lanzillo R, Bonavita S, Lavorgna L. Cost-Analysis of Telemedicine Interventions Compared with Traditional Care in the Management of Chronic Neurological Diseases: A Systematic Review. Telemed J E Health 2024; 30:404-414. [PMID: 37466471 DOI: 10.1089/tmj.2023.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Background: Telemedicine has proven successful in relieving the burden of chronic neurological disorders from the national health care systems by ensuring a highly customized and effective management plan. Although many studies focus on assessing telemedicine effectiveness, little is known about the economic implications of telemedicine applications in chronic neurological diseases (CNDs). This issue could account for a lack of widespread implementation. Objective: Our study attempted to fill this gap by systematically reviewing scientific literature on the economic evaluation of telemedicine compared with traditional care in the management of CNDs. Methods: We performed a literature search on PubMed, Google Scholar, Scopus, Embase, and Medline. The inclusion criteria were as follows: (1) studies with a full cost-analysis; (2) randomized controlled trials; (3) studies comparing telemedicine interventions with traditional care; (4) articles focusing only on CNDs. Conversely, the exclusion criteria were as follows: (1) studies focusing on acute neurological conditions or other diseases and (2) study protocols, case report, duplicate articles, abstract only, books, letters to editors, and review articles. Results: Ten articles met the inclusion criteria. Three different approaches of telemedicine intervention could be identified: digital cognitive-behavioral therapy (CBT), motor telerehabilitation, and home monitoring and assessment devices. Conclusion: Cost-analysis showed an overall benefit in terms of both cost and effectiveness from the application of telemedicine instead of in-presence management in CNDs. Among the identified interventions, digital CBT proved to be the most cost-saving. However, promising results were also found in monitoring and assessment devices and in telerehabilitation. Definitely, however, more thorough, comprehensive, and high-quality economic evaluation studies are needed.
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Affiliation(s)
- Elisabetta Maida
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Napoli, Italy
| | - Vincenzo Bresciamorra
- Department of Neurosciences and Reproductive and Odontostomatological Sciences and University "Federico II" of Naples, Naples, Italy
| | - Maria Triassi
- Department of Public Health, University "Federico II" of Naples, Naples, Italy
- Interdepartmental Research Center in Healthcare Management and Innovation in Healthcare (CIRMIS), University "Federico II" of Naples, Naples, Italy
| | - Roberta Lanzillo
- Department of Neurosciences and Reproductive and Odontostomatological Sciences and University "Federico II" of Naples, Naples, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Napoli, Italy
| | - Luigi Lavorgna
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Napoli, Italy
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21
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Dratch L, Azage M, Baldwin A, Johnson K, Paul RA, Bardakjian TM, Michon SC, Amado DA, Baer M, Deik AF, Elman LB, Gonzalez-Alegre P, Guo MH, Hamedani AG, Irwin DJ, Lasker A, Orthmann-Murphy J, Quinn C, Tropea TF, Scherer SS, Ellis CA. Genetic testing in adults with neurologic disorders: indications, approach, and clinical impacts. J Neurol 2024; 271:733-747. [PMID: 37891417 DOI: 10.1007/s00415-023-12058-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
The role of genetic testing in neurologic clinical practice has increased dramatically in recent years, driven by research on genetic causes of neurologic disease and increased availability of genetic sequencing technology. Genetic testing is now indicated for adults with a wide range of common neurologic conditions. The potential clinical impacts of a genetic diagnosis are also rapidly expanding, with a growing list of gene-specific treatments and clinical trials, in addition to important implications for prognosis, surveillance, family planning, and diagnostic closure. The goals of this review are to provide practical guidance for clinicians about the role of genetics in their practice and to provide the neuroscience research community with a broad survey of current progress in this field. We aim to answer three questions for the neurologist in practice: Which of my patients need genetic testing? What testing should I order? And how will genetic testing help my patient? We focus on common neurologic disorders and presentations to the neurology clinic. For each condition, we review the most current guidelines and evidence regarding indications for genetic testing, expected diagnostic yield, and recommended testing approach. We also focus on clinical impacts of genetic diagnoses, highlighting a number of gene-specific therapies recently approved for clinical use, and a rapidly expanding landscape of gene-specific clinical trials, many using novel nucleotide-based therapeutic modalities like antisense oligonucleotides and gene transfer. We anticipate that more widespread use of genetic testing will help advance therapeutic development and improve the care, and outcomes, of patients with neurologic conditions.
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Affiliation(s)
- Laynie Dratch
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, 3 West Gates Building, Philadelphia, PA, 19104, USA
| | - Meron Azage
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, 3 West Gates Building, Philadelphia, PA, 19104, USA
| | - Aaron Baldwin
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, 3 West Gates Building, Philadelphia, PA, 19104, USA
| | - Kelsey Johnson
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, 3 West Gates Building, Philadelphia, PA, 19104, USA
| | - Rachel A Paul
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, 3 West Gates Building, Philadelphia, PA, 19104, USA
| | - Tanya M Bardakjian
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, 3 West Gates Building, Philadelphia, PA, 19104, USA
- Sarepta Therapeutics Inc, Cambridge, MA, 02142, USA
| | - Sara-Claude Michon
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, 3 West Gates Building, Philadelphia, PA, 19104, USA
| | - Defne A Amado
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, 3 West Gates Building, Philadelphia, PA, 19104, USA
| | - Michael Baer
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, 3 West Gates Building, Philadelphia, PA, 19104, USA
| | - Andres F Deik
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, 3 West Gates Building, Philadelphia, PA, 19104, USA
| | - Lauren B Elman
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, 3 West Gates Building, Philadelphia, PA, 19104, USA
| | - Pedro Gonzalez-Alegre
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, 3 West Gates Building, Philadelphia, PA, 19104, USA
- Spark Therapeutics Inc, Philadelphia, PA, 19104, USA
| | - Michael H Guo
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, 3 West Gates Building, Philadelphia, PA, 19104, USA
| | - Ali G Hamedani
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, 3 West Gates Building, Philadelphia, PA, 19104, USA
| | - David J Irwin
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, 3 West Gates Building, Philadelphia, PA, 19104, USA
| | - Aaron Lasker
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, 3 West Gates Building, Philadelphia, PA, 19104, USA
| | - Jennifer Orthmann-Murphy
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, 3 West Gates Building, Philadelphia, PA, 19104, USA
| | - Colin Quinn
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, 3 West Gates Building, Philadelphia, PA, 19104, USA
| | - Thomas F Tropea
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, 3 West Gates Building, Philadelphia, PA, 19104, USA
| | - Steven S Scherer
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, 3 West Gates Building, Philadelphia, PA, 19104, USA
| | - Colin A Ellis
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, 3 West Gates Building, Philadelphia, PA, 19104, USA.
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22
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Chai X, Cao T, He Q, Wang N, Zhang X, Shan X, Lv Z, Tu W, Yang Y, Zhao J. Brain-computer interface digital prescription for neurological disorders. CNS Neurosci Ther 2024; 30:e14615. [PMID: 38358054 PMCID: PMC10867871 DOI: 10.1111/cns.14615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/13/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
Neurological and psychiatric diseases can lead to motor, language, emotional disorder, and cognitive, hearing or visual impairment By decoding the intention of the brain in real time, the Brain-computer interface (BCI) can first assist in the diagnosis of diseases, and can also compensate for its damaged function by directly interacting with the environment; In addition, provide output signals in various forms, such as actual motion, tactile or visual feedback, to assist in rehabilitation training; Further intervention in brain disorders is achieved by close-looped neural modulation. In this article, we envision the future BCI digital prescription system for patients with different functional disorders and discuss the key contents in the prescription the brain signals, coding and decoding protocols and interaction paradigms, and assistive technology. Then, we discuss the details that need to be specially included in the digital prescription for different intervention technologies. The third part summarizes previous examples of intervention, focusing on how to select appropriate interaction paradigms for patients with different functional impairments. For the last part, we discussed the indicators and influencing factors in evaluating the therapeutic effect of BCI as intervention.
