2 Minute Medicine ® - Neurology

1. Monthly migraine days were significantly reduced in atogepant 30 mg twice daily and atogepant 60 mg once daily groups compared to placebo. 2. The frequency of acute medication use for headaches was reduced among patients receiving atogepant compared to placebo. Evidence Rating Level: 1 (Excellent) Study Rundown: Migraine is a chronic neurological disease affecting more than 1 billion people globally. Injectable chronic migraine therapy includes calcitonin gene-related peptide (CGRP) receptor antagonists (gepants) and onabotulinumtoxinA...

1. This retrospective cohort study found that higher low-grade inflammation (LGI) scores were associated with significantly higher acute ischemic stroke (AIS) severity, worse early neurological deterioration (END), and poor outcomes at 90 days after stroke onset. Evidence Rating Level : 2 (Good) Ischemic stroke is a significant global cause of neurological morbidity and mortality. Inflammation, both systemic and local, plays a key role in its pathogenesis. There has been growing interest in using serum biomarkers to predict outcomes in AIS...

1. Children living in areas of North Carolina composed predominantly of non-Hispanic Black individuals had higher blood lead levels than children living in areas with fewer non-Hispanic Black individuals. 2. This relationship persisted from the early 1990s to 2015, despite the decline of blood lead levels over time in North Carolina. Evidence Rating Level:  2 (Good) Study Rundown: Racial residential segregation (RRS) — the geographic separation of racial or ethnic groups — has been linked to worse health outcomes and increased mortality...

1. In this prospective cohort study, 1 out of 500 newborns were diagnosed with a medical condition that was detected via genetic sequencing but was missed by more commonly used biochemical screening tests.  Evidence rating level: 1 (Excellent) Newborn screening (NBS) is routinely performed across the world using biochemical testing methods. The effectiveness of genetic sequencing as an alternative method for NBS has not previously been studied. Researchers aimed to compare the ability of biochemical and genetic sequencing methods to detect disorders in newborns...

1. In this randomized controlled trial, an oral orexin receptor 2 (OX2R) agonist (TAK-994) was associated with improvements in wakefulness, sleepiness, and cataplexy incidence among patients with narcolepsy type 1. 2. TAK-994 was also associated with liver enzyme elevation and drug-induced hepatotoxicity. Evidence Rating Level: 1 (Excellent) Study Rundown: Narcolepsy is a rare chronic disorder of the central nervous system resulting in excessive daytime sleepiness, disrupted nighttime sleep, and cataplexy...

1. The offspring of individuals consuming a Mediterranean diet or engaging in a mindfulness-based stress reduction program during pregnancy had better neurodevelopmental outcomes in certain domains at age 24 months compared to the control group.  Evidence Rating Level: 3 (Average) Study Rundown: Prior studies have demonstrated that maternal high-fat diets, obesity, and psychological stress are associated with adverse fetal neurodevelopment. Researchers aimed to determine whether lifestyle interventions, specifically a consuming Mediterranean diet or engaging in mindfulness-based stress reduction (MBSR), can improve offspring neurodevelopment...

1. This analysis of a prospective cohort of moderate and late preterm (MLPT) children found both MLPT-specific and MLPT-sex-specific neurodevelopmental delays. The gross motor and personal-social domains of development were most affected, particularly in males. 2. Two placental genes, apolipoprotein E (APOE) and cystatin c ( CST 3 ), were identified as predictive of neurodevelopmental delay in MLPT children and postulated to be part of a placenta-brain axis in fetal development.  Evidence Rating Level: 2 (Good) Preterm birth is defined as delivery before 37 weeks gestation according to the World Health Organization...

1. This randomized clinical trial found that an oral lipid nanocrystal (LNC) formulation of amphotericin B was no less effective in the treatment of cryptococcal meningitis in patient cohorts with Human Immunodeficiency Virus (HIV). Early fungicidal activity in the cerebrospinal fluid was comparable among both experimental and control groups. 2. LNC also demonstrated higher tolerability compared to intravenous (IV) amphotericin, as well as a comparable safety profile.  Evidence Rating Level: 1 (Excellent) HIV and acquired immune deficiency syndrome (AIDS) predisposes sufferers to opportunistic infections...

1. In this randomized controlled trial, there were no significant differences in the Montreal Cognitive Assessment (MoCA) scores of older adults on the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) versus a control caloric restriction diet at three-year follow-up.  2. There were also no significant differences in brain magnetic resonance imaging (MRI) findings between the two groups at the end of three years. Evidence Rating Level: 1 (Excellent) Study Rundown: There has been growing interest in identifying strategies possibly beneficial towards the prevention of dementia...

1. In this cross-sectional analysis, long sleep duration (≥9 hours) was significantly associated with carotid plaque presence and larger total plaque area. 2. However, short sleep duration and daytime sleepiness showed no association with carotid plaque burden. Evidence Rating Level: 2 (Good) Sleep is an essential part of cardiovascular health, as the American Heart Association outlines. Prior studies have indicated a relationship between sleep duration and stroke risk. However, the pathology behind this association has yet to be well studied...

