Notable in Neurology this week
This issue features an article that determines that at least 2 sleep-onset REM periods are valid and reliable markers for a pediatric narcolepsy type 1 diagnosis; another investigates whether plasma neurofilament light chain levels are associated with motor and cognitive progression in Parkinson disease. Featured special articles update practice guidelines for acute treatment of migraine in children and adolescents and for pharmacologic preventive treatment for pediatric migraine.
Articles
Sex-specific relationship of cardiometabolic syndrome with lower cortical thickness
Women with cardiometabolic risk factors are more vulnerable to cortical atrophy than men. When analyzing the relationship between cardiometabolic risk factors and cortical thickness, hypertension, diabetes mellitus, obesity, and low education level were associated in women; in men, being underweight was associated with lower cortical thickness. Sex-specific prevention strategies may be needed to protect against accelerated brain aging.
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Dual energy CT after stroke thrombectomy alters assessment of hemorrhagic complications
Hyperattenuating CT findings are common after stroke thrombectomy. Dual energy CT (DECT) differentiates between blood and extravasated contrast staining. Fewer patients were deemed to have intracranial hemorrhage after thrombectomy using DECT for a 24-hour follow-up scan, compared to plain CT. This may be relevant for management and timing of secondary prevention initiation.
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Varied phenotypes and management of immune checkpoint inhibitor-associated neuropathies
This large multicenter case series provides clinically relevant insights into diagnosis, treatment, and long-term outcomes of toxic neuropathies from immune checkpoint inhibitors (ICIs). ICI-related neuropathy phenotypes are variable; cranial neuropathies and non-length-dependent polyradiculoneuropathies are most common. Data support current consensus guidelines recommending ICI discontinuation and corticosteroids.
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Community-informed connectomics to the thalamocortical system in generalized epilepsy
The authors report atypical thalamocortical network organization in generalized epilepsy, which is related to future drug response. Intrinsic brain function was probed at macroscale using resting-state fMRI; connectomics methods were utilized to show imbalances in thalamocortical networks. Network imbalances were present in newly diagnosed patients, suggesting a preexisting anomaly of genetic or neurodevelopmental origin.
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NB: “Child Neurology: Spastic paraparesis and dystonia with a novel ADCY5 mutation,” p. 510. To check out other Resident & Fellow Child Neurology 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 Teaching NeuroImage that illustrates an abnormal sleep-onset REM period EEG finding due to sleep deprivation. This week also includes a Resident & Fellow Teaching Video NeuroImage titled “Characteristic head jerks in congenital oculomotor apraxia due to Joubert syndrome.”
Editor's Summary: NPub.org/edsum
- © 2019 American Academy of Neurology
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Recommended articles
Validation of Multiple Sleep Latency Test for the diagnosis of pediatric narcolepsy type 1
Effect of age on MSLT results in patients with narcolepsy–cataplexy
The hypocretin neurotransmission system in myotonic dystrophy type 1
Sex-specific relationship of cardiometabolic syndrome with lower cortical thickness