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In This Issue of JAMA Neurology
January 2015


JAMA Neurol. 2015;72(1):3. doi:10.1001/jamaneurol.2014.2826


Ebinger and coauthors determine the achievable rate of golden hour thrombolysis in prehospital care and its effect on outcome. The stroke emergency mobile unit (STEMO) was deployed when the dispatchers suspected an acute stroke during emergency calls. The authors show that thrombolysis rates in ischemic stroke were 200 of 614 patients (32.6%) when STEMO was deployed and 330 of 1497 patients (22.0%) when conventional care was administered (P < .001). Editorial perspective is provided by Steven Warach, MD, PhD.


Continuing Medical Education

Arvin and colleagues assess the incidence, risk factors, and clinical characteristics of varicella-zoster virus (VZV) infections in fingolimod-treated patients and provide recommendations for prevention and management. In clinical trials, patients received fingolimod at a dosage of 0.5 or 1.25 mg/d, interferon beta-1a, or placebo. They report that the rates of VZV infections in clinical trials were low with fingolimod, 0.5 mg/d, but higher than in placebo recipients. Editorial perspective is provided by Kenneth L. Tyler, MD.


Author Audio Interview

Lin and colleagues investigate the association between the use of angiotensin-converting enzyme inhibitors (ACEIs) and the risk for developing amyotrophic lateral sclerosis (ALS). The use of ACEIs was analyzed using a conditional logistic regression model that controlled for other antihypertensives, aspirin, steroids, nonsteroidal anti-inflammatory drugs, Charlson Comorbidity Index score, length of hospital stay, and number of outpatient visits. They report that there was a dose-dependent inverse association between ACEI use and the risk for developing ALS.

Nwachuku and coauthors evaluate whether changes in somatosensory evoked potential (SSEP) during carotid endarterectomy (CEA) are diagnostic of perioperative stroke in patients with symptomatic carotid stenosis (CS). They searched PubMed and the World Science Database for reference lists of retrieved studies and/or experiments on SSEP use in postoperative outcomes following CEA in patients with symptomatic CS from January 1, 1950, through January 1, 2013. They indicate that intraoperative SSEP is a highly specific test in predicting neurological outcome following CEA.

Clinical Review & Education

Korin and colleagues indicate that obstruction of normal blood flow, which occurs in a variety of diseases, including thromboembolism in stroke and atherosclerosis, is a leading cause of death and long-term adult disability in the Western world. In vitro and in vivo studies have shown that that nanotherapeutic drug-delivery approach can be used to efficiently lyse clots using a significantly lower amount of thrombolytic drug than is required when administered in a soluble formulation. This nanotherapeutic strategy can potentially improve both the efficacy and safety of thrombolytic drugs, particularly in patients who are at high risk for brain hemorrhage, and thus provide a new approach for the treatment of many life-threatening and debilitating vascular disorders.