AlphaMissense prediction for the evaluation of missense variants in the diagnostic setting of neuromuscular disorders.

Next-generation sequencing has improved diagnostic outcomes for neuromuscular disorders, but interpreting rare missense variants remains challenging. We evaluated AlphaMissense, a recently developed machine learning tool, for predicting missense variant pathogenicity, using 45 (likely) pathogenic variants and 21 variants of uncertain significance from 58 deeply phenotyped patients. AlphaMissense predicted 69% of pathogenic variants correctly, but also classified 62% of variants of uncertain significance as pathogenic.

Signs of Intracranial Hypertension in Chronic Inflammatory Polyradiculoneuropathies-A Cross Sectional Cohort Study.

Introduction: Inflammatory polyradiculoneuropathy (IPN) has been associated with intracranial hypertension (IH) in various case reports, suggesting a potential link between the two conditions. However, the prevalence of IH in patients with IPN has not been addressed by prospective studies.

Methods: In this cross-sectional prospective study, we prospectively screened consecutive patients with chronic IPN for the presence of clinical and paraclinical signs of IH (fundoscopy, perimetry, optical coherence tomography, ultrasonography) between August 31, 2021, and December 31, 2023.

Liquid phase exfoliation of graphene using ammonia as an easy-to-remove additive in low-boiling organic-water co-solvent suspensions.

Graphene nanosheets from suspensions are key to applications such as in printable films, battery/supercapacitor electrodes, fillers in composite materials or catalyst supports. We present a straightforward method for achieving high-concentration and long-term stable graphene suspensions by liquid phase exfoliation (LPE) via a combination of ammonia (NH) as an easily removable additive together with low-boiling point, benign organic-water co-solvent mixtures as suspension media. We find that the addition of small amounts of NH as an additive drastically improves the obtainable LPE graphene concentrations by up to 2 orders of magnitude for a wide range of organic-water co-solvent mixtures including with isopropanol, methanol, ethanol, 1-propanol, tetrahydrofuran, acetonitrile, acetone, ethylene glycol and tert-butanol.

Holistic Exome-Based Genetic Testing in Adults With Epilepsy.

Background And Objectives: Exome sequencing (ES) is increasingly used in the diagnostic workup of epilepsies. While its utility has been extensively demonstrated in children, its role in adults remains to be defined. In this study, we evaluate the outcomes of a holistic exome-based approach in adults with epilepsy.

Clinical heterogeneity within the ALS-FTD spectrum in a family with a homozygous optineurin mutation.

Objective: Mutations in the gene encoding for optineurin (OPTN) have been reported in the context of different neurodegenerative diseases including the amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) spectrum. Based on single case reports, neuropathological data in OPTN mutation carriers have revealed transactive response DNA-binding protein 43 kDa (TDP-43) pathology, in addition to accumulations of tau and alpha-synuclein. Herein, we present two siblings from a consanguineous family with a homozygous frameshift mutation in the OPTN gene and different clinical presentations.

A Homozygous PTRHD1 Missense Variant (p.Arg122Gln) in an Individual with Intellectual Disability, Generalized Epilepsy, and Juvenile Parkinsonism.

Biallelic variants in have been associated with autosomal recessive intellectual disability, spasticity, and juvenile parkinsonism, with few reported cases. Here, we present the clinical and genetic findings of a female of Austrian origin exhibiting infantile neurodevelopmental abnormalities, intellectual disability, and childhood-onset parkinsonian features, consistent with the established phenotypic spectrum. Notably, she developed genetic generalized epilepsy at age 4, persisting into adulthood.

Next-generation sequencing and comprehensive data reassessment in 263 adult patients with neuromuscular disorders: insights into the gray zone of molecular diagnoses.

Background: Neuromuscular disorders (NMDs) are heterogeneous conditions with a considerable fraction attributed to monogenic defects. Despite the advancements in genomic medicine, many patients remain without a diagnosis. Here, we investigate whether a comprehensive reassessment strategy improves the diagnostic outcomes.

