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This Month in Archives of Neurology
June 2009

This Month in Archives of Neurology

Arch Neurol. 2009;66(6):689-690. doi:10.1001/archneurol.2009.111

Deep Brain Stimulation, Neuroethics, and the Minimally Conscious State: Moving Beyond Proof of Principle

Schiff and colleagues Article describe their motivation for, ethical framing of, and results from a recent single-subject study of central thalamic deep brain stimulation in a patient remaining in the chronic minimally conscious state. The results demonstrate dramatically a causal relationship between brain stimulation and cognitive recovery.

Primary Angiitis of the Central Nervous System

Birnbaum and Hellmann Article review their experience with primary angiitis of the central nervous system (PACNS). The clinical features, complex and difficult differential diagnosis, and current therapies are reviewed. However, most patients thought to have PACNS have a different disorder. Most interpretations of angiograms as being highly suggestive of PACNS will be owing to vasospasm. This and other compelling issues of diagnosis are amplified and defined.

Antithrombotic Drugs and Cerebral Microbleeds

Vernooij et al Article report that the use of platelet aggregation–inhibiting drugs is related to the presence of cerebral microbleeds. Further, their data support the position that aspirin and carbasalate calcium may relate to the presence of strictly lobar microbleeds. Editorial perspective is provided by Philip B. Gorelick, MD, MPH.Article

Electroencephalographic Monitoring and Prescribing of Antiepileptic Medications

Kilbride and colleagues Article find that continuous electroencephalographic (cEEG) monitoring results in a change in antiepileptic drug (AED) prescribing during or after cEEG in a significant percentage of cases. Most AED changes were made owing to the detection of electrographic seizures.

Automatisms in Absence Seizures in Children

Sadleir et al Article indicate that automatisms are frequent during childhood absence seizures. The characteristic pattern of automatisms suggests a reactive phenomenon to internal and external stimuli.

Percentage of seizures with automatisms in each state.

Percentage of seizures with automatisms in each state.

Ganglionic Acetylcholine Receptor Autoantibody

McKeon et al Article describe the clinical utility of the nicotinic ganglionic acetylcholine receptor autoantibody as a marker of neurological autoimmunity and cancer.

Differentiation of Multiple System Atrophy From Parkinson Disease With and Without Autonomic Failure

Lipp and colleagues Article report in a comprehensive study that the severity, distribution, and pattern of autonomic deficits at entry will distinguish multiple system atrophy (MSA) from Parkinson disease (PD) and MSA from PD with autonomic failure.

Natural Course of Lower Motor Neuron Syndromes

Van den Berg-Vos and colleagues Article note that patients who have lower motor neuron syndromes with a disease duration of at least 4 years usually have a favorable prognosis if muscle involvement has a segmental distribution. A generalized phenotype progression is relentlessly progressive, with a rapid degree of impairment.

Defining Survival as an Outcome Measure in Amyotrophic Lateral Sclerosis

Gordon et al Article emphasize that tracheostomy and permanent assisted ventilation are not equivalent to death in amyotrophic lateral sclerosis. The use of respiratory interventions differs between centers, leading to variability in combined outcome assessments.

Effect of Changes in Fat Use on Exercise Capacity in McArdle Disease

Andersen et al Article find that lipids are an important source of fuel for exercising muscle in McArdle disease but that maximal rates of fat oxidation are limited and cannot be increased above the physiological normal rates during exercise.

Biracial Study of Mild Cognitive Impairment and Alzheimer Disease

Wilson and colleagues Article report that the presence and severity of mild cognitive impairment and Alzheimer disease are associated with reduced survival in African American individuals, and these effects are comparable with those in white persons.

Stability of the Clinical Dementia Rating: 1979-2007

Williams and colleagues Article note that despite changes in participant characteristics, the Clinical Dementia Rating demonstrated general stability for assessment of dementia over almost 3 decades.