[Personal View] Diagnostic challenges in epilepsy: seizure under-reporting and seizure detection
Epileptic seizures vary greatly in clinical phenomenology and can markedly affect the patient's quality of life. As therapeutic interventions focus on reduction or elimination of seizures, the accurate documentation of seizure occurrence is essential. However, patient self-evaluation compared with objective evaluation by video-electroencephalography (EEG) monitoring or long-term ambulatory EEG revealed that patients document fewer than 50% of their seizures, on average, and that documentation accuracy varies significantly over time. (Source: Lancet Neurology)
Source: Lancet Neurology - February 14, 2018 Category: Neurology Authors: Christian E Elger, Christian Hoppe Tags: Personal View Source Type: research
[Review] Technological advances and changing indications for lumbar puncture in neurological disorders
Technological advances have changed the indications for and the way in which lumbar puncture is done. Suspected CNS infection remains the most common indication for lumbar puncture, but new molecular techniques have broadened CSF analysis indications, such as the determination of neuronal autoantibodies in autoimmune encephalitis. New screening techniques have increased sensitvity for pathogen detection and can be used to identify pathogens that were previously unknown to cause CNS infections. Evidence suggests that potential treatments for neurodegenerative diseases, such as Alzheimer's disease, will rely on early detecti...
Source: Lancet Neurology - February 14, 2018 Category: Neurology Authors: Joost M Costerus, Matthijs C Brouwer, Diederik van de Beek Tags: Review Source Type: research
[Articles] Behavioural outcomes of subthalamic stimulation and medical therapy versus medical therapy alone for Parkinson's disease with early motor complications (EARLYSTIM trial): secondary analysis of an open-label randomised trial
In a large cohort with Parkinson's disease and early motor complications, better overall behavioural outcomes were noted with bilateral subthalamic stimulation plus medical therapy compared with medical therapy alone. The presence of hyperdopaminergic behaviours and neuropsychiatric fluctuations can be judged additional arguments in favour of subthalamic stimulation if surgery is considered for disabling motor complications. (Source: Lancet Neurology)
Source: Lancet Neurology - February 14, 2018 Category: Neurology Authors: Eug énie Lhommée, Lars Wojtecki, Virginie Czernecki, Karsten Witt, Franziska Maier, Lisa Tonder, Lars Timmermann, Thomas D Hälbig, Fanny Pineau, Franck Durif, Tatiana Witjas, Marcus Pinsker, Maximilian Mehdorn, Friederike Sixel-Döring, Andreas Kupsch, Tags: Articles Source Type: research
[Articles] Evaluation of the safety, tolerability, and efficacy of pimavanserin versus placebo in patients with Alzheimer's disease psychosis: a phase 2, randomised, placebo-controlled, double-blind study
Pimavanserin showed efficacy in patients with Alzheimer's disease psychosis at the primary endpoint (week 6) with an acceptable tolerability profile and without negative effect on cognition. Further follow-up to week 12 did not show significant advantage for pimavanserin versus placebo. (Source: Lancet Neurology)
Source: Lancet Neurology - February 14, 2018 Category: Neurology Authors: Clive Ballard, Carol Banister, Zunera Khan, Jeffrey Cummings, George Demos, Bruce Coate, James M Youakim, Randall Owen, Srdjan Stankovic, ADP Investigators Tags: Articles Source Type: research
[In Context] Temporal lobe epilepsy in The Passion According to GH
Clarice Lispector was an iconic Brazilian writer who was known for her strange, almost mystical writings. Her novel, The Passion According to GH,1 has long been considered to describe the internal workings of a woman (GH), who suddenly and unexpectedly finds herself in the midst of a spiritual crisis that is triggered by the sight of a cockroach in a clean room. During her crisis, the protagonist reports feeling disoriented and irritated, with subsequent auditory and visual hallucinations, and a range of symptoms including screaming, dry mouth, clenching of the jaw, intense sweating, and sudden vomiting. (Source: Lancet Neurology)
Source: Lancet Neurology - February 14, 2018 Category: Neurology Authors: Saudamini Deo, Philippe Charlier Tags: In Context Source Type: research
[In Context] Brian Andrew Gordon
Brian Andrew Gordon is an Assistant Professor at the Departments of Radiology and Psychological and Brain Sciences, Washington University, St Louis (MO, USA). He did a PhD at the University of Illinois, Urbana-Champaign (IL, USA), studying modifiers of healthy ageing. He held a postdoctoral fellowship in the Department of Psychological and Brain Sciences at Washington University before taking a faculty position in the Department of Radiology in 2013. His research focuses on understanding the pathophysiology of Alzheimer's disease using MRI, PET, and fluid-based biomarkers. (Source: Lancet Neurology)
Source: Lancet Neurology - February 14, 2018 Category: Neurology Tags: In Context Source Type: research
[In Context] The enthusiasm of Christian Elger
It's the first thing you notice. He's 68, but he has the enthusiasm (for everything) of someone 60 years younger. That must-have new computer, that fancy new smartphone, figuring out what single cells are up to in the brains of people with epilepsy, diagnose-a-thons in Ethiopia, the Russian ballet, modern art, flying helicopters (yes, he does); he loves them all, and he makes you love them too. His enthusiasm is infectious! (Source: Lancet Neurology)
Source: Lancet Neurology - February 14, 2018 Category: Neurology Authors: Adrian Burton Tags: In Context Source Type: research
[Correspondence] Distinct representation of muscle weakness in QMG and MG-ADL – Authors' reply
We would like to thank Robert de Meel and colleagues for their interest in and comments on our Article.1 The sub-analysis correlations between MG-ADL and QMG data in the phase 2 eculizumab trial2 were based on change from baseline to week 16 in 13 patients who were refractory to immunosuppressive treatments. No correlation analyses have been done on the phase 3 worst-rank data. (Source: Lancet Neurology)
Source: Lancet Neurology - February 14, 2018 Category: Neurology Authors: James F Howard, Fanny O'Brien, Jing-Jing Wang Tags: Correspondence Source Type: research
[Correspondence] Distinct representation of muscle weakness in QMG and MG-ADL
We read the findings of James Howard and colleagues with interest.1 Their phase 3, randomised, double-blind, placebo-controlled multicentre study investigated the effect of eculizumab in patients with anti-acetylcholine receptor antibody-positive refractory generalised myasthenia gravis. Notably, Howard and colleagues showed an apparent discrepancy between the primary (Myasthenia Gravis Activities of Daily Living; MG-ADL) and secondary (Quantitative Myasthenia Gravis test; QMG) endpoints. The primary endpoint, the change from baseline to week 26 in MG-ADL total score, did not significantly differ between the eculizumab-tre...
