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NEWS - Neurology

Association of Antidepressant Use With Drug-Related Extrapyramidal Symptoms: A Pharmacoepidemiological Study – Journal of Clinical Psychopharmacology (link to abstract – $ for full-text)

Commentaries: Incidence of Extrapyramidal Symptoms Higher With Certain Antidepressants – MPR (free) AND Antidepressants tied to Parkinson’s-like symptoms – Univadis (free registration required)

“Observational study: Incidence of EPSs with antidepressants. RRs: duloxetine, 5.68; mirtazapine, 3.78; citalopram, 3.47; escitalopram, 3.23; paroxetine, 3.07; sertraline, 2.57; venlafaxine, 2.37; bupropion, 2.31; and fluoxetine, 2.03 (all significant)” (via @psychopharmacol see Tweet)


Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs – American Academy of Neurology and the American Epilepsy Society

Part I: Treatment of new-onset epilepsy (free PDF)

Part II: Treatment-resistant epilepsy (free PDF)

Commentary: New Epilepsy Guidelines Shed Light on Explosion of New Drugs – MedPage Today (free registration required)


Continuous low-dose antibiotic prophylaxis to prevent urinary tract infection in adults who perform clean intermittent self-catheterisation: the AnTIC RCT – Health Technology Assessment (free)

“The results of this large randomised trial, conducted in accordance with best practice, demonstrate clear benefit for antibiotic prophylaxis in terms of reducing the frequency of UTI for people carrying out CISC”.


Effect of Fremanezumab Compared With Placebo for Prevention of Episodic Migraine: A Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)

Commentary: Fremanezumab effective in preventing episodic migraine – 2 Minute Medicine (free)

“Among patients with episodic migraine in whom multiple medication classes had not previously failed, subcutaneous fremanezumab, compared with placebo, resulted in a statistically significant 1.3- to 1.5-day reduction in the mean number of monthly migraine days over a 12-week period”. (from JAMA)

“The small effect size in terms of reduction in number of days with migraine dampens enthusiasm for this medication, though without head-to-head comparison against other prophylactics, this is hard to assess” (from 2 Minute Medicine)


Rapid Recommendations: Atraumatic (pencil-point) versus conventional needles for lumbar puncture: a clinical practice guideline – The BMJ (free)

We issue a strong recommendation for use of atraumatic needles in all patients (adults and children) undergoing lumbar puncture because they decrease complications and are no less likely to work than conventional needles”


Support for midlife anxiety diagnosis as an independent risk factor for dementia: a systematic review – BMJ Open (free)

Commentaries: Moderate to severe mid-life anxiety may be linked to later life dementia – BMJ Open Blog (free) AND Anxiety in middle age linked to dementia later – Reuters (free) AND Expert reaction to a review of the association between mid-life anxiety and later life dementia – Science Media Centre (free)

“The current study isn’t designed to explain how anxiety and dementia might be connected, Iadecola added.

“We cannot say with confidence that anxiety is a cause (risk factor), an early manifestation of the dementia, or only coincidentally associated with it,”” (from Reuters)


Anticholinergic drugs and risk of dementia: case-control study – The BMJ (free)

Editorial: Anticholinergic drugs and dementia in older adults (free)

Commentaries: Expert reaction to study investigating the association between different types of anticholinergic drugs and risk of dementia – Science Media Centre (free) AND Anticholinergic drugs may be linked to increased risk of dementia – OnMedica (free)

“The effect of anticholinergic therapy is relatively small (odds ratio 1.1 – 1.2) and establishing an association does not prove a causal link. Nevertheless, the paper may act as a useful guide for future research and clinical practice”. (by Prof Les Iversen, in Science Media Centre)


Case managers improve outcomes for people with dementia and their carers – NIHR Signal (free)

Original Article: The effectiveness of community-based coordinating interventions in dementia care: a meta-analysis and subgroup analysis of intervention components – BMC Health Services Research (free)

“The review suggests that nurses may be particularly well placed to act as case managers for people with dementia, perhaps because they have the skills to perform the broad range of tasks associated with the role.” (via @NIHR_DC see Tweet)


Non-invasive brain stimulation techniques for chronic pain – Cochrane Library (free)

“There is a lack of high-quality evidence to support or refute the effectiveness of non-invasive brain stimulation techniques for chronic pain”


Time to Endovascular Treatment and Outcome in Acute Ischemic Stroke: MR CLEAN Registry Results – Circulation (link to abstract – $ for full-text)

Commentary: Time to endovascular therapy predicted functional outcome after stroke in registry study – ACP Hospitalist (free)

“Every hour of delay from stroke onset to the start of endovascular therapy resulted in a 5.3% decreased probability of functional independence” (from ACP Hospitalist)


Increased coronary heart disease and stroke hospitalisations from ambient temperatures in Ontario – Heart (free)

Related study: Big Swings in Daily Temperatures Linked to Spikes in MI Rates – TCTMD (free)

“Cold and hot weather associated with risk of cardiovascular disease hospitalization” (via @kamleshkhunti see Tweet)


Patent foramen ovale closure vs. medical therapy for cryptogenic stroke: a meta-analysis of randomized controlled trials – European Heart Journal (free)

“5-study EHJ meta analysis confirms value of PFO closure after cryptogenic stroke. “Number Needed to Close”: 178 pts to prevent one stroke over 1 year. Size matters (no effect for small shunts, “NNC” 96 for large shunts)” (via @Steph_Achenbach see Tweet)


Endovascular treatment for acute ischaemic stroke in routine clinical practice: prospective, observational cohort study (MR CLEAN Registry) – The BMJ (free)

Related guideline: 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association / American Stroke Association (free PDF) AND Summary for ED-relevant care: 2018 AHA/ASA Ischemic Stroke Updates – emDocs (free)

“In routine clinical practice, endovascular treatment for patients with acute ischemic stroke is at least as effective and safe as in the setting of a randomized controlled trial”.


