295 results match your criteria: "University College London-Queen Square Institute of Neurology[Affiliation]"

Hypertension and small vessel disease: do the drugs work?

Br J Hosp Med (Lond)

September 2023

Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, University College London, London, UK.

Article Synopsis
  • High blood pressure (hypertension) is linked to serious brain problems like strokes and bleeding in the brain, especially due to small blood vessel issues.
  • There isn’t enough strong proof that lowering blood pressure can stop these small vessel problems from getting worse, even though it seems like it should help.
  • The article suggests that keeping blood pressure below 130/80 mmHg might help protect both brain and kidney health, but more research is needed to see how this affects long-term brain health and memory issues.
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  • - Huntington's disease results from a CAG repeat expansion in the Huntingtin gene, with longer repeats leading to earlier disease onset. The 'CAG Age Product' (CAP) allows for the analysis of individuals with different CAG lengths by plotting age against repeat lengths.
  • - Structural MRI studies show that striatal atrophy occurs years before motor symptoms appear, as demonstrated by multicenter studies (PREDICT-HD, TRACK-HD, IMAGE-HD), but the link between different brain region atrophy has been unclear.
  • - This study analyzed multiple datasets to examine brain atrophy in relation to CAP, revealing significant degeneration in basal ganglia structures like the caudate and putamen, while other brain regions showed slower decline,
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Perception has been proposed to result from the integration of feedforward sensory signals with internally generated feedback signals. Feedback signals are believed to play an important role in driving false percepts, that is, seeing things that are not actually there. Feedforward and feedback influences on perception can be studied using layer-specific fMRI, which we used here to interrogate neural activity underlying high-confidence false percepts while healthy human participants ( = 25, male and female) performed a perceptual orientation discrimination task.

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Background: Cardiovascular disease and dementia often coexist at advanced stages. Yet, longitudinal studies examining the interplay between atherosclerosis and its risk factors on brain health in midlife are scarce. We aimed to characterise the longitudinal associations between cerebral glucose metabolism, subclinical atherosclerosis, and cardiovascular risk factors in middle-aged asymptomatic individuals.

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Exploring the Role of Plasma Lipids and Statin Interventions on Multiple Sclerosis Risk and Severity: A Mendelian Randomization Study.

Neurology

October 2023

From the Department of Clinical and Movement Neurosciences (M.M.A., C.S.S., D.A.K., R.R.C., N.W.W.), University College London Queen Square Institute of Neurology, United Kingdom; Department of Medical Technology (M.M.A.), Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia; Institute of Cardiovascular Science (C.F., A.F.S., S.C., A.D.H.), Faculty of Population Health, and Health Data Research UK London (A.D.H.), University College London; British Heart Foundation University College London Research Accelerator (C.F., A.F.S., S.C., A.D.H.), United Kingdom; and Department of Cardiology (C.F., A.F.S.), Division Heart and Lungs, University Medical Center Utrecht, the Netherlands.

Background And Objectives: There has been considerable interest in statins because of their pleiotropic effects beyond their lipid-lowering properties. Many of these pleiotropic effects are predominantly ascribed to Rho small guanosine triphosphatases (Rho GTPases) proteins. We aimed to genetically investigate the role of lipids and statin interventions on multiple sclerosis (MS) risk and severity.

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Background: Intracerebral haemorrhage (ICH) is a severe clinical consequence of cerebral small vessel disease (SVD), but associations between renal impairment and SVD in patients with ICH have not been fully characterised.

Methods: Using data from the CROMIS-2 ICH observational study, we compared SVD neuroimaging markers and total burden (score 0-3) identified using CT brain imaging in patients with and without renal impairment (estimated glomerular filtration rate, eGFR<60). We assessed functional outcome at 6-month follow-up using the modified Rankin scale.

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Objective: The objective of this study was to aggregate data for the first genomewide association study meta-analysis of cluster headache, to identify genetic risk variants, and gain biological insights.

Methods: A total of 4,777 cases (3,348 men and 1,429 women) with clinically diagnosed cluster headache were recruited from 10 European and 1 East Asian cohorts. We first performed an inverse-variance genomewide association meta-analysis of 4,043 cases and 21,729 controls of European ancestry.

