Spotlight on the August 27 Issue

T-cell homeostasis in pediatric multiple sclerosis: Old cells in young patients

The authors compared peripheral T-cell compartment and regulatory T-cell function in 30 pediatric multiple sclerosis (pMS) patients with adult patients and controls. With ratios between naive and memory T-cell subsets matching those of adult controls, signs of early thymic involution already found in pMS suggest an intrinsic compromise in thymic-dependent T-cell neogenesis contributing to MS pathogenesis.

See p. 784

From editorialists Bar-Or & Muraro: “Their work contributes to a growing body of evidence implicating abnormalities of lymphocyte homeostasis (that may reflect an intrinsic defect of thymic function) in the pathogenesis of both pediatric- and adult-onset MS.”

See p. 778

Predictors of outcome in acute encephalitis

In 103 patients with encephalitis admitted to an intensive care unit, several treatable conditions—status epilepticus, cerebral edema, and thrombocytopenia—were strongly associated with mortality. Aggressive vigilance and treatment of potentially reversible conditions may improve outcomes of patients with encephalitis regardless of the specific etiology.

See p. 793

Cognitive impairment and PD patients’ capacity to consent to research

Ninety patients with Parkinson disease (PD) and 30 controls completed 2 interviews using the MacArthur Competence Assessment Tool for Clinical Research. PD patients with borderline cognitive impairment had notable impairments in their decisional capacity. The Montreal Cognitive Assessment may be useful for identifying patients at risk of impaired capacity.

See p. 801; Editorial, p. 780

Triple dissociation of attention networks in stroke according to lesion location

One hundred ten acute stroke patients and 62 controls underwent the attention network test, which measures the three principal types of attention. Performance was related to lesion anatomy. The majority of stroke patients may be suitable for 1 of 3 “personalized therapies” depending on the site of their lesion.

See p. 812; Editorial, p. 782

Association of atrial fibrillation with mortality and disability after ischemic stroke

Older age and increased stroke severity explained most of the association between atrial fibrillation and poor stroke outcomes, with no association found in patients receiving preadmission therapeutic oral anticoagulant (OAC) therapy. Nonuse of OAC therapy represents a modifiable care gap to mitigate the association between atrial fibrillation and poor outcomes after ischemic stroke.

See p. 825

Risk factors for dementia with Lewy bodies: A case-control study

The authors identified 147 dementia with Lewy bodies (DLB) patients and 236 Alzheimer disease (AD) patients. Smoking and education had opposing risk effects in AD and Parkinson disease (PD), but not in DLB. Depression and low caffeine intake, risk factors for AD and PD, increased risk for DLB.

See p. 833

OnabotulinumtoxinA improves quality of life in patients with neurogenic detrusor overactivity

This study evaluated the effects of onabotulinumtoxinA 200 U or 300 U on patient-reported outcomes in patients with urinary incontinence due to neurogenic detrusor overactivity. At week 6, both onabotulinumtoxinA-treated groups showed greater improvements in Incontinence Quality of Life, Overactive Bladder Patient Satisfaction with Treatment Questionnaire, and Patient Global Assessment versus placebo.

See p. 841