Neurological Sciences最新文献

Objectives: Amyotrophic Lateral Sclerosis (ALS) is a debilitating motor neuron disorder characterized by muscle weakness, atrophy, and spasticity. This meta-analysis aims to assess the safety and efficacy of Arimoclomol in patients with ALS.

Method: A comprehensive literature search was conducted on 3 databases to discover articles published up to August 2024. Included studies were randomized controlled trials (RCTs). Data was analysed using Review Manager (v5.4). Cochrane Risk of Bias-2 (RoB-2) was adopted to assess the quality of RCTs.

Results: A total of 359 patients were analysed, with 239 individuals in the Arimoclomol group and 120 individuals in the placebo group. The pooled analysis of the primary outcome, change in Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) score from baseline, did not demonstrate a statistically significant difference favoring the Arimoclomol group (MD = 0.4495; 95% CI: -0.39, 1.27; p = 0.30). Similarly, secondary outcomes, including the Combined Assessment of Function and Survival (CAFS) rank score (MD = 1.00; 95% CI: -2.68, 4.67; p = 0.60), increase in transaminases (RR = 1.05; 95% CI: 0.19, 5.70; p = 0.95), mortality rate (RR = 0.86; 95% CI: 0.55, 1.34; p = 0.50), and adverse events (RR = 0.86; 95% CI: 0.55, 1.34; p = 0.50), showed no statistically significant differences between the groups.

Conclusion: This study does not conclusively demonstrate that Arimoclomol has beneficial effects on ALS patients' physical functionality but shows promise for safety. Further clinical trials are needed to explore the neuroprotective effects of Arimoclomol in the treatment of ALS.

Objectives: Recently, Repetitive Transcranial Magnetic Stimulation (rTMS) has gained attention for its potential in relieving neuropathic pain (NP). NP encompasses central and peripheral neuralgia, characterized by sensory abnormalities and spontaneous pain. Pharmacological treatments often provide partial relief with significant side effects, making rTMS an attractive alternative. This study aimed to assess the efficacy of rTMS in treating NP and its impact on quality of life over three months.

Methods: A total of 51 patients with drug-resistant NP were included, undergoing 15 sessions of rTMS targeting motor cortex areas over three weeks. Clinical response was evaluated using various psychometric scales, including VAS for pain and PGIC. Quality of life was assessed using the SF-36 questionnaire.

Results: Results showed significant clinical improvements in pain severity and quality of life following rTMS treatment. Predictive factors of quality of life improvement were identified, with mental health being crucial across all NP areas. Notably, patients with cerebral NP showed improvements linked to physical dimensions, emphasizing tailored treatment approaches.

Conclusions: This study underscores the efficacy of rTMS in managing NP, highlighting sustained improvements in pain severity and quality of life. The findings offer valuable insights for personalized treatment approaches and optimizing patient outcomes in NP management.

This position paper explores the complex issue of Physician-Assisted Suicide (PAS) in the context of Neurology. It discusses the legal, ethical, and clinical challenges surrounding PAS, including the role of neurologists in assessing eligibility based on prognosis, decision-making capacity, and functional status. The paper outlines Italy's legal framework regarding PAS, following a landmark 2019 Constitutional Court ruling, which permits PAS under strict conditions for patients suffering from incurable illnesses. It also compares PAS regulations in other European and non-European countries. The Italian Society of Neurology (SIN) emphasizes the importance of respecting patient autonomy while advocating for comprehensive palliative care (PC). The SIN's position is that PAS should be legalized under specific circumstances but insists on ensuring equitable access to PC services before considering PAS. Additionally, the SIN supports the training of neurologists in palliative and end-of-life care, underlining the need for careful monitoring and regulation of PAS practices to prevent potential ethical and legal abuses.