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The global disparity of magnetic resonance imaging (MRI) is a major challenge, with many low- and middle-income countries (LMICs) experiencing limited access to MRI. The reasons for limited access are technological, economic and social. With the advancement of MRI technology, we explore why these challenges still prevail, highlighting the importance of MRI as the epidemiology of disease changes in LMICs.

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Background: The optimal strategy for diagnosis and antithrombotic treatment of patients with antiphospholipid syndrome (APS)-associated acute ischemic stroke (AIS), transient ischemic attack (TIA), or other brain ischemic injury is poorly defined.

Objectives: The survey goal was to capture variations in diagnosis and antithrombotic treatment of APS-associated ischemic stroke and related disorders to inform guidance and clinical trials to define optimal management.

Methods: Professional colleagues, including key opinion leaders, were invited to complete a REDCap survey questionnaire initiated by the International Society on Thrombosis and Haemostasis Scientific and Standardisation Committee Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibodies.

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Spinal cord MRI is not routinely performed for multiple sclerosis (MS) monitoring. Here, we explored whether spinal cord MRI activity offers any added value over brain MRI activity for clinical outcomes prediction in MS. This is a retrospective, monocentric study including 830 MS patients who underwent longitudinal brain and spinal cord MRI [median follow-up 7 years (range: < 1-26)].

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Article Synopsis
  • The study investigates how interactions between different genetic factors (gene-gene interactions, or G×G) may influence the risk of developing Parkinson's disease (PD), potentially uncovering reasons for previously unexplained heritability in the condition.
  • Using extensive genetic data from nearly 19,000 PD patients, researchers identified 116 significant interactions between specific SNPs (single nucleotide polymorphisms), suggesting that these genetic pairings could play a crucial role in PD risk.
  • Notably, the study highlighted important interactions between the LRRK2 gene and the SYT10 gene, showing that variations in these genes are not only linked to PD risk but also impact how early the disease
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Background: PREDICT-PD is a United Kingdom population-based study aiming to stratify individuals for future Parkinson's disease (PD) using a risk algorithm.

Methods: A randomly selected, representative sample of participants in PREDICT-PD were examined using several motor assessments, including the motor section of the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS)-III, at baseline (2012) and after an average of 6 years of follow-up. We checked for new PD diagnoses in participants seen at baseline and examined the association between risk scores and incident sub-threshold parkinsonism, motor decline (increasing ≥5 points in MDS-UPDRS-III) and single motor domains in the MDS-UPDRS-III.

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Background: The triglyceride-glucose (TyG) index is a novel biomarker of insulin resistance which might plausibly influence endogenous fibrinolysis and thus early neurological outcomes in patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis using recombinant tissue-plasminogen activator.

Methods: We included consecutive AIS patients within 4.5 h of symptom onset undergoing intravenous thrombolysis between January 2015 and June 2022 in this multi-center retrospective observational study.

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Cerebral amyloid angiopathy, which is defined by cerebrovascular deposition of amyloid β, is a common age-related small vessel pathology associated with intracerebral haemorrhage and cognitive impairment. Based on complementary lines of evidence from in vivo studies of individuals with hereditary, sporadic, and iatrogenic forms of cerebral amyloid angiopathy, histopathological analyses of affected brains, and experimental studies in transgenic mouse models, we present a framework and timeline for the progression of cerebral amyloid angiopathy from subclinical pathology to the clinical manifestation of the disease. Key stages that appear to evolve sequentially over two to three decades are (stage one) initial vascular amyloid deposition, (stage two) alteration of cerebrovascular physiology, (stage three) non-haemorrhagic brain injury, and (stage four) appearance of haemorrhagic brain lesions.

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Early versus Later Anticoagulation for Stroke with Atrial Fibrillation.