Hierarchically Micro- and Mesoporous Zeolitic Imidazolate Frameworks Through Selective Ligand Removal.

A new method to engineer hierarchically porous zeolitic imidazolate frameworks (ZIFs) through selective ligand removal (SeLiRe) is presented. This innovative approach involves crafting mixed-ligand ZIFs (ML-ZIFs) with varying proportions of 2-aminobenzimidazole (NH-bIm) and 2-methylimidazole (2-mIm), followed by controlled thermal treatments. This process creates a dual-pore system, incorporating both micropores and additional mesopores, suggesting selective cleavage of metal-ligand coordination bonds.

Thymectomy in myasthenia gravis.

Purpose Of Review: Thymectomy has long been used in the treatment of patients with myasthenia gravis and antibodies against the acetylcholine receptor. However, its effectiveness has only been proven a few years ago in a randomized controlled trial in patients under the age of 65. Here, we review the current literature focusing on patient subgroups, potential biomarkers for outcome prediction and the choice of surgical approach.

Microwave-assisted synthesis of metal-organic chalcogenolate assemblies as electrocatalysts for syngas production.

Today, many essential industrial processes depend on syngas. Due to a high energy demand and overall cost as well as a dependence on natural gas as its precursor, alternative routes to produce this valuable mixture of hydrogen and carbon monoxide are urgently needed. Electrochemical syngas production via two competing processes, namely carbon dioxide (CO) reduction and hydrogen (H) evolution, is a promising method.

The diagnostic and prognostic utility of repetitive nerve stimulation in patients with myasthenia gravis.

Repetitive nerve stimulation (RNS) is a standard test for the diagnosis of myasthenia gravis (MG), where decrement of compound muscle action potentials (CMAP) corresponds to clinical muscle fatigability. Our aim was to ascertain the diagnostic and prognostic utility of RNS in MG patients. This study included MG patients treated between 01/2000 and 12/2016, with an observational period of at least one year and a minimum of two neurological examinations.

The clinical and molecular landscape of congenital myasthenic syndromes in Austria: a nationwide study.

Background: Congenital myasthenic syndromes (CMS) are a heterogeneous group of disorders caused by genetic defects resulting in impaired neuromuscular transmission. Although effective treatments are available, CMS is probably underdiagnosed, and systematic clinico-genetic investigations are warranted.

Methods: We used a nationwide approach to collect Austrian patients with genetically confirmed CMS.

Short-term and sustained clinical response following thymectomy in patients with myasthenia gravis.

Background And Purpose: This study was undertaken to investigate short- and long-term outcome following thymectomy in patients with acetylcholine receptor antibody (AChR-Ab)-positive myasthenia gravis (MG).

Methods: Rates of clinical response (defined as minimal manifestation, pharmacological remission, or complete stable remission) lasting for at least 1 year were retrospectively analyzed using Cox proportional hazard models. The occurrence of relapses was recorded during follow-up.

Clinico-genetic spectrum of limb-girdle muscular weakness in Austria: A multicentre cohort study.

Background And Purpose: Hereditary myopathies with limb-girdle muscular weakness (LGW) are a genetically heterogeneous group of disorders, in which molecular diagnosis remains challenging. Our aim was to present a detailed clinical and genetic characterization of a large cohort of patients with LGW.

Methods: This nationwide cohort study included patients with LGW suspected to be associated with hereditary myopathies.

Neuroradiological differentiation of white matter lesions in patients with multiple sclerosis and Fabry disease.

Objective: White matter lesions (WML) in multiple sclerosis (MS) differ from vascular WML caused by Fabry disease (FD). However, in atypical cases the discrimination can be difficult and may vary between individual raters. The aim of this study was to evaluate interrater reliability of WML differentiation between MS and FD patients.

Incidence and clinical spectrum of rhabdomyolysis in general neurology: a retrospective cohort study.

