Chronic migraine is a disabling and prevalent neurological disease that significantly impacts patients' quality of life. OnabotulinumtoxinA (OnabotA) is a safe and effective chronic migraine preventive treatment. The objective was to evaluate adherence to the recommended time interval between consecutive OnabotA injections according to the Phase III Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) protocol, and to analyze changes in the interval adherence before and after the introduction of an Advanced Practice Nurse (APN) in a specialized Headache Unit of a tertiary hospital.
This was a retrospective study performed in a Spanish specialized Headache Clinic. Patients diagnosed with chronic migraine and treated with OnabotA following the PREEMPT protocol were included, before and after the introduction of APNs. Treatment was considered interval-compliant if the injection interval ranged from 75 to 105 days. The data collected included three 18-month periods. Statistical analyses examined differences across periods using R-Studio.
A total of 2991 participants were included, of whom 83.8% (2507/2991) were women, with a median age [interquartile range (IQR)] of 48.0 [40.0–57.0] years old. A statistically significant association between the introduction of the APN and improved adherence to the PREEMPT protocol was observed over time (Z = –19.60, p < 0.001). Adherence rates increased from 52.1% in P1 to 76.1% in both P2 and P3. The median time between visits decreased from 105 days in P1 to 96 days in P2, with a slight increase to 98 days in P3.
The involvement of advanced practice nurses in OnabotA administration decreased the time interval between infiltrations and improved adherence to the PREEMPT protocol. These findings highlight the APN's role in optimizing patient care.
Sudden Unexpected Death in Epilepsy (SUDEP) is the leading cause of death in patients with epilepsy (PWE), although the mechanisms are unclear. Early studies have shown that abnormal cardiopulmonary function plays a key role in SUDEP. Cardiopulmonary activity is regulated by the autonomic nervous system. Serotonin (5-hydroxytryptamine or 5-HT) neurons significantly influence respiration and are also closely related to epilepsy. Therefore, serotonin is hypothesized to be involved in SUDEP, and a substantial amount of research has focused on it. Notably, serotonin signals through at least 14 known receptor subtypes, with preclinical data suggesting a particular involvement of the 5-HT2, 5-HT3, and 5-HT4 receptors in SUDEP. Dilute Brown Non-Agouti (DBA)/1 and DBA/2 mice, which often die of seizure-induced respiratory arrest (S-IRA) following audiogenic seizures (AGS), are the most commonly used animal models for studying SUDEP. Increased serotonin reduces S-IRA, activating serotonin neurons prevents SUDEP, abnormalities in serotonin receptors are associated with SUDEP, and selective serotonin reuptake inhibitors (SSRIs) affect electroencephalogram (EEG) activity. Other studies have found that serotonin protects against S-IRA in PWE. Pathological studies in patients with SUDEP have also revealed that, in comparison with controls, the axonal length (AL) of serotonin transporter (SERT)-positive axons is longer and the level of tryptophan hydroxylase (TPH), the rate-limiting enzyme in serotonin synthesis, is lower. Consequently, serotonin is possibly a potential target for preventing SUDEP. However, most of the results are from animal studies, while the experimental data in PWE are limited. More human studies are needed in the future.
Gait training using robotic devices in stroke patients is a widely researched treatment modality. Therefore, there is a lot of heterogeneous information that needs to be synthesized, sorted, and classified. The aim of this work was to synthesize and analyze the scientific evidence on the application of robotic devices for gait training in people with stroke.
This overview of systematic reviews and meta-analysis was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Searches were performed in four electronic databases: PubMed, Scopus, Web of Science, and Cochrane Library Plus. Systematic reviews and meta-analyses that included randomized controlled trials (RCTs) that investigated the effects of robotic devices in combination or not with another physiotherapy treatment on gait recovery in stroke patients were included.
Thirteen studies with a total of 101 RCTs were included. Data regarding the participants, outcome measures, training protocols and main results were extracted. The A Messurement Tool to Assess Systematic Review (AMSTAR-2) scale and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of certainty of evidence were applied. Only one study had a high certainty of evidence; while four had a moderate certainty, six were classified as having a low certainty and two had a critically low quality.