N Engl J Med

June 2023

From the Department of Neurology, University Hospital Basel, University of Basel, Basel (U.F., T.K.), the Department of Neurology (U.F., S.A., K.N., M.G., M.A., C. Ferrari, S.B., C.B., D.J.S., T.H.), the Support Center for Advanced Neuroimaging, Institute of Diagnostic and Interventional Neuroradiology (B.J.W.), and the Institute for Diagnostic and Interventional Neuroradiology (S.F., B.R.-K., A.H., J.G.), University Hospital Bern, and CTU Bern (M.B., S.T.), Institute of Social and Preventive Medicine (G.S.), University of Bern, Bern, the Department of Neurology, University Hospital Lausanne, University of Lausanne, Lausanne (P.M., A.S.), the Department of Neurology, Cantonal Hospital Aarau, Aarau (K.N., T.K.), the Research Department, Reha Rheinfelden, Rheinfelden (L.H.B.), and the Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen (J.V.) - all in Switzerland; the Departments of Cerebrovascular Medicine (M. Koga, K.T.) and Neurology (T.Y.), National Cerebral and Cardiovascular Center, Osaka, the Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi (K.M.), and the Department of Neurology, Kansai Medical University, Hirakata (Y.Y.) - all in Japan; the Department of Neurology, Helsinki University Hospital, and University of Helsinki, Helsinki (D.S., M.T., S.R.); Internal, Vascular, and Emergency Medicine, Stroke Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia (M.P., D.G.), and the Department of Human Neurosciences, University La Sapienza, Rome (N.C.) - both in Italy; the Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg (G.T.), the Department of Neurology, Heidelberg University Hospital (C.G.), and the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (A.A.), Heidelberg, the Department of Neurology and Stroke and the Hertie Institute for Clinical Brain Research, Tübingen University, Tübingen (S.P.), and the Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg (C. Fung) - all in Germany; the Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece (G.N.); the Department of Neurology, and the Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz (T.G., M. Kneihsl), and the Department of Neurology 2, Kepler University Hospital, Johannes Kepler University, Linz (C.K.) - both in Austria; the Department of Neurology, Oslo University Hospital (E.-C.S.), the Department of General Practice, University of Oslo (E.K.), and the Norwegian Air Ambulance Foundation (E.-C.S.), Oslo, and the Department of Neurology, Akershus University Hospital, Lørenskog (E.K.) - all in Norway; the Department of Neurology, Mater Misericordiae University Hospital, Dublin (P.K.); KU Leuven, Department of Neurosciences, Experimental Neurology, and the Department of Neurology, University Hospitals Leuven, Leuven (R.L., J. Demeestere), the Department of Neurology, Comprehensive Stroke Unit, CHC MontLégia Hospital, Liège (P.D.), the Department of Neurology, Algemeen Ziekenhuis Groeninge Kortrijk, Kortrijk (P.V.), the Neurovascular Center and Stroke Unit Antwerp, Antwerp University Hospital, and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (P.V.), and the Department of Neurology, Ghent University Hospital, Ghent (D.H.) - all in Belgium; Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India (P.N.S.); the Stroke Center, Lisbon Central University Hospital (D.A.S., A.P.N.) and Faculty of Medicine, University of Lisbon (D.A.S.) - both in Lisbon, Portugal; the Department of Neurology, Shaare Zedek Medical Center, Jerusalem (N.M.B.); the Department of Neurology, Faculty of Medicine, Pavol Jozef Safarik University, and University Hospital Louis Pasteur - both in Košice, Slovakia (Z.G.); Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, Rhyl (H.T., R.H.), the Stroke Unit, Morriston Hospital, Swansea Bay University Health Board, Swansea (M. Krishnan, P.S.), the Stroke Department, University Hospital of North Durham, Durham (G.C.S.), the Department of Neurology, St. George's University Hospital (L.Z.), and the Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, University College London (D.J.W.), London, and the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (J. Dawson) - all in the United Kingdom; and the Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, and the Department of Neurology, Sahlgrenska University Hospital - both in Gothenburg, Sweden (T.T.).

Background: The effect of early as compared with later initiation of direct oral anticoagulants (DOACs) in persons with atrial fibrillation who have had an acute ischemic stroke is unclear.