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Affiliation(s)
- Xiaoke Chai
- Brain Computer Interface Transitional Research Center, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Center for Neurological DisordersBeijingChina
- Translation Laboratory of Clinical MedicineChinese Institute for Brain Research & Beijing Tiantan HospitalBeijingChina
| | - Tianqing Cao
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Qiheng He
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Nan Wang
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Xuemin Zhang
- National Research Center for Rehabilitation Technical AidsBeijingChina
| | - Xinying Shan
- National Research Center for Rehabilitation Technical AidsBeijingChina
| | - Zeping Lv
- National Research Center for Rehabilitation Technical AidsBeijingChina
| | - Wenjun Tu
- Translation Laboratory of Clinical MedicineChinese Institute for Brain Research & Beijing Tiantan HospitalBeijingChina
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Yi Yang
- Brain Computer Interface Transitional Research Center, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Center for Neurological DisordersBeijingChina
- Translation Laboratory of Clinical MedicineChinese Institute for Brain Research & Beijing Tiantan HospitalBeijingChina
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- National Research Center for Rehabilitation Technical AidsBeijingChina
- Beijing Institute of Brain DisordersBeijingChina
- Chinese Institute for Brain ResearchBeijingChina
| | - Jizong Zhao
- Brain Computer Interface Transitional Research Center, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Center for Neurological DisordersBeijingChina
- Translation Laboratory of Clinical MedicineChinese Institute for Brain Research & Beijing Tiantan HospitalBeijingChina
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
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23
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Li H, Yuan Y, Xie Q, Dong Z. Exosomes: potential targets for the diagnosis and treatment of neuropsychiatric disorders. J Transl Med 2024; 22:115. [PMID: 38287384 PMCID: PMC10826005 DOI: 10.1186/s12967-024-04893-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/14/2024] [Indexed: 01/31/2024] Open
Abstract
The field of neuropsychiatry is considered a middle ground between neurological and psychiatric disorders, thereby bridging the conventional boundaries between matter and mind, consciousness, and function. Neuropsychiatry aims to evaluate and treat cognitive, behavioral, and emotional disorders in individuals with neurological conditions. However, the pathophysiology of these disorders is not yet fully understood, and objective biological indicators for these conditions are currently lacking. Treatment options are also limited due to the blood-brain barrier, which results in poor treatment effects. Additionally, many drugs, particularly antipsychotic drugs, have adverse reactions, which make them difficult to tolerate for patients. As a result, patients often abandon treatment owing to these adverse reactions. Since the discovery of exosomes in 1983, they have been extensively studied in various diseases owing to their potential as nanocellulators for information exchange between cells. Because exosomes can freely travel between the center and periphery, brain-derived exosomes can reflect the state of the brain, which has considerable advantages in diagnosis and treatment. In addition, administration of engineered exosomes can improve therapeutic efficacy, allow lesion targeting, ensure drug stability, and prevent systemic adverse effects. Therefore, this article reviews the source and biological function of exosomes, relationship between exosomes and the blood-brain barrier, relationship between exosomes and the pathological mechanism of neuropsychiatric disorders, exosomes in the diagnosis and treatment of neuropsychiatric disorders, and application of engineered exosomes in neuropsychiatric disorders.
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Affiliation(s)
- Haorao Li
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yanling Yuan
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Qinglian Xie
- Department of Outpatient, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
| | - Zaiquan Dong
- Department of Psychiatry and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
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24
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Nguyen L. RNA therapeutics for neurological disease. Prog Mol Biol Transl Sci 2024; 203:165-180. [PMID: 38359997 DOI: 10.1016/bs.pmbts.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Neurological disorders are the group of diseases that primarily affect the center nervous system, which could lead to a significant negative impact on the ability of learning new skills, speaking, breathing, walking, judging, making decision, and other essential living skills. In the last decade, neurological disorders have significantly increased their impact to our community and become the one of leading causes of disability and death. The World Health Organization has identified neurological disorders including Alzheimer's disease and other dementia as the health crisis for the modern life. Tremendous ongoing research efforts focus on understanding of disease genetics, molecular mechanisms and developing therapeutic interventions. Because of the urgent need of the effective therapeutics and the recent advances in the toolkits and understanding for developing more drug-like RNA molecules, there is a growing interest for developing RNA therapeutics for neurological disorders. This article will discuss genetics and mechanisms of neurological disorders and how RNA-based molecules have been used to develop therapeutics for this group of diseases, challenges of RNA therapeutics and future perspectives on this rising therapeutic intervention tool.
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Affiliation(s)
- Lien Nguyen
- Department of Molecular Genetics and Microbiology, Center for NeuroGenetics, University of Florida, Cancer Genetics Research Complex (CGRC), Gainesville, FL, United States.
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25
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Okar SV, Fagiani F, Absinta M, Reich DS. Imaging of brain barrier inflammation and brain fluid drainage in human neurological diseases. Cell Mol Life Sci 2024; 81:31. [PMID: 38212566 PMCID: PMC10838199 DOI: 10.1007/s00018-023-05073-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/22/2023] [Accepted: 11/29/2023] [Indexed: 01/13/2024]
Abstract
The intricate relationship between the central nervous system (CNS) and the immune system plays a crucial role in the pathogenesis of various neurological diseases. Understanding the interactions among the immunopathological processes at the brain borders is essential for advancing our knowledge of disease mechanisms and developing novel diagnostic and therapeutic approaches. In this review, we explore the emerging role of neuroimaging in providing valuable insights into brain barrier inflammation and brain fluid drainage in human neurological diseases. Neuroimaging techniques have enabled us not only to visualize and assess brain structures, but also to study the dynamics of the CNS in health and disease in vivo. By analyzing imaging findings, we can gain a deeper understanding of the immunopathology observed at the brain-immune interface barriers, which serve as critical gatekeepers that regulate immune cell trafficking, cytokine release, and clearance of waste products from the brain. This review explores the integration of neuroimaging data with immunopathological findings, providing valuable insights into brain barrier integrity and immune responses in neurological diseases. Such integration may lead to the development of novel diagnostic markers and targeted therapeutic approaches that can benefit patients with neurological disorders.
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Affiliation(s)
- Serhat V Okar
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Francesca Fagiani
- Translational Neuropathology Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Martina Absinta
- Translational Neuropathology Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy.
- Division of Neuroscience, Vita-Salute San Raffaele University, 20132, Milan, Italy.
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, 20892, USA.
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26
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Luo EY, Sugimura RR. Taming microglia: the promise of engineered microglia in treating neurological diseases. J Neuroinflammation 2024; 21:19. [PMID: 38212785 PMCID: PMC10785527 DOI: 10.1186/s12974-024-03015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024] Open
Abstract
Microglia, the CNS-resident immune cells, are implicated in many neurological diseases. Nearly one in six of the world's population suffers from neurological disorders, encompassing neurodegenerative and neuroautoimmune diseases, most with dysregulated neuroinflammation involved. Activated microglia become phagocytotic and secret various immune molecules, which are mediators of the brain immune microenvironment. Given their ability to penetrate through the blood-brain barrier in the neuroinflammatory context and their close interaction with neurons and other glial cells, microglia are potential therapeutic delivery vehicles and modulators of neuronal activity. Re-engineering microglia to treat neurological diseases is, thus, increasingly gaining attention. By altering gene expression, re-programmed microglia can be utilized to deliver therapeutics to targeted sites and control neuroinflammation in various neuroinflammatory diseases. This review addresses the current development in microglial engineering, including genetic targeting and therapeutic modulation. Furthermore, we discuss limitations to the genetic engineering techniques and models used to test the functionality of re-engineered microglia, including cell culture and animal models. Finally, we will discuss future directions for the application of engineered microglia in treating neurological diseases.
