Charles Yonan

Treatment of tardive dyskinesia with tetrabenazine or valbenazine: a systematic review

Up to 30% of patients taking antipsychotics may develop tardive dyskinesia (TD). Recent evidence-based recommendations demonstrate an unmet need for effective TD management. This systematic review was designed to update the evidence for TD treatment, comparing two vesicular monoamine transporter 2 (VMAT2) inhibitors, tetrabenazine and valbenazine. Of 487 PubMed/Embase search results, 11 studies met the review criteria. Valbenazine efficacy was demonstrated in rigorously designed clinical trials that meet the guidelines for AAN Class I evidence. Due to differences in study designs and a lack of standardized and controlled trials with tetrabenazine, a formal meta-analysis comparing the agents was not possible. However, valbenazine appears to have fewer side effects and a more favorable once-daily dosing regimen for the treatment of TD.

Erratum to: PRISM II: An open-label study to assess effectiveness of dextromethorphan/quinidine for pseudobulbar affect in patients with dementia, stroke or traumatic brain injury [BMC Neurol., 16 (2016) 89], DOI:10.1186/s12883-016-0609-0

Erratum After publication of the original article [1], the authors noticed that there were errors in the caption of Fig. 3, and the y-axis of Fig. 6 itself. The following statement should not have been included in the caption of Fig. 3: “CNS-LS scores were not normalized.” The CNS-LS is a rank-order scale, and is not normalized. This statement was included erroneously and the authors intended on removing it prior to resubmission, but this was unfortunately overlooked. Similarly, the y-axis within Fig. 6 was mislabelled. The CNS-LS scale ranges from 7 to 35, so the y-axis for Fig. 6 should start at a base score of 7 and not zero. The correct and updated version of Fig. 6, in which the data presented remain accurate and are unchanged, is published in this erratum.

PRISM II: AN OPEN-LABEL STUDY TO ASSESS THE SAFETY, TOLERABILITY, AND EFFECTIVENESS OF DEXTROMETHORPHAN 20 MG/QUINIDINE 10 MG (NUEDEXTA®) IN PSEUDOBULBAR AFFECT (PBA) SECONDARY TO DEMENTIA, STROKE, OR TRAUMATIC BRAIN INJURY (TBI)–EARLY RESULTS OF TRIAL

explanation for the paradoxical findings. Methods: Hyman and colleagues have demonstrated in the mouse taoupathy model that NFT formation does not lead rapidly to cell death (de Calignon, 2011). Rather, NFT-containing neurons appear to be long-lived and able to revert to a normal state (Polydoro, 2013). We have modeled the inferred biology and run simulations using Vensim PLE+, version 6.2Results: The rate of neuronal loss, which in this framework is directly related to the absolute size of the NFT-containing neuron pool, follows a distinctive pattern: an initial increase; a build to a near plateau due to reversion to normal neurons and establishment of an equilibrium between NFT formation and reversion; a decline after the peak, driven by decrease in the size of the pool of NFT-containing neurons due to neuronal death. Importantly, we maintained the same k ATR, representing neurodegenerative stress, over time. Thus this model accounts for an increase in the absolute number of neurons dying per unit time, and associated CSF-ptau, in the initial phases of disease followed by a decline despite constant neurodegenerative stress.The model further predicts that interventions that blocks neuronal loss from the NFT-containing neuron pool (i.e. prevented neurodegeneration) should lead to an acute decrease, rather than preventing an increase, in CSF-ptau. Conclusions: Reductions in CSF-ptau in advanced Alzheimer’s can be accounted for by a biological model in which the number of neurons dying per unit time is related to the size of the pool of long-lived NFT-containing neurons.

QUANTIFYING THE IMPACT OF PSEUDOBULBAR AFFECT (PBA) ON HEALTH-RELATED QUALITY OF LIFE (HRQOL) IN PATIENTS WITH ALZHEIMER'S DISEASE TREATED WITH NUEDEXTA OR CONVENTIONAL MEDICATION

Community services On-site CGAT consultation 30.4 6 24.3 32.9 6 24.4 25.5 6 23.5 0.01 CGAT fast-track clinic 0.8 6 7.0 0.3 6 1.7 1.7 6 11.8 0.09 CVMO consultation 33.9 6 60.0 28.8 6 35.4 41.0 6 90.0 0.09 VMO consultation 4.7 6 17.4 5.2 6 18.4 3.9 6 15.6 0.55 Psychogeriatric team consultation 1.4 6 5.6 1.5 6 5.6 1.2 6 5.6 0.6 Speech therapist assessment 2.3 6 8.0 1.9 6 5.0 3.2 6 11.7 0.18 Physiotherapist intervention 0.2 6 2.2 0.2 6 2.4 0.2 6 1.7 0.9 Occupational therapist intervention 1.8 6 5.9 2.6 6 6.9 0.3 6 2.6 0.001 Dietitian intervention 0.7 6 3.0 0.9 6 3.3 0.3 6 2.0 0.09 Community Care Nursing Service Wound care 187.6 6 417.6 130.0 6 320.0 299.0 6 543.0 0.001 Enteral feeding tube care 46.2 6 58.1 40.6 6 47.9 57.0 6 73.0 0.018 Urinary catheter care 13.3 6 45.9 6.6 6 28.0 26.0 6 66.0 <0.001 Injection of medicine service 1.4 6 7.2 1.5 6 6.6 1.3 6 8.1 0.87