ASM Interactions

ASM Interactions

Only interesting and freq asked

Valproate

Clobazam 
VPA ⊖→ CYP2C19→ ↑N‑desmethylclobazam
The increase in clobazam does not change VPA level

Neurofibromatosis

Neurofibromatosis

NF1

NF2/ NF2-related schwannomatosis
AKA: MISME (multiple inherited schwannomas, meningiomas, and ependymomas)

Definition
AD characterized by multiple CNS tumors

History
1992 Manchester criteria
2017 Revised Manchester
2022 NF2-related schwannomatosis

Pathophys
-22q12.2→ Merlin (tumor supressor gene)
>cytoskeletal and contact-dependent
-Schawannomas→ Antoni A & B
A→ dense (Verocay bodies)
B→ loose

Incidence
1 in 40,000 births

Dx
-NF2-SWN 2022
-Manchester
DDx
-Schwannomatosis→ only peripheral, no central

Management
-If found NF2:
>Annually eval→ bMRI, ophthal, audiologic
>Every 2y→ spine-MRI 
-If tumor present, more freq
-Therapies
>Bevacizumab→ good VS, poor meningioma; SAEs in 10% (HTN, thromboembolic)
>Brigatinib→ good VS and meningioma

Neuronland History

Neuronland Blogspot History

Purpose

- Self‑repository of articles
- Concepts and lessons learned throughout my life

Authors

Jamir Pitton Rissardo
Ana Leticia Fornari Caprara

Remarkable milestones

🏅Jan 3, 2020
>1st post

https://neuronland.blogspot.com/2020/01/number-1-article-type-case-report.html

🏅Jan 30, 2026
> 1,000,000 views

🏅Apr 12, 2026 → free Google indexation 



233. Neurochagas: Experimental and human literature of an uncommon entity (Review)

Article type: Narrative Review
Article title: Neurochagas: Experimental and human literature of an uncommon entity (Review)

Journal: Medicine International
Year: 2026
Authors: Jamir Pitton Rissardo, Hossam Tharwat Ali, Vishnu Vardhan Byroju, Ana Leticia Fornari Caprara
E-mail: jamirrissardo@gmail.com

ABSTRACT
Neurochagas, the neurological manifestation of Chagas disease, presents a challenge to global health, affecting millions of individuals worldwide. Despite significant progress being made in the understanding of the pathogenesis and clinical presentation of neurochagas, numerous gaps persist in the literature, hindering effective diagnosis and management. The present review discusses the relevant experimental and human literature regarding neurochagas and its epidemiology, pathophysiology, clinical manifestations, diagnostic approaches, treatment strategies and future directions for research. Neurochagas includes a broad spectrum of neurological manifestations, including meningoencephalitis, stroke‑like syndromes, cognitive impairment, movement disorders, peripheral neuropathy and autonomic dysfunction, resulting from Trypanosoma cruzi invasion and neuroinflammatory responses. Diagnosing this neurozoonotic disease relies on a multidimensional approach, incorporating clinical evaluation, serological testing, neuroimaging studies, cerebrospinal fluid analysis and ancillary tests. Treatment strategies for neurochagas focus on antiparasitic therapy, symptomatic management, immunomodulation and supportive care. However, available clinical evidence and evidence of proper nervous system penetration is limited, particularly for advanced neurological complications. Future studies are required in order to advance the understanding of the disease mechanisms, identifying biomarkers for early diagnosis and treatment response assessment, developing novel therapeutic interventions, implementing precision medicine approaches, and strengthening global health initiatives to reduce the burden of neurochagas.
Keywords: chagas disease; trypanosoma cruzi; neurochagas; neurological manifestations; central nervous system; peripheral nervous system; immunosuppression; neuroimmune interactions; encephalitis; brain inflammation.

Full text available at:

DOI

Citation
Rissardo JP, Ali HT, Byroju VV, Caprara ALF. Neurochagas: Experimental and human literature of an uncommon entity (Review). Med Int 2026;6:36.
Figure 1. Life cycle of Trypanosoma cruzi. Kissing bug bites infect humans and trypomastigotes, which undergo reproductive cycles in the bug's gut, are ingested. This bug excretes these parasites into the wound site during a meal. Replication inside the human host occurs by binary fission, and trypomastigotes circulate across the bloodstream.
Figure 2. Neural invasion of T. cruzi and pathophysiology of neurochagas. As hypothesized from experimental models, T. cruzi species gain access to the central nervous system via retrograde axonal transport using microtubules, as well as adhesion molecules on the neuronal surface. While hijacking physiological function, T. cruzi enhances the release of inflammatory cytokines, which further contribute to the neuronal damage process. T. cruzi, Trypanosoma cruzi.
Table I. Prevalence and incidence of Chagas disease.
Table II. Rodent models exhibiting CNS abnormalities following Trypanosoma cruzi infection.
Table III. Suggested molecular interactions in conditions such as neurochagas and host molecules in the CNS.
Table IV. Studies on stroke associated with Chagas disease.
Table V. Factors associated with stroke recurrence and stroke mortality in Chagas disease.
Table VI. Antiparasitic choices for managing neurochagas.

232. Accepted

231. Accepted


230. Accepted


Rowan Research Day - 2026

Rowan Research Day - 2026

Reference list

Irritability and Related Behavioral Adverse Events Associated With Levetiracetam: A Meta‑Analysis and Meta‑Regression of Randomized Trials
Wearable and Technology‑Assisted Gait and Balance Interventions in Parkinson’s Disease: A Systematic Review and Meta‑Analysis
Trends and Disparities in Mortality Involving Epilepsy and Aspiration Pneumonia Among Older Adults in the United States, 1999–2020
Cerebrospinal Fluid and Serum Manganese Levels in Parkinson’s Disease: A Method‑Stratified Meta‑analysis
Efficacy and Safety of Levetiracetam for Essential Tremor: A Systematic Review and Meta‑Analysis
Prevalence and Clinical Correlates of Restless Legs Syndrome in Neuromyelitis Optica Spectrum Disorder: A Systematic Review and Meta‑analysis
Effects of Subthalamic Nucleus Deep Brain Stimulation on Depressive Symptoms in Patients with Parkinson’s Disease: A Meta‑Analysis
Efficacy and Safety of Droxidopa for Neurogenic Orthostatic Hypotension: A Systematic Review and Meta‑analysis
Focal Status Epilepticus in a Patient with Responsive Neurostimulation: A Rare Complication and Management Insights

Post-concussion syndrome

Post-concussion syndrome

Definition
mTBI ✚ persistent sx ✚ fx impact ✚ exclusion

mTBI
•Head trauma with ± brief loss of consciousness (<30 min)
•± post‑traumatic amnesia (<24 h)
•± confusion/disorientation
•GCS 13–15
•No structural brain injury explaining symptoms

Persistent sx
•One or more post‑concussive sx
•Persisting beyond expected recovery
>4 weeks (children/adolescents)
>3 months (adults)

Sx domains
-Somatic: headache, dizziness, fatigue, photophobia/phonophobia
-Cognitive: attention deficit, memory impairment, slowed processing, executive dysfunction
-Emotional/Behavioral: irritability, anxiety, depression, emotional lability
-Sleep: insomnia, hypersomnia, fragmented sleep

Cannabis use disorder

Cannabis use disorder (CUD)

Note
-DSM-V criteria for CUD
-RCVS

Cannabis withdrawal syndrome
>not life-threatening, but can last 2 wks

Treatment
-Psychosocial tx (CBT) 

-OFF-label
>Acetylcysteine (NAC 1200 mg BID)
>Gabapentin
>Mirtazapine
>Dronabinol/nabiximols
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