Dietary restriction (DR) interventions, which encompass both chronic and intermittent reductions in energy intake, are emerging as potential therapeutic approaches for dampening neuroinflammation and demyelination in multiple sclerosis (MS). Mechanisms mediating the beneficial effects of DR include the regulation of pro- and anti-inflammatory signalling molecules and gut microbiome remodelling. This article summarises the preclinical evidence supporting the role of DR in attenuating disease in animal models of MS and the developing clinical evidence indicating the safety and feasibility of such DR interventions in people with MS (pwMS).
{"title":"Dietary restriction in multiple sclerosis: evidence from preclinical and clinical studies","authors":"E. Liao, L. Ghezzi, L. Piccio","doi":"10.47795/mcln8939","DOIUrl":"https://doi.org/10.47795/mcln8939","url":null,"abstract":"Dietary restriction (DR) interventions, which encompass both chronic and intermittent reductions in energy intake, are emerging as potential therapeutic approaches for dampening neuroinflammation and demyelination in multiple sclerosis (MS). Mechanisms mediating the beneficial effects of DR include the regulation of pro- and anti-inflammatory signalling molecules and gut microbiome remodelling. This article summarises the preclinical evidence supporting the role of DR in attenuating disease in animal models of MS and the developing clinical evidence indicating the safety and feasibility of such DR interventions in people with MS (pwMS).","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83543243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adam Boardman, Salman Lari, A. Manuel, Roberta Shaw, Simon R Clark
Cerebrospinal fluid (CSF) hydrothorax has been reported most commonly as a complication of ventriculo-pleural/-peritoneal shunt insertion, but also due to duro-pleural fistula. Here we report a case of CSF hydrothorax in a rehabilitation patient due to duro-pleural fistula following thoracotomy for thoracic myelopathy secondary to disc protrusion. This case highlights the need for high clinical suspicion following thoracotomy, and urgent specialist input from the neurosurgical team.
{"title":"Cerebrospinal fluid hydrothorax in a rehabilitation medicine patient following thoracotomy for thoracic disc protrusion","authors":"Adam Boardman, Salman Lari, A. Manuel, Roberta Shaw, Simon R Clark","doi":"10.47795/jati7770","DOIUrl":"https://doi.org/10.47795/jati7770","url":null,"abstract":"Cerebrospinal fluid (CSF) hydrothorax has been reported most commonly as a complication of ventriculo-pleural/-peritoneal shunt insertion, but also due to duro-pleural fistula. Here we report a case of CSF hydrothorax in a rehabilitation patient due to duro-pleural fistula following thoracotomy for thoracic myelopathy secondary to disc protrusion. This case highlights the need for high clinical suspicion following thoracotomy, and urgent specialist input from the neurosurgical team.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88951670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There is an unmet need for effective diagnosis and management of migraine in perimenopausal women. Menstrual cycle hormone disruption during perimenopause is associated with an increase in migraine and menstrual migraine prevalence, together with other more commonly recognised menopause symptoms. Women of perimenopause age, i.e., early 40s to mid 50s, should routinely be asked about migraine and menopause symptoms, and provided with effective tools for management as appropriate. Simple diaries can be used to identify the frequency and duration of attacks, as well as the relationship to menstruation at outset, and to monitor response to treatment. While there is no evidence to support prescription of hormone replacement therapy (HRT) solely for management of migraine, it is the most commonly used treatment for menopause symptoms. As some types and regimens of HRT can negatively affect migraine, the general recommendation is to use transdermal oestrogen and continuous progestogen regimens where possible. In contrast to contraceptive synthetic oestrogens, physiological doses of natural oestrogen can be used by women with migraine aura. Most women, particularly those with a history of menstrual migraine, can be reassured that the natural history of migraine is to improve with increasing years post menopause.
