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What's new in neurology

What's new in neurology
Authors:
John F Dashe, MD, PhD
Janet L Wilterdink, MD
April F Eichler, MD, MPH
Richard P Goddeau, Jr, DO, FAHA
Literature review current through: Feb 2022. | This topic last updated: Feb 25, 2022.

The following represent additions to UpToDate from the past six months that were considered by the editors and authors to be of particular interest. The most recent What's New entries are at the top of each subsection.

CEREBROVASCULAR DISEASE

Patent foramen ovale closure for stroke prevention (December 2021)

Evidence from multiple trials has shown that percutaneous device closure of patent foramen ovale (PFO) is more effective than medical therapy alone for reducing the risk of recurrent stroke in select patients with an embolic-appearing ischemic stroke who have a PFO but no other identified cause of stroke, but the degree of benefit for patient subgroups was unknown. A recent meta-analysis of individual patient data from six randomized trials used the PASCAL classification (table 1) to analyze outcomes based on the estimated probability that stroke was associated with a PFO [1]. PASCAL is based upon the RoPE score (table 2) combined with anatomic and clinical factors (shunt size, presence or absence of atrial septal aneurysm and/or venous thromboembolism) in patients with embolic-appearing infarcts and no other major sources of ischemic stroke. The meta-analysis found that PFO closure was associated with benefit if the stroke was probably or possibly related to the PFO per PASCAL score, but not if stroke was unlikely related to the PFO. These data support the use of PASCAL and RoPE to guide informed decision-making for PFO closure. (See "Treatment of patent foramen ovale (PFO) for secondary stroke prevention", section on 'Benefit'.)

Glucocorticoid therapy in patients with cerebral amyloid angiopathy-related inflammation (November 2021)

For patients with cerebral amyloid angiopathy (CAA) who develop progressive neurologic symptoms due to an inflammatory response to amyloid deposition, glucocorticoids or other immunotherapy have been used despite uncertain benefit. In a longitudinal study of 113 patients with CAA-related inflammation, of whom 88 percent received immunosuppressive therapy (mostly high-dose pulse glucocorticoids with a subsequent oral taper), clinical recovery was reported by three months in 70 percent, and resolution of inflammatory features on neuroimaging occurred in 45 percent [2]. By 12 months, rates of clinical and radiologic recovery were 84 and 77 percent, respectively. Symptomatic recurrence was less likely when pulse glucocorticoids were followed by an oral steroid taper. These results support our treatment preference of intravenous glucocorticoids with a subsequent gradual oral taper for patients with CAA-related inflammation. (See "Cerebral amyloid angiopathy", section on 'Management'.)

Somatic PIK3CA variants in sporadic cerebral cavernous malformations (September 2021)

Cerebral cavernous malformations (CMs) are sporadic in most cases, but a minority are familial due to germline pathogenic variants in one of several CCM genes. The pathogenesis of sporadic CMs has not been well defined. In a study of lesional tissue from 88 patients with sporadic CM, somatic variants in the PIK3CA oncogene were identified in nearly 40 percent of lesions [3]. Ten percent of lesions also contained somatic CCM variants. The preponderance of PIK3CA variants in CM is a novel that sheds new light on the pathogenesis of sporadic CM and may serve as a target for future treatments. (See "Vascular malformations of the central nervous system", section on 'Sporadic CMs'.)

Outcomes of mobile stroke units in acute ischemic stroke (September 2021)

Mobile stroke units (MSUs), which are ambulances equipped with a CT scanner and staffed by personnel trained to diagnose and treat stroke patients in the ambulance with thrombolytic therapy, have the potential to improve outcomes from acute ischemic stroke. In a nonrandomized study in the United States, patients treated by MSU had a higher rate of thrombolysis, shorter median time to thrombolysis, improved rate of no or minimal disability at 90 days (55.0 versus 44.4 percent), and lower mortality compared with the standard emergency medical services care group [4]. A similar study from Berlin also found improvements in thrombolysis delivery and 90-day functional outcomes with MSUs [5]. MSUs are available in only a few urban areas throughout the world; further confirmation of clinical benefit and cost-effectiveness is needed before widespread use of MSUs can be considered. (See "Approach to reperfusion therapy for acute ischemic stroke", section on 'Prehospital recognition and management'.)

