Current Opinion in Neurology最新文献

Purpose of review: Direct neurological consequences from emerging and re-emerging infectious diseases such as poliomyelitis, West Nile virus and Zika virus, and those with indirect neurological effects such as COVID-19 and Influenza, are major contributors to the profound impact of infectious diseases on global human health. Here, we highlight select infections of the nervous system of public health significance and discuss some of the key factors of emergence. We focus on vector-borne infections including Oropouche virus and West Nile virus, those transmitted by other nonvector animal species including Nipah and Hendra virus, and vaccine preventable infections including neurological effects of Measles virus.

Recent findings: Currently, the emergence of Oropouche virus, Avian Influenza, and the re-emergence of Measles outbreaks across Europe and America, are examples of current emerging infectious disease outbreaks. As pathogens spread to new areas, we will continue to see a rise in populations at risk of severe neurological effects. The recent resurgence of measles virus cases exemplifies the importance of strong vaccination programs and preventive public health measures to mitigate the impact of preventable re-emerging infections in vulnerable populations.

Summary: Neuroinfectious diseases will continue to drive significant morbidity and mortality on global populations as risk factors remain high, and global public health initiatives are hampered by inadequate governmental support.

Purpose of review: Imaging plays a key role in neuromodulation for Parkinson's disease, particularly for deep brain stimulation (DBS), which is the most frequently employed neuromodulatory treatment. Its role is rapidly expanding due to improving neuroradiological techniques.

Recent findings: Imaging is crucial at each stage of DBS care: pre, intra-, and postoperative, with roles now going beyond the traditional surgical planning and lead localization. Imaging opens the door to patient selection informed by their unique preoperative features and individualized electrode placement due to the direct visualization of targets. Imaging also permits intra-operative localization of electrodes with widely accessible fluoroscopy and offers the possibility of visualizing the orientation of segmented contacts. Advanced imaging techniques have defined anatomical sweets spots and efficacious connectomes associated with best outcomes after DBS. They also offer opportunities to develop new biomarker of successful stimulation, which is critical to the future of DBS programming.

Summary: Imaging should be thought as a powerful tool to push the neuromodulation field towards new boundaries focusing on personalized electrode implantation and stimulation titration. This will improve patient outcomes and inform alternative neuromodulation modalities, for which the data remain limited.

Purpose of review: COP28 Health Day demonstrated the growing global attention to climate health. The purpose of this article is to review the impact of climate change on the emergence of neuro-infectious diseases.

Recent findings: Climate change influences meteorological shifts and extreme weather events which may have significant and complex effects on the emergence of neuroinfectious diseases. Particularly concerning is increasing vector borne, water borne and food borne diseases. Climate associated factors contribute to the high incidence of bacterial meningitis in the African Meningitis Belt, and expansion of viral and fungal meningitis in other regions. Increased risks to those living with HIV is a public health concern. The most vulnerable communities, especially in low and middle-income countries, will be particularly impacted.

Summary: The complex effects of climate change on the emergence of neuroinfectious diseases result from consequences on ecologies, populations and health systems. The growing health burden must be addressed with a multifaceted approach to establishing climate resilient healthcare systems.

Purpose of review: This review provides an updated overview of amyloid-related imaging abnormalities (ARIA) associated with antiamyloid monoclonal antibodies (mAbs) in Alzheimer's disease (AD). Following regulatory approvals for both lecanemab and donanemab in the United States, and pending decisions in Europe, standardized understanding of ARIA definitions, risk factors, and optimal MRI surveillance is increasingly important to guide treatment and ensure safety.

Recent findings: ARIA, including vasogenic edema (ARIA-E) and microhemorrhages/siderosis (ARIA-H), are a frequent adverse event in patients receiving antiamyloid mAbs, particularly among APOE ε4 homozygotes. Incidence varies by agent and trial design. While often asymptomatic and self-limiting, ARIA can occasionally present with symptoms or recur. MRI, especially FLAIR and susceptibility-sensitive imaging, is essential for baseline risk stratification and monitoring. Key imaging biomarkers include microbleeds and superficial siderosis. Recent guidelines support genotyping and risk-adapted MRI protocols before and during therapy.

Summary: ARIA reflect vascular vulnerability during amyloid clearance in AD. Their management requires close collaboration between neurologists and neuroradiologists, with harmonized MRI protocols and risk mitigation strategies critical for safe and effective use of disease-modifying therapies.

