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In This Issue of JAMA Neurology
October 2018


JAMA Neurol. 2018;75(10):1165. doi:10.1001/jamaneurol.2017.2661


The signaling molecule calcitonin gene-related peptide (CGRP) induces migraine attacks, and anti-CGRP drugs are effective in aborting and preventing migraine; however, it is not clear if CGRP functions in the same way for cluster headache attacks. In a randomized crossover trial of 32 patients with cluster headache, Vollesen and coauthors found that CGRP provoked cluster headache attacks in patients with episodic cluster headache during the active phase and in those with chronic cluster headache, suggesting that anti-CGRP drugs could have a potential role in treating patients experiencing cluster headaches. Editorial perspective is provided by Gelfand and Goadsby.


Synaptic loss correlates with cognitive impairment in Alzheimer disease (AD), so it would seem that measurement of synaptic density could be used as an indicator in vivo of AD progression. In a cross-sectional positron emission tomography imaging study, Chen and coauthors examined ((R)-1-((3-(11C-methyl-11C)pyridin-4-yl)methyl)-4-(3,4,5-trifluorophenyl)pyrrolidin-2-one) (11C-UCB-J)–specific binding as a biomarker for synaptic density in 11 cognitively normal participants and 10 participants with mild cognitive impairment to early AD. Significant reductions of hippocampal synaptic densities were found in participants with AD compared with age-matched participants who were cognitively normal. Positron emission tomography scanning with 11C-UCB-J may provide a direct measure of synaptic density in AD in vivo, yielding results consistent with previous neuropathological investigations. Editorial perspective is provided by Mormino and Jagust.


Public health campaigns have been effective in improving awareness of what to do in the event of a major stroke, but it is not known if the benefit extends to transient ischemic attack (TIA) and minor stroke. In a prospective population-based study of 2243 patients with TIA or stroke in the United Kingdom, Wolters and coauthors looked at the association of the Face, Arm, Speech, Time (FAST)–based public education campaign with delays and failure to seek medical attention. Results demonstrated that the FAST campaign has been successful in getting people to respond more quickly to the symptoms of major stroke but has not improved the response to symptoms of minor stroke and TIAs. Many people ignored minor warning symptoms and subsequently experienced major strokes that would have been preventable, suggesting that public education programs should also emphasize symptoms of TIA and minor stroke.

Continuing Medical Education

Movement disorders are characterized by a marked genotypic and phenotypic heterogeneity, complicating diagnostic work in clinical practice and molecular diagnosis. Montaut and coauthors developed and evaluated a targeted sequencing approach using a panel of genes. Of the 378 eligible patients suspected of having inherited movement disorders, probable pathogenic variants were identified in 83 patients (22.0%). Use of a high-coverage sequencing panel is quick and efficient and provides a cost-effective alternative to whole-exome and whole-genome sequencing for the diagnosis of movement disorders.