Carotid stenting versus endarterectomy for asymptomatic carotid stenosis (September 2021)

Earlier trials comparing transfemoral carotid artery stenting (TF-CAS) with carotid endarterectomy (CEA) for asymptomatic carotid stenosis reported that the periprocedural (30-day) stroke or death rate is higher for TF-CAS, while long-term outcomes are similar. In the recent ACST-2 trial, the periprocedural rate of death or any stroke was slightly higher with TF-CAS compared with CEA, but the difference was not statistically significant [6]. This result largely reflected a higher incidence of nondisabling stroke in the TF-CAS group. The five-year rate of periprocedural death or any fatal or disabling stroke was similar for TF-CAS and CEA (3.3 versus 3.5 percent). For medically stable individuals with asymptomatic carotid stenosis of 70 to 99 percent, we advise a shared decision-making approach; either intensive medical therapy alone or intensive medical therapy plus revascularization with CEA are reasonable treatment options. For those with an unacceptably high surgical risk with suitable anatomy, carotid artery stenting is an alternative. (See "Management of asymptomatic extracranial carotid atherosclerotic disease", section on 'Stenting versus endarterectomy trials'.)

DEMENTIA

Clinical use of pimavanserin in patients with neurodegenerative dementias (September 2021)

Pimavanserin is a newer antipsychotic agent that has been approved in the United States (US) since 2016 for treatment of psychosis in patients with Parkinson disease (PD). Two new reports expand information on both efficacy and potential risks in patients with neurodegenerative diseases:

In a randomized discontinuation trial of pimavanserin in 351 patients with dementia-related psychosis, among those who responded initially to treatment, relapses were approximately half as common in patients assigned to continued pimavanserin compared with placebo [7].

In a retrospective cohort study of >20,000 older adults with PD living in long-term care facilities in the US, pimavanserin use, compared with nonuse, was associated with an increased adjusted risk of 30-day hospitalization and mortality at multiple time points [8]. Residual confounding is possible, although other studies have raised similar safety concerns for antipsychotic agents as a class.

Like other antipsychotic agents, pimavanserin should be used selectively in patients with dementia and/or PD after discussing potential risks and benefits of treatment, alternative therapies for psychosis (algorithm 1 and algorithm 2), and risks related to ongoing symptoms. (See "Management of nonmotor symptoms in Parkinson disease", section on 'Refractory psychotic symptoms' and "Management of neuropsychiatric symptoms of dementia", section on 'Antipsychotic drugs'.)

EPILEPSY

New guidelines for tuberous sclerosis complex (October 2021)

The guidelines for the diagnosis and management of tuberous sclerosis complex (TSC) were recently updated in an international consensus conference [9]. Compared with the prior 2012 guidelines, changes include two revisions to the diagnostic criteria and several surveillance and treatment updates. The guidelines now recommend routine baseline electroencephalogram (EEG) and avoidance of contrast agents with brain MRI unless there is an enlarging lesion or clinical suspicion for subependymal giant cell tumors. Greater attention is placed on TSC-associated neuropsychiatric disorders (TAND), and everolimus and a formulation of cannabidiol are now included in therapy options. Management should be coordinated by a multidisciplinary team with expertise in TSC. (See "Tuberous sclerosis complex: Genetics, clinical features, and diagnosis" and "Gene test interpretation: TSC1 and TSC2 (tuberous sclerosis complex genes)" and "Tuberous sclerosis complex: Management and prognosis".)

HEADACHE

Role of PRRT2 variants in familial hemiplegic migraine (January 2022)

Three channelopathy genes (ATP1A, CACNA1A, and SCN1A) explain only a minority of patients with familial hemiplegic migraine (FHM). Variants in a transmembrane protein gene, PRRT2, have been described in patients with hemiplegic migraine and other paroxysmal neurologic disorders, but their importance relative to known FHM genes has not been established. In a study of 860 patients with hemiplegic migraine who were screened for all four genes, pathologic PRRT2 variants were identified in 30 patients, representing 3.5 percent of the cohort [10]. Among patients found to have a genetic cause, PRRT2 variants accounted for 17 percent, compared with ATP1A2 (42 percent), CACNA1A (25 percent), and SCN1A (15 percent). These data support PRRT2 as a fourth genetic cause of FHM. (See "Hemiplegic migraine", section on 'Familial hemiplegic migraine'.)

