Neurology

RCT | Effects of globus pallidus focused ultrasound ablation in Parkinson’s disease

27 Feb, 2023 | 13:02h | UTC

Summary: The study evaluated the efficacy and safety of unilateral focused ultrasound ablation of the internal segment of globus pallidus in patients with Parkinson’s disease and dyskinesias or motor fluctuations. The randomized controlled trial involved 94 patients who were either assigned to undergo ultrasound ablation or a sham procedure. The study found that unilateral pallidal ultrasound ablation resulted in a higher percentage of patients who improved motor function or reduced dyskinesia than a sham procedure over a period of 3 months but was associated with adverse events. The study suggests the need for longer and larger trials to determine the effect and safety of this technique in persons with Parkinson’s disease.

Article: Trial of Globus Pallidus Focused Ultrasound Ablation in Parkinson’s Disease – New England Journal of Medicine (link to abstract – $ for full-text)

News Release: Parkinson’s Disease Patients Experience Significant Reduction in Symptoms with Non-Surgical Focused Ultrasound Treatment – University of Maryland School of Medicine

Commentary: Focused ultrasound reduces physical symptoms of Parkinson’s disease – Health Imaging

Video Summary: Focused Ultrasound Ablation for Parkinson’s Disease | NEJM

Parkinson disease primer for the general practitioner

27 Feb, 2023 | 13:00h | UTC

Part 1: Diagnosis – Canadian Family Physician

Part 2: Management of motor and nonmotor symptoms – Canadian Family Physician

Podcast | Parkinson’s Disease for primary care.

Cohort Study | Could regular laxative use be associated with an increased risk of dementia?

27 Feb, 2023 | 12:59h | UTC

Association Between Regular Laxative Use and Incident Dementia in UK Biobank Participants – Neurology (link to abstract – $ for full-text)

News Release: Study: People Who Regularly Use Laxatives May Have an Increased Risk of Dementia – American Academy of Neurology

Commentary: Regular Use of Laxatives Linked to Risk for All-Cause Dementia – HealthDay

Review | Glioblastoma and other primary brain malignancies in adults

24 Feb, 2023 | 13:54h | UTC

Article: Glioblastoma and Other Primary Brain Malignancies in Adults: A Review – JAMA (free for a limited period)

Audio clinical review: Glioblastoma and Other Primary Brain Malignancies in Adults – JAMA

Commentary on Twitter

Review summarizes current evidence regarding diagnosis and treatment of primary malignant brain tumors in adults. https://t.co/pNKio61bN5

— JAMA (@JAMA_current) February 21, 2023

Review | Young-onset dementia diagnosis, management and care

24 Feb, 2023 | 13:37h | UTC

Young-onset dementia diagnosis, management and care: a narrative review – The Medical Journal of Australia

Injurious falls before, during and after dementia diagnosis: a population-based study

24 Feb, 2023 | 13:31h | UTC

Injurious falls before, during and after dementia diagnosis: a population-based study – Age and Ageing

Cohort Study | Pre-pregnancy migraine linked to a higher risk of adverse pregnancy outcomes

23 Feb, 2023 | 13:31h | UTC

Summary: This study investigated the relationship between migraine and adverse pregnancy outcomes. Researchers examined data from the Nurses’ Health Study II, which included 30,555 pregnancies from 19,694 women. Pre-pregnancy migraine was associated with a higher risk of preterm delivery, gestational hypertension, and preeclampsia. Migraine with aura was associated with a higher preeclampsia risk than migraine without aura. However, migraine was not associated with low birth weight or gestational diabetes mellitus. The study suggests that migraine history, and to a lesser extent, migraine phenotype, could be useful in identifying women at risk of pregnancy complications. Regular aspirin use prior to pregnancy was associated with a lower risk of preterm delivery for women with migraine, but randomized trials are needed to evaluate this hypothesis.