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Affiliation(s)
- Echo Yongqi Luo
- School of Biological Sciences, Faculty of Science, The University of Hong Kong, Pokfulam, Hong Kong
| | - Rio Ryohichi Sugimura
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
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27
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Cheng M, Ding Y, Kim E, Geng X. Exploring the Therapeutic Potential of Peritoneal Dialysis (PD) in the Treatment of Neurological Disorders. Cell Transplant 2024; 33:9636897241236576. [PMID: 38506429 PMCID: PMC10956140 DOI: 10.1177/09636897241236576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 03/21/2024] Open
Abstract
Peritoneal dialysis (PD) is a well-established renal replacement therapy commonly employed in clinical practice. While its primary application is in the treatment of kidney disease, its potential in addressing other systemic disorders, including neurological diseases, has garnered increasing interest. This study provides a comprehensive overview of the related technologies, unique advantages, and clinical applications of PD in the context of neurological disorders. By exploring the mechanism underlying PD, its application in neurological diseases, and associated complications, we addressed the feasibility and benefits of PD as an adjunct therapy for various neurological conditions. Our study aims to highlight its role in detoxification and symptom management, as well as its advantages over other universally accepted methods of renal replacement therapy. Our goal is to bring to the spotlight the therapeutic potential of PD in neurological diseases, such as stroke, stimulate further research, and broaden the scope of its application in the clinical setting.
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Affiliation(s)
- Muyuan Cheng
- Luhe Institute of Neuroscience, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Enoch Kim
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xiaokun Geng
- Luhe Institute of Neuroscience, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
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28
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Fatima SM, Khan A, Asghar B. Use of probiotics in treating psychiatric and neurological disorders. J PAK MED ASSOC 2024; 74:202. [PMID: 38219197 DOI: 10.47391/jpma.10044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
To the Editor,
The gut-brain axis is a bidirectional pathway through which the central nervous system and gut microbiota communicate. Metabolites from the gut microbiota can interact with ANS gut synapses, similarly, gut physiology can be controlled by the ANS. Visceral sensory signals from the gut travel to the CNS via the vagus nerve and can influence mood changes. Any alterations in this complex pathway can lead to the development of several gastrointestinal, psychiatric, and neurological disorders that include depression, anxiety, Alzheimer’s disease and Parkinson’s disorder [1-2]. As the relationship between psychiatric and gastrointestinal symptoms becomes well-established with 60% of patients with gastroenterological complaints having psychiatric origins [3], the question arises of whether it would be beneficial to focus on the gut microbiota and use probiotics to treat psychiatric and neurological ailments.
Recent research has opened a new door to targeting the gut microbiota to treat disorders such as depression, anxiety, Alzheimer's disease, Parkinson's disease, and autism spectrum disorder [1]. The effect of modifying gut microbiota to treat psychiatric illnesses that include depression, anxiety, and schizophrenia has been studied, showing that the use of probiotics can alleviate depression but has no effect on schizophrenia. The gut microbiota influences the hypothalamic-pituitary-adrenal axis, allowing probiotics to alter the stress response of cortisol; however, sufficient data is not available to comment on the effect of probiotics on anxiety [4]. Furthermore, the scope of probiotics seems to extend beyond mood disorders to relieving symptoms of neurological disorders that include Parkinson’s, migraine and epilepsy [5]
The close relationship of gastrointestinal and neuropsychiatric health often results in disorders of both systems appearing concomitantly and GIT manifestations are often dismissed as being caused by the psychiatric complain; however, we may look at the other side of the picture which is that gastrointestinal dysbiosis may be a cause or an exacerbating factor of the neuropsychiatric symptoms in which case probiotics can be a reliable treatment. More evidence needs to be obtained on their effectiveness and whether they may be used as stand-alone or along with other medications.
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Affiliation(s)
| | - Areeb Khan
- Final Year MBBS Student, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Bushra Asghar
- Final Year MBBS Student, Jinnah Sindh Medical University, Karachi, Pakistan
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29
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Santilli F, Fabrizi J, Santacroce C, Caissutti D, Spinello Z, Candelise N, Lancia L, Pulcini F, Delle Monache S, Mattei V. Analogies and Differences Between Dental Stem Cells: Focus on Secretome in Combination with Scaffolds in Neurological Disorders. Stem Cell Rev Rep 2024; 20:159-174. [PMID: 37962698 PMCID: PMC10799818 DOI: 10.1007/s12015-023-10652-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 11/15/2023]
Abstract
Mesenchymal stem cells (MSCs) are well known for their beneficial effects, differentiation capacity and regenerative potential. Dental-derived MSCs (DSCs) are more easily accessible and have a non-invasive isolation method rather than MSCs isolated from other sources (umbilical cord, bone marrow, and adipose tissue). In addition, DSCs appear to have a relevant neuro-regenerative potential due to their neural crest origin. However, it is now known that the beneficial effects of MSCs depend, at least in part, on their secretome, referring to all the bioactive molecules (neurotrophic factors) released in the conditioned medium (CM) or in the extracellular vesicles (EVs) in particular exosomes (Exos). In this review, we described the similarities and differences between various DSCs. Our focus was on the secretome of DSCs and their applications in cell therapy for neurological disorders. For neuro-regenerative purposes, the secretome of different DSCs has been tested. Among these, the secretome of dental pulp stem cells and stem cells from human exfoliated deciduous teeth have been the most widely studied. Both CM and Exos obtained from DSCs have been shown to promote neurite outgrowth and neuroprotective effects as well as their combination with scaffold materials (to improve their functional integration in the tissue). For these reasons, the secretome obtained from DSCs in combination with scaffold materials may represent a promising tissue engineering approach for neuroprotective and neuro-regenerative treatments.
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Affiliation(s)
- Francesca Santilli
- Biomedicine and Advanced Technologies Rieti Center, "Sabina Universitas", Via A.M. Ricci 35/A, 02100, Rieti, Italy
| | - Jessica Fabrizi
- Department of Experimental Medicine, "Sapienza" University, Viale Regina Elena 324, 00161, Rome, Italy
| | - Costantino Santacroce
- Biomedicine and Advanced Technologies Rieti Center, "Sabina Universitas", Via A.M. Ricci 35/A, 02100, Rieti, Italy
| | - Daniela Caissutti
- Department of Experimental Medicine, "Sapienza" University, Viale Regina Elena 324, 00161, Rome, Italy
| | - Zaira Spinello
- Department of Experimental Medicine, "Sapienza" University, Viale Regina Elena 324, 00161, Rome, Italy
| | - Niccolò Candelise
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Viale Regina Elena, 29900161, Rome, Italy
| | - Loreto Lancia
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy
| | - Fanny Pulcini
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy
| | - Simona Delle Monache
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy.
| | - Vincenzo Mattei
- Dipartimento di Scienze della Vita, della Salute e delle Professioni Sanitarie, Link Campus University, Via del Casale di San Pio V 44, 00165, Rome, Italy.
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30
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Ahmed W, Huang S, Chen L. Engineered exosomes derived from stem cells: a new brain-targeted strategy. Expert Opin Drug Deliv 2024; 21:91-110. [PMID: 38258509 DOI: 10.1080/17425247.2024.2306877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/15/2024] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Using engineered exosomes produced from stem cells is an experimental therapeutic approach for treating brain diseases. According to reports, preclinical research has demonstrated notable neurogenesis and angiogenesis effects using modified stem cell-derived exosomes. These biological nanoparticles have a variety of anti-apoptotic, anti-inflammatory, and antioxidant properties that make them very promising for treating nervous system disorders. AREAS COVERED This review examines different ways to enhance the delivery of modified stem cell-derived exosomes, how they infiltrate the blood-brain barrier (BBB), and how they facilitate their access to the brain. We would also like to determine whether these nanoparticles have the most significant transmission rates through BBB when targeting brain lesions. EXPERT OPINION Using engineered stem cell-derived exosomes for treating brain disorders has generated considerable attention toward clinical research and application. However, stem cell-derived exosomes lack consistency, and their mechanisms of action are uncertain. Therefore, upcoming research needs to prioritize examining the underlying mechanisms and strategies via which these nanoparticles combat neurological disorders.
