Notable in Neurology this week
This issue features an article that uses diffusion tensor imaging to compare the microstructural integrity of white matter tracts in patients with Parkinson disease, with and without psychosis; another investigates whether symptoms of persistent postural perceptual dizziness are more common than previously assumed. A featured Contemporary Issues article reviews various fund flow models and arrangements among neurology departments, medical centers, and university entities within integrated academic health systems.
Articles
Markers of coagulation and hemostatic activation aid in identifying causes of cryptogenic stroke
Patients with embolic stroke of undetermined source were tested for markers of coagulation and hemostatic activation (MOCHA profile) at least 2 weeks after stroke. Patients with ≥2 elevated markers were more likely to have subsequent diagnoses of malignancy, venous thromboembolism, or a hypercoagulable state. The MOCHA profile can assist in identifying potential causes of cryptogenic stroke.
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Scrambler therapy improves pain in neuromyelitis optica: A randomized controlled trial
Patients with neuromyelitis optica spectrum disorder (NMOSD) may experience neuropathic pain that is resistant to standard therapies. A phase II randomized sham-controlled trial in patients with NMOSD found that the Scrambler transcutaneous electrical nerve stimulation (TENS) device was well-tolerated and led to a reduction in pain in participants treated with the Scrambler TENS device.
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Abnormal development of cerebellar-striatal circuitry in Huntington disease
The developmental theory of neurodegeneration posits that the primary pathology of Huntington disease is due to abnormal brain development. In a resting-state functional MRI study, children with 36 or more CAG repeats had higher functional connectivity between the cerebellum and striatum than did children with fewer repeats. This higher connectivity may be a compensatory mechanism that leads to normal function in childhood despite abnormal neurodevelopment.
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Pregnancy-related relapses and breastfeeding in a contemporary multiple sclerosis cohort
Data from decades ago suggested that the risk of a multiple sclerosis (MS) relapse increases postpartum. A contemporary propensity-matched study found that the relapse rate decreased during pregnancy, that it had no increase during the postpartum year, and that in the 6 months postpartum, breastfeeding was associated with decreased risk of relapse. The authors conclude that women with MS should be encouraged to breastfeed exclusively.
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From editorialists Dobson and Mowry: “Making individual-level clinical recommendations to a woman with MS on the basis of population-based studies is difficult. Nonetheless, combined with innovative approaches to use of MS [disease-modifying therapies] before conception and during breastfeeding, this study provides relevant information that neurologists can use to counsel women with MS regarding pregnancy and postpartum decisions.”
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NB: “Journal Club: Width and neurophysiologic properties of tissue bridges predict recovery after cervical injury,” p. e1961. To check out other Resident & Fellow Section Journal Club 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 Section Teaching NeuroImage illustrating a tigroid MRI pattern found in an 8-month-old girl with Krabbe disease. This week also includes a Humanities in Neurology piece titled “Happy Mother's Day to patients I have lost.”
- © 2020 American Academy of Neurology
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