1. Compared to healthy controls, participants with a first episode of schizophrenia had reduced expression of a microglia-associated protein, CSF1R.  2. CSF1R inhibition worsened anxiety behaviors in mice exposed to chronic unpredictable stress.  Evidence-rating level: 3 (Average) Psychosocial stress is thought to contribute to the development of schizophrenia, mainly for those with underlying genetic susceptibility. Though microglia are important regulators of stress in the brain, the role of microglia in the development of schizophrenia has not previously been thoroughly investigated...

1. For patients newly initiated on lithium or valproate, the absolute risks of chronic kidney disease (CKD) progression or acute kidney injury (AKI) were low and similar. 2. Higher cumulative exposure to lithium was associated with greater risk of CKD progression compared to valproate. 3. Higher median lithium levels were associated with increased risk of AKI in a dose-response relationship. EvidEnce Rating Level: 2 (Good) Study Rundown:  Lithium is used in the treatment of bipolar disorder, but has always been associated with concerns of nephrotoxicity, although the pathophysiology is not well understood...

1. In a population-based study based in Southern California, the risk of autism spectrum disorder (ASD) in children was increased with exposure to labour epidural analgesia (LEA), independent of exposure to oxytocin. 2. There was no significant association between risk of ASD and exposure to oxytocin in labour, independently of exposure to LEA. Evidence Rating Level: 2 (Good) While some population-based studies have reported an association between labour epidural analgesia (LEA) and risk of children with autism spectrum disorder (ASD), the results overall from these studies have been inconsistent...

1. In this randomized controlled trial, for patients in a coma post-cardiac arrest, neurologic outcomes were similar at six months between those receiving targeted mild hypercapnia compared to normocapnia. 2. Mortality rates were also comparable at six months between the mild hypercapnia and normocapnia groups.  Evidence Rating Level: 1 (Excellent) Study Rundown: Hypoxic-ischemic encephalopathy results from brain hypoxia during cardiac arrest and hypoperfusion after return of spontaneous circulation. For patients with coma who have been resuscitated following out-of-hospital cardiac arrest, the risk of this injury and subsequent poor neurologic outcomes is especially high...

1. For patients with schizophrenia, symptomatic response to antipsychotic medication at 2 and 4 weeks after initiation can appropriately predict non-response at 8 weeks, varying by baseline severity and specific antipsychotic trialed. Evidence Rating Level: 1 (Excellent) For patients with schizophrenia trialed on antipsychotic medication, it is unclear when to switch medication for failed responses, with guidelines ranging from 2-8 weeks. Though a meta-analysis suggested that non-improvement after 2 weeks of an antipsychotic trial was predictive of future non-improvement, baseline severity of schizophrenia was not accounted for...

1. Patients with mild cognitive impairment (MCI) randomized to a combined intervention of aerobic-resistance exercise and computerized cognitive training, had significantly improved cognitive scores compared to control. 2. There was no significant difference in cognitive improvement when comparing interventions with and without Vitamin D supplementation. Evidence Rating Level: 1 (Excellent) For individuals with mild cognitive impairment (MCI), interventions that have improved cognition include Vitamin D supplementation, aerobic exercise, resistance training, and computer-based cognitive training...

1. In this prospective cohort study, higher blood levels of the polyunsaturated fatty acid (PUFA), alpha-linolenic acid (ALA), were associated with slower disease progression and lower risk of death in patients with amyotrophic lateral sclerosis (ALS). 2. However, higher levels of palmitic acid, a monounsaturated fatty acid, were associated with a higher risk of death in ALS patients. Evidence Rating Level: 2 (Good) Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with no effective disease reversal or curative therapeutics...

1. For obese patients with minor stroke or transient ischemic attacks (TIA), subsequent therapy with ticagrelor-acetylsalicylic acid (ASA) was associated with lower risk of subsequent stroke compared to clopidogrel-ASA. 2. This difference in risk reduction was not observed in nonobese patients.  Evidence Rating Level : 1 (Excellent) The treatment of patients with minor ischemic stroke and TIA with dual antiplatelet therapy, namely clopidogrel and ASA or with ticagrelor and ASA, is well established as efficacious...

1. Butylphthalide is effective — the BAST trial showed that butylphthalide is associated with more favorable functional outcomes compared to placebo in patients who underwent reperfusion therapy for acute ischemic stroke. 2. Butylphthalide is safe – the treatment and placebo group had similar incidences of serious adverse outcomes (death, symptomatic intracranial hemorrhage and other side effects). Evidence Rating Level: 1 (Excellent) Study Rundown: Although reperfusion therapy is the primary approach for treating ischemic stroke, unfortunately, a substantial proportion of patients do not experience its benefits in a timely manner...

1. In this randomized controlled trial, patients who received digital cognitive behavioral therapy (dCBT) demonstrated improvements in insomnia symptoms compared to the control group. 2. Although there were also improvements in sleep-onset latency and mood in those who received dCBT, there was no significant improvement in quality of life. Evidence Rating Level: 1 (Excellent) Stroke survivors tend to suffer from long-term sleep disruption, negatively impacting their quality of life. Cognitive behavioral therapy (CBT) is often prescribed for the treatment of insomnia, but its role in improving sleep disruption in stroke patients has not been well established...