Oral atogepant for episodic migraine prevention (October 2021)

Small-molecule calcitonin gene-related peptide (CGRP) antagonists ("gepants") are orally administered medications formulated typically for the acute treatment of migraine. The effectiveness of a novel agent, atogepant, was evaluated in a preventive trial in 873 patients with migraine. After 12 weeks, patients assigned to atogepant had fewer migraine days per month than those assigned to placebo and were also likelier to achieve at least 50 percent reduction in the three-month mean number of monthly migraine days (58 versus 29 percent) [11]. These data support the addition of oral atogepant as an effective agent for the prevention of episodic migraine. (See "Preventive treatment of episodic migraine in adults", section on 'CGRP antagonists'.)

MOVEMENT DISORDERS

Progressive parkinsonism after BCMA-targeted CAR-T cell therapy (January 2022)

Immune effector cell-associated neurotoxicity syndrome (ICANS) is a well-known acute and usually reversible complication of chimeric antigen receptor T (CAR-T) cell therapy, but long-term neurologic effects have not been well documented. A recent case report described the onset of progressive parkinsonism approximately 100 days after administration of ciltacabtagene autoleucel, an investigational CAR-T cell therapy for multiple myeloma targeting B-cell maturation antigen (BCMA) [12]. Based on postmortem studies, the syndrome appeared to be an on-target effect of CAR-T cells on BCMA-expressing astrocytes and neurons in the basal ganglia. Delayed parkinsonism has also been reported after idacabtagene vicleucel, another BCMA-targeted product. Further studies are needed to understand risk factors and treatment strategies. (See "Immune effector cell-associated neurotoxicity syndrome (ICANS)", section on 'Delayed parkinsonism'.)

Updated guidelines for Tourette syndrome management (January 2022)

Updated guidelines for the management of Tourette syndrome (TS) in children and adults have been published by the European Society for the Study of Tourette Syndrome (ESSTS) [13]. As before, psychoeducation and behavioral approaches are preferred as first-line therapies. For patients who require pharmacotherapy, the ESSTS suggests dopamine-blocking agents, in particular aripiprazole, as well as clonidine and guanfacine, especially in patients with concomitant attention deficit hyperactivity disorder. In the United States, the dopamine depleting agent, tetrabenazine, is an additional option that is preferred over antipsychotic agents by some experts, including UpToDate contributors, although supporting evidence is conflicting. (See "Tourette syndrome: Management", section on 'Antidopaminergic drugs'.)

Updated guidelines for management of restless legs syndrome (October 2021)

Updated consensus-based guidelines for the management of restless legs syndrome (RLS) have been published by the RLS Foundation [14]. For chronic persistent RLS in adults despite appropriate iron supplementation, the guideline suggests first-line therapy with an alpha-2-delta calcium channel ligand (gabapentin, gabapentin enacarbil, or pregabalin), except when certain comorbidities are present (eg, obesity, moderate to severe depression, gait instability, respiratory disease, or a history of substance use disorder). In such cases, a non-ergot dopamine agonist (pramipexole, ropinirole, rotigotine) is preferred initially, with monitoring for complications such as augmentation and impulse control disorders. Our approach is consistent with these guidelines (algorithm 3). (See "Management of restless legs syndrome and periodic limb movement disorder in adults", section on 'Choice of therapy'.)

