Notable in Neurology this week
This issue features an article that documents an increase in interfacility emergency department transfers for patients with TIA and stroke, and another that describes visible and invisible disabilities in adult patients with arthrogryposis multiplex congenita. A featured Views & Reviews acknowledges the discrepancy between standard of care for pediatric cancer and that of early-life epilepsies, and calls for the development and support of a national cooperative group: The Children's Epilepsy Group.
Articles
Preventive Antibiotics in Stroke Study (PASS): A cost-effectiveness study
In a randomized, multicenter, open-label trial, the authors calculated the cost-effectiveness of preventive ceftriaxone for patients with acute stroke against standard stroke care (without preventive antimicrobial therapy). Preventive ceftriaxone was determined likely less costly than the standard treatment per unit decrease in modified Rankin Scale and per quality-adjusted life year gained.
Page 828
Sensory cortex hyperexcitability predicts short survival in amyotrophic lateral sclerosis
In this study, patients with amyotrophic lateral sclerosis, compared to controls, displayed a larger amplitude of early cortical component (N20-P25) in the median nerve somatosensory evoked potential. Sensory cortex hyperexcitability was associated with shorter survival time in patients with amyotrophic lateral sclerosis, and might be a new prognostic biomarker.
Page 831
Demoralization in Parkinson disease
Demoralization is characterized by hopelessness and subjective incompetence. In this study, the authors assessed prevalence and associated features of demoralization in Parkinson disease (PD), finding an association with motor dysfunction and low PD-related life quality. Demoralization is treated with cognitive behavioral therapy, rather than antidepressants, and should be assessed by clinicians.
Page 835
Baseline symptoms and basal forebrain volume predict future psychosis in early Parkinson disease
The authors confirm that REM sleep behavior disorder, excessive daytime sleepiness, autonomic symptoms, and lower cholinergic nucleus 4 (Ch4) density are associated with greater risk of future psychotic symptoms in Parkinson disease (PD). Reduced Ch4 density is also associated with nonmotor symptom burden. Ch4 measurement may be a neuroimaging biomarker in PD.
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From editorialists Bohnen and Teipel: “The study by Barrett et al. provides novel information about associations between the integrity of the CBFB [cholinergic basal forebrain] and psychosis and autonomic symptoms in PD. Their observations suggest that the CBFB plays an important role in nonmotor symptoms in PD that are not limited to cognitive changes alone.”
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NB: “Acute coronary syndrome associated with alemtuzumab infusion,” p. 852. 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 Right Brain article discussing the ethical considerations and consequences of the highly publicized case of an infant with mitochondrial DNA depletion syndrome. This week also includes a Reflections: Neurology and the Humanities poem titled “Subdural hematoma.”
Editor's Summary: NPub.org/edsum
- © 2018 American Academy of Neurology
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