{"title":"Migraine in perimenopausal women","authors":"A. Macgregor","doi":"10.47795/sbkp2228","DOIUrl":"https://doi.org/10.47795/sbkp2228","url":null,"abstract":"There is an unmet need for effective diagnosis and management of migraine in perimenopausal women. Menstrual cycle hormone disruption during perimenopause is associated with an increase in migraine and menstrual migraine prevalence, together with other more commonly recognised menopause symptoms. Women of perimenopause age, i.e., early 40s to mid 50s, should routinely be asked about migraine and menopause symptoms, and provided with effective tools for management as appropriate. Simple diaries can be used to identify the frequency and duration of attacks, as well as the relationship to menstruation at outset, and to monitor response to treatment. While there is no evidence to support prescription of hormone replacement therapy (HRT) solely for management of migraine, it is the most commonly used treatment for menopause symptoms. As some types and regimens of HRT can negatively affect migraine, the general recommendation is to use transdermal oestrogen and continuous progestogen regimens where possible. In contrast to contraceptive synthetic oestrogens, physiological doses of natural oestrogen can be used by women with migraine aura. Most women, particularly those with a history of menstrual migraine, can be reassured that the natural history of migraine is to improve with increasing years post menopause.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74600271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Progressive supranuclear palsy (PSP) is an uncommon, progressive, neurodegenerative condition which classically presents with eye movement abnormalities, axial rigidity, early falls and cognitive impairment. The range of recognised phenotypes associated with PSP has expanded significantly in recent years. Imaging markers can assist in the diagnosis of PSP, while novel imaging modalities and laboratory-based biomarkers offer hope for earlier and more accurate diagnosis. While no disease modifying treatments are yet available several therapies may be useful in ameliorating symptoms. Despite disappointing recent clinical trial results, several agents are currently under investigation for the treatment of PSP.
{"title":"Progressive Supranuclear Palsy in 2022: recent developments and an eye to the future","authors":"S. Lyons, S. O’Dowd, R. Walsh, Tim Lynch","doi":"10.47795/hmmc8661","DOIUrl":"https://doi.org/10.47795/hmmc8661","url":null,"abstract":"Progressive supranuclear palsy (PSP) is an uncommon, progressive, neurodegenerative condition which classically presents with eye movement abnormalities, axial rigidity, early falls and cognitive impairment. The range of recognised phenotypes associated with PSP has expanded significantly in recent years. Imaging markers can assist in the diagnosis of PSP, while novel imaging modalities and laboratory-based biomarkers offer hope for earlier and more accurate diagnosis. While no disease modifying treatments are yet available several therapies may be useful in ameliorating symptoms. Despite disappointing recent clinical trial results, several agents are currently under investigation for the treatment of PSP.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"68 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77338126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aphasia is an acquired language disorder commonly caused by a stroke or brain injury. A slowly growing number of studies have emerged reporting the psychosocial disruptions experienced by people with aphasia (PWA) in the present COVID-19 pandemic. To extend this topic of better addressing PWA’s rehabilitation needs, this paper aims to draw attention to the significance of helping PWA stay “COVID-informed” through the use of resources that are communicatively-accessible. Keeping PWA abreast of the evolution of the pandemic can reasonably ensure they stay connected to their society, even without an actual physical presence in their community. However, aphasia-friendly health information is currently available predominantly in English only. Similar materials are relatively scarce in other languages and not necessarily updated, albeit such a need for these resources is apparent globally. It is essential that healthcare providers ensure that accessible, comprehensible, high-quality and reliable health-related resources are made available for PWA; this will ultimately benefit them to navigate the pandemic and prepare for the post-COVID era.
{"title":"Keeping people with aphasia worldwide “COVID-informed” amid and after the pandemic","authors":"Anthony Pak-Hin Kong","doi":"10.47795/qhxc5791","DOIUrl":"https://doi.org/10.47795/qhxc5791","url":null,"abstract":"Aphasia is an acquired language disorder commonly caused by a stroke or brain injury. A slowly growing number of studies have emerged reporting the psychosocial disruptions experienced by people with aphasia (PWA) in the present COVID-19 pandemic. To extend this topic of better addressing PWA’s rehabilitation needs, this paper aims to draw attention to the significance of helping PWA stay “COVID-informed” through the use of resources that are communicatively-accessible. Keeping PWA abreast of the evolution of the pandemic can reasonably ensure they stay connected to their society, even without an actual physical presence in their community. However, aphasia-friendly health information is currently available predominantly in English only. Similar materials are relatively scarce in other languages and not necessarily updated, albeit such a need for these resources is apparent globally. It is essential that healthcare providers ensure that accessible, comprehensible, high-quality and reliable health-related resources are made available for PWA; this will ultimately benefit them to navigate the pandemic and prepare for the post-COVID era.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"107 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79561764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
An improved understanding of the pathological processes leading to neurodegeneration in Parkinson’s disease (PD) is leading to the development of a number of disease modifying agents. These include both novel and repurposed drugs. Some of these disease modifying therapies act on cellular targets that have been identified by genetic mutations, while others act on other cellular process which we know are affected in PD. This review provides an update on the progress in the field, and highlights some areas of special interest.
