Background and ObjectivesTo describe the clinical features and disease outcomes of coronavirus disease 2019 (COVID-19) in patients with neuromyelitis optica spectrum disorder (NMOSD).MethodsThe Neuroimmunology Brazilian Study Group has set up the report of severe acute respiratory syndrome (SARS-CoV2) cases in patients with NMOSD (pwNMOSD) using a designed web-based case report form. All neuroimmunology outpatient centers and individual neurologists were invited to register their patients across the country. Data collected between March 19 and July 25, 2020, were uploaded at the REDONE.br platform. Inclusion criteria were as follows: (1) NMOSD diagnosis according to the 2015 International Panel Criteria and (2) confirmed SARS-CoV2 infection (reverse transcription-polymerase chain reaction or serology) or clinical suspicion of COVID-19, diagnosed according to Center for Disease Control / Council of State and Territorial Epidemiologists (CDC/CSTE) case definition. Demographic and NMOSD-related clinical data, comorbidities, disease-modifying therapy (DMT), COVID-19 clinical features, and severity were described.ResultsAmong the 2,061 pwNMOSD followed up by Brazilian neurologists involved on the registry of COVID-19 in pwNMOSD at the REDONE.br platform, 34 patients (29 women) aged 37 years (range 8–77), with disease onset at 31 years (range 4–69) and disease duration of 6 years (range 0.2–20.5), developed COVID-19 (18 confirmed and 16 probable cases). Most patients exhibited mild disease, being treated at home (77%); 4 patients required admission at intensive care units (severe cases); and 1 patient died. Five of 34 (15%) presented neurologic manifestations (relapse or pseudoexacerbation) during or after SARS-CoV2 infection.DiscussionMost NMOSD patients with COVID-19 presented mild disease forms. However, pwNMOSD had much higher odds of hospitalization and intensive care unit admission comparing with the general Brazilian population. The frequency of death was not clearly different. NMOSD disability, DMT type, and comorbidities were not associated with COVID-19 outcome. SARS-CoV2 infection was demonstrated as a risk factor for NMOSD relapses. Collaborative studies using shared NMOSD data are needed to suitably define factors related to COVID-19 severity and neurologic manifestations.

Guillain‐Barre syndrome following COVID‐19 vaccines (GBSfCV19v) is a reported adverse effect that remains unclear. We present a structured review based on two case reports of GBSfCV19v, a systematic review, and Vaccine Adverse Event Reporting System (VAERS) analysis to estimate the risk and describe the clinical characteristics (CC) of these events. We've searched on MEDLINE and Embase, from the inception to May 20, 2021, using the keywords: “Guillain barre syndrome” and cross‐referenced with “covid‐19 vaccines.” We estimated the risk of GBSfCV19v, comparing it with the risk of GBS following the influenza vaccine (GBSfIv), considering the VAERS sensitivity. The clinical characteristics included: age, sex, comorbidities, type of vaccine, administered dose, clinical onset, deaths, cerebrospinal fluid (CSF), and electromyography (EMG) pattern. We found 43 cases, considering the risk of GBSfCV19v lower than GBSfIv (160–320 cases). The patients had a mean age of 54 years and 23 (56%) were male. The types of vaccines used: Pfizer (22), Moderna (9), AstraZeneca (3), Janssen (3), and Johnson & Johnson (1). 24 cases of GBS occurred after the first dose, with clinical onset of 7 days. CSF albuminocytological dissociation was reported in 7 patients, and EMG revealed a predominant demyelinating pattern. GBSfCV19v risk appears to be lower than what was expected from other respiratory virus vaccines. Most cases of GBS were middle‐aged males within a week following the first dose of the COVID‐19 vaccine, showing a typical demyelinating neuropathy with albuminocytological dissociation.

Approximately one third of epilepsy patients do not become seizure free with antiseizure medications. This treatment gap motivates research for new therapeutic options, such as cannabidiol (CBD). CBD differs from other cannabis derivatives because of its consistent efficacy and lack of a psychoactive effect. CBD can be recommended as adjunctive therapy in patients with Dravet and Lennox-Gastaut syndromes. The most common adverse effects (AEs) are drowsiness, reduced appetite, diarrhea, and vomiting. Transaminase elevation is the most common AE that leads to CBD discontinuation. Coadministration with valproate may increase the risk of hepatotoxicity. The combination of CBD and clobazam may increase both the effectiveness and the risk of AEs associated with these drugs. The most striking gaps in knowledge are the efficacy and optimal dose of CBD for adults with focal epilepsies, the long-term safety of CBD use, and strategies to improve access to CBD for people living with epilepsy.

