2 Minute Medicine ® - Neurology

1. In a large cohort of individuals with disorders of consciousness exhibiting no observable response to verbal commands, approximately 25% performed a cognitive task observed on functional magnetic resonance imaging (fMRI) or electroencephalography (EEG). 2. Approximately one in three of those exhibiting an observable response to commands demonstrated a corresponding cognitive response.  Evidence Rating Level: 1 (Excellent) Study Rundown: Individuals with severe neurologic conditions lack behavioral responses to commands...

1. In this randomized controlled trial, among traumatic brain injury (TBI) patients with anemia, a liberal red-cell transfusion strategy resulted in no significant difference in neurological outcomes at six months compared with a restrictive transfusion strategy. 2. A liberal transfusion strategy was associated with improvement in several measures of functional independence and quality of life six months post-TBI.  Evidence Rating Level: 1 (Excellent) Study Rundown: Most critically ill patients with TBI develop anemia, which is thought to decrease oxygen delivery to an already vulnerable brain and further contribute to poor neurological outcomes among survivors...

1. Early occupational therapy in stroke patients significantly improves recovery of functional independence, quality of life, cognition skills, and level of depression 3 months post-discharge Evidence Rating Level: 1 (Excellent) Strokes incur significant changes in patients’ lives causing health, social, and economic problems that can cause disability. Additionally, there is an increasing incidence of stroke in the younger population leading to long-term health problems including mental health, cognitive impairment, and difficulties in activities of daily living (ADLs)...

1. In this target trial emulation study of older adult patients with type 2 diabetes, those who received sodium-glucose cotransporter-2 inhibitors had a similar incidence of dementia versus those who received dulaglutide. 2. The two groups continued to have virtually no risk difference after adjusting for confounders and diagnosis timing. Evidence Rating Level: 2 (Good) Study Rundown: Dementia, a neurodegenerative disorder involving cognitive impairment and memory loss, has become a growing public health concern in light of the aging population...

1. Perturbation-based balance training only showed moderate physical benefits in the short term (<6 months) but no benefits in physical, cognitive, or sociopsychological measures after 6 months Evidence Rating Level: 1 (Excellent)  As we age, there is an increased risk of falls and fall-related injuries due to physical and cognitive deterioration. This can also cause psychological consequences such as fear of falling leading to loss of independence which can greatly reduce the quality of life for older adults...

1. Approximately 88% of patients with GD2-positive diffuse midline glioma or other progressive CNS tumours receiving C7R-GD2.CARTs had a partial response to therapy or stable disease. 2. No dose-limiting toxicities were observed in any patient treated with GD2.CARTs or C7R-GD2.CARTs. Evidence Rating Level: 2 (Good) Study Rundown: Current treatment options remain limited for children with diffuse midline glioma (DMG), resulting in a poor prognosis for these patients. One promising novel approach is adoptive cell transfer involving T cells armed with chimeric antigen receptors (CART)...

1. Incidence of recurrent ischemic stroke, myocardial infarction, cardiac arrest, and hospitalization was not statistically significant between both groups. 2. Patients receiving colchicine had lower CRP levels than those assigned to usual care. Evidence Rating Level: 1 (Excellent) Study Rundown: Anti-inflammatory therapy with long-term colchicine has been shown to prevent vascular recurrence in coronary artery disease. However, a paucity of data exists around the effect of colchicine on ischemic stroke. This randomized controlled trial aimed to determine whether long-term colchicine could reduce recurrent events after non-cardioembolic ischemic stroke...

1. Patients who underwent burr-hole drainage with subdural irrigation had fewer reoperation rates with comparable functional outcomes than those without subdural irrigation. 2. Functional outcomes were similar between groups. Evidence Rating Level: 1 (Excellent) Study Rundown: Chronic subdural hematoma is an emergency that is often treated with burr-hole drainage surgery. While using a subdural drain is known to be beneficial, the impact of subdural irrigation has not been fully explored. This randomized controlled trial aimed to determine whether subdural irrigation is necessary for burr-hole drainage surgery...

1. Overground Robot-assisted gait training (RAGT), using a new torque-assisted wearable exoskeletal robot significantly improved gross motor function and gait pattern in children with cerebral palsy (CP). 2. RAGT may complement standard rehabilitation by providing adequate assistance and therapeutic support to children with CP . Evidence Rating Level: 1 (Excellent) As children with cerebral palsy (CP) experience gait impairments that significantly impact daily activities and social integration, a key therapeutic goal in children with cerebral palsy (CP) is to enhance their walking ability...

1. In this randomized controlled trial, among patients with ischemic stroke without access to thrombectomy, tenecteplase given between 4.5 and 24 hours after onset demonstrated improved disability-free survival. 2. Tenecteplase was associated with an elevated risk of symptomatic intracranial hemorrhage (ICH) compared to standard medical therapy.  Evidence Rating Level: 1 (Excellent) Study Rundown: Timely treatment is critical in patients with ischemic stroke, with endovascular thrombectomy demonstrating benefits when performed up to 24 hours following onset...

