Nature Reviews Neurology最新文献

Evidence suggests that anthropogenic climate change is accelerating and is affecting human health globally. Despite urgent calls to address health effects in the context of the additional challenges of environmental degradation, biodiversity loss and ageing populations, the effects of climate change on specific health conditions are still poorly understood. Neurological diseases contribute substantially to the global burden of disease, and the possible direct and indirect consequences of climate change for people with these conditions are a cause for concern. Unaccustomed temperature extremes can impair the systems of resilience of the brain, thereby exacerbating or increasing susceptibility to neurological disease. In this Perspective, we explore how changing weather patterns resulting from climate change affect sleep — an essential restorative human brain activity, the quality of which is important for people with neurological diseases. We also consider the pervasive and complex influences of climate change on two common neurological conditions: stroke and epilepsy. We highlight the urgent need for research into the mechanisms underlying the effects of climate change on the brain in health and disease. We also discuss how neurologists can respond constructively to the climate crisis by raising awareness and promoting mitigation measures and research — actions that will bring widespread co-benefits.

Real-world data indicate that ocrelizumab is safe and effective in Latino people with multiple sclerosis (MS), according to a recent report. In a prospective observational study, a total of 305 people with relapsing–remitting MS, primary progressive MS or secondary progressive MS received ocrelizumab during a median follow-up period of 29.5 months. Only one person experienced a relapse, and disability worsened in only 12.4% of participants overall, with the highest risk in the group with secondary progressive MS. The findings provide evidence for efficacy and safety in a group that has been underrepresented in clinical trials of the drug.

Characterization of the networks formed between neurons and glioblastoma cells enables targeting of these networks with the potential to improve treatment, according to new research. Researchers used retrograde tracing with modified rabies virus to visualize neuron–tumour networks in patient-derived glioblastoma spheroid cultures, which revealed widespread connections. Surprisingly, the connections were strengthened by radiotherapy alone, which potentially explains the therapeutic resistance of glioblastoma, but were decreased by radiotherapy in combination with inhibition of neural activity. Furthermore, development of the modified rabies virus retrograde tracing approach enabled selective ablation of tumour-connected neurons, which led to a reduction in tumour cells.

In a new study, deep brain stimulation (DBS) of the lateral hypothalamus facilitated recovery after spinal cord injury (SCI) in rodents and humans. The researchers identified glutamatergic neurons in the lateral hypothalamus as a therapeutic target from a brain atlas of neurons involved in recovery of walking. Stimulation of these neurons in mice and rats with SCI improved walking and led to a durable improvement in recovery. Application of the same approach in two people with incomplete SCI also improved walking and supported longer-term recovery when combined with rehabilitation. Further trials are now needed to establish the safety and efficacy of the approach.

Biomarkers of Alzheimer disease (AD) pathology can predict the development of dementia with Lewy bodies (DLB) in people with idiopathic REM sleep behaviour disorder (iRBD), new research has shown. Levels of amyloid-β₄₀ (Aβ₄₀), Aβ₄₂ and phosphorylated tau-181 (pTau181) were measured in blood from 142 people with iRBD. Among people who went on to develop DLB, the ratio of Aβ₄₀ to Aβ₄₂ was lower and the levels of pTau181 were higher than among people who did not develop DLB.

Autologous haematopoietic stem cell transplantation (AHSCT) is a treatment option for relapsing forms of multiple sclerosis (MS) that are refractory to disease-modifying therapy (DMT). AHSCT after failure of high-efficacy DMT in aggressive forms of relapsing–remitting MS is a generally accepted indication, yet the optimal placement of this approach in the treatment sequence is not universally agreed upon. Uncertainties also remain with respect to other indications, such as in rapidly evolving, severe, treatment-naive MS, progressive MS, and neuromyelitis optica spectrum disorder (NMOSD). Furthermore, treatment and monitoring protocols, rehabilitation and other supportive care before and after AHSCT need to be optimized. To address these issues, we convened a European Committee for Treatment and Research in Multiple Sclerosis Focused Workshop in partnership with the European Society for Blood and Marrow Transplantation Autoimmune Diseases Working Party, in which evidence and key questions were presented and discussed by experts in these diseases and in AHSCT. Based on the workshop output and subsequent written interactions, this Consensus Statement provides practical guidance and recommendations on the use of AHSCT in MS and NMOSD. Recommendations are based on the available evidence, or on consensus when evidence was insufficient. We summarize the key evidence, report the final recommendations, and identify areas for further research.

Three monoclonal antibodies directed against specific forms of the amyloid-β (Aβ) peptide have been granted accelerated or traditional approval by the FDA as treatments for Alzheimer disease, representing the first step towards bringing disease-modifying treatments for this disease into clinical practice. Here, we review the detection, underlying pathophysiological mechanisms and clinical implications of amyloid-related imaging abnormalities (ARIA), the most impactful adverse effect of anti-Aβ immunotherapy. ARIA appears as regions of oedema or effusions (ARIA-E) in brain parenchyma or sulci or as haemorrhagic lesions (ARIA-H) in the form of cerebral microbleeds, convexity subarachnoid haemorrhage, cortical superficial siderosis or intracerebral haemorrhage. Analysis of the radiographic appearance of ARIA, its clinical risk factors and underlying neuropathology, and results from animal models point to a central role for cerebral amyloid angiopathy — a condition characterized by cerebrovascular Aβ deposits — as a key component, either as a direct target for antibody-mediated inflammation or as recipient of Aβ mobilized from plaques in the Alzheimer brain parenchyma. The great majority of ARIA occurrences are associated with mild or no clinical symptoms. However, ~5% of all ARIA events are severe enough to result in hospitalization, permanent disability or death and thus raise challenging clinical questions regarding patient selection and use of concomitant agents. Therefore, identifying novel approaches to predicting, modelling, preventing and treating ARIA remains a key step towards allowing safe use of anti-Aβ immunotherapy for the world’s rapidly ageing population.

Sleep is essential for brain development and overall health, particularly in children with neurodevelopmental disorders (NDDs). Sleep disruptions can considerably impact brain structure and function, leading to dysfunction of neurotransmitter systems, metabolism, hormonal balance and inflammatory processes, potentially contributing to the pathophysiology of NDDs. This Review examines the prevalence, types and mechanisms of sleep disturbances in children with NDDs, including autism spectrum disorder, attention-deficit hyperactivity disorder and various genetic syndromes. Common sleep disorders in these populations include insomnia, hypersomnia, circadian rhythm disorders, sleep-related breathing disorders and parasomnias, with underlying factors often involving genetic, neurobiological, environmental and neurophysiological influences. Sleep problems such as insomnia, night awakenings and sleep fragmentation are closely linked to both internalizing symptoms such as anxiety and depression, and externalizing behaviours such as hyperactivity and aggression. Assessment of sleep in children with NDDs presents unique challenges owing to communication difficulties, comorbid conditions and altered sensory processing. The Review underscores the importance of further research to unravel the complex interactions between sleep and neurodevelopment, advocating for longitudinal studies and the identification of predictive biomarkers. Understanding and addressing sleep disturbances in NDDs is crucial for improving developmental outcomes and the overall quality of life for affected individuals and their families.