Annals of Clinical and Translational Neurology

Age-Related Characteristics of SYT1-Associated Neurodevelopmental Disorder
Norwitz SG, Eck J, Winston JS and Baker K
We describe the clinical manifestations and developmental abilities of individuals with SYT1-associated neurodevelopmental disorder (Baker-Gordon syndrome) from infancy to adulthood. We further describe the neuroradiological and electrophysiological characteristics of the condition at different ages, and explore the associations between these characteristics and clinical symptoms.
Evaluation of the Efficacy and Safety of Satralizumab in a Pregnant NMOSD Patient With AQP4/MOG-IgG Dual Seropositive: A Case Report
Luo Y, Xie S and Liu X
Neuromyelitis Optica Spectrum Disorder (NMOSD) is a chronic autoimmune neuroinflammatory disease, typically characterized by antibodies against aquaporin 4 (AQP4-IgG) or myelin oligodendrocyte glycoprotein (MOG-IgG). Simultaneous seropositivity for both antibodies in a single patient is exceedingly rare. We present a dual AQP4-IgG/MOG-IgG seropositivity case who was treated with satralizumab throughout the whole preconception-to-postpartum course, to evaluate the effectiveness and safety of satralizumab, especially during the perinatal period. A 34 year-old female, initially presenting with decreased visual acuity in the left eye, was diagnosed with NMOSD as both AQP4-IgG and MOG-IgG seropositive. With traditional treatment of corticosteroids and mycophenolate mofetil, her vision gradually recovered and overall condition stabilized. Due to the desire for conception, her treatment regimen was transitioned to satralizumab monotherapy. Three months later with five doses of satralizumab, she successfully conceived and delivered a healthy female infant at 38 weeks' gestation. Satralizumab treatment was continued throughout the preconception-to-postpartum course. All routine and perinatal assessments were within normal limits, and 4 months postpartum, the condition of both mother and child remained stable, further supporting the favorable effectiveness and safety of satralizumab in this case. The coexistence of AQP4-IgG and MOG-IgG in an NMOSD patient represents an extremely rare and complex clinical scenario. When fertility is desired, the selection of disease-modifying therapy must carefully balance effectiveness and safety. In such cases, satralizumab may serve as a viable option, supported by promising real-world data.
Refractory Status Epilepticus Treated With Bilateral Pulvinar Deep Brain Stimulation-A Case Study
Tang M, Bai A, Ferreira FRM, Pati S, Walczak T, Miller B, Bentho O, Henry T, Leppik I, Shams M, Sha Z, Sanger Z, Netoff TI, Lisko T, Naik A, McGovern R and Patel S
New-onset refractory status epilepticus (NORSE) arises without an identifiable cause or prior epilepsy history, with a 16%-27% mortality rate and significant long-term neurological sequelae. Neuromodulation such as deep brain stimulation (DBS) targeting the anterior and centromedian thalamic nuclei has shown promise when the traditional approach of anti-seizure medications (ASMs), anesthetics, and immunomodulation fails. We present a case of cryptogenic NORSE in a 30-year-old male with autism and developmental delay, with refractory seizures localized to bilateral posterior quadrants. Sensing-enabled DBS targeting the pulvinar thalami led to decreased seizure burden and clinical improvement, highlighting the importance of tailoring neuromodulatory targets to seizure localization.
Effectiveness and Safety of Nusinersen and Risdiplam in Spinal Muscular Atrophy: A Systematic Review
Mehrabian A, Auguste P, Grove A, Brown A, Parr J, Patel M, Butt F, Donoghue J, Yousefi M and Parsons J
Spinal Muscular Atrophy (SMA) is a rare genetic disorder marked by progressive muscle weakness and mobility loss. It has a profound physical, emotional and social impact on patients and caregivers, requiring comprehensive medical and supportive care. SMA is classified into Types 1-4, with some individuals identified presymptomatically. This systematic review examined the safety and effectiveness of nusinersen and risdiplam for treating SMA.
Functional Connectivity Linked to Cognitive Recovery After Minor Stroke
Commuri V, Dallasta I, Stone C, Girgenti S, Gould N, Llinas RH, Simon JZ and Marsh EB
Patients with minor stroke exhibit slowed processing speed and generalized alterations in functional connectivity involving frontoparietal cortex (FPC). The pattern of connectivity evolves over time. In this study, we examine the relationship of functional connectivity patterns to cognitive performance, to determine neurophysiological underpinnings of improvement, and whether connectivity profiles may be useful in evaluating and predicting longer-term cognitive outcomes.
Changes in Immune-Inflammation Status and Acute Ischemic Stroke Prognosis in Prospective Cohort
Chen S, Huang W, Liu Y, Chen X, Ke B, Shen Q, Cai H, Sun J, Li Y, Cao Y, Hu B and Chen K
Inflammation is a critical risk factor for poor outcomes in cerebral infarction. Prior studies focused primarily on baseline inflammation status, neglecting dynamic longitudinal changes. We try to investigate the association between immune-inflammation status alterations and stroke prognosis, and evaluated three systemic biomarkers' predictive efficacy.
