Notable in Neurology this week
This issue features an article that explains the clinical value of the central vein sign on a clinical 3T scanner for the differential diagnosis of multiple sclerosis and neuromyelitis optica spectrum disorder; another details the suitability of atrophy, demyelination, and iron accumulation as markers of therapeutic intervention following spinal cord injury. A featured Special Article outlines the American Academy of Neurology Institute and Society for Neuro-Oncology approved quality measurement set for neuro-oncology.
Articles
Sun exposure over the life course and associations with multiple sclerosis
Sunlight exposure may alter multiple sclerosis (MS) risk; however, its measurement and timing are not well-delineated. The authors reviewed sun exposure in patients with MS and age-matched controls, and found that living in high (vs low) ultraviolet B areas prior to MS onset was associated with a lower MS risk.
Page 638
Randomized, dose-ranging safety trial of cannabidiol in Dravet syndrome
As cannabidiol use increases among patients with epilepsy, pharmacokinetic data are needed. In this study of children with Dravet syndrome, cannabidiol levels and levels of its metabolites increased proportionally with dose. The only antiepileptic drug interaction was an increase in the nordesmethyl metabolite of clobazam. These findings emphasize a need for more cannabidiol data.
Page 640
Randomized dose-escalation trial of elamipretide in adults with primary mitochondrial myopathy
In this article, the authors elucidate a potential new therapy for an underdiagnosed and disabling genetic condition: primary mitochondrial myopathy (PMM). Elamipretide, studied in PMM, improved exercise performance following 5 days of IV treatment without safety concerns. Elamipretide's therapeutic benefits support initiation of a phase 3 program in patients with PMM.
Page 641
From editorialists Vissing and Angelini: “Remodeling the mitochondrial inner membrane with elamipretide is an interesting new treatment strategy for mitochondrial myopathies, which although not curative, could prove an important treatment option for this patient group, not only as monotherapy, but potentially also in combination with aerobic training or other noncurative therapies.”
Page 633
Arterial stiffness and dementia pathology: Atherosclerosis Risk in Communities (ARIC)-PET Study
Arterial stiffness is underappreciated as a biomarker of dementia risk. The authors show, in a cross-sectional study, that greater arterial stiffness is associated with evidence of dementia pathology seen on MRI and PET. The effects of hemodynamic abnormalities in the pathologic progression of dementia are just beginning to emerge.
Page 645
From editorialists Lopez and Maillard: “These findings confirmed previous observations on the relationship between arterial stiffness and Aβ amyloid deposition, and consolidated the notion that there is an association between systemic vascular disease and Aβ amyloid deposition.”
Page 635
NB: “International Issues: A guide to US academic global health programs in neurology,” p. 662. To check out other Resident & Fellow International Issues articles, point your browser to Neurology.org/N and click on the link to the Resident & Fellow section. At the end of the issue, check out the Resident & Fellow Clinical Reasoning paper discussing the case of a middle-aged woman presenting with headache and an altered mental status. This week also includes a Video NeuroImage titled “Paraneoplastic spinal myoclonus associated with Caspr2 antibodies.”
Editor's Summary: NPub.org/edsum
- © 2018 American Academy of Neurology
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