Consultants in Neurology

The Virginia Department of Transportation (VDOT) has implemented the Balanced Mix Design (BMD) concept for its dense-graded surface mixtures to improve the durability and service life of asphalt pavements. The VDOT’s BMD framework specifies the use of the indirect tensile cracking test to assess the cracking susceptibility of asphalt mixtures, requiring a minimum cracking tolerance (CT) index of 70 after short-term oven aging for 4 h at compaction temperature (T comp ). However, the current framework does not account for oxidative aging over the service life of asphalt mixtures, which is becoming increasingly relevant with the use of additives and recycled materials. This study aims to develop a practical laboratory long-term aging protocol to be used in the VDOT’s BMD framework, while balancing the need for an effective differentiation of asphalt mixtures’ performance and ensuring a practical implementation in routine laboratory settings. This study includes 10 asphalt mixtures with varying reclaimed asphalt pavement contents and asphalt binder performance grades. The asphalt mixtures underwent laboratory oven aging at 95°C and 135°C or higher (i.e., T comp ) to determine appropriate aging durations. The CT index of the asphalt mixtures was measured alongside the rheological and chemical properties of the virgin and recovered asphalt binders. This study identified a reduced aging duration at 95°C and established an equivalent accelerated aging duration at T comp . Preliminary criteria for the CT index were also developed based on the observed relationship between the CT index of the asphalt mixtures at different aging conditions and their corresponding Glover–Rowe parameter of recovered asphalt binders.

To evaluate the immunological safety profile of prolonged UBL treatment.

To evaluate efficacy with ublituximab in treatment-naive participants with relapsing multiple sclerosis enrolled in ULTIMATE I and II.

The availability of raw DNA and genetic interpretation tools allow individuals to access genetic health risk information, where analytical false-positives exist. Little is known about the experience of individuals who receive pathogenic or likely pathogenic variant(s) through raw DNA interpretation and follow-up with clinical confirmatory genetic testing. This qualitative study set out to describe the experiences of individuals who pursued clinical confirmatory genetic testing, including their perception of the process. Participants were recruited from social media and eligible if they discovered a potential pathogenic or likely pathogenic variant in a raw DNA interpretation report, completed clinical confirmatory genetic testing in the U.S., and provided documentation of those results. Individuals participated in semi-structured interviews, which were transcribed and inductively coded to identify themes. Of the 12 participants, 3 received clinical genetic testing results that confirmed pathogenic or likely pathogenic variants noted in raw DNA interpretation reports (confirmation positive), and 9 were not confirmed. Nearly all (n = 11) participants described emotional distress and information-seeking behavior as a coping mechanism after discovering a pathogenic or likely pathogenic variant in raw DNA interpretation. When pursuing confirmatory genetic testing, many (n = 9) faced challenges with finding knowledgeable healthcare providers and obtaining insurance coverage. Despite reporting concerns over raw DNA interpretation and a desire for more safeguards, almost all (n = 10) participants stated interest in using the service again. Overall, participants' experiences reveal they find personal utility in raw DNA interpretation results and provide insight into opportunities for patient and provider education.

To characterize the effects of ublituximab on relapse rate and time to first relapse.

Describe efficacy and safety in patients with relapsing MS (RMS) who had highly active disease (HAD) at baseline in the phase 2b trial of tolebrutinib (NCT03889639).

Multiple sclerosis (MS) is a chronic progressive neurodegenerative demyelinating disease affecting the central nervous system. Glatiramer acetate (GA; Copaxone®) was the first disease-modifying treatment (DMT) for MS successfully tested in humans (1977) and was approved by the US Food and Drug Administration in December 1996. Since then, there have been numerous developments in the MS field: advances in neuroimaging allowing more rapid and accurate diagnosis; the availability of a range of DMTs including immunosuppressant monoclonal antibodies and oral agents; a more holistic approach to treatment by multidisciplinary teams; and an improved awareness of the need to consider a patient's preferences and patient-reported outcomes such as quality of life. The use of GA has endured throughout these advances. The purpose of this article is to provide an overview of the important developments in the MS field during the 20 years since GA was approved and to review clinical data for GA in MS, with the aim of understanding the continued and widespread use of GA. Both drug-related (efficacy versus side-effect profile and monitoring requirements) and patient factors (preferences regarding mode of administration and possible pregnancy) will be explored.

Objective: The primary objective of this study is to describe the disease characteristics of the cohort of MS patients undergoing Rebif treatment. Design:This is a multicentre, open label, non comparative, non randomized study conducted in Egypt on the use of interferon beta-1a (Rebif) therapy in Egyptian patients with relapsing multiple sclerosis according to McDonald criteria. Subjects: Egyptian patients with relapsing multiple sclerosis who are naive to interferon and are 18 to 65 years old. Settings:A total number of 36 patients were enrolled. Main Outcome Measures:include the mean number of relapses, time from diagnosis to start of treatment, number of relapses prior to start of treatment, annualized relapse rate, incidence of adverse events associated with Rebif therapy and number and location of lesions in MRI. Results:7 patients were excluded from Intention-to-Treat Population as they were enrolled regardless of the inclusion/exclusion criteria. Therefore, the Per Protocol Population included 29 patients including 11 males and 18 females and with a mean age of 31.41 years old. The number of reported relapses was 4.3 and 11 at visit 1, visit 2 and end of the study respectively. Despite this increase, only 13 out of 29 patients (44.83% - 95%CI: 28.4% to 62.4%) had relapse attacks during the study (48 weeks). The annualized relapse rate was 0.79 ± 0.41 (95% CI) relapse per year. 9 patients out of 36 patients (25% - 95%CI: 13.75 to 41.07%) in the safety population had adverse events during the study. 2 were reported at baseline, 5 at visit 1, 1 at visit two and 1 at visit 3. The adverse events were elevated liver enzymes (2), depression (2), injection site pain (1), allergic skin reaction (2) and flu like symptoms (1). Conclusion:Compared to previously reported results, this study indicates that Rebif appears to have a favorable efficacy profile as well as a favorable safety profile in delaying MS progression in Egyptian patients.

Pseudobulbar affect (PBA) is a neurological condition of disinhibition of emotional expression characterized by uncontrollable, exaggerated, and often inappropriate outbursts of laughter and/or crying that may cause severe distress, embarrassment, and social dysfunction. This article discusses results from a study to examine the relationships between physical disability and the severity of PBA in patients with underlying multiple sclerosis.