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Affiliation(s)
- Waqas Ahmed
- Department of Neurosurgery, Integrated Traditional Chinese and Western Medicine Hospital, Southern Medical University, Guangzhou, Guangdong, China
- School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Songze Huang
- Department of Neurosurgery, Integrated Traditional Chinese and Western Medicine Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Lukui Chen
- Department of Neurosurgery, Integrated Traditional Chinese and Western Medicine Hospital, Southern Medical University, Guangzhou, Guangdong, China
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31
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Balaji S, Chakraborty R, Aggarwal S. Neurological Complications Caused by Human Immunodeficiency Virus (HIV) and Associated Opportunistic Co-infections: A Review on their Diagnosis and Therapeutic Insights. CNS Neurol Disord Drug Targets 2024; 23:284-305. [PMID: 37005520 DOI: 10.2174/1871527322666230330083708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 12/28/2022] [Accepted: 01/25/2023] [Indexed: 04/04/2023]
Abstract
Neurocognitive disorders associated with human immunodeficiency virus (HIV) infected individuals increase the risk of mortality and morbidity that remain a prevalent clinical complication even in the antiretroviral therapy era. It is estimated that a considerable number of people in the HIV community are developing neurological complications at their early stages of infection. The daily lives of people with chronic HIV infections are greatly affected by cognitive declines such as loss of attention, learning, and executive functions, and other adverse conditions like neuronal injury and dementia. It has been found that the entry of HIV into the brain and subsequently crossing the blood-brain barrier (BBB) causes brain cell damage, which is the prerequisite for the development of neurocognitive disorders. Besides the HIV replication in the central nervous system and the adverse effects of antiretroviral therapy on the BBB, a range of opportunistic infections, including viral, bacterial, and parasitic agents, augment the neurological complications in people living with HIV (PLHIV). Given the immuno-compromised state of PLHIV, these co-infections can present a wide range of clinical syndromes with atypical manifestations that pose challenges in diagnosis and clinical management, representing a substantial burden for the public health system. Therefore, the present review narrates the neurological complications triggered by HIV and their diagnosis and treatment options. Moreover, coinfections that are known to cause neurological disorders in HIV infected individuals are highlighted.
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Affiliation(s)
- Sivaraman Balaji
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research-Headquarters, Ansari Nagar, New Delhi, 110029, India
| | - Rohan Chakraborty
- Department of Medical Elementology and Toxicology, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi 110062, India
| | - Sumit Aggarwal
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research-Headquarters, Ansari Nagar, New Delhi, 110029, India
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Connors MH, Quinto L, Deeley Q, Halligan PW, Oakley DA, Kanaan RA. Hypnosis and suggestion as interventions for functional neurological disorder: A systematic review. Gen Hosp Psychiatry 2024; 86:92-102. [PMID: 38154334 DOI: 10.1016/j.genhosppsych.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/10/2023] [Accepted: 12/10/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE Functional neurological disorder (FND) involves the presence of neurological symptoms that cannot be explained by neurological disease. FND has long been linked to hypnosis and suggestion, both of which have been used as treatments. Given ongoing interest, this review examined evidence for the efficacy of hypnosis and suggestion as treatment interventions for FND. METHOD A systematic search of bibliographic databases was conducted to identify group studies published over the last hundred years. No restrictions were placed on study design, language, or clinical setting. Two reviewers independently assessed papers for inclusion, extracted data, and rated study quality. RESULTS The search identified 35 studies, including 5 randomised controlled trials, 2 non-randomised trials, and 28 pre-post studies. Of 1584 patients receiving either intervention, 1379 (87%) showed significant improvements, including many who demonstrated resolution of their symptoms in the short-term. Given the heterogeneity of interventions and limitations in study quality overall, more formal quantitative synthesis was not possible. CONCLUSIONS The findings highlight longstanding and ongoing interest in using hypnosis and suggestion as interventions for FND. While the findings appear promising, limitations in the evidence base, reflecting limitations in FND research more broadly, prevent definitive recommendations. Further research seems warranted given these supportive findings.
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Affiliation(s)
- Michael H Connors
- Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, Australia; Department of Psychiatry, University of Melbourne, Austin Health, Melbourne, Australia.
| | - Lena Quinto
- Forensic & Analytical Science Services, NSW Health, Sydney, Australia
| | - Quinton Deeley
- Cultural and Social Neuroscience Research Group, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - David A Oakley
- School of Psychology, Cardiff University, Cardiff, UK; Division of Psychology & Language Sciences, University College London, London, UK
| | - Richard A Kanaan
- Department of Psychiatry, University of Melbourne, Austin Health, Melbourne, Australia
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Wang YY, Cheng J, Liu YD, Wang YP, Yang QW, Zhou N. Exosome-based regenerative rehabilitation: A novel ice breaker for neurological disorders. Biomed Pharmacother 2023; 169:115920. [PMID: 37995565 DOI: 10.1016/j.biopha.2023.115920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/11/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023] Open
Abstract
Neurological disorders affect a large population, often leading to different levels of disability and resulting in decreased quality of life. Due to the limited recovery obtained from surgical procedures and other medical approaches, a large number of patients with prolonged dysfunction receive neurorehabilitation protocols to improve their neural plasticity and regeneration. However, the poor neural regeneration ability cannot effectively rebuild the tissue integrity and neural functional networks; consequently, the prognoses of neurorehabilitation remain undetermined. To increase the chances of neural regeneration and functional recovery for patients with neurological disorders, regenerative rehabilitation was introduced with combined regenerative medicine and neurorehabilitation protocols to repair neural tissue damage and create an optimized biophysical microenvironment for neural regeneration potential. With the deepening of exosome research, an increasing number of studies have found that the systemic therapeutic effects of neurorehabilitation approaches are mediated by exosomes released by physically stimulated cells, which provides new insight into rehabilitative mechanisms. Meanwhile, exosome therapy also serves as an alternative cell-free therapy of regenerative medicine that is applied in partnership with neurorehabilitation approaches and formulates exosome-based neurological regenerative rehabilitation. In this study, we review the current state of exosome-associated neurorehabilitation. On the one hand, we focus on presenting the varied mediating effects of exosomes in neurorehabilitation protocols of specific neurological pathologies; on the other hand, we discuss the diverse combinations of exosome therapies and neurorehabilitation approaches in the field of neurological regenerative rehabilitation, aiming to increase the awareness of exosome research and applications in the rehabilitation of neurological disorders.
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Affiliation(s)
- Yuan-Yi Wang
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Jin Cheng
- Department of Sport Medicine, Peking University Third Hospital, Beijing, China
| | - Ya-Dong Liu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yi-Peng Wang
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China.
| | - Qi-Wei Yang
- Medical Research Center, The Second Hospital of Jilin University, Changchun, Jilin Province, China.
| | - Nan Zhou
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Henan Province, China.