The objective of this retrospective cohort study was to evaluate demographic, clinical and laboratory characteristics of patients with rhabdomyolysis as defined by a serum creatine kinase (sCK) activity > 950 U/L. A total of 248 patients were recruited from the Department of Neurology, Medical University of Vienna, between 01/2000 and 12/2017, with a median sCK activity of 2,160 U/l (IQR 1,342-4,786). Seizures (31.

Real-world treatment of adult patients with Guillain-Barré syndrome over the last two decades.

This study investigated treatment characteristics of Guillain-Barré syndrome (GBS) in a real-world setting between 2000 and 2019. We analyzed clinical improvement between nadir and last follow-up in patients with severe GBS (defined as having a GBS disability scale > 2 at nadir) and aimed to detect clinical factors associated with multiple treatments. We included 121 patients (74 male; median age 48 [IQR 35-60]) with sensorimotor (63%), pure motor (15%), pure sensory (10%) and localized GBS (6%) as well as Miller Fisher syndrome (6%).

Cerebrospinal fluid analysis in Guillain-Barré syndrome: value of albumin quotients.

Background: Albuminocytologic dissociation in cerebrospinal fluid (CSF) is a diagnostic hallmark of Guillain-Barré syndrome (GBS). Compared to CSF total protein (TP), the CSF/serum albumin quotient (Qalb) has the advantage of method-independent reference ranges. Whether the diagnostic yield differs between Qalb and CSF-TP is currently unknown.

Nerve conduction studies in Guillain-Barré syndrome: Influence of timing and value of repeated measurements.

Objective: Nerve conduction studies (NCS) are essential to differentiate between demyelinating and axonal subtypes in Guillain-Barré syndrome (GBS). However, it is debated to which extent the delay of NCS after symptom onset and repeated measurements during the disease course influence the diagnostic accuracy.

Methods: We evaluated NCS in 93 patients with a classical GBS applying two widely used criteria (Hadden's and Rajabally's).

Pathomechanisms and Clinical Implications of Myasthenic Syndromes Exacerbated and Induced by Medical Treatments.

Myasthenic syndromes are typically characterized by muscle weakness and increased fatigability due to an impaired transmission at the neuromuscular junction (NMJ). Most cases are caused by acquired autoimmune conditions such as myasthenia gravis (MG), typically with antibodies against the acetylcholine receptor (AChR). Different drugs are among the major factors that may complicate pre-existing autoimmune myasthenic conditions by further impairing transmission at the NMJ.

Subgroup stratification and outcome in recently diagnosed generalized myasthenia gravis.

Objective: To describe disease outcomes of myasthenia gravis (MG) subgroups and which factors influence outcomes by reviewing individual patient records of a representative cohort.

Methods: We performed a retrospective analysis of 199 patients with generalized MG and disease onset after the year 2000 who were treated at 2 tertiary referral centers in Austria. We stratified patients as early- and late-onset acetylcholine receptor antibody-positive, muscle-specific tyrosine kinase (MuSK) antibody-positive, and seronegative patients and patients with thymoma regardless of antibody status.

Laboratory Tests for Neuropathies: What to do and to Avoid.

Objectives: laboratory tests for work-up of hereditary and acquired neuropathies of peripheral nerves are frequently uncritically utilized. This overview focuses on the most common laboratory tests and investigations needed for diagnosing PNPs by the general neurologist.

Method: Literature search.

Increased serum neurofilament light chain concentration indicates poor outcome in Guillain-Barré syndrome.

Background: Guillain-Barré syndrome (GBS) is an autoimmune disease that results in demyelination and axonal damage. Five percent of patients die and 20% remain significantly disabled on recovery. Recovery is slow in most cases and eventual disability is difficult to predict, especially early in the disease.

Frequency and clinical features of treatment-refractory myasthenia gravis.

Background: To investigate the frequency and characterize the clinical features of treatment-refractory myasthenia gravis in an Austrian cohort.

Methods: Patient charts of 126 patients with generalized myasthenia gravis and onset between 2000 and 2016 were analyzed retrospectively. Patients were classified as treatment-refractory according to strict, predefined criteria.