{"title":"Disease modifying treatments for Parkinson’s disease – an update","authors":"V. Chandran, D. Grosset","doi":"10.47795/jhqt7239","DOIUrl":"https://doi.org/10.47795/jhqt7239","url":null,"abstract":"An improved understanding of the pathological processes leading to neurodegeneration in Parkinson’s disease (PD) is leading to the development of a number of disease modifying agents. These include both novel and repurposed drugs. Some of these disease modifying therapies act on cellular targets that have been identified by genetic mutations, while others act on other cellular process which we know are affected in PD. This review provides an update on the progress in the field, and highlights some areas of special interest.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83171567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Headaches make up 30% of all Neurology outpatient consultations.1 There is distinct variability in the management of headaches by Neurologists, leading to unnecessary disparities in the standard of care and likelihood of response between patients. A significant proportion of patients with headache diagnoses do not receive the evidence-based treatments recommended in national or international guidelines,2 and substantial numbers of patients are not receiving preventive therapies.3 Ziegeler et al. found that a third of patients reporting to a tertiary headache centre had not received preventive therapy in line with guidelines, and half had never been prescribed a preventive treatment.2 Considering that 46% of the global adult population are estimated to have a headache disorder,4 this lack of a consistent, evidence-based approach is somewhat incongruent with the patient socio-economic impact. It is probable that lack of adherence to current headache guidelines is a multi-faceted issue. This variation in treatment (and therefore patient outcome), although unexplored,2 is not likely to be a simple educational issue. To add to this, an educational approach, in the form of seminars and workshops, does not have entirely positive evidence to support its use in implementing changes to patient care.5 It seems more probable that there are also structural issues within the health service that in some way preclude patients with headache disorders from gaining appropriate care. For example, using only doctors to care for patients with such a common condition may cause bottle-necking in access, and may not be an appropriate use of clinical resource. The current context of a global pandemic has shown us the importance of using the skillsets of all NHS staff working together for patient care. For headache care this could involve greater use of nursing colleagues or allied health professionals such as Pharmacists. To facilitate such an aim, an easily used and standardised approach is essential. We believe that the guidelines from the British Association for the Study of Headache (BASH),6 could facilitate such an approach.
{"title":"The New National Headache Management System is an easy solution to provide more efficient and evidence-based headache services","authors":"Alexander Gordon, D. Lashley, S. Weatherby","doi":"10.47795/wltd2936","DOIUrl":"https://doi.org/10.47795/wltd2936","url":null,"abstract":"Headaches make up 30% of all Neurology outpatient consultations.1 There is distinct variability in the management of headaches by Neurologists, leading to unnecessary disparities in the standard of care and likelihood of response between patients. A significant proportion of patients with headache diagnoses do not receive the evidence-based treatments recommended in national or international guidelines,2 and substantial numbers of patients are not receiving preventive therapies.3 Ziegeler et al. found that a third of patients reporting to a tertiary headache centre had not received preventive therapy in line with guidelines, and half had never been prescribed a preventive treatment.2 Considering that 46% of the global adult population are estimated to have a headache disorder,4 this lack of a consistent, evidence-based approach is somewhat incongruent with the patient socio-economic impact. It is probable that lack of adherence to current headache guidelines is a multi-faceted issue. This variation in treatment (and therefore patient outcome), although unexplored,2 is not likely to be a simple educational issue. To add to this, an educational approach, in the form of seminars and workshops, does not have entirely positive evidence to support its use in implementing changes to patient care.5 It seems more probable that there are also structural issues within the health service that in some way preclude patients with headache disorders from gaining appropriate care. For example, using only doctors to care for patients with such a common condition may cause bottle-necking in access, and may not be an appropriate use of clinical resource. The current context of a global pandemic has shown us the importance of using the skillsets of all NHS staff working together for patient care. For headache care this could involve greater use of nursing colleagues or allied health professionals such as Pharmacists. To facilitate such an aim, an easily used and standardised approach is essential. We believe that the guidelines from the British Association for the Study of Headache (BASH),6 could facilitate such an approach.","PeriodicalId":34274,"journal":{"name":"Advances in Clinical Neuroscience Rehabilitation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47404552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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