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Wang N. Neurologic Complications of Cancer Immunotherapy. Continuum (Minneap Minn) 2023; 29:1827-1843. [PMID: 38085900 DOI: 10.1212/con.0000000000001362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE Immunotherapeutic approaches have revolutionized cancer treatment with immune checkpoint inhibitors and adoptive T-cell therapy now approved to treat a variety of solid and hematologic malignancies. This article summarizes the distinctive neurologic side effects of these therapies as well as their management. LATEST DEVELOPMENTS Neurologic immune-related adverse events are rare but potentially serious complications of immune checkpoint inhibitors. Both peripheral and central nervous system disorders have been described, often necessitating a pause or cessation of immunotherapy. Immune effector cell-associated neurotoxicity syndrome is a potentially serious complication of chimeric antigen receptor T-cell therapy. While symptoms may be mild and self-limited, delirium, encephalopathy, seizures, focal neurologic deficits, and fulminant cerebral edema can be seen. Close neurologic monitoring is imperative. The mainstay of treatment for neurologic complications includes high-dose corticosteroids, although other immunomodulatory strategies may be used in severe or refractory cases. ESSENTIAL POINTS The spectrum of neurologic complications of cancer immunotherapy is broad, encompassing both central and peripheral nervous system disorders, indolent as well as fulminant clinical presentations, and wide-ranging severity with variable response to treatment. Early identification and multidisciplinary management are crucial to balance neurologic recovery and antitumor control.
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McArthur JC, Augustine EF, Carmichael ST, Ferriero DM, Jensen FE, Jeste SS, Jordan LC, Llinas RH, Schlaggar BL, Sun LR, Pomeroy SL. Recognizing and Responding to the Needs of Future Child and Adult Neurology Care Through the Evolution of Residency Training. Ann Neurol 2023; 94:1005-1007. [PMID: 37755722 DOI: 10.1002/ana.26809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 09/28/2023]
Abstract
Recent insights into the frequency of occurrence and the genetic and mechanistic basis of nervous system disease have demonstrated that neurologic disorders occur as a spectrum across all ages. To meet future needs of patients with neurologic disease of all ages and prepare for increasing implementaton of precision therapies, greater integration of child and adult neurology residency training is needed. ANN NEUROL 2023;94:1005-1007.
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Affiliation(s)
| | - Erika F Augustine
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Kennedy Krieger Institute, Baltimore, MD, USA
| | - S Thomas Carmichael
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Donna M Ferriero
- Departments of Neurology and Pediatrics, University of California, San Francisco, CA, USA
| | - Frances E Jensen
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shafali S Jeste
- Departments of Neurology and Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rafael H Llinas
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bradley L Schlaggar
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Kennedy Krieger Institute, Baltimore, MD, USA
| | - Lisa R Sun
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Scott L Pomeroy
- Department of Neurology, Harvard Medical School, Boston, MA, USA
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36
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Fischer D. Come hell or high water: climate change through the lens of neurocritical care. Intensive Care Med 2023; 49:1526-1528. [PMID: 37982823 DOI: 10.1007/s00134-023-07253-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/10/2023] [Indexed: 11/21/2023]
Affiliation(s)
- David Fischer
- Division of Neurocritical Care, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 1 Convention Ave., Pavilion, 10th floor, NeuroICU, Philadelphia, PA, 19104, USA.
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37
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Hommel S, Lücke T, Schmidt-Choudhury A. Nutritional Management in Children and Adolescents with Severe Neurological Impairment-Who Cares? A Web-Based Survey Among Pediatric Specialists in Germany. Neuropediatrics 2023; 54:371-380. [PMID: 37607575 DOI: 10.1055/s-0043-1772708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND Nutritional management of children and adolescents with severe neurological impairment (SNI) is challenging. A web-based survey was distributed to identify the present situation and the knowledge of the involved medical professionals in Germany. METHODS The survey was created with LimeSurvey, and access data were distributed by several medical societies. Eighty-three questions covered four topics: "general information," "gastro- and jejunostomy procedure," "handling of gastrostomies and feeding tubes," and "nutritional management and follow-up of children and adolescents with SNI." A descriptive analysis was performed with Microsoft Excel. RESULTS A total of 156 participated (65 completed and 91 partially), 27% being pediatric gastroenterologists, 23% pediatric neurologists, and 10% pediatric surgeons. The most common indications for gastrostomy and tube feeding were oropharyngeal dysfunction and failure to thrive. Many patients were still underweight after some months of enteral feeding. The procedure of gastrostomy and handling recommendations varied broadly. Frequently, standard operating procedures (SOPs) and written local guidelines did not exist, and there was a considerable request for training. Only 53% of participants were aware of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition position paper published in 2017, even fewer (38%) followed the guidelines. The recommended measures to assess a nutritional status were often not respected. CONCLUSION Nutritional management of children and adolescents with SNI in Germany is still strongly deficient. Despite the international guideline of 2017, few colleagues are aware of and adhere to the recommendations. This could be improved by interdisciplinary teaching and evaluation of the reasons for noncompliance. The procedure of gastrostomy and the patients' follow-up vary widely. Therefore, modified SOPs should be developed.
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Affiliation(s)
- Sara Hommel
- Department of Pediatric Gastroenterology, St. Josef Hospital, University Hospital of Pediatrics and Adolescent Medicine, Ruhr University, Bochum, Germany
| | - T Lücke
- Department of Pediatric Neurology, St. Josef Hospital, University Hospital of Pediatrics and Adolescent Medicine, Ruhr University, Bochum, Germany
| | - A Schmidt-Choudhury
- Department of Pediatric Gastroenterology, St. Josef Hospital, University Hospital of Pediatrics and Adolescent Medicine, Ruhr University, Bochum, Germany
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38
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Mesnage V, Galmiche P. Medical assistance in dying and neurological disease. Rev Neurol (Paris) 2023; 179:1045-1046. [PMID: 37500353 DOI: 10.1016/j.neurol.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 07/29/2023]
Affiliation(s)
- V Mesnage
- Service de neurologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Centre d'éthique clinique de l'AP-HP, Paris, France.
| | - P Galmiche
- Centre d'éthique clinique de l'AP-HP, Paris, France
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39
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Perez DL, Finkelstein SA. Functional Neurological Disorder. Neurol Clin 2023; 41:xiii-xv. [PMID: 37775204 DOI: 10.1016/j.ncl.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Affiliation(s)
- David L Perez
- Functional Neurological Disorder Unit, Division of Behavioral Neurology, Department of Neurology, Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Sara A Finkelstein
- Functional Neurological Disorder Unit, Division of Behavioral Neurology, Division of Comprehensive Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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40
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Abstract
The idea that a neurologist would do an 'FND clinic' or that functional neurological disorder (FND) could be a subspecialty of neurology would have been outlandish even 20 years ago but has become a reality in many places around the world. In this personal review, I reflect on 25 years of being a neurologist with an interest in FND, initially as a research fellow and later as a consultant/attending. I review lessons from diagnosis and management in the hope that they may assist other neurologists embarking on a similar career as well as other health professionals whose roles overlap.
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Affiliation(s)
- Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
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41
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Bari S, Robertson NP. MRI-guided focused ultrasound: new hope for drug-resistant neurological conditions. J Neurol 2023; 270:5671-5673. [PMID: 37787811 PMCID: PMC10576717 DOI: 10.1007/s00415-023-12024-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/04/2023]
Affiliation(s)
- S Bari
- Department of Neurology, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK
| | - N P Robertson
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK.
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42
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Finkelstein SA, O'Neal MA, Gaston Baslet, Dworetzky BA, Godena E, Maggio J, Millstein D, Milligan T, Perez DL. Developing a Curriculum for Functional Neurological Disorder in Neurology Training: Questions and Answers. Neurol Clin 2023; 41:711-728. [PMID: 37775200 DOI: 10.1016/j.ncl.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Functional neurologic disorder (FND) is a common condition for which neurology residents often receive little to no formal teaching. Using a question-and-answer format, this article puts forward a case for why an FND curriculum is needed and aims to provide guidance on possible curricular content including medical knowledge, clinical skills, communication, and team-based collaboration. The authors also discuss methods for teaching and evaluating this knowledge and associated clinical skills, linking this to current Accreditation Council for Graduate Medical Education neurology milestones. Finally, the authors consider how to better engage and energize neurology trainees around this underserved yet challenging patient population.
