Spreadsheet: 139497d1328276113-excel-2007-copy-data-from-cells-in-one-workbook-to-another-based-on-the-cell-headings-sampleforload
Sheet: NEUR

Author | Affiliation | Title | Comment | Disclosure | commentStatusID | datePublished | publishingUserID | volume | issue | page | dateSubmitted | siteID | userID | creationDate | updateDate
[NAME],  medicine  Medicine |  |  | Good day sir. I'm a medical student in Philippines. I have a report in neurocysticercosis whether albendazole or praziquantel is more effective. Can you please send me a copy of your study. It would be a big help for me. Thank you. |  | NR |  |  | 49 | 3 | 290
[NAME],  MD  Department of Clinical Neurosciences, Derriford Hospital, Plymouth, UK |  |  | Several novel immunomodulatory drugs are currently being studied for multiple sclerosis (MS) in a bid to increase the therapeutic options for people with this disease. In this small (N=9) study, Kerr et al. propose the use of cyclophosphamide at immunoablative doses. Results show a considerable mean decrease in clinical disability 2 years post-treatment. However, we feel aspects of the study conception and data analysis require further comment.   1) Treatment with cyclophosphamide contradicts current trends in MS immunomodulation. The authors justify pursuing blanket immunosuppression on the heterogeneity of MS autoimmune pathways(1). Yet different inflammatory pathways in separate MS phenotypes are linked by the central role played by T and (to a lesser extent) B lymphocytes. Therefore the search for new treatments is presently focused on the targeted destruction(2) or functional inhibition(3) of lymphocytes, combining maximal efficacy with fewer unwanted effects(4).   2) Cyclophosphamide expedites clinical recovery but often fails to suppress inflammation long-term. The measured improvement in mean EDSS is unsurprising considering the high number of GAD-enhancing lesions in the cohort, which dropped considerably post-treatment. However, three patients underwent radiological reactivation and two manifested persistent inflammation on MRI. Although only one reported clinical symptoms, clinically-silent disease may bear long-term pathologic and clinical implications in multiple sclerosis(5).   3) Clinical amelioration after cyclophosphamide may also be short- lived. The authors compared change in EDSS at 24 months with baseline (- 39.4%). At 12 months, reduction in aggregate disability was similar (- 43.1%), but individually, three patients show an increase in EDSS between 12 and 24 months, two of which were clinically meaningful (1.0 and 2.0 points at scores <4.0). All three had resumption or persistence of activity on MRI. Therefore a third of patients re-accumulated disability following initial improvement, although none went back to pre-treatment levels.   4) Proffering cyclophosphamide as an alternative to bone marrow transplantation in MS feels premature. Published studies have reported conflicting results on the efficacy of bone marrow transplantation (BMT) in MS. Clinical improvement may be solely due to pre-transplant immune conditioning rather than the establishment of a more permissive immune environment following transplantation. In summary, cyclophosphamide may successfully suppress inflammation and aid recovery of function in aggressive MS in the short term. However, its efficacy may not be long-lasting, and must be weighed against concerns associated with immunoablation. While worthy of further study, it should be kept as a second-line option after targeted treatments such as monoclonal antibodies.   REFERENCES 1. [NAME], [NAME], [NAME] of multiple sclerosis pathogenesis:implications for diagnosis and therapy. . Trends in Molecular Medicine. 2001;7(3):115-21. 2. Hirst CL, Pace A, Pickersgill TP, [NAME] R, McLean BN, [NAME], et al. Campath 1-H treatment in patients with aggressive relapsing remitting multiple sclerosis. Journal of Neurology. 2008;255(2):231-8. 3. [NAME]: A new treatment for relapsing remitting multiple sclerosis. Therapeutics and Clinical Risk Management. 2007;3(2):259–68. 4. Hohlfield R, [NAME] concepts of multiple sclerosis as a basis for selective immunotherapy: From pipe dreams to (therapeutic) pipelines. Proceedings of the National Academy of Science. 2004;101(suppl.2). 5. [NAME] relapses have significant pathologic and clinical implications in multiple sclerosis. Journal of the Neurological Sciences. 2007;256(Supplement 1):S19-S22.   No relevant conflicts of interest |  | NR |  |  | 65 | 8 | 1044
SABINO G ECHEBARRIA MENDIETA,  neurologist [NAME] area.osakidetza-basque health service. H San Eloy -Barakaldo-Bizkaia |  |  | "We read with interest the article and remember the clinical developing of the Halmagyi-Curthoys head impulse test , useful for identifying a loss of function of the horizontal semicircular canal described in 1988 as a clinical sign of unilateral peripheral vestibulopathy ( extended in 2005 )   It is relevant to describe the diagnostic possibilities in intercurrent diseases associated to this case: as it is known , cardiogenic vertigo , or vertigo as a presenting manifestation of primary cardiac disease may be described in the differental diagnostic spectrum.( [NAME] Neurol 2006 - Newman and Camargo )    Conflict of Interest: None declared" |  | NR |  |  | 67 | 10 | 1272