Background: The novel coronavirus disease 2019 (COVID-19) pandemic poses a potential threat to patients with autoimmune disorders, including multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). Such patients are usually treated with immunomodulatory or immunosuppressive agents, which may tamper with the organism’s normal response to infections. Currently, no consensus has been reached on how to manage MS and NMOSD patients during the pandemic. Objective: To discuss strategies to manage those patients. Methods: We focus on how to 1) reduce COVID-19 infection risk, such as social distancing, telemedicine, and wider interval between laboratory testing/imaging; 2) manage relapses, such as avoiding treatment of mild relapse and using oral steroids; 3) manage disease-modifying therapies, such as preference for drugs associated with lower infection risk (interferons, glatiramer, teriflunomide, and natalizumab) and extended-interval dosing of natalizumab, when safe; 4) individualize the chosen MS induction-therapy (anti-CD20 monoclonal antibodies, alemtuzumab, and cladribine); 5) manage NMOSD preventive therapies, including initial therapy selection and current treatment maintenance; 6) manage MS/NMOSD patients infected with COVID-19. Conclusions: In the future, real-world case series of MS/NMOSD patients infected with COVID-19 will help us define the best management strategies. For the time being, we rely on expert experience and guidance.

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Background: For the last 20 years, the amyloid-beta (Aβ) cascade hypothesis has been dominant in the research of disease-modifying therapeutics, with spent of financial and clinical resources in potential drugs targeting Aβ peptide production or clearance. (1) In this context, monoclonal antibodies targeting beta-amyloid (Aβ-mAbs) are being tested to reduce the amyloid burden in patients with Alzheimer's Disease (AD). (2) However, the cognitive impact of Aβ-mAbs remains controversial. (3) We aim to evaluate the conflicting results of previous studies using a meta-analysis. Method: We searched PubMed, Embase, and Cochrane databases, following until April 2021, using the search terms: ''Alzheimer's disease'' OR ''dementia'' cross-referenced with ''monoclonal antibodies'' , considering the synonyms. Eligible articles were randomized clinical trials with Aβ-mAbs that reported cognitive outcomes. The cognitive function was assessed by Alzheimer's Disease Assessment Scale (ADAS-cog) and Mini-Mental State-Exam (MMSE). We performed a meta-analysis comparing mAbs and placebo, considering a minimal significant clinical change of 3 points in ADAS-Cog and 2 points in MMSE. Result: We found 12 eligible studies in 443 identified records, involving 6736 patients, mean age 71.4 ± 2. We found a small benefit in cognitive outcomes in patients treated with Aβ-mAbs: ADAS-Cog: mean difference (MD) = -0.65; 95% CI (-1.05 to -0.26); Iš = 12%; (p = 0.001) and MMSE: MD = 0.40; 95% CI (0.18 to 0.63); Iš = 10%; (p = 0.0004). The Funnel plot and Egger's test did not show publication bias. MD was below the minimal clinically relevant change in both scales. Conclusion:Aβ-mAbs may have a positive cognitive benefit in AD patients. However, the impact magnitude is small, not reaching minimal clinically relevant change for these scales. References: (1)

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A 48-year-old woman with chronic neck pain presented with a history of sudden neck pain and generalized weakness during a chiropractic session. Neurologic examination showed tetraplegia with C5 sensory level. Cervical spine CT revealed a fracture affecting C5 and C6 vertebra (Figure , A and B). Cervical spine MRI confirmed spinal cord injury (Figure , C). Bilateral vertebral artery occlusion and acute cerebellar infarction were found (Figure , D-F). Bony ankylosis was found in cervical CT spine, suggesting undiagnosed ankylosing spondylitis was a risk factor for spine fracture. Other neurologic lesions related to chiropractic manipulation include vertebral artery dissection, epidural hematoma, and acute disk herniation. 1,2 Study FundingThe authors report no targeted funding. Figure Spinal Cord Injury, Vertebral Artery Dissection, and Cerebellar Strokes after Chiropractic Manipulation (A, B) Sagittal cervical spine CT revealed a fracture and intense bony ankylosis. (C) T2-weighted sagittal cervical spinal cord MRI showed a spinal cord injury. (D) CT angiography identified bilateral vertebral artery occlusion. (E, F) Axial diffusion-weighted imaging and fluid-attenuated inversion recovery brain MRI documented cerebellar ischemia.