This Month in Archives of Neurology

Bronstein and colleaguesArticle provide recommendations to patients, physicians, and other health care providers involving deep brain stimulation (DBS) for Parkinson disease (PD). An international consortium of experts organized, reviewed the literature, and attended the workshop. A draft of a consensus statement was presented and further edited after plenary debate. The final statements were agreed on by all members: (1) Patients with PD without significant active cognitive or psychiatric problems who suffer from medically intractable motor fluctuations, intractable tremor, or intolerance of medication adverse effects are good candidates for DBS. (2) Deep brain stimulation surgery is best performed by an experienced neurosurgeon with expertise in stereotactic neurosurgery who is working as part of a interprofessional team. (3) Surgical complication rates are extremely variable, with infection being the most commonly reported complication of DBS. (4) Deep brain stimulation programming is best accomplished by a highly trained clinician and can take 3 to 6 months to obtain optimal results. (5) Deep brain stimulation improves levodopa-responsive symptoms, dyskinesia, and tremor; benefits seem to be long-lasting in many motor domains. (6) Subthalamic nuclei DBS may be complicated by increased depression, apathy, impulsivity, worsened verbal fluency, and executive dysfunction in a subset of patients. (7) Both globus pallidus pars interna and subthalamic nuclei DBS have been shown to be effective in addressing the motor symptoms of PD. (8) Ablative therapy is still an effective alternative and should be considered in a select group of appropriate patients.

Miravalle and colleaguesArticle assess clinical consequences of temporary natalizumab dosage suspension. In this cohort of patients with multiple sclerosis who were refractive to multiple therapeutics before starting natalizumab treatment, magnetic resonance imaging and clinical disease activity returned, often aggressively, following discontinuation of natalizumab therapy. These findings suggest we should consider strategies to minimize the risk of immune reconstitution inflammatory syndrome after natalizumab discontinuation.

Bangalore et alArticle evaluate the periprocedural and intermediate to long-term benefits and harms of carotid artery stenting compared with carotid endarterectomy. In this largest and most comprehensive meta-analysis to date using outcomes that are standard in contemporary studies, carotid artery stenting was associated with an increased risk of both periprocedural and intermediate to long-term outcomes, but with a reduction in periprocedural myocardial infarction and cranial nerve injury. Strategies are urgently needed to identify patients who are best served by carotid artery stenting vs carotid endarterectomy. Editorial perspective is provided by Louis R. Caplan, MD, and Thomas G. Brott, MD. (page 157)

Chao and colleaguesArticle investigate the skin innervation and its clinical significance in late-stage chronic kidney disease. They report that small-fiber sensory and autonomic neuropathies constitute the major form of neuropathy in late-stage chronic kidney disease. Furthermore, skin denervation was associated with the duration of renal disease.

Klein et alArticle determine the specific type of amyloid from nerve biopsies using laser microdissection (LMD) and mass spectrometry (MS)–based proteomic analysis. Proteomic analysis of nerve tissue using LMD/MS distinguishes specific types of amyloid independent of clinical information. This new proteomic approach will enhance both diagnostic and research efforts in amyloidosis and other neurologic diseases.

Wang et alArticle prospectively examine the relation between smoking and amyotrophic lateral sclerosis in 5 well-established large cohorts. They find that cigarette smoking increases the risk of amyotrophic lateral sclerosis. The potential importance of age at smoking initiation and the lack of a dose response deserve further investigation.

Lin et alArticle determine whether hearing loss is associated with incident all-cause dementia and Alzheimer disease. They report that hearing loss is independently associated with incident all-cause dementia. Whether hearing loss is a marker for early-stage dementia or is actually a modifiable risk factor for dementia deserves further study.

Moreno-López and colleaguesArticle survey the occurrence of excessive daytime sleepiness (EDS) in consecutive patients with multiple system atrophy and compare these patients with patients with Parkinson disease and individuals without known neurologic disease. More than one-quarter of patients with multiple system atrophy experience EDS, a frequency similar to that encountered in Parkinson disease. In these 2 conditions, EDS seems to be associated with different causes.

Sojkova et alArticle compare β-amyloid (Aβ) quantified using in vivo carbon 11–labeled Pittsburgh Compound B ([¹¹C]PiB) positron emission tomography and postmortem neuropathologic assessment of Aβ in older adults. They find that, in older adults, variable agreement between in vivo amyloid imaging and Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuritic plaque score was observed. The limited agreement may, in part, reflect differences in typical measurements of Aβ using imaging compared with the CERAD neuropathologic protocol. Direct quantification of regional Aβ in relation to in vivo imaging is necessary to further enhance our understanding of the imaging–pathologic assessment correlation.