Article: Prepregnancy Migraine, Migraine Phenotype, and Risk of Adverse Pregnancy Outcomes – Neurology (link to abstract – $ for full-text)

News Release: Migraine associated with increased risk for pregnancy complications – Brigham and Women’s Hospital

Commentary: Prepregnancy Migraine Tied to Adverse Pregnancy Outcomes – HealthDay

Review | Brain monitoring after cardiac arrest

23 Feb, 2023 | 13:23h | UTC

Brain monitoring after cardiac arrest – Current Opinion in Critical Care

Review | Diagnosis and management of patients with polyneuropathy

21 Feb, 2023 | 11:40h | UTC

Diagnosis and management of patients with polyneuropathy – Canadian Medical Association Journal

Study finds low rates of antipsychotic medication discontinuation in older adults following infection-related hospitalization

20 Feb, 2023 | 12:25h | UTC

Summary: The study aimed to investigate discontinuation rates of antipsychotic medications (APMs) used to treat delirium due to acute hospitalization and infection in older adults. The cohort study involved 5,835 patients in the US, who were aged 65 years or older, without prior psychiatric disorders and had newly initiated an APM prescription within 30 days of an infection-related hospitalization. The study found that only 11% of new atypical APM users and 52% of new haloperidol users discontinued the medication by 30 days after initiation. The discontinuation of haloperidol and atypical APM was less likely to occur in patients with dementia and prolonged hospitalization. The findings suggest that APM discontinuation rates following infection-related hospitalization are low, especially for atypical APM, and call for effective interventions to proactively discontinue APMs when they are no longer indicated.

Article: Antipsychotic Medication Use Among Older Adults Following Infection-Related Hospitalization – JAMA Network Open

M-A | General Anesthesia vs. to Non-GA in endovascular thrombectomy for ischemic stroke

20 Feb, 2023 | 12:20h | UTC

Summary: The study analyzed randomized controlled trials comparing the use of general anesthesia (GA) versus non-GA techniques, such as conscious sedation or local anesthesia for endovascular thrombectomy (EVT) in patients with ischemic stroke. The meta-analysis included seven trials with a total of 980 participants, showing that GA is associated with a 9% improvement in recanalization rates and an 8.4% improvement in functional recovery compared to non-GA techniques. There was no difference in hemorrhagic complications or 3-month mortality. The study recommends that GA be the first choice for most EVT procedures in acute ischemic stroke.

Article: General Anesthesia Compared to Non-GA in Endovascular Thrombectomy for Ischemic Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials – Neurology (link to abstract – $ for full-text)

Review | Neurological complications of sepsis

20 Feb, 2023 | 12:16h | UTC

Summary: This article covers the latest developments in the prevention, diagnosis, and treatment of sepsis-associated encephalopathy (SAE) and ICU-acquired weakness (ICUAW). SAE diagnosis is clinical with supporting EEG and neuroimaging. Treatment involves early identification and treatment of infections and organ dysfunction. ICUAW is due to an overlap between critical illness polyneuropathy, critical illness myopathy, and muscle disuse atrophy. It affects all limbs and respiratory muscles and is associated with prolonged hospital stay, increased costs, and both short and long-term mortality. Recovery is typical in weeks or months, but severe cases may result in persistent functional impairments for ICU survivors.

Article: Neurological complications of sepsis – Current Opinion in Critical Care

Acute pain management pearls: a focused review for the hospital clinician

17 Feb, 2023 | 12:42h | UTC

Acute Pain Management Pearls: A Focused Review for the Hospital Clinician – Healthcare

Guideline | Diagnosis and management of subarachnoid hemorrhage caused by a ruptured aneurysm

16 Feb, 2023 | 15:23h | UTC

Subarachnoid haemorrhage caused by a ruptured aneurysm: diagnosis and management – National Institute for Health and Care Excellence

M-A | Radiofrequency therapies for trigeminal neuralgia

16 Feb, 2023 | 14:51h | UTC

Radiofrequency Therapies for Trigeminal Neuralgia: A Systematic Review and Updated Meta-analysis – Pain Physician (PDF)

M-A | Efficacy of endovascular therapy for basilar and vertebral artery occlusion

16 Feb, 2023 | 14:50h | UTC

Efficacy of endovascular therapy for basilar and vertebral artery occlusion: A systematic review and meta-analysis of randomized controlled trials – European Journal of Internal Medicine

RCTs | Thrombectomy improved recovery in basilar artery stroke but increased procedural complications and hemorrhages.