Methods: We performed an investigator-initiated, open-label trial at 103 sites in 15 countries. Participants were randomly assigned in a 1:1 ratio to early anticoagulation (within 48 hours after a minor or moderate stroke or on day 6 or 7 after a major stroke) or later anticoagulation (day 3 or 4 after a minor stroke, day 6 or 7 after a moderate stroke, or day 12, 13, or 14 after a major stroke).

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Article Synopsis
  • Cerebral small vessel disease (cSVD) can cause strokes and affect thinking and mood, but there are no specific treatments for it.
  • Researchers wanted to see if two medications, isosorbide mononitrate (ISMN) and cilostazol, were safe and effective for people who had a type of stroke called lacunar stroke.
  • In a study involving 400 people, almost 91% were successfully included, and most stayed in the study for the whole year to see how the medications worked.
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Objectives: To evaluate compliance with the available recommendations, we assessed the current clinical practice of imaging in the evaluation of multiple sclerosis (MS).

Methods: An online questionnaire was emailed to all members and affiliates. Information was gathered on applied MR imaging protocols, gadolinium-based contrast agents (GBCA) use and image analysis.

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Mutations in GBA1, the gene encoding the lysosomal enzyme β-glucocerebrosidase (GCase), which cause Gaucher's disease, are the most frequent genetic risk factor for Parkinson's disease (PD). Here, we employ global proteomic and single-cell genomic approaches in stable cell lines as well as induced pluripotent stem cell (iPSC)-derived neurons and midbrain organoids to dissect the mechanisms underlying GCase-related neurodegeneration. We demonstrate that GCase can be imported from the cytosol into the mitochondria via recognition of internal mitochondrial targeting sequence-like signals.

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Although a striking female preponderance has been consistently reported in epilepsy with eyelid myoclonia (EEM), no study has specifically explored the variability of clinical presentation according to sex in this syndrome. Here, we aimed to investigate sex-specific electroclinical differences and prognostic determinants in EEM. Data from 267 EEM patients were retrospectively analyzed by the EEM Study Group, and a dedicated multivariable logistic regression analysis was developed separately for each sex.

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Aims: Atrial fibrillation (AF) is a risk factor for brain infarction, which can lead to epilepsy. We aimed to investigate whether treatment of AF with direct oral anticoagulants (DOACs) affects the risk of epilepsy in comparison to treatment with the vitamin K antagonist phenprocoumon (PPC).

Methods And Results: We performed an active comparator, nested case-control study based on the German Pharmacoepidemiological Research Database that includes claims data from statutory health insurance providers of about 25 million persons since 2004.

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Dravet syndrome is an archetypal rare severe epilepsy, considered 'monogenic', typically caused by loss-of-function SCN1A variants. Despite a recognizable core phenotype, its marked phenotypic heterogeneity is incompletely explained by differences in the causal SCN1A variant or clinical factors. In 34 adults with SCN1A-related Dravet syndrome, we show additional genomic variation beyond SCN1A contributes to phenotype and its diversity, with an excess of rare variants in epilepsy-related genes as a set and examples of blended phenotypes, including one individual with an ultra-rare DEPDC5 variant and focal cortical dysplasia.

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Human prion diseases are remarkable for long incubation times followed typically by rapid clinical decline. Seed amplification assays and neurodegeneration biofluid biomarkers are remarkably useful in the clinical phase, but their potential to predict clinical onset in healthy people remains unclear. This is relevant not only to the design of preventive strategies in those at-risk of prion diseases, but more broadly, because prion-like mechanisms are thought to underpin many neurodegenerative disorders.

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Optimising epilepsy surgery.

Lancet Neurol

May 2023

Computational Neurology, Neuroscience & Psychiatry Lab, Interdisciplinary Computing and Complex BioSystems group, School of Computing, Newcastle Helix, Newcastle University, Newcastle, UK.

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Frontal circuits play a critical role in motor, cognitive, and affective processing - and their dysfunction may result in a variety of brain disorders. However, exactly which frontal domains mediate which (dys)function remains largely elusive. Here, we study 534 deep brain stimulation electrodes implanted to treat four different brain disorders.

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