General anesthesia versus monitored anesthesia for deep brain stimulator placement (October 2021)

Whether deep brain stimulator (DBS) placement with the patient asleep versus awake affects outcomes has been uncertain. In a randomized trial comparing general anesthesia (GA) versus monitored anesthesia care (MAC) in 110 patients with Parkinson's disease undergoing frame-based microelectrode-guided DBS, both groups had similar motor function improvement and frequency of adverse effects [15]. Although MAC with patient feedback has been preferred because it allows precise microelectrode placement and intraoperative stimulation testing, GA may be a reasonable alternative for patients who may not tolerate MAC. (See "Anesthesia for deep brain stimulator implantation", section on 'Choice of anesthetic technique'.)

Palliative care and hospice referral guidance in Parkinson disease (September 2021)

In patients with advanced Parkinson disease (PD), it can be difficult to determine the most appropriate timing for hospice referral, and there are no validated end-of-life prognostic tools. A working group sponsored by the Parkinson's Foundation has proposed guidance to identify patients who would likely benefit from hospice/palliative care [16]. Referral should be considered in patients with critical nutrition impairment, life-threatening complications, or poorly responsive motor symptoms causing impaired self care in the prior year; rapid or accelerating motor or nonmotor disease progression and disability; or advanced dementia meeting hospice referral criteria based on Medicare eligibility guidelines or other prognostic tools. (See "Palliative approach to Parkinson disease and parkinsonian disorders", section on 'Life expectancy and hospice eligibility'.)

NEUROMUSCULAR DISEASE

Efgartigimod alfa for treatment of myasthenia gravis (February 2022)

Efgartigimod alfa, a novel immunoglobulin G1 (IgG1) Fc fragment that inhibits the neonatal Fc receptor and reduces circulating IgG antibody levels, has been under investigation for myasthenia gravis (MG) and other autoimmune disorders associated with IgG autoantibodies. In a trial of 167 patients with generalized MG, weekly infusions of efgartigimod increased the rate of symptomatic improvement at four weeks compared with placebo (68 versus 30 percent) [17]. Adverse effects were mild and similar between groups with short-term follow-up. Based on these results, efgartigimod was approved by the US Food and Drug Administration for treatment of MG in patients with antiacetylcholine receptor antibodies. It will likely find use initially as an alternative steroid-sparing agent for patients unable to tolerate first-line therapies with slower time to effect (table 3). (See "Chronic immunosuppressive therapy for myasthenia gravis", section on 'AChR-positive and seronegative MG'.)

NEUROONCOLOGY

Long-term follow-up of nivolumab plus ipilimumab for melanoma brain metastases (November 2021)

For patients with metastatic melanoma, immunotherapy with nivolumab plus ipilimumab is effective against central nervous system (CNS) metastases, but long-term follow-up of overall survival (OS) was previously limited. In the final analysis of a phase II trial (CheckMate-204) in over 100 patients with metastatic melanoma and asymptomatic CNS metastases treated with nivolumab plus ipilimumab, at median follow-up of 34 months, intracranial objective and complete response rates were 54 and 33 percent, respectively, and three-year OS was 72 percent [18]. Based on these and other data, nivolumab plus ipilimumab continues to be an acceptable treatment option for systemic therapy-naïve patients with metastatic melanoma and small, minimally symptomatic or asymptotic untreated CNS metastases. (See "Management of brain metastases in melanoma", section on 'Asymptomatic brain metastases'.)

Radiation fields in children >3 years with average-risk medulloblastoma (November 2021)

Results of a recent multicenter randomized trial in children with medulloblastoma support providing lower doses of radiation therapy (RT) to some areas of normal brain without sacrificing tumor control. In the Children's Oncology Group ACNS0331 trial, 549 patients age 3 to 21 years with average-risk medulloblastoma were treated with craniospinal RT plus a boost to either the entire posterior fossa (standard) or to the tumor bed only (narrower volume) [19]. Survival outcomes were similar between groups, and there were no local failures outside the narrower boost volume. Thus, use of a boost confined to the tumor bed plus a margin is now appropriate for patients receiving craniospinal RT for medulloblastoma. (See "Treatment and prognosis of medulloblastoma", section on 'Average-risk disease in children ≥3 years of age'.)

