This Month in Archives of Neurology

Mobley and RosenbergArticle predict that we are on the cusp of what promises to be an era of unprecedented progress in neurology. Even with current fiscal constraints and serious concerns about how health care will be organized and financed, in the next 2 decades progress in neurology and neurological science will create important new insights into understanding the brain as we decipher its disorders and discover and apply effective treatments.

Hartung and DihnéArticle hypothesize that pathologic cerebrospinal fluid alterations are not just passive indicators of brain diseases but that they actively and directly evoke functional disturbances in global brain activity through the distribution of neuroactive substances, for instance, secondary to focal neurologic disease. For this mechanism, we propose the new term volume transmission–mediated encephalopathies.

Striano and colleaguesArticle perform an extensive search for genomic rearrangements by microarray-based comparative genomic hybridization in patients with epilepsy. They find that patients with epilepsy show a significantly increased burden of large, rare, gene-rich copy number variations, particularly when associated with mental retardation and neuropsychiatric features. Editorial perspective is provided by Kirk C. Wilhelmsen, MD, PhDArticle.

Callaghan and colleaguesArticle define current clinical practice for evaluating distal symmetric polyneuropathy. They indicate that current practice intent on evaluating distal symmetric polyneuropathy is highly variable and differs widely. For this disorder of the peripheral nerves, a high-yield test such as the glucose tolerance test is rarely used, whereas magnetic resonance imaging is likely overused. Research that defines the optimal evaluation of distal symmetric polyneuropathy has the potential to result in more efficient care.

Searls et alArticle evaluate the frequencies of symptoms and signs in patients with posterior circulation ischemia in a large case series of prospectively collected patients. They report the most frequent symptoms and signs in the largest published registry of patients with posterior circulation ischemia who had complete neurological examinations and extensive cerebrovascular imaging. Knowledge of the vascular territory involved aids in the diagnosis of the causative vascular lesion and stroke mechanism.

Mealy and colleaguesArticle investigate the association between low serum vitamin D levels and recurrent spinal cord disease. They show that vitamin D levels are significantly lower in patients who developed recurrent spinal cord disease, adjusting for season, age, sex, and race. This study provides a basis for a prospective trial of measuring 25-hydroxyvitamin D levels in these patient populations and assessing the influence of vitamin D supplementation on the frequency of relapses in those with recurrent inflammatory spinal cord disease.

Bourre et alArticle indicate that acute partial transverse myelitis may be the first clinical symptom of multiple sclerosis (MS) or may remain a monophasic event. Few data are available to evaluate the risk of conversion to MS and long-term disability. This study, with a mean (SD) follow-up period of 104.8 (29.8) months, confirms that abnormal brain magnetic resonance imaging (MRI) results and the presence of oligoclonal bands in cerebrospinal fluid are 2 independent predictive factors for conversion to MS. No clinical, biological, or MRI factor at onset was predictive of long-term disability.

Choi and colleaguesArticle classify with diffusion tensor imaging the causes of motor weakness in patients with traumatic brain injury (TBI) by conducting an analysis of the injury mechanism of the corticospinal tract (CST). They found that diffusion tensor imaging was useful in elucidation and classification of the causes of motor weakness resulting from CST injury in patients with TBI.

Irizarry et alArticle estimate the incidence rate and predictors of seizures in patients with mild to moderate Alzheimer disease (AD). They report that seizure rates in patients with mild to moderate AD in clinical trials are similar to rates observed in longer observational cohort studies, but they are greater than that expected in the general elderly population. Younger age, greater degree of cognitive impairment, and history of antipsychotic use were independent risk factors for new-onset seizures in AD.

Caglayan and colleaguesArticle identify SORL1 risk genotypes that determine receptor protein expression in the human brain. Their findings suggest a functional mechanism that correlates SORL1 genotype with efficiency of receptor expression in the human brain.

Gao et alArticle examine whether use of statins is associated with altered risk of Parkinson disease (PD). They found that regular use of statins was associated with a modest reduction in PD risk. The possibility that some statins may reduce PD risk deserves further consideration.

Reeve and colleaguesArticle explore the relationship between α-synuclein pathology and mitochondrial respiratory chain protein levels within single substantia nigra neurons. They show that the finding of increased levels of respiratory chain complex subunits within neurons containing α-synuclein does not support a direct association between mitochondrial respiratory chain dysfunction and the formation of α-synuclein pathology.

Sadun et alArticle evaluate the safety and efficacy of a new therapeutic agent, EPI-743, in Leber hereditary optic neuropathy (LHON) using standard clinical, anatomic, and functional visual outcome measures. They report EPI-743 arrested disease progression and reversed vision loss in all but 1 of the 5 consecutively treated patients with LHON.