Purpose of review: An update on brain health and cognitive function in persons living with HIV, with a focus on pathogenesis, classification and treatment.

Recent findings: Criteria for HIV-associated neurocognitive disorders overestimate prevalence of cognitive impairment and should no longer be used. Instead, HIV-associated brain injury should be considered as one cause of cognitive impairment in persons living with HIV, along with other non-HIV factors. The most widely used cardiovascular risk calculators and stroke categorization tools are not based on data including persons with HIV and appear to underestimate cardiovascular risk. A statin should be considered in all persons living with HIV over the age of 40 and assists in preventing cerebrovascular disease.

Summary: HIV is a neurotropic virus which penetrates the central nervous system (CNS) within days of infection, establishing a reservoir. Cerebrospinal fluid (CSF) HIV RNA escape can cause progressive neurologic symptoms and is treatable by targeting the CSF HIV genotypic resistance profile. As the population of persons living with HIV ages, it is important to address noncommunicable sequelae such as multifactorial causes of cognitive impairment and cerebrovascular disease. Strategies for HIV cure need to address barriers and risks posed by the CNS HIV reservoir.

Purpose of review: The purpose of this review is to highlight challenges in studying disparities in neuropsychiatric hyperkinetic movement disorders, specifically Tourette syndrome and Huntington's disease.

Recent findings: We highlight racial and ethnic disparities in understudied movement disorders, particularly the neuropsychiatric hyperkinetic movement disorders, Tourette syndrome and Huntington's disease. These diagnoses are likely under-recognized and under-diagnosed in racial and ethnic minority groups, leading to disparities in access to subspecialty care and treatment. Factors contributing to disparities are complex and likely include patient mistrust of the medical community, stigma, and structural racism. Application of health disparities research frameworks used in other disciplines may have utility in the study of inequities in neurology.

Summary: There are significant challenges in studying disparities in Tourette syndrome and Huntington's disease. We also highlight frameworks used in neurology as well as recommendations from the National Institute of Neurological Disorders and Stroke around training in health disparities and recommendations in reducing disparities in neurological disorders across the life span.

Purpose of review: Disparities in care and outcomes are well described in common neurologic disorders; however, less is known about disparities in rare diseases such as Huntington's disease (HD). This review summarizes HD epidemiology in the US and globally while highlighting disparities in HD diagnosis and outcomes across various HD groups. The review also discusses how the lack of diversity in HD research threatens the validity of clinical trials and raises concerns about global accessibility to emerging therapies.

Recent findings: Global HD prevalence and incidence vary worldwide, though the highest numbers are reported in Latin American cluster regions. Within North America, there are disparities in diagnosis and outcomes among Black and Latino patients. Socioeconomic status, educational attainment, and sex were also associated with differences in diagnosis, access, and outcomes. Many of the recent studies in this review used the ENROLL-HD longitudinal study. Yet, the dataset is 90% White Non-Hispanic, leading to an incomplete understanding of how HD manifests in diverse groups.

Summary: Racial, sex, and socioeconomic disparities exist in HD care and research. Addressing these disparities is imperative in improving access to HD care, clinical trial participation, and disease-specific outcomes for all patients with HD in the US and worldwide.

Purpose of review: The aim of this study is to highlight recent key developments in Parkinson's disease genetics research in underrepresented populations, point out gaps related to ethnic and geographical diversity, and suggest future directions for increasing representation in genetics.

Recent findings: Genome-wide association studies (GWAS) involving non-European ancestries have identified population-specific risk variants, even with relatively small sample sizes compared to European GWAS. Polygenic risk scores derived from European cohorts often fail to generalize to non-European populations. Additionally, the prevalence of variants in Parkinson's disease genes, such as LRRK2 and GBA1 , varies across populations. Monogenic studies in regions like African and Latin America face significant challenges, including limited research infrastructure and underrepresentation in genetic studies, hindering a comprehensive understanding of Parkinson's disease's genetic diversity.

Summary: Expanding Parkinson's disease genetics research to include diverse populations is essential to enhance disease understanding, uncover novel therapeutic targets, and ensure equitable access to precision medicine. Addressing participation barriers in underrepresented regions and investing in infrastructure development is essential for future progress.