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Affiliation(s)
- Sara A Finkelstein
- Functional Neurological Disorder Unit, Division of Behavioral Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
| | - M Angela O'Neal
- Division of General Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA.
| | - Gaston Baslet
- Division of Neuropsychiatry, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA
| | - Barbara A Dworetzky
- Division of Epilepsy, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA
| | - Ellen Godena
- Functional Neurological Disorder Unit, Division of Behavioral Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Julie Maggio
- Functional Neurological Disorder Unit, Division of Behavioral Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Department of Physical Therapy, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Daniel Millstein
- Functional Neurological Disorder Unit, Division of Behavioral Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Tracey Milligan
- Department of Neurology, Westchester Medical Center Health Network, New York Medical College, Valhalla, NY, USA
| | - David L Perez
- Functional Neurological Disorder Unit, Division of Behavioral Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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43
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Ranford J, MacLean J. Outpatient Approach to Occupational Therapy for Paroxysmal Functional Neurologic Symptoms: Sensory Modulation Training as an Emerging Treatment. Neurol Clin 2023; 41:695-709. [PMID: 37775199 DOI: 10.1016/j.ncl.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Occupational therapy (OT) is an important treatment modality for patients with paroxysmal functional neurologic disorder (FND) symptoms. In our clinical experience, an outpatient, OT-based sensory modulation treatment can address sensory processing difficulties often endorsed by patients with paroxysmal motor FND and functional seizures. This article aims to describe in detail the goals and treatment strategies for occupational therapists to replicate this approach. This article is also an important first step in aiding the development and execution of clinical trials to further evaluate the effectiveness of sensory-based treatment in patients with FND.
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Affiliation(s)
- Jessica Ranford
- Functional Neurological Disorder Unit and Research Group, Department of Neurology, Massachusetts General Hospital, Wang Ambulatory Care Center 8th Floor, Suite 835, 15 Parkman Street, Boston, MA, USA; Department of Occupational Therapy, Massachusetts General Hospital, Wang Ambulatory Care Center 1st Floor, Suite 127, 15 Parkman Street, Boston, MA 02114, USA.
| | - Julie MacLean
- Functional Neurological Disorder Unit and Research Group, Department of Neurology, Massachusetts General Hospital, Wang Ambulatory Care Center 8th Floor, Suite 835, 15 Parkman Street, Boston, MA, USA; Department of Occupational Therapy, Massachusetts General Hospital, Wang Ambulatory Care Center 1st Floor, Suite 127, 15 Parkman Street, Boston, MA 02114, USA
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44
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Shelash Al-Hawary SI, Yahya Ali A, Mustafa YF, Margiana R, Maksuda Ilyasovna S, Ramadan MF, Almalki SG, Alwave M, Alkhayyat S, Alsalamy A. The microRNAs (miRs) overexpressing mesenchymal stem cells (MSCs) therapy in neurological disorders; hope or hype. Biotechnol Prog 2023; 39:e3383. [PMID: 37642165 DOI: 10.1002/btpr.3383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/30/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023]
Abstract
Altered expression of multiple miRNAs was found to be extensively involved in the pathogenesis of different neurological disorders including Alzheimer's disease, Parkinson's disease, stroke, epilepsy, multiple sclerosis, amyotrophic lateral sclerosis, and Huntington's disease. One of the biggest concerns within gene-based therapy is the delivery of the therapeutic microRNAs to the intended place, which is obligated to surpass the biological barriers without undergoing degradation in the bloodstream or renal excretion. Hence, the delivery of modified and unmodified miRNA molecules using excellent vehicles is required. In this light, mesenchymal stem cells (MSCs) have attracted increasing attention. The MSCs can be genetically modified to express or overexpress a particular microRNA aimed with promote neurogenesis and neuroprotection. The current review has focused on the therapeutic capabilities of microRNAs-overexpressing MSCs to ameliorate functional deficits in neurological conditions.
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Affiliation(s)
| | - Anas Yahya Ali
- Department of Nursing, Al-maarif University College, Ramadi, Al-Anbar, Iraq
| | - Yasser Fakri Mustafa
- Department of Pharmaceutical Chemistry, College of Pharmacy, University of Mosul, Mosul, Iraq
| | - Ria Margiana
- Department of Anatomy, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Master's Programme Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Andrology Program, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | | | | | - Sami G Almalki
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | - Marim Alwave
- Medical Technical College, Al-Farahidi University, Baghdad, Iraq
| | - Safa Alkhayyat
- College of Pharmacy, The Islamic University, Najaf, Iraq
| | - Ali Alsalamy
- College of Technical Engineering, Imam Ja'afar Al-Sadiq University, Al-Muthanna, Iraq
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45
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Wilmshurst JM, Catsman-Berrevoets C, Gilbert DL, Nagarajan L, Samia P, Serdaroglu E, Triki C, Vidaurre J, Hameed B. Access to Pediatric Neurology Training and Services Worldwide: A Survey by the International Child Neurology Association. Neurology 2023; 101:798-808. [PMID: 37491325 PMCID: PMC10634651 DOI: 10.1212/wnl.0000000000207633] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 05/30/2023] [Indexed: 07/27/2023] Open
Abstract
Pediatric neurology is the medical subspecialty responsible for diagnosing and managing diseases and disorders of the nervous system in childhood and adolescence. In many, but not all, regions of the world, the discipline of pediatric neurology is recognized as a specialty or subspecialty of either neurology or pediatrics. Significant knowledge and competencies in this area are necessary to be effective in clinical practice. The need for this is driven by the high burden of disease from neurologic conditions in children and the effect on their families. As the first part of a multistaged project under the auspices of the International Child Neurology Association, in collaboration with key stakeholders, a survey was undertaken to establish which countries have practicing child neurologists. For those countries that have child neurologists, the survey established the number of practitioners and which countries have access to in-country child neurology training. Responses were obtained from 177 countries. Worldwide, there is a median of 0.07 and mean of 0.39 child neurologists per 100,000 population. The greatest deficits in child neurology specialists and access to training were evident in countries which fell under the World Bank rating of low-income country status (range of 0-0.008 child neurologists per 100,000 population). Seventy-three percent of low-income countries lack access to child neurologists: The majority are in the African and South-East Asia regions. For the population of 1.37 billion in the continent of Africa, there were 324 child neurologists, equating to a median of 0.01 per 100,000 population in comparison with a median of 0.59 child neurologists per 100,000 across high-income countries. Ninety-four countries had capacity to support in-country pediatric neurology training. Worldwide, there are inadequate numbers of child neurologists and a great need for increased training capacity.
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Affiliation(s)
- Jo M Wilmshurst
- From the Department of Paediatric Neurology (J.M.W.), Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa; Department of Paediatric Neurology (C.C.-B.), ErasmusMC / Sophia Childrens Hospital, Rotterdam, the Netherlands; Division of Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, OH; Department of Neurology (L.N.), Perth Children's Hospital; Faculty of Health and Medical Sciences, UWA; Telethon Kids Institute, Perth, Australia; Department of Paediatrics and Child Health (P.S.), Medical College, Aga Khan University, Nairobi, Kenya; Department of Child Neurology (E.S.), Gazi University School of Medicine, Ankara, Turkey; Child Neurology Department (C.T.), Hedi Chaker Hospital, University of Sfax, Tunisia; Pediatric Clinical Neurophysiology Fellowship (J.V.), Nationwide Children's Hospital, The Ohio State University; and Department of Paediatric Neurology and Neurodisability (B.H.), Great Ormond Street Hospital for Children, London.