No benefit of carboplatin during radiation for high-risk medulloblastoma (November 2021)

Patients with medulloblastoma who undergo partial resection or have disseminated disease at the time of diagnosis have poor outcomes, and there has been interest in intensified treatment regimens. In the Children's Oncology Group ACNS0332 trial, nearly 300 such children age 3 to 18 years with high-risk medulloblastoma were randomly assigned to receive craniospinal radiation and weekly vincristine with or without daily carboplatin, followed by six cycles of maintenance chemotherapy [20]. With a median follow-up of nearly seven years, carboplatin did not improve event-free or overall survival, and toxicity was greater. A subgroup analysis showing possible benefit in group 3 tumors requires prospective confirmation. (See "Treatment and prognosis of medulloblastoma", section on 'High-risk disease in children ≥3 years of age'.)

Selumetinib, a MEK1/2 inhibitor, in optic pathway gliomas (November 2021)

Optic pathway gliomas (OPGs) in children often harbor BRAF alterations, and case reports have suggested that MEK1/2 or BRAF inhibitors may be an effective therapeutic approach. In a multicenter phase 2 trial that included 25 children with recurrent/progressive sporadic OPG or hypothalamic low-grade glioma treated with selumetinib, an oral MEK1/2 inhibitor, two-year progression-free survival was 74 percent, and visual acuity improved or remained stable in the majority of patients [21]. In a previously reported subset, selumetinib also showed activity in neurofibromatosis type 1 (NF1)-associated OPGs. These data add support for the use of MEK1/2 inhibitors in refractory OPGs, and randomized trials are investigating selumetinib versus chemotherapy in the upfront setting. (See "Optic pathway glioma", section on 'Role of targeted therapies'.)

Updated diagnostic criteria for neurofibromatosis type 1 (September 2021)

Updated diagnostic criteria for neurofibromatosis type 1 (NF1) have been released by an international consensus conference (table 4) [22]. The criteria incorporate genetic testing as well as several new clinical features (eg, choroidal abnormalities, anterolateral bowing of the tibia, long bone pseudoarthrosis). The document also includes new diagnostic criteria for Legius syndrome (table 5), which has phenotypic overlap with NF1 in young patients with pigmentary findings, and criteria for mosaic forms of both conditions. (See "Neurofibromatosis type 1 (NF1): Pathogenesis, clinical features, and diagnosis", section on 'Diagnostic criteria'.)

PEDIATRIC NEUROLOGY

Ex vivo gene therapy for metachromatic leukodystrophy (January 2022)

Ex vivo gene therapy is a new treatment approach for metachromatic leukodystrophy (MLD), which is caused by pathogenic variants in the arylsulfatase A (ARSA) gene. A new study reported promising results in 26 children with pre- or early-symptomatic MLD who received an autologous hematopoietic stem cell transplant using stem cells transduced with an ARSA gene therapy construct (arsa-cel) [23]. Participants had improvement or stabilization of motor skills compared with an untreated cohort; most treated patients showed normal cognitive development, and a subset showed improvement in peripheral nerve conduction velocity. Interim analysis of this study led to approval of this therapy in the European Union and United Kingdom. However, autologous transplant using gene therapy has not been compared with allogeneic transplant; short- and long-term complications of gene therapy remain a concern; and the initial cost of gene therapy is greater. Allogeneic transplant remains the standard of care for individuals with presymptomatic or minimally symptomatic MLD who have an available donor. (See "Metachromatic leukodystrophy", section on 'Ex vivo gene therapy'.)

Rise in functional tics in adolescents and young adults (January 2022)

An increase in functional tics has been observed during the COVID-19 pandemic. Cases have been referred to as "TikTok tics," as affected individuals have commonly viewed online videos depicting tic-like behaviors [24]. Most patients are females between 15 and 25 years of age. Symptom onset is usually acute, with complex vocal and motor tics involving large-amplitude arm movements, self-injury, and a wide range of odd words or phrases, often with obscenities. The stresses of the pandemic are believed to be contributing, and comorbid depression and anxiety disorders are common. (See "Functional movement disorders", section on 'Functional tics'.)

