A Difficult Diagnosis And Challenging Management Of An Aggressive Case Of Aquaporin 4 Negative Nmosd.

Neuromyelitis optica spectrum disorders can be challenging to diagnose and manage. There is considerable potential long-term morbidity but this can be avoided by appropriate treatment. Here we present one such case that is interesting as well as instructive.

Deep brain stimulation for Parkinson's disease in Pakistan: Current status, opportunities and challenges.

Parkinson's disease is a slowly progressive neurodegenerative disease that commonly affects people aged 60 years and above. So far, no treatment has been shown to halt or slow the progression of the disease and our options are limited to symptomatic management. Levodopa is the most preferred antiparkinsonian medication that provides excellent control of symptoms early in the disease. However, in most patients the response declines over time and complications of motor fluctuations and dyskinesia arise. Other medical therapies play an adjunctive role in the management, as they are not as effective as levodopa. Advanced therapies like deep brain stimulation (DBS) can provide effective control of symptoms in moderate to advanced disease. Deep brain stimulation surgery has recently been started in Pakistan. This review provides an overview of deep brain stimulation, its indications, patient selection process and details of surgery, expected benefits and limitations as well as its history and challenges in Pakistan.

Recognizing Movement Disorder Emergencies - A Practical Review For Non-Neurologist.

Neurology still remains one of the most underserved specialties of medicine in Pakistan with roughly one neurologist per million people. Movement disorders (MD) are neurological problems that interfere with patient's motor abilities and diagnosis is typically clinical. In this review, we describe a practical approach to common MD emergencies that may be encountered by a non-neurologist physician, emphasizing on formulating a working diagnosis and their immediate management. Movement disorder emergencies can be classified based on MD phenomenology and we will provide a brief overview of dystonia including acute dystonic reaction, PAID syndrome and dystonic storm; chorea, myoclonus including serotonin syndrome and startle disease; and rigidity including neuroleptic malignant syndrome and malignant hyperthermia.

The growth factor progranulin binds to TNF receptors and is therapeutic against inflammatory arthritis in mice.

The growth factor progranulin (PGRN) has been implicated in embryonic development, tissue repair, tumorigenesis, and inflammation, but its receptors remain unidentified. We report that PGRN bound directly to tumor necrosis factor receptors (TNFRs) and disturbed the TNFα-TNFR interaction. PGRN-deficient mice were susceptible to collagen-induced arthritis, and administration of PGRN reversed inflammatory arthritis. Atsttrin, an engineered protein composed of three PGRN fragments, exhibited selective TNFR binding. PGRN and Atsttrin prevented inflammation in multiple arthritis mouse models and inhibited TNFα-activated intracellular signaling. Collectively, these findings demonstrate that PGRN is a ligand of TNFR, an antagonist of TNFα signaling, and plays a critical role in the pathogenesis of inflammatory arthritis in mice. They also suggest new potential therapeutic interventions for various TNFα-mediated pathologies and conditions, including rheumatoid arthritis.