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Sommaires des Revues - The Lancet Neurology

The Lancet Neurology


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[Editorial] Clearing the haze around medicinal cannabis  Voir?

Cannabis is legal for medicinal use or is decriminalised for recreational use in more than half of the states in the USA, in more than 10 European countries, and in Australia. On July 1, 2018, the Canadian federal government will legalise recreational use of cannabis. The increased availability of cannabis following legalisation raises questions about its implications for public health, but it also opens avenues for treatment of neurological conditions. There is some evidence that various forms of cannabis could be used to treat neurological disorders—including epilepsy and some symptoms of multiple sclerosis (eg, spasticity and pain)—and for palliative care, but medical guidelines for its use are scarce.

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[Comment] Pimavanserin for patients with Alzheimer's disease psychosis  Voir?

Pimavanserin is an atypical antipsychotic marketed in the USA for hallucinations and delusions associated with Parkinson's disease.1 It acts as an inverse agonist at the 5-HT2A receptor with no effect on dopamine receptors. A boxed warning on the prescribing information approved by the US Food and Drug Administration states that pimavanserin is not approved for elderly patients with dementia-related psychosis unrelated to Parkinson's disease psychosis, and that these patients are at increased risk of death when treated with antipsychotics.

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[Comment] DBS for Parkinson's disease with behavioural disturbances  Voir?

Behavioural problems—eg, impulse control disorders, excessive and uncontrollable intake of levodopa, punding, restlessness, and disarray behaviour—are common in patients with Parkinson's disease and frequently represent a challenge for clinical management.1 Behavioural complications are associated directly with medications for Parkinson's disease (particularly dopamine agonists) and typically arise after prolonged exposure to such drugs, leading to a functional hyperdopaminergic state. Disease-related structural features of the brain (eg, the pattern of nigrostriatal dopaminergic denervation) and individual predisposing factors (eg, male sex, young age at onset) are also determinants of behavioural complications.

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[Comment] CT scanning to diagnose CAA: back to the future?  Voir?

Most intracerebral haemorrhages are due to cerebral small vessel diseases hypertensive arteriopathy (arteriolosclerosis), which affects deep perforating vessels, and cerebral amyloid angiopathy (CAA), which affects superficial cortical and leptomeningeal vessels. Diagnosis of CAA is important because it has a high recurrence risk (7·4% per year in a pooled analysis of cohort studies)1 and might require specific prevention strategies (eg, modifying the use of antithrombotic drugs) or, in the future, disease-modifying treatments targeting vascular β-amyloid.

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[Comment] Capturing the Alzheimer's disease pathological cascade  Voir?

Alzheimer's disease is thought to begin insidiously, when amyloid β (Aβ) aggregates into plaques in the brain while cognition is still unimpaired. After Aβ aggregation has started, it can take up to 20 years for full-blown dementia to manifest.1,2 What happens during this period is uncertain, as long-term follow-up studies have not yet been completed. Current disease development models are based mostly on cross-sectional studies in people without dementia who have aggregated Aβ, as assessed indirectly by biomarkers in CSF or by PET scanning.

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[Comment] The future of seizure detection  Voir?

In clinical practice, we rely on seizure diaries of our patients to manage epilepsy. In their Personal View1 in The Lancet Neurology, Christian Elger and Christian Hoppe review the literature on the accuracy with which patients with epilepsy document their seizures. Elger and Hoppe conclude that under-reporting of seizures is an important clinical problem; less than half of the patients could accurately document their seizures, and more than half of all seizures captured during long-term video-electroencephalography (EEG) monitoring were unreported.

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[Comment] The evolving landscape of epilepsy neuropathology  Voir?

The neuropathological findings from brain tissue specimens taken from 9523 adults and children with treatment-resistant focal epilepsy who had resective surgery were recently published in the New England Journal of Medicine.1 These specimens were taken from a collaborative brain tissue registry involving 27 European centres, which is possibly the largest database of surgically resected neuropathology in epilepsy compiled to date. The most common pathologies were hippocampal sclerosis (36%), developmental tumours (gangliogliomas and dysembryonic neuroepithelial tumours, 16%), focal cortical dysplasias (14%), cavernous angioma (4·5%), and glial scars (4·8%); in around 8% of the specimens no pathology was found.