Reduced Muscular Carnosine in Proximal Myotonic Myopathy-A Pilot H-MRS Study
Gussew A, Kargaran M, Rothe M, Deistung A, Stoevesandt D, Wohlgemuth WA, Strube D, Kendzierski T, Kölsch AK, Heuschen MGA, Otto M and Mensch A
Myotonic dystrophy type 2 (proximal myotonic myopathy, PROMM) is a progressive multisystem disorder with muscular symptoms (proximal weakness, pain, myotonia) and systemic manifestations such as diabetes mellitus, cataracts, and cardiac arrhythmias. A hallmark feature is the selective degeneration of type-II fibers, likely driven by chronic myotonia and sustained metabolic stress. In this study, proton magnetic resonance spectroscopy (H-MRS) was applied to assess intramuscular carnosine as a potential noninvasive marker of type-II fiber integrity, alongside extramyocellular lipids (EMCL) and intracellular pH. We hypothesized that carnosine would be reduced in PROMM as a consequence of type-II fiber loss.
Post-COVID Fatigue Is Associated With Reduced Cortical Thickness After Hospitalization
Hartung TJ, Steigerwald F, Romanello A, Kodde C, Endres M, Frank S, Heuschmann P, Koehler P, Krohn S, Pape D, Schaller J, Stöcklein S, Vadasz I, Vehreschild J, Witzenrath M, Zoller T, Finke C and
Neuropsychiatric symptoms are among the most prevalent sequelae of COVID-19, particularly among hospitalized patients. Recent research has identified volumetric brain changes associated with COVID-19. However, it currently remains poorly understood how brain changes relate to post-COVID fatigue and cognitive deficits. We, therefore, aimed to assess structural brain changes after hospitalization for COVID-19 and their associations with cognitive performance and fatigue.
Will Memantine Exacerbate Seizures in People With Epilepsy? A Prospective Cohort Study
Wang P, Lu L, Gao H, Zhang Q, Xiao J, Sander JW, Xiong W and Zhou D
To evaluate whether add-on memantine would exacerbate seizures in people with epilepsy.
Inhibition of Classical and Alternative Complement Pathway by Ravulizumab and Eculizumab
Gerischer L, Stascheit F, Mönch M, Doksani P, Dusemund C, Herdick M, Mergenthaler P, Stein M, Suboh A, Schröder-Braunstein J, Wabnitz G, Lünemann JD, Lehnerer S, Hoffmann S and Meisel A
To explore the feasibility of classical (CH50) and alternative (AH50) complement pathway activity as potential biomarkers for treatment guidance and monitoring during therapy with ravulizumab in patients with generalized myasthenia gravis (gMG) and compare these to therapeutic drug monitoring under eculizumab.
Use of Symptomatic Drug Treatment for Fatigue in Multiple Sclerosis and Patterns of Work Loss
Englund S, Reutfors J, Frisell T and Piehl F
To describe the use of central stimulants and amantadine for fatigue in MS and evaluate a potential association with reduced work loss in people with MS.
Acoustic Measures Capture Speech Dysfunction in Spinocerebellar Ataxia
Fadel Z, Hennessey C, Lee H, Parekh P, Kuo SH and Kumar A
Spinocerebellar ataxias (SCA) are hereditary cerebellar degenerative disorders with a common feature of dysarthria, involving impaired phonatory and articulatory control of speech, thereby affecting social communication. In this study, we investigated whether acoustic measures could objectively measure speech dysfunction and identify common indicators across SCA types 1, 2, and 3.
RETRACTION: α-Synuclein Conformational Antibodies Fused to Penetratin are Effective in Models of Lewy Body Disease
B. Spencer, S. Williams, E. Rockenstein, E. Valera, W. Xin, M. Mante, J. Florio, A. Adame, E. Masliah, and M.R. Sierks, "α-Synuclein Conformational Antibodies Fused to Penetratin are Effective in Models of Lewy Body Disease," Annals of Clinical and Translational Neurology 3, no. 8 (2016): 588-606, https://doi.org/10.1002/acn3.321. The above article, published online on 16 June 2016, in Wiley Online Library (http://onlinelibrary.wiley.com/), has been retracted by agreement between the journal Editor-in-Chief, Ahmet Hoke; the American Neurological Association; and Wiley Periodicals LLC. Following publication, a third party contacted the publisher with concerns about duplications in Figures 1A, 3A, 3C, and 4A. Additionally, duplicated panels were discovered for Figure 5 with an earlier publication by some of the same authors (Fields et al., 2016 [https://doi.org/10.1186/s12974-016-0585-8]). The retraction has been agreed to because of evidence that significant portions of multiple figures were duplicated, affecting the interpretation of the data and results presented. Author Eliezer Masliah did not indicate his agreement with the retraction. The other authors did not respond to communications from the Publisher regarding the retraction.
