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TSPO PET Imaging for Monitoring Natalizumab-Associated Progressive Multifocal Leukoencephalopathy

Authors of a recent study evaluated inflammatory activity in multiple sclerosis patients who developed natalizumab-associated progressive multifocal leukoencephalopathy (PML) using translocator protein positron emission tomography (TSPO PET) for imaging of microglia. They demonstrated that TSPO PET can monitor PML longitudinally.

Incidence, Prevalence, and Long-Term Consequences of Small Fiber Neuropathy

Small fiber neuropathy (SFN), a subtype of peripheral neuropathy characterized by painful distal neuropathic pain and autonomic symptoms, is increasing in incidence. SFN associated with diabetes and other causes is more likely to progress to large-fiber polyneuropathy and have faster deterioration and higher disability compared to slow progression with idiopathic SFN. Glucose impairment, obesity, and elevated triglycerides are modifiable risk factors of idiopathic SFN. Although major disability and neurologic impairment are uncommon in this slowly progressive condition, higher mortality and cardiovascular events are noted in patients with SFN.

Electrodiagnostic Findings in Thoracic Outlet Syndrome

The diagnosis of thoracic outlet syndrome may be difficult and relies on specific clinical, imaging, vascular, and electrodiagnostic features. None of the currently recommended treatments have been shown to be effective, but there are few randomized clinical treatment trials.

Is Pimavanserin Safe to Use in Patients with Parkinson’s Disease?

This retrospective cohort study of patients with Parkinson’s disease ages 65 years or older residing in Medicare-certified long-term care facilities revealed pimavanserin use vs. nonuse is associated with an increased risk of 30-day hospitalization and higher 90-, 180-, and 365-day mortality.

Neurodegenerative Ataxia: Improvement in Motor and Cognitive Outcomes with Cerebello-Spinal Stimulation

Concurrent cerebellar and spinal stimulation with a transcranial direct current stimulation device resulted in improvement of both motor and cognitive functions in patients with several different forms of neurodegenerative ataxia.

Is the Suicidality Class Warning Warranted for Antiseizure Medications?

This study reports data that refutes the U.S. Food and Drug Administration’s class warning regarding suicidality risk in patients with epilepsy who are taking the newer antiepileptics, approved since 2008. The class warning should be reconsidered.

Atogepant for Migraine Prevention

Atogepant, an oral small-molecule inhibitor of the calcitonin gene-related peptide pathway, administered once daily, effectively reduced migraine days in the preventive treatment trial of migraine over a period of 12 weeks.

In Young Adults, Marijuana Use Is Not Associated with Increased Risk of Early Onset Ischemic Stroke

Marijuana use, both recreational and medical, is increasing among young adults, and many states are legalizing its use. A variety of cardiovascular effects have been described, which could increase the risk of cardiovascular complications, including stroke, and some observational studies have suggested an increased stroke risk from marijuana use. But there are few epidemiological studies that have evaluated this association.

Clinical and Perfusion Mismatch Criteria Both Are Reliable in Identifying Patients Who Will Benefit from Endovascular Therapy

Since 2015, when multiple clinical trials were published showing the efficacy of endovascular thrombectomy (EVT) for large vessel occlusion within six hours of stroke onset, additional criteria have been developed to identify those patients who will benefit from EVT beyond six hours. The AURORA investigators collected patient data from six large clinical trials and performed a meta-analysis to determine if a clinical mismatch or an imaging mismatch protocol was better at predicting good outcomes in patients treated between six hours and 24 hours after the onset of clinical stroke symptoms.

Basilar Artery Occlusion: Endovascular Thrombectomy and Medical Therapy Have Similar Outcomes

Basilar artery occlusion is a rare form of ischemic stroke and accounts for about 10% of large vessel occlusions reported in the literature. These investigators conducted a randomized trial, enrolling patients from 2011 through 2019, even though multiple studies published in 2015 demonstrated benefit of endovascular therapy in anterior circulation large vessel occlusions. Efficacy and safety were compared with medical therapy in patients who underwent endovascular therapy within six hours after the estimated time of onset of symptoms.