Robotic gait training combined with physiotherapy improves walking speed after stroke, especially with end-effector devices. However, benefits do not reach clinically meaningful functional thresholds, and applicability is limited due to insufficient evidence, high costs, and limited accessibility.
CRD42021237915, https://www.crd.york.ac.uk/PROSPERO/view/CRD42021237915.
Neurovascular conflict (NVC) is a rare but often overlooked cause of oculomotor cranial nerve (OCN) palsy. In this study, we aimed to enhance understanding of NVC as a potential cause of cranial nerve palsies by summarizing the characteristics of eight OCN palsy cases associated with NVC and reviewing previously reported cases.
A retrospective case series of eight patients with OCN palsy due to NVC was analyzed. Diagnosis was made using 3.0 Tesla magnetic resonance imaging (MRI) with 3D-fast imaging with steady-state acquisition (3D-FIESTA) sequences. Differential diagnoses like myasthenia gravis, inflammatory diseases, and aneurysms were excluded.
The study involved eight patients (six males, two females), aged 34–78 years (average 58.4 years). Six had abducens nerve palsy, and two had partial oculomotor nerve palsy, all exhibiting painless partial ophthalmoplegia. Imaging revealed OCN compression by various arteries: abducens nerve palsy was due to the basilar artery (three patients), vertebral artery (one patient), and anterior inferior cerebellar artery (two patients); two cases of partial oculomotor nerve palsy were caused by compression of the superior cerebellar artery and the posterior cerebral artery, respectively.
NVC should be considered in patients with abducens nerve palsy, particularly those with intermittent symptoms and painless ophthalmoplegia, especially if they have atherosclerotic risk factors; in this descriptive single-center cohort, diagnosis was supported by high-resolution MRI, including 3D-FIESTA and magnetic resonance angiography.
Migraine aura status is a complication of migraine. It is characterised by the presence of at least 3 episodes of migraine aura within a 3-day period. The pain and/or associated symptoms are often debilitating. Cortical laminar necrosis (CLN) is a gyriform brain lesion caused by insufficient oxygen and glucose supply, resulting in the loss of cortical neurons, often due to cardiac arrest, global hypoxia, and hypoglycaemia. Metabolic disorders, hypoglycaemia, renal and hepatic dysfunction, and immunosuppressive chemotherapy. In children, cortical laminar necrosis has been linked to the subacute or chronic phase of brain damage due to hypoxic-ischaemic encephalopathy. Metabolic disorders, hypoglycaemia, renal and hepatic dysfunction, and immunosuppressive chemotherapy are included as other possible aetiologies. CLN has also been reported in patients with encephalitis, but it is extremely rare in migraine with or without aura.
We describe a 14-year-old boy with no previous neurological problems who was admitted to our unit due to the onset of acute and persistent symptoms characterised by headache, confusion, dysarthria, aphasia and visual disturbances. An initial emergency brain neuroimaging scan revealed edema localised in the supramarginal gyrus of the left cerebral hemisphere, with possible vascular etiology. A control magnetic resonance imaging revealed laminar necrosis of the cortico-pial area located in the same region.
This clinical case is interesting due to the uncommon correlation between cortical laminar necrosis and migraine with aura (MA), the pediatric presentation, the location of hypoperfusion and the atypical progression of the migraine aura. We have reported a narrative review of the two disorders.
In countries with a low incidence of human rabies, this lethal virus is rarely considered in the differential diagnosis of acute flaccid paralysis.
A young woman presented with fever and progressive weakness that evolved into flaccid quadriparesis, associated with neuropsychiatric symptoms, multiple cranial neuropathy, and dysautonomia. The complementary tests and the unusual reflexes that accompanied the diagnosis of brain death are described. The diagnosis was confirmed postmortem by compatible histopathological findings.
Human rabies should be considered in cases of flaccid paralysis with encephalitis due to its implications for preventing further deaths through public health measures.