Socioeconomic disparities in first stroke incidence, quality of care, and survival: a nationwide registry-based cohort study of 44 million adults in England – The Lancet Public Health (free)

Invited commentary: Preventing stroke on the street where you live, work, and play (free)

Patients from the lowest socioeconomic groups had first stroke a median of 7 years earlier than those from the highest and a 26% higher adjusted risk of 1-year mortality.


Outcomes, experiences and palliative care in major stroke: a multicentre, mixed-method, longitudinal study – Canadian Medical Association Journal (free)

““Palliative care” had connotations of treatment withdrawal and imminent death… practicing the principles of palliative care is needed, but the term “palliative care” should be avoided or reframed”.

See related articles on this subject: Palliative care: renaming as supportive care and integration into comprehensive cancer care – CMAJ (free) AND Perceptions of palliative care among patients with advanced cancer and their caregivers (free)


Comparative Effectiveness and Safety of Cognitive Enhancers for Treating Alzheimer’s Disease: Systematic Review and Network Meta-analysis – Journal of the American Geriatrics Society (free)

Source: Medscape (free registration required)

“Cognitive enhancers in general have minimal effects on cognition according to minimal clinically important difference and global ratings. The drugs appear safe, but this must be interpreted cautiously because trial participants may have less comorbidity and fewer adverse effects than those treated with these drugs in clinical practice”.


Effect of Haloperidol on Survival Among Critically Ill Adults With a High Risk of Delirium: The REDUCE Randomized Clinical Trial – JAMA (free)

Prophylactic haloperidol in this population with elevated risk of delirium did not reduce mortality or any of the 15 prespecified secondary outcomes, including delirium incidence, 28-day delirium-free and coma-free days, duration of mechanical ventilation, and ICU and hospital length of stay.


Prognostic effects of delirium motor subtypes in hospitalized older adults: A prospective cohort study – PLOS One (free) (via @DrMeganHoseyPhD)

“One in three acutely ill hospitalized older adults who suffered hypoactive or mixed delirium died in the hospital”


Five and 10 minute Apgar scores and risks of cerebral palsy and epilepsy: population based cohort study in Sweden – The BMJ (free)

Infographic: The vital ­first 10 minutes (free PDF)

Even slight changes within the normal Apgar score range (7-10) from five to 10 minutes have a major influence in the risks of cerebral palsy and epilepsy.


Traumatic brain injury and the risk of dementia diagnosis: A nationwide cohort study – PLOS One (free)

Commentaries: TBI is associated with increased dementia risk for decades after injury – PLOS, via ScienceDaily (free) AND More evidence traumatic brain injuries raise later dementia risk – Reuters (free)

“Using longitudinal, case-control, and sibling-matched analyses of nationwide data from Sweden, Peter Nordström & Anna Nordström describe the association between TBI and dementia, its time course, and the influence of familial factors”. (via @PLOSMedicine see Tweet)


2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association (free PDF)

Commentaries: More stroke patients eligible for crucial treatments under new guidelines – American Heart Association News (free) AND More stroke patients may receive crucial treatments under new guideline – AHA/ASA Newsroom (free)

“A new guideline for treating acute ischemic stroke recommends an increased treatment window for mechanical clot removal from six hours to up to 24 hours in certain patients with clots in large vessels”. (from AHA/ASA Newsroom)


Association of Time to Treatment With Short-term Outcomes for Pediatric Patients With Refractory Convulsive Status Epilepticus – JAMA Neurology (free for a period)

Editorial: Time May Be of the Essence in the Treatment of Pediatric Patients With Refractory Convulsive Status Epilepticus (free)

Commentary: Delays Raise Death Risk in Kids with Status Epilepticus – MedPage Today (free registration required)

“These findings may change the perception of acute seizure and status epilepticus treatment, tentatively converting it into an extremely time-sensitive emergency that is similar to stroke or other cardiovascular events”.


Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial – The Lancet (free)

Commentaries: Learning from TARDIS: time for more focused trials in stroke prevention – The Lancet (free) AND Triple Antiplatelets for Reducing Dependency After Ischaemic Stroke – TARDIS – American College of Cardiology, Latest in Cardiology (free)

“Among patients with recent cerebral ischaemia, intensive antiplatelet therapy did not reduce the incidence and severity of recurrent stroke or TIA, but did significantly increase the risk of major bleeding. Triple antiplatelet therapy should not be used in routine clinical practice”.


Practice guideline update summary: Mild cognitive impairment – American Academy of Neurology (free PDF)

Commentary: Mild cognitive impairment: a practice guideline update – Clinical Advisor (free)

“For patients diagnosed with MCI, clinicians may choose NOT to offer cholinesterase inhibitors”.

“If clinicians choose to offer cholinesterase inhibitors, they must first discuss with patients the fact that this is an off-label prescription not currently backed by empirical evidence”.


Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non–Vitamin‐K Oral Anticoagulants (RAF‐NOACs) Study – Journal of the American Heart Association (free)

“Composite rates of recurrence and major bleeding were 12.4% in patients who initiated NOACs within 2 days after acute stroke, 2.1% in those who initiated NOACs between 3 and 14 days, and 9.1% in patients who initiated NOACs >14 days after acute stroke. Future randomized studies to assess timing of initiation and choice of agent in patients with acute stroke and AF are warranted”.


First Dementia Global Monitoring System Launched: Global Dementia Observatory (free resources)

News release: Dementia: number of people affected to triple in next 30 years – World Health Organization (free)


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