Source: Lancet Neurology - February 14, 2018 Category: Neurology Authors: Robert Henri Pasquale de Meel, Jan J G M Verschuuren, Martijn R Tannemaat Tags: Correspondence Source Type: research
[Correspondence] The advocacy role of the World Federation of Neurology
The mission of the World Federation of Neurology (WFN) is to foster brain health worldwide. Our overarching aim is to promote neurological practice for the sake of patients with neurological disease. The findings from the 2015 Global Burden of Disease study1 have shown the enormous contribution of neurological diseases to disability-adjusted life-years, years of life lost, and years lived with disability. Furthermore, the WHO Atlas of Country Resources for Neurological Disorders2 shows that huge treatment gaps exist for these diseases worldwide. (Source: Lancet Neurology)
Source: Lancet Neurology - February 14, 2018 Category: Neurology Authors: Wolfgang Grisold, Wasay Mohammad Tags: Correspondence Source Type: research
[Corrections] Corrections
Meyfroidt G, Baguley I J, Menon D K. Paroxysmal sympathetic hyperactivity: the storm after acute brain injury. Lancet Neurol 2017; 16: 721 –29—In figure 2 of this Series paper, the placement of the labels and arrows at the spinal level for descending inhibition, non-noxious sensory input, and motor output were incorrect. Corrections to the placement of these labels and arrows have now been made to the online version as of Feb 13, 2 018. (Source: Lancet Neurology)
Source: Lancet Neurology - February 14, 2018 Category: Neurology Tags: Corrections Source Type: research
[Comment] The future of seizure detection
In clinical practice, we rely on seizure diaries of our patients to manage epilepsy. In their Personal View1 in The Lancet Neurology, Christian Elger and Christian Hoppe review the literature on the accuracy with which patients with epilepsy document their seizures. Elger and Hoppe conclude that under-reporting of seizures is an important clinical problem; less than half of the patients could accurately document their seizures, and more than half of all seizures captured during long-term video-electroencephalography (EEG) monitoring were unreported. (Source: Lancet Neurology)
Source: Lancet Neurology - February 14, 2018 Category: Neurology Authors: Wim Van Paesschen Tags: Comment Source Type: research
[Comment] DBS for Parkinson's disease with behavioural disturbances
Behavioural problems —eg, impulse control disorders, excessive and uncontrollable intake of levodopa, punding, restlessness, and disarray behaviour—are common in patients with Parkinson's disease and frequently represent a challenge for clinical management.1 Behavioural complications are associated directly with med ications for Parkinson's disease (particularly dopamine agonists) and typically arise after prolonged exposure to such drugs, leading to a functional hyperdopaminergic state. Disease-related structural features of the brain (eg, the pattern of nigrostriatal dopaminergic denervation) and individual p redispo...
Source: Lancet Neurology - February 14, 2018 Category: Neurology Authors: Angelo Antonini, Jose A Obeso Tags: Comment Source Type: research
[Comment] Pimavanserin for patients with Alzheimer's disease psychosis
Pimavanserin is an atypical antipsychotic marketed in the USA for hallucinations and delusions associated with Parkinson's disease.1 It acts as an inverse agonist at the 5-HT2A receptor with no effect on dopamine receptors. A boxed warning on the prescribing information approved by the US Food and Drug Administration states that pimavanserin is not approved for elderly patients with dementia-related psychosis unrelated to Parkinson's disease psychosis, and that these patients are at increased risk of death when treated with antipsychotics. (Source: Lancet Neurology)
Source: Lancet Neurology - February 14, 2018 Category: Neurology Authors: Lon S Schneider Tags: Comment Source Type: research
[Editorial] Clearing the haze around medicinal cannabis
Cannabis is legal for medicinal use or is decriminalised for recreational use in more than half of the states in the USA, in more than 10 European countries, and in Australia. On July 1, 2018, the Canadian federal government will legalise recreational use of cannabis. The increased availability of cannabis following legalisation raises questions about its implications for public health, but it also opens avenues for treatment of neurological conditions. There is some evidence that various forms of cannabis could be used to treat neurological disorders —including epilepsy and some symptoms of multiple sclerosis (eg, spast...
Source: Lancet Neurology - February 14, 2018 Category: Neurology Authors: The Lancet Neurology Tags: Editorial Source Type: research