Hospital Readmission After Traumatic Brain Injury Hospitalization in Community-Dwelling Older Adults
Thomas R, Law CA, Casey JA, Mosley T, Gottesman RF, Diaz-Arrastia R, Elser H and Schneider ALC
To examine the risk of hospital readmission after an index hospitalization for TBI in older adults.
Nationwide Survey of Atopic Myelitis and Plexin D1-Immunoglobulin G-Related Pain
Kira JI, Zhang X, Fujii T, Mitsuishi M, Ushijima M, Yoshidomi S, Sakoda A, Imamura T, Kuwabara S, Isobe N and Nakamura Y
To elucidate the features of plexin D1-immunoglobulin (Ig)G-associated neuropathic pain and its relationship to atopic myelitis (AM) in a nationwide Japanese survey.
Deep Learning-Assisted Differentiation of Four Peripheral Neuropathies Using Corneal Confocal Microscopy
Rabah CB, Petropoulos IN, Stettner M, Ferdousi M, Alam U, Efron N, Serag A and Malik RA
Peripheral neuropathies contribute to patient disability but may be diagnosed late or missed altogether due to late referral, limitation of current diagnostic methods and lack of specialized testing facilities. To address this clinical gap, we developed NeuropathAI, an interpretable deep learning-based multiclass classification system for rapid, automated diagnosis and differentiation of 88 patients with diabetic peripheral neuropathy (DPN), chemotherapy-induced peripheral neuropathy (CIPN), chronic inflammatory demyelinating polyneuropathy (CIDP), and human immunodeficiency virus-associated sensory neuropathy (HIV-SN).
Olink Proteomics Analysis Reveals Heterogeneous Responses to FcRn Blockade in Anti-AChR Antibody-Positive Myasthenia Gravis: FGF-19 as a Novel Biomarker
Luo T, Peng D, Zhang Z, Yang M, Guo X, Ma T, Huang X, Xu M, Fu L and Zhang Y
This study aimed to systematically observe the clinical manifestations, immune cell subsets, and dynamic changes in serological indicators in patients with myasthenia gravis (MG) before and after efgartigimod (EFG) treatment.
The Case of a 28-Year-Old Woman With Medically Refractory Focal Epilepsy
Sharma R, Leppik I, Henry T, Walczak T, Patel S and McGovern R
We present the case of a 28-year-old right-handed woman with medically refractory focal epilepsy. Her seizure semiology and electroencephalography (EEG) indicated a seizure onset zone in the right central-parietal area. However, both MRI and PET scans were unremarkable, showing no focal lesions or areas of altered metabolism. Intracranial monitoring, with extensive evaluation of both hemispheres, confirmed the seizure onset zone in the right central-parietal region. This area not only served as the site of seizure onset but also encompassed the primary sensory cortex.
Daratumumab Treatment for Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP): A Case Report
Zhang X, Zhao J, Zhao X, Hu X, Xiao Z, Wu J, Li X, Xu J and Li YJ
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune-mediated neuropathy featuring progressive weakness, sensory deficits, and areflexia. While corticosteroids, intravenous immunoglobulin, and plasmapheresis are effective first-line immunotherapies, a subset of patients remains treatment-refractory. Daratumumab, an anti-CD38 monoclonal antibody approved for multiple myeloma, demonstrates immunomodulatory effects suggesting utility in refractory neuroimmune disorders. However, evidence for its efficacy in CIDP remains limited. We report a case study of treatment-refractory CIDP successfully managed with daratumumab, including 1 year follow-up data.
Prediction of Myasthenia Gravis Worsening: A Machine Learning Algorithm Using Wearables and Patient-Reported Measures
Stein M, Sun H, Lehnerer S, Gerischer L, Mönch M, Meisel C, Meisel A and Narayanaswami P
Myasthenia gravis (MG) is a rare disorder characterized by fluctuating muscle weakness with potential life-threatening crises. Timely interventions may be delayed by limited access to care and fragmented documentation. Our objective was to develop predictive algorithms for MG deterioration using multimodal telemedicine data.
Domain Specific Placebo Response in the Modified Friedreich's Ataxia Rating Scale
Rummey C, Farmer JM and Lynch DR
The placebo response in clinical trials in ataxias complicates outcome interpretation and potentially obscures genuine treatment effects. We analyzed placebo group data from past trials in Friedreich Ataxia and observed notable responses in appendicular items, in contrast to minimal changes in axial function, as measured by respective subscores of the modified Friedreich Ataxia Rating Scale (mFARS). The effect increased with the number of consecutive tests, shorter testing intervals, and older group ages. This has implications for trial design and endpoint selection, thus strengthening the utility of the Upright Stability Score (USS), a sub-score of mFARS, as an independent measure.