Notable in Neurology
This issue features articles investigating the temporal relationship between infective endocarditis and stroke and the influence of stroke subtype and motor impairment on contralesional excitability. Another featured article focuses on retinal pathology in idiopathic moyamoya angiopathy detected by optical coherence tomography.
ARTICLES
Health care charges for youth with newly diagnosed epilepsy
Reducing substantial costs incurred in the year following an epilepsy diagnosis is important and timely. Seizure occurrence, more drug side effects, and poorer quality of life (QoL) predict higher health care charges 1 year after diagnosis. Optimizing seizure control, side effects, and QoL may facilitate cost-reduction efforts.
See p. 490
From editorialists Wagner & Berg: “The study by Ryan et al. complements and augments the extant literature to inform clinical practice in the treatment of pediatric epilepsy by proposing that behavioral health integration into epilepsy health care may not only improve QoL but also substantially reduce health care costs.”
See p. 486
CIDP diagnostic pitfalls and perception of treatment benefit
This study analyzed patients with a diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) for diagnostic accuracy. Commonly observed errors included liberal interpretation of “atypical” clinical symptoms, equivocal electrophysiologic findings, mild CSF cytoalbuminologic dissociation, and subjective patient-reported perception of benefit following immunotherapy. Utilization of existing CIDP diagnostic criteria and objective indicators of treatment efficacy is a potential solution to avoid CIDP diagnostic pitfalls.
See p. 498
From editorialists Gorson & Gooch: “The proper diagnosis and management of CIDP is essential for patients and the management of increasingly scarce medical resources. As the US health care system continues to evolve towards quality-based care, the use of IVIg and other emerging and expensive immunomodulatory therapies for CIDP will come under greater scrutiny.”
See p. 488
Acute stroke chameleons in a university hospital: Risk factors, circumstances, and outcomes
This review of a prospectively constructed stroke registry showed that strokes may be missed in patients presenting with lower cerebrovascular risk profiles or those with other acute conditions. Patients with stroke chameleons present more often with milder strokes, coma, or fewer focal signs. When confronted with an unusual medical or neurologic presentation, stroke may be the underlying condition.
See p. 505
Mixed pathology is more likely in black than white decedents with Alzheimer dementia
Multiple pathologies are common and related to dementia in the oldest-old: The 90+ Study
Black decedents with Alzheimer dementia were more likely to have mixed brain pathologies compared with age-, sex-, education-, and cognition-matched white decedents with Alzheimer dementia. However, in the older population, the presence of multiple pathologies was associated with increased likelihood and severity of dementia. The effect of the individual pathologies may be additive and synergistic and requires further research.
NB: “What is a reflex? A guide for understanding disorders of consciousness,” see p. 543. To check out other Contemporary Issues articles, point your browser to Neurology.org. At the end of the issue, check out the Clinical/Scientific Notes discussing unilateral magnetic resonance–guided focused ultrasound pallidotomy for Parkinson disease and how a CSF leak was reopened by vomiting associated with MRI. This week also includes a Humanities poem titled “Caring for Maggie.”
- © 2015 American Academy of Neurology
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Retinal pathology in idiopathic moyamoya angiopathy detected by optical coherence tomography
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