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In This Issue of JAMA Neurology
June 2017


JAMA Neurol. 2017;74(6):625. doi:10.1001/jamaneurol.2016.3999


Benign epilepsy with centrotemporal spikes (BECTS), the most common focal epilepsy syndrome among children, has an excellent prognosis and usually resolves before 16 years of age, and half of children with the disorder have only a few seizures. Many neurologists often do not prescribe antiseizure drugs for patients with BECTS; however, in a case series, Doumlele and coauthors identified 3 boys aged 9, 12, and 13 years with BECTS (2 with definite BECTS and 1 with probable BECTS) among 189 decedents of sudden unexpected death in epilepsy (SUDEP) enrolled in the North American SUDEP Registry between 2011 and 2016. The authors posit that neurologists should indeed still consider the risks of antiseizure drugs but also disclose the risk of SUDEP to families of children with BECTS and base treatment decisions on this discussion.

Childhood epilepsy is a common neurologic disorder, but no definitive cause is determined in more than 60% of patients. In a population-based cohort study of 1.4 million live single births in Sweden from 1997 to 2011, Razaz and coauthors found that the rate of childhood epilepsy in offspring increased in women with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) score of 25 to 40 in a dose-response pattern. The authors found strong evidence that asphyxia-related neonatal complications as well as less severe neonatal complications, including neonatal hypoglycemia, jaundice, and respiratory distress, independently increased the risk of childhood epilepsy and were increased in mothers with higher BMI. Editorial perspective is provided by Bell.


Continuing Medical Education

YARS2-related mitochondrial disease might be underdiagnosed because some patients don’t exhibit the full spectrum of myopathy, lactic acidosis, and sideroblastic anemia and are not of Middle Eastern descent. In an observational case series study conducted between 2000 and 2015, Sommerville and coauthors identified 17 patients with YARS2 variants; 11 patients with YARS2 variants were identified in a literature search and 6 patients (including 3 Scottish patients and 1 Irish/Scottish patient) with YARS2 variants were referred to a UK diagnostic and clinical center. The authors found that 15 individuals exhibited elevated blood lactate levels with generalized myopathy but only 12 manifested with sideroblastic anemia. The authors advise testing for YARS2 variants regardless of race/ethnicity in patients who present with mitochondrial myopathy, even in the absence of sideroblastic anemia.

In the last 20 years, stroke mortality rates in the United States for those 65 years and older has decreased, but stroke incidence and hospitalization for younger adults (aged 18-34 years and 35-44 years) has increased. George and coauthors examined data from the National Inpatient Sample, a database of hospital inpatient stays, from 1995 to 2012 to identify stroke hospitalization and the prevalence of stroke risk factors, such as hypertension, lipid disorders, diabetes, and tobacco use. The 2003-2004 data included 362 339 hospitalizations, and the 2011-2012 data included 421 815 hospitalizations. Acute ischemic stroke hospitalization rates as well as the prevalence of stroke risk factors increased significantly for men and women aged 18-34 years and 35-44 years between 2003-2004 and 2011-2012. The authors suggest physicians begin to focus on stroke prevention strategies for young adults. Editorial perspective is provided by Burke and Skolarus.


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