Background/Objectives: To compare changes in the thickness of retinal layers between patients with amyotrophic lateral sclerosis (ALS) and healthy controls using optical coherence tomography. Amyotrophic lateral sclerosis is a degenerative disease of the upper and lower motoneurons with a rapidly progressive course, but non-motor symptoms such as decreased ocular motility and reduced visual acuity have also been reported. Specific biomarkers or surrogate parameters assessing neurodegeneration in ALS are of interest. Methods: In a retrospective, longitudinal study using optic coherence tomography of the retinal layers, we compared changes in the thickness of the layers between patients with ALS and healthy controls. Correlations to clinical scores, such as the modified ranking scale, were analyzed. Results: In our cohort of patients with early ALS (disease duration 5.15 ± 21.4 months at baseline), we neither observed differences in retinal layer thickness at baseline nor did the thickness changes in any retinal layer differ in comparison to healthy controls at baseline. Moreover, we observed no significant thickness changes over the course of the observational period in our patients with ALS. However, a correlation analysis revealed a negative association of the thickness change rates in the complex of ganglion cell and inner plexiform layer and the inner nuclear layer with a higher modified Rankin scale at follow-up. Conclusions: This study adds to the notion that OCT may not be a suitable tool to monitor atrophy and disease progression in ALS. However, further longitudinal studies with longer follow-up times and larger cohorts are warranted.

Key Clinical Message: Recurrent depression with psychotic features is an atypical presentation of neurosyphilis. This case emphasizes the polymorphic clinical presentation of neurosyphilis and how it mimics affective disorders with psychotic symptoms.

A document by Aykut Aytulun. Click on the document to view its contents.

Auditory verbal hallucinations (AVH) are a core symptom of schizophrenia and contribute substantially to patient suffering and disability. They are among the most persistent symptoms and do not respond to medication in a substantial portion of patients. Here, we report the application of task-based functional magnetic resonance imaging (fMRI)-guided repetitive transcranial magnetic stimulation (rTMS) in a patient with treatment-resistant AVH. An individualized stimulation target was identified in the left temporal cortex near Heschl’s gyrus using a validated fMRI task. Over a period of 18 months, the patient underwent three cycles of inhibitory 1 Hz rTMS of this target. As a result, AVH severity decreased by 33% and the global symptom score improved by 40%. Functional connectivity analyses revealed an increase in coupling between the temporal target seed and a fronto-cingulate-insular network that has been implicated in reality and performance monitoring. This case highlights the potential of fMRI-guided rTMS as a personalized neuromodulatory therapy for refractory AVH in schizophrenia, warranting further systematic investigation.