| | - Coriene Catsman-Berrevoets
- From the Department of Paediatric Neurology (J.M.W.), Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa; Department of Paediatric Neurology (C.C.-B.), ErasmusMC / Sophia Childrens Hospital, Rotterdam, the Netherlands; Division of Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, OH; Department of Neurology (L.N.), Perth Children's Hospital; Faculty of Health and Medical Sciences, UWA; Telethon Kids Institute, Perth, Australia; Department of Paediatrics and Child Health (P.S.), Medical College, Aga Khan University, Nairobi, Kenya; Department of Child Neurology (E.S.), Gazi University School of Medicine, Ankara, Turkey; Child Neurology Department (C.T.), Hedi Chaker Hospital, University of Sfax, Tunisia; Pediatric Clinical Neurophysiology Fellowship (J.V.), Nationwide Children's Hospital, The Ohio State University; and Department of Paediatric Neurology and Neurodisability (B.H.), Great Ormond Street Hospital for Children, London
| | - Donald L Gilbert
- From the Department of Paediatric Neurology (J.M.W.), Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa; Department of Paediatric Neurology (C.C.-B.), ErasmusMC / Sophia Childrens Hospital, Rotterdam, the Netherlands; Division of Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, OH; Department of Neurology (L.N.), Perth Children's Hospital; Faculty of Health and Medical Sciences, UWA; Telethon Kids Institute, Perth, Australia; Department of Paediatrics and Child Health (P.S.), Medical College, Aga Khan University, Nairobi, Kenya; Department of Child Neurology (E.S.), Gazi University School of Medicine, Ankara, Turkey; Child Neurology Department (C.T.), Hedi Chaker Hospital, University of Sfax, Tunisia; Pediatric Clinical Neurophysiology Fellowship (J.V.), Nationwide Children's Hospital, The Ohio State University; and Department of Paediatric Neurology and Neurodisability (B.H.), Great Ormond Street Hospital for Children, London
| | - Lakshmi Nagarajan
- From the Department of Paediatric Neurology (J.M.W.), Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa; Department of Paediatric Neurology (C.C.-B.), ErasmusMC / Sophia Childrens Hospital, Rotterdam, the Netherlands; Division of Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, OH; Department of Neurology (L.N.), Perth Children's Hospital; Faculty of Health and Medical Sciences, UWA; Telethon Kids Institute, Perth, Australia; Department of Paediatrics and Child Health (P.S.), Medical College, Aga Khan University, Nairobi, Kenya; Department of Child Neurology (E.S.), Gazi University School of Medicine, Ankara, Turkey; Child Neurology Department (C.T.), Hedi Chaker Hospital, University of Sfax, Tunisia; Pediatric Clinical Neurophysiology Fellowship (J.V.), Nationwide Children's Hospital, The Ohio State University; and Department of Paediatric Neurology and Neurodisability (B.H.), Great Ormond Street Hospital for Children, London
| | - Pauline Samia
- From the Department of Paediatric Neurology (J.M.W.), Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa; Department of Paediatric Neurology (C.C.-B.), ErasmusMC / Sophia Childrens Hospital, Rotterdam, the Netherlands; Division of Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, OH; Department of Neurology (L.N.), Perth Children's Hospital; Faculty of Health and Medical Sciences, UWA; Telethon Kids Institute, Perth, Australia; Department of Paediatrics and Child Health (P.S.), Medical College, Aga Khan University, Nairobi, Kenya; Department of Child Neurology (E.S.), Gazi University School of Medicine, Ankara, Turkey; Child Neurology Department (C.T.), Hedi Chaker Hospital, University of Sfax, Tunisia; Pediatric Clinical Neurophysiology Fellowship (J.V.), Nationwide Children's Hospital, The Ohio State University; and Department of Paediatric Neurology and Neurodisability (B.H.), Great Ormond Street Hospital for Children, London
| | - Esra Serdaroglu
- From the Department of Paediatric Neurology (J.M.W.), Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa; Department of Paediatric Neurology (C.C.-B.), ErasmusMC / Sophia Childrens Hospital, Rotterdam, the Netherlands; Division of Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, OH; Department of Neurology (L.N.), Perth Children's Hospital; Faculty of Health and Medical Sciences, UWA; Telethon Kids Institute, Perth, Australia; Department of Paediatrics and Child Health (P.S.), Medical College, Aga Khan University, Nairobi, Kenya; Department of Child Neurology (E.S.), Gazi University School of Medicine, Ankara, Turkey; Child Neurology Department (C.T.), Hedi Chaker Hospital, University of Sfax, Tunisia; Pediatric Clinical Neurophysiology Fellowship (J.V.), Nationwide Children's Hospital, The Ohio State University; and Department of Paediatric Neurology and Neurodisability (B.H.), Great Ormond Street Hospital for Children, London
| | - Chahnez Triki
- From the Department of Paediatric Neurology (J.M.W.), Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa; Department of Paediatric Neurology (C.C.-B.), ErasmusMC / Sophia Childrens Hospital, Rotterdam, the Netherlands; Division of Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, OH; Department of Neurology (L.N.), Perth Children's Hospital; Faculty of Health and Medical Sciences, UWA; Telethon Kids Institute, Perth, Australia; Department of Paediatrics and Child Health (P.S.), Medical College, Aga Khan University, Nairobi, Kenya; Department of Child Neurology (E.S.), Gazi University School of Medicine, Ankara, Turkey; Child Neurology Department (C.T.), Hedi Chaker Hospital, University of Sfax, Tunisia; Pediatric Clinical Neurophysiology Fellowship (J.V.), Nationwide Children's Hospital, The Ohio State University; and Department of Paediatric Neurology and Neurodisability (B.H.), Great Ormond Street Hospital for Children, London
| | - Jorge Vidaurre
- From the Department of Paediatric Neurology (J.M.W.), Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa; Department of Paediatric Neurology (C.C.-B.), ErasmusMC / Sophia Childrens Hospital, Rotterdam, the Netherlands; Division of Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, OH; Department of Neurology (L.N.), Perth Children's Hospital; Faculty of Health and Medical Sciences, UWA; Telethon Kids Institute, Perth, Australia; Department of Paediatrics and Child Health (P.S.), Medical College, Aga Khan University, Nairobi, Kenya; Department of Child Neurology (E.S.), Gazi University School of Medicine, Ankara, Turkey; Child Neurology Department (C.T.), Hedi Chaker Hospital, University of Sfax, Tunisia; Pediatric Clinical Neurophysiology Fellowship (J.V.), Nationwide Children's Hospital, The Ohio State University; and Department of Paediatric Neurology and Neurodisability (B.H.), Great Ormond Street Hospital for Children, London
| | - Biju Hameed
- From the Department of Paediatric Neurology (J.M.W.), Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa; Department of Paediatric Neurology (C.C.-B.), ErasmusMC / Sophia Childrens Hospital, Rotterdam, the Netherlands; Division of Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, OH; Department of Neurology (L.N.), Perth Children's Hospital; Faculty of Health and Medical Sciences, UWA; Telethon Kids Institute, Perth, Australia; Department of Paediatrics and Child Health (P.S.), Medical College, Aga Khan University, Nairobi, Kenya; Department of Child Neurology (E.S.), Gazi University School of Medicine, Ankara, Turkey; Child Neurology Department (C.T.), Hedi Chaker Hospital, University of Sfax, Tunisia; Pediatric Clinical Neurophysiology Fellowship (J.V.), Nationwide Children's Hospital, The Ohio State University; and Department of Paediatric Neurology and Neurodisability (B.H.), Great Ormond Street Hospital for Children, London
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Kissoon NR. The crossroads of neurological disorders, neuromodulation, and chronic pain. Pain Med 2023; 24:S1-S2. [PMID: 37833044 DOI: 10.1093/pm/pnad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/10/2023] [Indexed: 10/15/2023]
Affiliation(s)
- Narayan R Kissoon
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, United States
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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McLoughlin C, Hoeritzauer I, Cabreira V, Aybek S, Adams C, Alty J, Ball HA, Baker J, Bullock K, Burness C, Dworetzky BA, Finkelstein S, Garcin B, Gelauff J, Goldstein LH, Jordbru A, Huys ACM, Laffan A, Lidstone SC, Linden SC, Ludwig L, Maggio J, Morgante F, Mallam E, Nicholson C, O'Neal M, O'Sullivan S, Pareés I, Petrochilos P, Pick S, Phillips W, Roelofs K, Newby R, Stanton B, Gray C, Joyce EM, Tijssen MA, Chalder T, McCormick M, Gardiner P, Bègue I, Tuttle MC, Williams I, McRae S, Voon V, McWhirter L. Functional neurological disorder is a feminist issue. J Neurol Neurosurg Psychiatry 2023; 94:855-862. [PMID: 36977553 PMCID: PMC10511956 DOI: 10.1136/jnnp-2022-330192] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/26/2023] [Indexed: 03/30/2023]
Abstract
Functional neurological disorder (FND) is a common and disabling disorder, often misunderstood by clinicians. Although viewed sceptically by some, FND is a diagnosis that can be made accurately, based on positive clinical signs, with clinical features that have remained stable for over 100 years. Despite some progress in the last decade, people with FND continue to suffer subtle and overt forms of discrimination by clinicians, researchers and the public. There is abundant evidence that disorders perceived as primarily affecting women are neglected in healthcare and medical research, and the course of FND mirrors this neglect. We outline the reasons why FND is a feminist issue, incorporating historical and contemporary clinical, research and social perspectives. We call for parity for FND in medical education, research and clinical service development so that people affected by FND can receive the care they need.