REFERENCES

  1. Kent DM, Saver JL, Kasner SE, et al. Heterogeneity of Treatment Effects in an Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale After Stroke. JAMA 2021; 326:2277.
  2. Antolini L, DiFrancesco JC, Zedde M, et al. Spontaneous ARIA-like Events in Cerebral Amyloid Angiopathy-Related Inflammation: A Multicenter Prospective Longitudinal Cohort Study. Neurology 2021; 97:e1809.
  3. Peyre M, Miyagishima D, Bielle F, et al. Somatic PIK3CA Mutations in Sporadic Cerebral Cavernous Malformations. N Engl J Med 2021; 385:996.
  4. Grotta JC, Yamal JM, Parker SA, et al. Prospective, Multicenter, Controlled Trial of Mobile Stroke Units. N Engl J Med 2021; 385:971.
  5. Ebinger M, Siegerink B, Kunz A, et al. Association Between Dispatch of Mobile Stroke Units and Functional Outcomes Among Patients With Acute Ischemic Stroke in Berlin. JAMA 2021; 325:454.
  6. Halliday A, Bulbulia R, Bonati LH, et al. Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy. Lancet 2021; 398:1065.
  7. Tariot PN, Cummings JL, Soto-Martin ME, et al. Trial of Pimavanserin in Dementia-Related Psychosis. N Engl J Med 2021; 385:309.
  8. Hwang YJ, Alexander GC, An H, et al. Risk of Hospitalization and Death Associated With Pimavanserin Use in Older Adults With Parkinson Disease. Neurology 2021; 97:e1266.
  9. Northrup H, Aronow ME, Bebin EM, et al. Updated International Tuberous Sclerosis Complex Diagnostic Criteria and Surveillance and Management Recommendations. Pediatr Neurol 2021; 123:50.
  10. Riant F, Roos C, Roubertie A, et al. Hemiplegic Migraine Associated With PRRT2 Variations: A Clinical and Genetic Study. Neurology 2022; 98:e51.
  11. Ailani J, Lipton RB, Goadsby PJ, et al. Atogepant for the Preventive Treatment of Migraine. N Engl J Med 2021; 385:695.
  12. Van Oekelen O, Aleman A, Upadhyaya B, et al. Neurocognitive and hypokinetic movement disorder with features of parkinsonism after BCMA-targeting CAR-T cell therapy. Nat Med 2021; 27:2099.
  13. Roessner V, Eichele H, Stern JS, et al. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part III: pharmacological treatment. Eur Child Adolesc Psychiatry 2021.
  14. Silber MH, Buchfuhrer MJ, Earley CJ, et al. The Management of Restless Legs Syndrome: An Updated Algorithm. Mayo Clin Proc 2021; 96:1921.
  15. Holewijn RA, Verbaan D, van den Munckhof PM, et al. General Anesthesia vs Local Anesthesia in Microelectrode Recording-Guided Deep-Brain Stimulation for Parkinson Disease: The GALAXY Randomized Clinical Trial. JAMA Neurol 2021; 78:1212.
  16. Akbar U, McQueen RB, Bemski J, et al. Prognostic predictors relevant to end-of-life palliative care in Parkinson's disease and related disorders: a systematic review. J Neurol Neurosurg Psychiatry 2021.
  17. Howard JF Jr, Bril V, Vu T, et al. Safety, efficacy, and tolerability of efgartigimod in patients with generalised myasthenia gravis (ADAPT): a multicentre, randomised, placebo-controlled, phase 3 trial. Lancet Neurol 2021; 20:526.
  18. Tawbi HA, Forsyth PA, Hodi FS, et al. Long-term outcomes of patients with active melanoma brain metastases treated with combination nivolumab plus ipilimumab (CheckMate 204): final results of an open-label, multicentre, phase 2 study. Lancet Oncol 2021; 22:1692.
  19. Michalski JM, Janss AJ, Vezina LG, et al. Children's Oncology Group Phase III Trial of Reduced-Dose and Reduced-Volume Radiotherapy With Chemotherapy for Newly Diagnosed Average-Risk Medulloblastoma. J Clin Oncol 2021; 39:2685.
  20. Leary SES, Packer RJ, Li Y, et al. Efficacy of Carboplatin and Isotretinoin in Children With High-risk Medulloblastoma: A Randomized Clinical Trial From the Children's Oncology Group. JAMA Oncol 2021; 7:1313.
  21. Fangusaro J, Onar-Thomas A, Poussaint TY, et al. A phase II trial of selumetinib in children with recurrent optic pathway and hypothalamic low-grade glioma without NF1: a Pediatric Brain Tumor Consortium study. Neuro Oncol 2021; 23:1777.
  22. Legius E, Messiaen L, Wolkenstein P, et al. Revised diagnostic criteria for neurofibromatosis type 1 and Legius syndrome: an international consensus recommendation. Genet Med 2021; 23:1506.
  23. Fumagalli F, Calbi V, Natali Sora MG, et al. Lentiviral haematopoietic stem-cell gene therapy for early-onset metachromatic leukodystrophy: long-term results from a non-randomised, open-label, phase 1/2 trial and expanded access. Lancet 2022; 399:372.
  24. Pringsheim T, Ganos C, McGuire JF, et al. Rapid Onset Functional Tic-Like Behaviors in Young Females During the COVID-19 Pandemic. Mov Disord 2021; 36:2707.
Topic 8362 Version 10977.0

