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MeSH: neurologie-metody

130 záznamů v Články Filtry

Článek

Secondary Immunodeficiency and Risk of Infection Following Immune Therapies in Neurology

Szepanowski, Fabian
Autor Szepanowski, Fabian Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
Warnke, Clemens
Autor Warnke, Clemens Department of Neurology, University of Cologne, Cologne, Germany
Meyer Zu Hörste, Gerd
Autor Meyer Zu Hörste, Gerd Department of Neurology, University of Muenster, Muenster, Germany
Mausberg, Anne K
Autor Mausberg, Anne K Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
Hartung, Hans-Peter
Autor Hartung, Hans-Peter Department of Neurology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia Medical University Vienna, Vienna, Austria Department of Neurology, Palacky University, Olomouc, Czech Republic
Kleinschnitz, Christoph
Autor Kleinschnitz, Christoph Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
Stettner, Mark
Autor Stettner, Mark Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany. mark.stettner@uk-essen.de

CNS drugs. 2021 ; 35 (11) : 1173-1188. [pub] 20211016

CNS Drugs
ISSN 1179-1934
Medvik
Zdroj

Secondary immunodeficiencies (SIDs) are acquired conditions that may occur as sequelae of immune therapy. In recent years a number of disease-modifying therapies (DMTs) has been approved for multiple sclerosis and related disorders such as neuromyelitis optica spectrum disorders, some of which are frequently also used in- or off-label to treat conditions such as chronic inflammatory demyelinating polyneuropathy (CIDP), myasthenia gravis, myositis, and encephalitis. In this review, we focus on currently available immune therapeutics in neurology to explore their specific modes of action that might contribute to SID, with particular emphasis on their potential to induce secondary antibody deficiency. Considering evidence from clinical trials as well as long-term observational studies related to the patients' immune status and risks of severe infections, we delineate long-term anti-CD20 therapy, with the greatest data availability for rituximab, as a major risk factor for the development of SID, particularly through secondary antibody deficiency. Alemtuzumab and cladribine have relevant effects on circulating B-cell counts; however, evidence for SID mediated by antibody deficiency appears limited and urgently warrants further systematic evaluation. To date, there has been no evidence suggesting that treatment with fingolimod, dimethyl fumarate, or natalizumab leads to antibody deficiency. Risk factors predisposing to development of SID include duration of therapy, increasing age, and pre-existing low immunoglobulin (Ig) levels. Prevention strategies of SID comprise awareness of risk factors, individualized treatment protocols, and vaccination concepts. Immune supplementation employing Ig replacement therapy might reduce morbidity and mortality associated with SIDs in neurological conditions. In light of the broad range of existing and emerging therapies, the potential for SID warrants urgent consideration among neurologists and other healthcare professionals.

Kapitola

Paliativní péče a dětská neurologie

Štěrbová, Katalin
Autor Autorita Klinika dětské neurologie, 2. lékařská fakulta Univerzity Karlovy a Fakultní nemocnice v Motole, Praha

Základy dětské neurologie. 2021 ; () : 177-178.

ISBN 978-80-7492-510-8
Medvik
Zdroj

Článek

Evaluation of regional ventilation by electric impedance tomography during percutaneous dilatational tracheostomy in neurocritical care: a pilot study

BMC neurology. 2020 ; 20 (1) : 374. [pub] 20201012

BMC Neurol
ISSN 1471-2377
Medvik
Zdroj

BACKGROUND: Percutaneous dilatational tracheostomy (PDT) has become a widely performed technique in neurocritical care, which is however known to be accompanied by some risks to the patient. The aim of this pilot study was to assess the derecruitment effects of PDT with the electric impedance tomography (EIT) during the PDT procedure in neurocritical care. METHODS: The prospective observational pilot study investigated 11 adult, intubated, mechanically ventilated patients with acute brain disease. We recorded EIT data to determine regional ventilation delay standard deviation (RVD SD), compliance win (CW) and loss (CL), end-expiratory lung impedance (EELI), with the EIT belt placed at the level of Th 4 before, during and after the PDT, performed in the standard PDT position ensuring hyperextension of the neck. RESULTS: From 11 patients, we finally analyzed EIT data in 6 patients - EIT data of 5 patients have been excluded due to the insufficient EIT recordings. The mean RVD SD post-PDT decreased to 7.00 ± 1.29% from 7.33 ± 1.89%. The mean post-PDT CW was 27.33 ± 15.81 and PDT CL 6.33 ± 6.55. Only in one patient, where the trachea was open for 170 s, was a massive dorsal collapse (∆EELI - 25%) detected. In other patients, the trachea was open from 15 to 50 s. CONCLUSIONS: This pilot study demonstrated the feasibility of EIT to detect early lung derecruitment occurring due to the PDT procedure. The ability to detect regional changes in ventilation could be helpful in predicting further progression of ventilation impairment and subsequent hypoxemia, to consider optimal ventilation regimes or time-schedule and type of recruitment maneuvres required after the PDT.