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[Corrections] Corrections  Voir?

Meyfroidt G, Baguley I J, Menon D K. Paroxysmal sympathetic hyperactivity: the storm after acute brain injury. Lancet Neurol 2017; 16: 721–29—In figure 2 of this Series paper, the placement of the labels and arrows at the spinal level for descending inhibition, non-noxious sensory input, and motor output were incorrect. Corrections to the placement of these labels and arrows have now been made to the online version as of Feb 13, 2018.

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[Correspondence] The advocacy role of the World Federation of Neurology  Voir?

The mission of the World Federation of Neurology (WFN) is to foster brain health worldwide. Our overarching aim is to promote neurological practice for the sake of patients with neurological disease. The findings from the 2015 Global Burden of Disease study1 have shown the enormous contribution of neurological diseases to disability-adjusted life-years, years of life lost, and years lived with disability. Furthermore, the WHO Atlas of Country Resources for Neurological Disorders2 shows that huge treatment gaps exist for these diseases worldwide.

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[Correspondence] Distinct representation of muscle weakness in QMG and MG-ADL  Voir?

We read the findings of James Howard and colleagues with interest.1 Their phase 3, randomised, double-blind, placebo-controlled multicentre study investigated the effect of eculizumab in patients with anti-acetylcholine receptor antibody-positive refractory generalised myasthenia gravis. Notably, Howard and colleagues showed an apparent discrepancy between the primary (Myasthenia Gravis Activities of Daily Living; MG-ADL) and secondary (Quantitative Myasthenia Gravis test; QMG) endpoints. The primary endpoint, the change from baseline to week 26 in MG-ADL total score, did not significantly differ between the eculizumab-treated and placebo groups (p=0·0698).

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[Correspondence] Distinct representation of muscle weakness in QMG and MG-ADL – Authors' reply  Voir?

We would like to thank Robert de Meel and colleagues for their interest in and comments on our Article.1 The sub-analysis correlations between MG-ADL and QMG data in the phase 2 eculizumab trial2 were based on change from baseline to week 16 in 13 patients who were refractory to immunosuppressive treatments. No correlation analyses have been done on the phase 3 worst-rank data.

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[In Context] Multiple sclerosis: what's it got to do with your guts?  Voir?

Might the gut microbiota of people with multiple sclerosis differ from that of healthy people? Do some bacteria aggravate symptoms? Are other species protective? Could we treat patients by manipulating their intestinal microbes? Work is underway to find out. Adrian Burton investigates.
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[In Context] The enthusiasm of Christian Elger  Voir?

It's the first thing you notice. He's 68, but he has the enthusiasm (for everything) of someone 60 years younger. That must-have new computer, that fancy new smartphone, figuring out what single cells are up to in the brains of people with epilepsy, diagnose-a-thons in Ethiopia, the Russian ballet, modern art, flying helicopters (yes, he does); he loves them all, and he makes you love them too. His enthusiasm is infectious!

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[In Context] Brian Andrew Gordon  Voir?

Brian Andrew Gordon is an Assistant Professor at the Departments of Radiology and Psychological and Brain Sciences, Washington University, St Louis (MO, USA). He did a PhD at the University of Illinois, Urbana-Champaign (IL, USA), studying modifiers of healthy ageing. He held a postdoctoral fellowship in the Department of Psychological and Brain Sciences at Washington University before taking a faculty position in the Department of Radiology in 2013. His research focuses on understanding the pathophysiology of Alzheimer's disease using MRI, PET, and fluid-based biomarkers.

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[In Context] Temporal lobe epilepsy in The Passion According to GH  Voir?

Clarice Lispector was an iconic Brazilian writer who was known for her strange, almost mystical writings. Her novel, The Passion According to GH,1 has long been considered to describe the internal workings of a woman (GH), who suddenly and unexpectedly finds herself in the midst of a spiritual crisis that is triggered by the sight of a cockroach in a clean room. During her crisis, the protagonist reports feeling disoriented and irritated, with subsequent auditory and visual hallucinations, and a range of symptoms including screaming, dry mouth, clenching of the jaw, intense sweating, and sudden vomiting.

