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In This Issue of JAMA Neurology
August 2014


JAMA Neurol. 2014;71(8):935. doi:10.1001/jamaneurol.2013.4161

Clerico and colleagues evaluate the effect of therapeutic choices on the mean annualized relapse rate and on magnetic resonance imaging multiple sclerosis (MS) activity after 24 doses of natalizumab in patients with relapsing-remitting MS. The TY-STOP study recruited at 8 Italian MS centers 124 adult patients who demonstrated no clinical or magnetic resonance imaging MS activity after 24 doses of natalizumab. They report class III evidence of an increased risk of MS activity resumption after natalizumab discontinuation. Editorial perspective is provided by Olaf Stüve, MD, PhD, and Gary R. Cutter, PhD.


Ooms and colleagues determine the effect of 1 night of total sleep deprivation on cerebrospinal fluid (CSF) Aβ42 protein levels in healthy middle-aged men. Patients were recruited at the Alzheimer, Wakefulness, and Amyloid Kinetics (AWAKE) study at the Radboud Alzheimer Center. They found that sleep deprivation, or prolonged wakefulness, interferes with a physiological morning decrease in Aβ42.

Dehlendorff and colleagues determine whether the obesity paradox in stroke is real or an artificial finding due to selection bias. They studied survival after stroke in relation to body mass index (BMI, calculated as weight in kilograms divided by height in meters squared). They found no evidence of an obesity paradox in patients with stroke because stroke occurred at a significantly younger age in patients with higher BMI.

Continuing Medical Education

Greene and colleagues describe a patient with anti-Tr and confirm that Delta/notch-like epidermal growth factor–related receptor (DNER) is the autoantigen for a series of patients with anti-Tr. Observational study and analysis of biological samples for antibodies to DNER were conducted at the hospital of the University of Pennsylvania. This case demonstrates the importance of testing for the anti-Tr immune response in patients with cerebellar degeneration.

Ariño and colleagues report the symptoms, additional antibodies, prognostic factors, and long-term outcomes in a cohort of patients with cerebellar ataxia (CA) with glutamic acid decarboxylase 65 antibodies (GAD65-Abs). Retrospective cohort study and laboratory investigations were performed at a center for autoimmune neurologic disorders among 34 patients with CA and GAD65-Abs, including 25 with long-term follow-up data (median, 5.4 years; interquartile range, 3.1-10.3 years). In patients with CA and GAD65-Abs, subacute onset of symptoms and prompt immunotherapy are associated with good outcome.

Vemuri and colleagues investigate the association of lifetime intellectual enrichment with baseline cognitive performance and rate of cognitive decline in an older population without dementia and estimate the years of protection provided against cognitive impairment by these factors. They prospectively analyzed individuals enrolled from October 1, 2004, and in 2008 and 2009 in the Mayo Clinic Study of Aging, a longitudinal, population-based study of cognitive aging in Olmsted County, Minnesota. Higher education/occupation scores were associated with higher levels of cognition.