Notable in Neurology this week
This issue features an article that investigates neurologic outcome of cardiac arrest in patients with refractory status epilepticus treated with antiepileptic drugs and anesthetics; another identifies genes involved in the etiology of intracranial aneurysms and subarachnoid hemorrhages using whole exome sequencing. A featured Views & Reviews examines the pathologic aspects of chronic inflammatory demyelinating polyneuropathy with a focus on the classical macrophage-mediated mechanism.
Articles
Concussion Biomarkers Assessed in Collegiate Student-Athletes (BASICS) I, II, & III
The Biomarkers Assessed in Collegiate Student-Athletes (BASICS) series addresses several unanswered questions limiting the clinical translation of fluid biomarker tests. A demographically diverse sample of over 400 collegiate athletes provided blood samples that demonstrated that baseline biomarker concentrations differ by sex and race, but not based on concussion or sport history. Clinical concussion diagnoses are often incongruent with blood biomarker indicators. If concussion researchers continue to enroll participants based on symptoms, biological indicators of injury may fall short of this clinical gold standard. This problem is not solved by more research, but by better research and a willingness to reconceptualize modern definitions of concussion.
I Page 1040; II Page 1041; III Page 1042
From editorialists Bigler & Deibert: “The takeaway from this, at least in SRC (sports-related concussion), is that a serum biomarker may detect injury, yet not relate in meaningful ways to current motor, neurobehavioral, and neurocognitive outcome measures.”
Page 1035
Nomograms to predict naming decline after temporal lobe surgery in adults with epilepsy
The authors report easy-to-use tools (nomograms) for reliable individualized prediction of naming decline after temporal epilepsy surgery. Externally validated multivariable prediction models showed good to excellent discriminatory ability (c statistic >0.8) in identifying at-risk patients. These nomograms address the challenge of translating multiple, often contradictory, risk factors into individualized preoperative counseling.
Page 1043
Patient-reported outcomes across cerebrovascular event types: More similar than different
In this study, the effect of a cerebrovascular event on adjusted outcomes across different domains of health were similar for patients with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage, but were worse for patients with TIA. This suggests that the mechanisms for outcomes after TIA may differ from other cerebrovascular events.
Page 1047
From editorialists Marsh & Llinas: “Katzan's study emphasizes the need for a more comprehensive approach to patients with all types of cerebrovascular disease, even those with seemingly minor deficits.”
Page 1038
NB: “Cortical myoclonic tremor induced by fixation-off sensitivity: An unusual cause of insomnia,” p. 1061. To check out other Clinical/Scientific Notes, point your browser to Neurology.org/N. At the end of the issue, check out the Resident & Fellow Residency Training article incrementally illustrating the diagnosis and treatment plan for a patient with HIV presenting with progressive gait difficulty and incontinence. This week also includes a Reflections: Neurology and the Humanities poem titled “Dosing.”
Editor's Summary: NPub.org/edsum
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