1. Six-year follow-up data reveal that ME/CFS patients treated with cyclophosphamide reported greater and more lasting improvements than those treated with rituximab or placebo. Evidence Rating Level: 2 (Good)   Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a disease with unknown etiology, no validated biomarker, and no approved effective treatment. In the past, some ME/CFS patients with cancer have reported that their cancer drug treatment, which included the cytotoxic drug cyclophosphamide or rituximab, unexpectedly had beneficial effects on their ME/CFS symptoms...

1. In a retrospective cohort study of women newly diagnosed with breast cancer, use of hormone therapy was associated with a decreased risk of developing alzheimer’s disease and related dementia (ADRD), especially in Black women and women younger than 75 years old.  Evidence Rating Level: 2 (Good)  Breast cancer is one of the most common cancer diagnoses in the United States and is the most common among women. One significant non-modifiable risk factor for developing cancer is age and the majority of breast cancer cases (83%) are found in women 50 years or older...

Associations of sugar intake, high-sugar dietary pattern, and the risk of dementia: a prospective cohort study of 210,832 participants : https://read.qxmd.com/read/39020335 1. A population-based cohort study showed that there was a significant association between high dietary sugar content and an increased risk of developing dementia.  Evidence Rating Level: 1 (Excellent)  Dementia is increasing rapidly around the world and is a serious public health concern. Although some progress has been made regarding treatment targeting amyloid-related pathologies, there are still steps that must be taken...

1. The data from two cohort studies show that the chances of receiving an autism diagnosis was decreased in mothers who had a higher adherence to a healthy prenatal dietary pattern (HPDP) compared to mothers who had low adherence to a HPDP.  Evidence Rating Level: 1 (Excellent) Autism spectrum disorder includes a spectrum of characteristics related to neurodevelopmental conditions such as lack of eye contact and differences responding in social situations. Previous studies have mainly focused on specific nutrient intake (such as folic acid) and their relationship to autism diagnosis, therefore leaving a gap in the literature regarding the relationship between an overall healthy prenatal diet and autism diagnosis...

1. Return to baseline function was comparable in tenecteplase and standard-of-care groups. 2. More deaths and intracranial hemorrhages were reported among patients on tenecteplase. Evidence Rating Level: 1 (Excellent) Study Rundown: Individuals with minor ischemic stroke and intracranial occlusion have poor prognosis. Intravenous (IV) thrombolysis with tenecteplase may benefit these patients, although little is known. This randomized controlled trial aimed to assess the safety and efficacy of IV tenecteplase in patients with minor ischemic stroke...

1. In a randomized controlled trial of patients who suffered an acute ischemic stroke, the reteplase group reported a greater number of patients experiencing an excellent functional score compared to the alteplase group. 2. A greater proportion of patients reported intracranial hemorrhages within 90 days in the reteplase group compared to the alteplase group.  Evidence Rating Level: 1 (Excellent) Study Rundown: One proven intercession for ischemic strokes is reperfusion therapy, currently done by intravenous infusion of alteplase within 4...

1. In this randomized controlled trial, brigatinib reduced the size of progressively growing tumors in patients with neurofibromatosis type 2-related schwannomatosis (NF2-SWN) . 2. In participants receiving brigatinib, hearing improvement occurred in some patients according to the audiologic testing, while pain severity decreased according to self-reported data. Evidence Rating Level: 1 (Excellent) Study Rundown: NF2-SWN is a tumor-suppressor syndrome that predisposes individuals to developing schwannomas, meningiomas, and ependymomas...

1. Carriers of the E280A variant of presenilin 1 (PSEN1E280A) who were heterozygous for the apolipoprotein E3 Christchurch variant (APOE3Ch) had a lower median age of onset of cognitive impairment and dementia compared to those without APOE3Ch. 2. Carriers of PSEN1E280A with APOE3Ch heterozygosity had limited tau pathologic findings and fewer vascular amyloid pathologic features based on autopsy and positron-emission tomography (PET). Evidence Rating Level: 2 (Good) Study Rundown: Individuals with PSEN1E280A, which involves a glutamic acid to alanine mutation at codon 280 in the presenilin 1 gene, are almost certainly destined to develop autosomal dominant Alzheimer’s disease by their mid-to-late 40s...

1. A cross-over study compared clinicians’ electroencephalogram (EEG) interpretation accuracy with artificial intelligence (AI) assistance against the same participants without AI assistance. 2. The performance of all clinicians was significantly higher with AI assistance as compared to without (71% vs 47%). Evidence Rating Level: 2 (Good) Study Rundown: Seizures are serious medical events that increase the risk of permanent disability or death. However, clinical interpretations of seizures with electroencephalography (EEG) are hampered by clinician availability and subjectivity...

1. Transcranial direct current stimulation (tDCS) led to improvement in the learning of complex rhythmic movements via stimulation of the primary motor cortex Evidence Rating Level: 1 (Excellent) Motor learning is a key component of everyday functioning from simple tasks like pressing a button to more complex, coordinated tasks like playing an instrument. Motor skills can be learned during a single practice session (online) or after the session (offline). Various areas of the brain a responsible for motor learning depending on the task...