Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
Citations 0
This Month in Archives of Neurology
Nov 2011

This Month in Archives of Neurology

Arch Neurol. 2011;68(11):1371-1372. doi:10.1001/archneurol.2011.1499

Chronic cerebrospinal venous insufficiency has recently been proposed to be etiologic to multiple sclerosis. Bagert et alArticle indicate that an independent investigation into this theory during the past 2 years has not succeeded in verifying this relationship. A critical analysis of the scientific methods used in the original studies of chronic cerebrospinal venous insufficiency in multiple sclerosis reveals several methodological problems with regard to potential bias and confounding. The current evidence calls into question whether chronic cerebrospinal venous insufficiency in multiple sclerosis exists at all.

Shepardson and colleaguesArticle identify several confounding factors among the human studies, including differing blood-brain barrier permeabilities among statins, the stage in Alzheimer disease at which statins were administered, and the drugs' pleiotropic metabolic effects, all of which contribute to the substantial variability observed to date.

Khot et alArticle developed Death Rounds to provide emotional support and end-of-life care teaching for residents caring for dying patients on the inpatient neurology service. Death Rounds are monthly 1-hour clinical case discussions where residents identify issues through shared experiences. Death Rounds afford an opportunity for physicians-in-training to process as a group their feelings, intense emotions, and insecurities while learning from the dying process. Most residents found it a rewarding and valuable experience.

Wolk and colleaguesArticle demonstrate the concordance of fluorine 18–labeled flutemetamol amyloid positron emission tomography imaging with histopathology, supporting its sensitivity to detect amyloid and potential use in the study and detection of Alzheimer disease. Editorial perspective is provided by William Jagust, MDArticle.

The findings of the analysis by Fleisher and colleaguesArticle confirm the ability of florbetapir F 18 positron emission tomographic standard uptake value ratios to characterize amyloid levels in clinically probable Alzheimer disease, mild cognitive impairment, and older healthy control groups using continuous and binary measures of fibrillar Aβ burden. Editorial perspective is provided by William Jagust, MDArticle.

Image not available

Percentages of florbetapir positivity by diagnostic group. The percentages of positivity in all 3 diagnostic groups and in 2 subgroups of older healthy controls (APOE ε4 carriers [OHC E+] and noncarriers [OHC E4−]) are based on meeting criteria for florbetapir F 18 levels associated with intermediate or high likelihood neuropathological Alzheimer disease (AD) (hereafter referred to as PATHAMY levels, with a standard uptake value ratio [SUVR] of ≥1.17) or the presence of any identifiable cortical Aβ (hereafter referred to as any-amyloid levels, with SUVR > 1.08). The probable AD (PAD), mild cognitive impairment (MCI), and OHC diagnostic groups differed significantly in their percentage of positivity for both thresholds (P < 1.0 × 10−7) but not between the 2 OHC subgroups, likely owing to the small sample size. Only the full OHC group shows significant differences in their percentage of positivity based on threshold used (P = .03).

Kim et alArticle show that repeated treatment with rituximab appeared to produce consistent and sustained efficacy over 24 months with good tolerability in patients with neuromyelitis optica.

Tur and colleaguesArticle find that modest but beneficial effects of interferon beta-1b on clinical variables and brain atrophy development were observed 5 years after trial termination.

Saure et alArticle report that natalizumab mediates an increase in circulating CD34+ cells by interfering with homing to the bone marrow. Thus, CD34+ cells appear unlikely to represent a source mobilizing JC virus out of the bone marrow in patients treated with natalizumab.

Chan and colleaguesArticle show that brain involvement manifesting clinically as brainstem encephalitis is common among Hong Kong Chinese patients with neuromyelitis optica spectrum disorders.

Using candidate gene identification based on prior biological knowledge and the functional prediction of rare variants, Fecto et alArticle identified several novel SQSTM1 mutations in patients with amyotrophic lateral sclerosis. Their findings provide evidence of a direct genetic role for p62 in amyotrophic lateral sclerosis pathogenesis and suggest that regulation of protein degradation pathways may represent an important therapeutic target in motor neuron degeneration.

Kesler and colleaguesArticle provide further evidence of neurologic impairment associated with primary breast cancer irrespective of treatment history.

Seet et alArticle find that patients with chronic atrial fibrillation have worse stroke outcomes than do patients without atrial fibrillation, and the risk for worse outcomes was greater in patients with a longer duration of atrial fibrillation.