Neurology

OBJECTIVE: To prospectively examine the associations between long-term dietary flavonoids and subjective cognitive decline (SCD). METHODS: We followed 49,493 women from the Nurses' Health Study (NHS) (1984-2006) and 27,842 men from the Health Professionals Follow-up Study (HPFS) (1986-2002). Poisson regression was used to evaluate the associations between dietary flavonoids (flavonols, flavones, flavanones, flavan-3-ols, anthocyanins, polymeric flavonoids, and proanthocyanidins) and subsequent SCD...

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OBJECTIVE: Since metabolic syndrome is a significant risk factor for cardio-cerebrovascular diseases, and the relationship between metabolic syndrome (including its components) and the prognosis of stroke are controversial, this study was conducted to evaluate whether metabolic syndrome is associated with a high recurrence and mortality of stroke. METHODS: This study was registered in the PROSPERO database (CRD42020177118). We searched for relevant observational cohort studies published from inception to April 23, 2020 using PubMed, Embase, and the Cochrane Library...

No abstract text is available yet for this article.

Development of effective treatment for amyotrophic lateral sclerosis (ALS) has been hampered by disease heterogeneity, a limited understanding of underlying pathophysiology and methodological design challenges. Here we have evaluated two major themes in the design of pivotal, phase 3 clinical trials for ALS: (1) patient selection and (2) analytical strategy, and discussed potential solutions with the European Medicines Agency (EMA). Several design considerations were assessed using data from five placebo-controlled clinical trials (N = 988), four population-based cohorts (N = 5,100), and 2,436 placebo-allocated patients from the PRO-ACT database...

Pre-emptive recognition of the ethical implications of study design and algorithm choices in artificial intelligence (AI) research is an important but challenging process. AI applications have begun to transition from a promising future to clinical reality in neurology. As the clinical management of neurology is often concerned with discrete, often unpredictable, and highly consequential events linked to multimodal data streams over long timescales, forthcoming advances in AI have great potential to transform care for patients...

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With the rapid aging of populations, neurological disorders have become among the leading causes of disability and mortality worldwide. Most neurological conditions have a prolonged prodromal phase - even if they tend to manifest with an acute syndrome such as stroke - and can lead to a relentless, often deleterious course creating a major burden on patients, caregivers, and society. This unique nature of neurological diseases signifies the strong need for equally effective primary and secondary prevention strategies and focus on brain health before brain diseases ensue...

OBJECTIVE: We aimed to determine the genetic and clinical phenotypes of desmin-related myopathy patients and long-term outcomes after cardiac transplant. METHODS: Retrospective review of cardiac and neurological manifestations of genetically confirmed desmin-related myopathy patients (Jan 1st , 1999-Jan 1st , 2020). RESULTS: Twenty-five patients in 20 different families were recognized. Median age at onset of symptoms was 20 years (range: 4-50), median follow-up time of 36 months (range: 1-156)...

We present the case of a 23-year-old right-handed man who presented to an emergency department in Lusaka, Zambia with new-onset headaches and focal seizures. He was on combination antiretroviral therapy (cART) for HIV and had been started on anti-tuberculous therapy at his local clinic two weeks prior to presentation based on chest x-ray findings. On examination, he had subtle weakness and hyperreflexia in his left upper extremity. The remainder of the neurological examination was normal. Brain computed tomography (CT) scan revealed a single, ring-enhancing heterogenous mass in the right posterior parietal lobe with marked vasogenic edema...

OBJECTIVE: Venous thromboses and thrombocytopenia after vaccination with the adenovirus-vectored COVID-19 vaccine ChAdOx1 nCov-19 (AstraZeneca) have been linked to serum antibodies against platelet factor 4 (PF4)-polyanion complexes. We here report vaccine-induced isolated carotid arterial thrombosis. METHODS: Imaging and laboratory findings, treatment decisions and outcome of this case are presented. RESULTS: Eight days after having received the first dose of ChAdOx1 nCov-19 vaccine, a 31-year-old man was admitted to our stroke unit with acute headache, aphasia, and hemiparesis...

OBJECTIVE: To investigate the behavioral and neuronal responses of patients with migraine to a visual stimulation of self-motion through a virtual roller coaster ride, in comparison to controls. METHODS: Twenty consecutive migraine patients from a university-based hospital headache clinic and 20 controls were included. Participants underwent an experiment where a visually displayed self-motion paradigm was presented based on customized roller coaster videos during fMRI...

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OBJECTIVE: To investigate the association of silent vascular lesions, imaging negative ischemia, and symptomatic cerebrovascular disease with long-term progression of brain atrophy and cerebrovascular lesions in patients with arterial disease. METHODS: Within the SMART-MR study, stroke status of participants at baseline was classified as no cerebrovascular disease (reference group, n=829), symptomatic cerebrovascular disease (n=206), silent vascular lesion (n=157), and imaging negative ischemia (n=90) based upon clinical and MRI findings...

OBJECTIVE: To determine the risk of mortality and causes of death in persons with late-onset epilepsy (LOE) compared to those without epilepsy in a community-based sample, adjusting for demographics and comorbid conditions. METHODS: This is an analysis of the prospective Atherosclerosis Risk in Communities (ARIC) study, initiated in 1987-1989 among 15,792 mostly black and white men and women in 4 U.S. communities. We used Centers for Medicare Services fee-for-service claims codes to identify cases of incident epilepsy starting at or after age 67...

OBJECTIVE: Previous research has shown that elevated blood C-reactive protein (CRP) is associated with increased Alzheimer's disease (AD) risk only in apoliprotein E4 genotype ( APOE ε4) allele carriers. The objective of this study was to examine the interactive effects of plasma CRP and apoliprotein E ( APOE ) genotype on cognition and AD biomarkers. METHODS: Data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) study was analyzed, including APOE genotype; plasma CRP concentrations; diagnostic status (i...

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Hereditary hyperekplexia is a rare neurological disorder characterized by an exaggerated startle response with profound muscle stiffness. Given the nature of the spells, this condition is often misdiagnosed as epilepsy. Mutations in glycine receptors and transporters are the primary cause of this syndrome. We present an example of stimulus induced hyperekplexia captured on video EEG in a 7-week-old girl with compound heterozygous variants in the presynaptic glycine transporter gene SLC6A5.

OBJECTIVE: To assess accuracy of definitions of drug-resistant epilepsy applied to administrative claims data. METHODS: We randomly sampled 450 patients from a tertiary health system with <u>></u>1 epilepsy/convulsion encounter and <u>></u>2 distinct antiseizure medications (ASMs) from 2014-2020 and <u>></u>2 years of electronic medical records (EMR) data. We established a drug-resistant epilepsy diagnosis at a specific visit by reviewing EMR data and employing a rubric based in the 2010 International League Against Epilepsy definition...

OBJECTIVE: Compare the effectiveness of initial treatment for infantile spasms. METHODS: The National Infantile Spasms Consortium prospectively followed children with new onset infantile spasms that began at age 2-24 months at 23 US centers (2012-2018). Freedom from treatment failure at 60 days required no second treatment for infantile spasms and no clinical spasms after 30 days of treatment initiation. We managed treatment selection bias with propensity score weighting and within-center correlation with generalized estimating equations...