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[In Context] Music lives on: fine tuning the memory  Voir?

“Music is part of being human.”Oliver Sacks
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[Articles] Evaluation of the safety, tolerability, and efficacy of pimavanserin versus placebo in patients with Alzheimer's disease psychosis: a phase 2, randomised, placebo-controlled, double-blind study  Voir?

Pimavanserin showed efficacy in patients with Alzheimer's disease psychosis at the primary endpoint (week 6) with an acceptable tolerability profile and without negative effect on cognition. Further follow-up to week 12 did not show significant advantage for pimavanserin versus placebo.
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[Articles] Behavioural outcomes of subthalamic stimulation and medical therapy versus medical therapy alone for Parkinson's disease with early motor complications (EARLYSTIM trial): secondary analysis of an open-label randomised trial  Voir?

In a large cohort with Parkinson's disease and early motor complications, better overall behavioural outcomes were noted with bilateral subthalamic stimulation plus medical therapy compared with medical therapy alone. The presence of hyperdopaminergic behaviours and neuropsychiatric fluctuations can be judged additional arguments in favour of subthalamic stimulation if surgery is considered for disabling motor complications.

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[Articles] The Edinburgh CT and genetic diagnostic criteria for lobar intracerebral haemorrhage associated with cerebral amyloid angiopathy: model development and diagnostic test accuracy study  Voir?

The CT and APOE genotype prediction model for CAA-associated lobar intracerebral haemorrhage shows excellent discrimination in this cohort, but requires external validation. The Edinburgh rule-in and rule-out diagnostic criteria might inform prognostic and therapeutic decisions that depend on identification of CAA-associated lobar intracerebral haemorrhage.

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[Articles] Spatial patterns of neuroimaging biomarker change in individuals from families with autosomal dominant Alzheimer's disease: a longitudinal study  Voir?

Mutation carriers had elevations in Aβ deposition, reduced glucose metabolism, and cortical thinning compared with non-carriers which preceded the expected onset of dementia. Accrual of these pathologies varied throughout the brain, suggesting differential regional and temporal vulnerabilities to Aβ, metabolic decline, and structural atrophy, which should be taken into account when using biomarkers in a clinical setting as well as designing and evaluating clinical trials.

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[Review] Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and neuromuscular, rehabilitation, endocrine, and gastrointestinal and nutritional management  Voir?

Since the publication of the Duchenne muscular dystrophy (DMD) care considerations in 2010, multidisciplinary care of this severe, progressive neuromuscular disease has evolved. In conjunction with improved patient survival, a shift to more anticipatory diagnostic and therapeutic strategies has occurred, with a renewed focus on patient quality of life. In 2014, a steering committee of experts from a wide range of disciplines was established to update the 2010 DMD care considerations, with the goal of improving patient care.

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[Review] Technological advances and changing indications for lumbar puncture in neurological disorders  Voir?

Technological advances have changed the indications for and the way in which lumbar puncture is done. Suspected CNS infection remains the most common indication for lumbar puncture, but new molecular techniques have broadened CSF analysis indications, such as the determination of neuronal autoantibodies in autoimmune encephalitis. New screening techniques have increased sensitvity for pathogen detection and can be used to identify pathogens that were previously unknown to cause CNS infections. Evidence suggests that potential treatments for neurodegenerative diseases, such as Alzheimer's disease, will rely on early detection of the disease with the use of CSF biomarkers.

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[Personal View] Diagnostic challenges in epilepsy: seizure under-reporting and seizure detection  Voir?

Epileptic seizures vary greatly in clinical phenomenology and can markedly affect the patient's quality of life. As therapeutic interventions focus on reduction or elimination of seizures, the accurate documentation of seizure occurrence is essential. However, patient self-evaluation compared with objective evaluation by video-electroencephalography (EEG) monitoring or long-term ambulatory EEG revealed that patients document fewer than 50% of their seizures, on average, and that documentation accuracy varies significantly over time.

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Dernière mise à jour : 24/02/2018 : 18:38


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