References

1 : Heterogeneity of Treatment Effects in an Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale After Stroke.

2 : Spontaneous ARIA-like Events in Cerebral Amyloid Angiopathy-Related Inflammation: A Multicenter Prospective Longitudinal Cohort Study.

3 : Somatic PIK3CA Mutations in Sporadic Cerebral Cavernous Malformations.

4 : Prospective, Multicenter, Controlled Trial of Mobile Stroke Units.

5 : Association Between Dispatch of Mobile Stroke Units and Functional Outcomes Among Patients With Acute Ischemic Stroke in Berlin.

6 : Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy.

7 : Trial of Pimavanserin in Dementia-Related Psychosis.

8 : Risk of Hospitalization and Death Associated With Pimavanserin Use in Older Adults With Parkinson Disease.

9 : Updated International Tuberous Sclerosis Complex Diagnostic Criteria and Surveillance and Management Recommendations.

10 : Hemiplegic Migraine Associated With PRRT2 Variations: A Clinical and Genetic Study.

11 : Atogepant for the Preventive Treatment of Migraine.

12 : Neurocognitive and hypokinetic movement disorder with features of parkinsonism after BCMA-targeting CAR-T cell therapy.

13 : European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part III: pharmacological treatment.

14 : The Management of Restless Legs Syndrome: An Updated Algorithm.

15 : General Anesthesia vs Local Anesthesia in Microelectrode Recording-Guided Deep-Brain Stimulation for Parkinson Disease: The GALAXY Randomized Clinical Trial.

16 : Prognostic predictors relevant to end-of-life palliative care in Parkinson's disease and related disorders: a systematic review.

17 : Safety, efficacy, and tolerability of efgartigimod in patients with generalised myasthenia gravis (ADAPT): a multicentre, randomised, placebo-controlled, phase 3 trial.

18 : Long-term outcomes of patients with active melanoma brain metastases treated with combination nivolumab plus ipilimumab (CheckMate 204): final results of an open-label, multicentre, phase 2 study.

19 : Children's Oncology Group Phase III Trial of Reduced-Dose and Reduced-Volume Radiotherapy With Chemotherapy for Newly Diagnosed Average-Risk Medulloblastoma.

20 : Efficacy of Carboplatin and Isotretinoin in Children With High-risk Medulloblastoma: A Randomized Clinical Trial From the Children's Oncology Group.

21 : A phase II trial of selumetinib in children with recurrent optic pathway and hypothalamic low-grade glioma without NF1: a Pediatric Brain Tumor Consortium study.

22 : Revised diagnostic criteria for neurofibromatosis type 1 and Legius syndrome: an international consensus recommendation.

23 : Lentiviral haematopoietic stem-cell gene therapy for early-onset metachromatic leukodystrophy: long-term results from a non-randomised, open-label, phase 1/2 trial and expanded access.

24 : Rapid Onset Functional Tic-Like Behaviors in Young Females During the COVID-19 Pandemic.