Registry-based cohort study: Endovascular treatment vs. best medical management in acute basilar artery occlusion strokes.

RCT: Endovascular therapy for stroke due to basilar-artery occlusion – “endovascular therapy and medical therapy did not differ significantly with respect to a favorable functional outcome”.

Guideline Synopsis | The use of opioids in the management of chronic pain

15 Feb, 2023 | 16:16h | UTC

Summary: The VA/DoD guideline for chronic pain management recommends non-opioid treatments, such as cognitive-behavioral and physical therapy, with opioid use reserved for specific circumstances. Mental health evaluations are emphasized, along with regular treatment reassessments. Opioid use is not recommended due to small benefits outweighed by risks, but if used, buprenorphine is suggested due to a lower risk profile. Screening for mood disorders and traumatic brain injury is also advised, although evidence for risk mitigation strategies is lacking.*

Article: The Use of Opioids in the Management of Chronic Pain: Synopsis of the 2022 Updated U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline – Annals of Internal Medicine

News Release: Summary of VA/DoD guidelines for management of chronic pain provides new recommendations on opioid use and mental health evaluations – American College of Physicians

Summary for patients: The Use of Opioids in the Management of Chronic Pain: Synopsis of the 2022 Updated U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline – Annals of Internal Medicine

Commentary: Initiation of Opioids Not Recommended for Chronic Pain – HealthDay

*Note: This summary was created through the collaboration of a medical editor and ChatGPT.

RCTs | Endovascular therapy improves functional outcomes in large ischemic strokes, but increases bleeding and vascular complications

13 Feb, 2023 | 13:00h | UTC

Study 1: Trial of Endovascular Thrombectomy for Large Ischemic Strokes – New England Journal of Medicine (link to abstract – $ for full-text)

Commentary: Major international study finds thrombectomy highly effective treatment for large strokes – University Hospitals Cleveland Medical Center

Study 2: Trial of Endovascular Therapy for Acute Ischemic Stroke with Large Infarct – New England Journal of Medicine (link to abstract – $ for full-text)

M-A | Tenecteplase vs. alteplase for treatment of acute ischemic stroke

13 Feb, 2023 | 12:57h | UTC

Tenecteplase vs. alteplase for treatment of acute ischemic stroke: A systematic review and meta-analysis of randomized trials – Frontiers in Neurology

RCT | Argatroban plus Alteplase not better than Alteplase alone in patients with acute ischemic stroke

10 Feb, 2023 | 13:59h | UTC

Effect of Argatroban Plus Intravenous Alteplase vs Intravenous Alteplase Alone on Neurologic Function in Patients With Acute Ischemic Stroke: The ARAIS Randomized Clinical Trial – JAMA (free for a limited period)

Commentary on Twitter

Among patients with acute ischemic #stroke who received intravenous alteplase, argatroban was not significantly associated with better neurologic function. https://t.co/s9BDEvRvFA pic.twitter.com/HIRnGmiWMU

— JAMA (@JAMA_current) February 9, 2023

Consensus Paper | Use of cerebral CT angiography to support a clinical diagnosis of death using neurological criteria

10 Feb, 2023 | 13:48h | UTC

The use of cerebral computed tomographic angiography as an ancillary investigation to support a clinical diagnosis of death using neurological criteria: a consensus guideline – Anaesthesia

Guillain–Barré syndrome following influenza vaccination: a 15-year nationwide population-based case–control study

10 Feb, 2023 | 13:35h | UTC

Guillain–Barré syndrome following influenza vaccination: A 15-year nationwide population-based case–control study – European Journal of Neurology

Commentary: Influenza vaccination increases risk of Guillain-Barre syndrome within one month – Medical Dialogues