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Carotid Endarterectomy vs. Medical Therapy in Patients with Asymptomatic Carotid Stenosis

Multiple randomized clinical trials have demonstrated that carotid endarterectomy is beneficial in patients who have symptomatic carotid stenosis, and currently, that is the recommendation for such patients. However, in the intervening years, advances in medical therapy, as well as significant improvement in the management of blood pressure, diabetes, diet, and exercise, have been shown to reduce stroke rate. Therefore, it is currently controversial whether carotid endarterectomy is still beneficial in asymptomatic patients with carotid artery stenosis compared to current medical management.

Tranexamic Acid and Outcomes in Patients with Moderate or Severe TBI

In this randomized, placebo-controlled trial using tranexamic acid to treat patients with moderate or severe traumatic brain injury within two hours of injury, there was no significant difference between treatment groups in either mortality or functional recovery at six months.

IqYmune for CIDP

IqYmune is a highly purified 10% concentration of human immunoglobulin obtained from healthy volunteers. It appears to have similar efficacy in the treatment of chronic inflammatory demyelinating polyneuropathy (CIDP) as conventional intravenous immunoglobulin, with 76% of the study patients showing a significant improvement in a standardized disability score.

COVID-19 Infection in MS Patients

In a multicenter, retrospective analysis of patients in a multiple sclerosis (MS) registry, the authors described the clinical characteristics and risks associated with severity of complications from COVID-19 infection in patients with MS.

Ketamine for Super-Refractory Status Epilepticus

In this retrospective paper, the authors review the efficacy and safety of ketamine infusion in patients with status epilepticus who have failed benzodiazepine, standard anticonvulsant, and at least one other anesthetic drip.

Gut Microbiome in Patients at Risk for Parkinson’s Disease

Certain risk factors and prodromal markers of Parkinson’s disease (PD), such as constipation and rapid eye movement sleep behavior disorder, are associated with specific bacterial compositions of the gut. However, the value of gut microbiome data to predict the risk of PD development needs further investigation.

Auditory Startle Response as a Predictor of Recovery from Coma

Preserved habituation of the auditory startle response, performed at the bedside, indicates intact cortical structures and cortico-cortical white matter tract connections. Preservation of this reaction in patients with unresponsive wakefulness can help distinguish the vegetative state from minimally conscious state and may even predict eventual awakening.

Oral Calcitonin Gene-Related Peptide Antagonist for Prevention of Migraine

Atogepant, an oral calcitonin gene-related peptide (CGRP) antagonist, was shown to be effective and safe for migraine prevention. This adds an additional CGRP antagonist to the growing arsenal of such medications, both oral and parenteral, for both prevention and treatment of migraine.

A Novel Therapy for Amyotrophic Lateral Sclerosis Shows Promise

A novel drug combination was taken from an animal model and tested in a Phase II trial of patients with amyotrophic lateral sclerosis. Although there was a trend toward benefit, there were no statistically significant endpoints at the end of the trial. Future trials need to enroll a larger number of patients.

Transthyretin Amyloidosis and Neuropathy

Wild-type transthyretin amyloidosis, referred to as “senile” amyloidosis previously, usually occurs in the aging population and affects the peripheral nerves and the heart. Usually, neurological symptoms precede cardiac symptoms.