Inflammatory neuropathies with paranodal antibodies: more than just IgG

  In the last five years exciting discoveries have been made regarding the role of different antibodies in inflammatory neuropathies. Specifically, patients with IgG-autoantibodies against paranodal proteins (e.g. contactin-1 or neurofascin-155) have a specific clinical phenotype characterized by a subacute motor predominant neuropathy, which tend to be refractory to intravenous immunoglobulins (IVIG) but may respond […]

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Epilepsy and psychiatry: a bidirectional response that needs further evaluation

The meta-analysis presented in the article ‘Cognitive-behavioural therapy does not meaningfully reduce depression in most people with epilepsy’ by Nobel and colleagues in this month’s October edition of JNNP explored the clinical impact of psychological treatment (cognitive-behavioural therapy, CBT) in patients with epilepsy. Specifically, findings from 5 randomised controlled studies that used CBT to treat […]

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“No evidence of disease activity” does not mean no evidence of brain deterioration

  Tremendous advances have been achieved in the therapeutic armament of disease modifying therapies (DMT) in relapsing-remitting multiple sclerosis (RRMS), leading to the concept of “no evidence of disease activity” (NEDA). This concept measures the success of treatment determined by the absence of clinical worsening (EDSS increase) and radiological activity (new/enlarging T2 lesions or gadolinium-enhancing […]

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Symptomatic intracranial haemorrhage after tPA: identifying the risks

‘Time is brain’ is an increasingly iterated mantra in stroke care, underlying the push for swifter treatment for one of the leading causes morbidity and mortality in the world. The use of intravenous tissue plasminogen activator (tPA) has undeniably remodelled expectations of stroke care, and the recent introduction of the First Mobile Stroke Unit in […]

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Novel motor mapping techniques of the spinal cord: why does it matter?

  Intraoperative neurophysiological monitoring (IONM) is generally used during complex surgeries that can compromise central and peripheral nervous system structures, providing real-time information about the functional integrity of these pathways and detecting reversible neurophysiological changes. This is particularly relevant in the surgery of intramedullary spinal cord (SC) tumors, which is associated with a high risk […]

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Functional neurological disorders: deconstructing “the crisis for neurology”

Functional neurological disorders are increasingly prevalent, but a limited understanding of their pathophysiology continues to make this one of the most challenging disorders seen in neurological practice. Its chequered history is reflected in outdated terms such as ‘hysteria’, ‘psychogenic’ and ‘non-organic’, and for the present time, the term ‘functional’ has been adopted for use in […]

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Uncovering the clinicopathological spectrum in neuropathy associated with anti-MAG antibodies

  Neuropathy associated with anti-myelin-associated glycoprotein (anti-MAG) IgM antibodies typically presents as a distal variant of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) called distal acquired demyelinating symmetric (DADS) neuropathy. Clinically, it is characterized by chronic distal symmetric sensory or sensorimotor deficits, associated with sensory ataxia and postural tremor. However, patients with positive anti-MAG antibodies range from […]

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A window into the pathoanatomy of ALS: visualising disease spread using DTI

The critical involvement of central pathways in the spread of amyotrophic lateral sclerosis (ALS) is well-recognised both clinically and neuropathologically, and post-mortem studies have classified distinct pathological disease stages.  Recently, neuroimaging studies have proposed four main anatomical stages of disease spread: the first stage involving the corticospinal tract (CST), stage 2 involving corticorubral and corticopontine […]

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Chitotriosidase, neuroinflammation and ALS

  In the last few years, the role of neuroinflammation has been established as a relevant pathophysiological mechanism in multiple neurodegenerative diseases. Specifically, in ALS, activated microglia contribute to the non-cell autonomous neurodegeneration of the motor neurons. Moreover, there is no doubt that biomarkers for ALS diagnosis, prognosis and clinical trial stratification are needed. In […]

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Atrial fibrillation and white matter hyperintensities: more than just coincidence

  Cerebral small vessel disease (SVD) is quite a common finding on computer tomography (CT) and magnetic resonance imaging (MRI) scans of older people. SVD includes white matter lesions (WML) and lacunar infarcts, which are frequently associated to cardiovascular factors such as hypertension, diabetes mellitus and atrial fibrillation (AF). Interestingly, patients with WML present an […]

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