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Affiliation(s)
- Caoimhe McLoughlin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Verónica Cabreira
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Neurology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Selma Aybek
- Department of Clinical Neuroscience, Hopitaux Universitaires de Geneve, Geneva, Switzerland
- Department of Clinical Neuroscience, Inselspital Universitatsspital Bern Universitatsklinik fur Neurologie, Bern, Switzerland
| | - Caitlin Adams
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jane Alty
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Neurology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Harriet A Ball
- Bristol Medical School, University of Bristol Faculty of Health Sciences, Bristol, UK
- Neurology, North Bristol NHS Trust, Westbury on Trym, UK
| | - Janet Baker
- Randwick Specialist Centre, Private Practice, Randwick, New South Wales, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Kim Bullock
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, California, USA
| | | | - Barbara A Dworetzky
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sara Finkelstein
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Jeannette Gelauff
- Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anika Jordbru
- Faculty of Humanities, Sport and Educational Science, University of South-Eastern Norway, Kongsberg, Norway
| | - Anne-Catherine Ml Huys
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Aoife Laffan
- Neurology, St. James's Hospital, Dublin, Ireland
| | - Sarah C Lidstone
- University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Stefanie Caroline Linden
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Lea Ludwig
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Julie Maggio
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Physical Therapy and Functional Neurological Disorder Unit and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University Hospitals NHS Foundation Trust, London, UK
- Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy
| | - Elizabeth Mallam
- The Rosa Burden Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Clare Nicholson
- Therapy Services, National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mary O'Neal
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Isabel Pareés
- Movement Disorders Program, Neurology Deparment Hospital Ruber Internacional, Madrid, Spain
- Movement Disorders Unit, Neurology Department, Hospital Ramón y Cajal, Madrid, Spain
| | | | - Susannah Pick
- Section of Cognitive Neuropsychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Wendy Phillips
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Karin Roelofs
- Donders Institute for Brain Cognition and Behaviour: Donders Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Rachel Newby
- Neurology, Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Cordelia Gray
- Neurology Psychotherapy Service, Sheffield Teaching Hospital, Academic Neurology Unit, The University of Sheffield, Sheffield, UK
| | - Eileen M Joyce
- Neuropsychiatry, UCL Queen Square Institute of Neurology, London, UK
| | - Marina Aj Tijssen
- Expertise Center Movement Disorders Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Maxanne McCormick
- Physician assistant/patient with FND, FNDRecovery.com, -, Monument CO, USA
| | - Paula Gardiner
- Psychological Therapy in Primary Care, University of Dundee, Dundee, UK
- enhance-cbt.com therapist, NeuroSpecialist Physiotherapist, Stirling, UK
| | - Indrit Bègue
- Department of Psychiatry, Geneva University Hospitals, Geneve, Switzerland
| | - Margaret C Tuttle
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Functional Neurological Disorder Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Isobel Williams
- Neuropsychology, Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Sarah McRae
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Valerie Voon
- Psychiatry, University of Cambridge, Cambridge, UK
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Abstract
Recent advancements in gene supplementation therapy are expanding the options for the treatment of neurological disorders. Among the available delivery vehicles, adeno-associated virus (AAV) is often the favoured vector. However, the results have been variable, with some trials dramatically altering the course of disease whereas others have shown negligible efficacy or even unforeseen toxicity. Unlike traditional drug development with small molecules, therapeutic profiles of AAV gene therapies are dependent on both the AAV capsid and the therapeutic transgene. In this rapidly evolving field, numerous clinical trials of gene supplementation for neurological disorders are ongoing. Knowledge is growing about factors that impact the translation of preclinical studies to humans, including the administration route, timing of treatment, immune responses and limitations of available model systems. The field is also developing potential solutions to mitigate adverse effects, including AAV capsid engineering and designs to regulate transgene expression. At the same time, preclinical research is addressing new frontiers of gene supplementation for neurological disorders, with a focus on mitochondrial and neurodevelopmental disorders. In this Review, we describe the current state of AAV-mediated neurological gene supplementation therapy, including critical factors for optimizing the safety and efficacy of treatments, as well as unmet needs in this field.
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Affiliation(s)
- Qinglan Ling
- Department of Paediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jessica A Herstine
- Center for Gene Therapy, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Paediatrics, The Ohio State University, Columbus, OH, USA
| | - Allison Bradbury
- Center for Gene Therapy, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Paediatrics, The Ohio State University, Columbus, OH, USA
| | - Steven J Gray
- Department of Paediatrics, UT Southwestern Medical Center, Dallas, TX, USA.
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49
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52nd Annual Meeting of the Child Neurology Society Scientific Program. Ann Neurol 2023; 94 Suppl 31:S1-S155. [PMID: 37779235 DOI: 10.1002/ana.26746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 10/03/2023]
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50
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Saito T, Koda T, Okuno T, Ikeda A, Mochizuki H. [Questionnaire for Kinki area Japanese Society of Neurology board members regarding transitional medicine for neurological disease patients]. Rinsho Shinkeigaku 2023; 63:559-565. [PMID: 37648474 DOI: 10.5692/clinicalneurol.cn-001884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
In July 2020, The Special Committee for Measures Against Transition from Pediatric to Adult Health Care of the Japanese Society of Neurology was established to address transitional care for patients with childhood-onset neurological disorders. One of the measures used was a questionnaire regarding transitional medicine given to the 129 board members in the Kinki area. Of the 46 respondents, 42 answered that they would "generally examine such patients" or "judge on a case-by-case basis" for patients referred from a pediatric physician. Most of the responses noted "epilepsy" and "neuromuscular disease" as target conditions. Generally, doctors in an adult medical department do not form a relationship with the patient or their family members, different than pediatric department doctors. Furthermore, adult clinical departments typically do not have sufficient knowledge regarding treatment of diseases such as developmental disorders. The present support system for transitional medicine is not sufficient and there is no means for reimbursement. Several issues must be resolved to facilitate a smooth medical transition.
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Affiliation(s)
- Toshio Saito
- Division of Child Neurology, Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center
| | - Toru Koda
- Department of Neurology, Osaka University Graduate School of Medicine
| | - Tatsusada Okuno
- Department of Neurology, Osaka University Graduate School of Medicine
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine
- President of Japanese Society of Neurology Kinki Branch
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