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In This Issue of JAMA Neurology
December 2019

Highlights

JAMA Neurol. 2019;76(12):1411. doi:10.1001/jamaneurol.2018.3021

Research

Previous studies have suggested that head trauma in men may be associated with testosterone deficiency and erectile dysfunction (ED) through mechanisms that likely include damage to the pituitary; however, it is not known if multiple concussive events are associated with more testosterone deficiency and a greater frequency of ED. Professional US-style football players may be at increased risk because of high numbers of head injuries experienced during their careers. In a cross-sectional study of 3409 former players, Grashow and coauthors found that concussion symptoms during professional play were significantly associated with current self-reported low testosterone levels and ED. Men who have experienced head injuries may benefit from discussions with their health care clinicians regarding these treatable conditions.

Author Audio Interview

CME

Patients with cerebral venous thrombosis (CVT) are at risk of recurrent venous thrombotic events and progressive brain ischemia. While vitamin K antagonists are recommended for anticoagulation after CVT, direct non–vitamin K oral anticoagulants have been used off-label for patients with CVT with some success in small nonrandomized studies. In an open-label randomized clinical trial of 120 patients with CVT, Ferro and coauthors compared dabigatran, 150 mg twice daily, with dose-adjusted warfarin for the prevention of recurrent events. The authors found no recurrent venous thrombotic events in patients randomized to either dabigatran or warfarin. One major bleeding event was recorded among users of dabigatran and 2 among users of warfarin, suggesting that both dabigatran and dose-adjusted warfarin may be safe options to prevent recurrent venous thrombotic events in patients with CVT.

Dual antiplatelet therapy with clopidogrel-aspirin is effective for minor ischemic stroke and transient ischemic attack (TIA), but the optimal duration of this dual antiplatelet therapy is unknown. Using pooled individual patient-level data from 2 randomized clinical trials (5170 patients from the Clopidogrel in High-Risk Patients With Acute Non-Disabling Cerebrovascular Events [CHANCE] trial and 4881 patients from the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke [POINT] trial), Pan and coauthors found that early, short-term clopidogrel-aspirin treatment reduced the risk of major ischemic events without increasing the risk of major hemorrhage in patients with minor stroke or TIA and that the main net clinical benefit of dual antiplatelet therapy occurred within the first 21 days.

CME

Clinical Review & Education

Developing new diagnostic and therapeutic tools for central nervous system disorders requires conducting human neural device research. Conducting such research ethically is vital to progress in the field. Hendriks and coauthors analyze existing regulations and standard practices to address analysis of risk, informed consent, and potential posttrial responsibilities for research participants in human neural device studies. Although many of the ethical challenges identified and analyzed are not unique to neural device studies (eg, determining patient capacity to provide informed consent, ensuring that patients know that participation is voluntary), the authors note some unique features, including the importance of communicating potential posttrial care needs and costs to maintain or remove neural devices to the patient.

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