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In This Issue of JAMA Neurology
March 2018


JAMA Neurol. 2018;75(3):265. doi:10.1001/jamaneurol.2017.2626

It has been suggested that clinical outcome in multiple sclerosis is driven by not only remyelination but also adaptive reorganization. In this ongoing prospective cohort study, Backner and coauthors explore anatomical wiring and functional networking in 18 patients (11 women [61%]; mean [SD] age, 32.8 [8.5] years) with first-time optic neuritis as a clinically isolated syndrome in an attempt to assess the relative weight of each connectivity modality in expediting visual recovery. Results revealed no effects on anatomical wiring beyond local lesion damage extension; however, a clear change in functional networking was found, suggesting that functional modification may occur even in the presence of an intact anatomical network, perhaps influencing the recovery process. Editorial perspective is provided by Toosy.

Original Investigation, Editorial

Continuing Medical Education

Severe visual impairment following attacks of optic neuritis is a major symptom of neuromyelitis optica spectrum disorder, but the association with functional network reorganization has not been investigated. In this cross-sectional functional neuroimaging study, Finke and coauthors investigated the association of retinal damage and visual dysfunction with visual network organization in 31 patients (28 women [90%]; mean [SD] age, 48.2 [13.9] years) with aquaporin-4 antibody–positive neuromyelitis optica spectrum disorder. Patients were found to have a selective and pronounced increase of visual network functional connectivity that correlated with reduced visual acuity and more severe retinal damage measured by optical coherence tomography. These findings identify functional reorganization within the visual cortex in response to anterior visual system damage in neuromyelitis optica spectrum disorder. Editorial perspective is provided by Toosy.

Original Investigation, Editorial

Comparative data on initial disease-modifying treatment outcomes for relapsing-remitting multiple sclerosis are lacking. In a Swedish community-based study, Granqvist and coauthors used an unselected, real-world patient population of 494 patients (336 women [68.0%]; median [interquartile range] age, 34.4 [27.4-43.4] years) from 2 counties with different treatment approaches: a traditional escalation strategy and a sustained induction strategy, predominantly with rituximab. Rituximab displayed the lowest rate of drug discontinuation, with superior clinical efficacy compared with injectables and dimethyl fumarate and a tendency for lower relapse rates compared with natalizumab and fingolimod. The findings suggest rituximab to have better short-term and medium-term treatment outcomes.

Surgical ablation has been used since the early 1960s to treat Tourette syndrome but has had inconsistent clinical outcomes. An alternative, deep brain stimulation, has shown some success in treatment of Tourette syndrome. In a prospective study, Martinez-Ramirez and coauthors enrolled 185 patients (134 male [72.4%]; mean [SD] age at surgery, 29.1 [10.8] years) from the International Deep Brain Stimulation Database and Registry from 10 countries. The pooled 1-year data revealed a 45.1% improvement in the Yale Global Tic Severity Scale. Three brain targets were frequently used, and all had similar outcomes. The most common adverse effects were dysarthria and paresthesia. Intracranial hemorrhage, infection, and lead explantation rates were 1.3%, 3.2%, and 0.6%, respectively.