Journal of neurology
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Journal of neurology · Aug 2018
Randomized Controlled TrialFatigue, not self-rated motor symptom severity, affects quality of life in functional motor disorders.
While fatigue is found to be an impairing symptom in functional motor disorders (FMD) in clinical practice, scientific evidence is lacking. We investigated fatigue severity and subtypes in FMD compared to organic neurological disease. Furthermore, the role of fatigue within FMD and its impact on quality of life and self-rated health were investigated. ⋯ Fatigue was found to be a prevalent problem in FMD, more so than in organic neurological disease. It significantly affected quality of life and self-rated health, while other factors such as motor symptom severity did not. Fatigue should be taken into account in clinical practice and treatment trials.
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Journal of neurology · Jul 2018
Severe neurologic complications of immune checkpoint inhibitors: a single-center review.
Immune checkpoint inhibitors (ICIs) are a promising class of anticancer drugs associated with immune-related adverse events (IRAEs). In registration studies of selected cancer populations, neurologic IRAEs were rare. Post-marketing experience describing their prevalence in clinical practice continues to be reported. ⋯ In this clinical practice study, the incidence of neurologic IRAEs from ICIs was 0.95%. Although rare, neurologic IRAEs can be highly variable and severe, and patients with combination immunotherapy appeared to suffer more severe IRAEs. Neurologists play an important role in the early identification and management of IRAEs to reduce long-term morbidity and mortality.
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Journal of neurology · Jun 2018
Randomized Controlled Trial Comparative StudyPersonalized botulinum toxin type A therapy for cervical dystonia based on kinematic guidance.
Botulinum toxin type A (BoNT-A) injections is the accepted first-line therapy for cervical dystonia (CD), however, numerous patients discontinue treatment early due to perceived sub-optimal relief. To improve BoNT-A therapy for CD, proper assessment of neck motion and selection of relevant muscles and dosing must be met. Kinematic technology may improve treatment outcomes by guiding physicians to better tailor muscle selection and BoNT-A dosing for CD therapy. ⋯ Clinical judgement guided by kinematic analysis of CD biomechanics can result in faster optimal muscle selections and minimize use of higher BoNT-A doses as compared to visual determination, thereby achieving comparable and potentially better treatment outcomes.
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Journal of neurology · Apr 2018
Predicting functional outcomes of posterior circulation acute ischemic stroke in first 36 h of stroke onset.
Posterior circulation acute ischemic stroke constitutes one-fourth of all ischemic strokes and can be efficiently quantified using the posterior circulation Alberta stroke program early computed tomography score (PC-ASPECTS) through diffusion-weighted imaging. We investigated whether the PC-ASPECTS and National Institutes of Health Stroke Scale (NIHSS) facilitate functional outcome prediction among Chinese patients with posterior circulation acute ischemic stroke. Participants were selected from our prospective stroke registry from January 1, 2015, to December 31, 2016. ⋯ On ROC curve analysis, the PC-ASPECTS demonstrated more reliability than the baseline NIHSS for predicting functional outcomes of minor posterior circulation stroke. In conclusion, both the PC-ASPECTS and NIHSS help clinicians predict functional outcomes. PC-ASPECTS > 7 is a helpful discriminator for achieving favorable functional outcome prediction in posterior circulation acute ischemic stroke.
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Journal of neurology · Apr 2018
Riluzole and other prognostic factors in ALS: a population-based registry study in Italy.
In this prospective population-based registry study on ALS survival, we investigated the role of riluzole treatment, together with other clinical factors, on the prognosis in incident ALS cases in Emilia Romagna Region (ERR), Italy. ⋯ Independently from other prognostic factors, patients who received riluzole for a longer period of time survived longer, but further population based studies are needed to verify if long-tem use of riluzole prolongs survival.