Neurolist Journal Watch

Neurology March 17, 2009

 

 

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Restless Leg Syndrom

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Case control study involving 245 patients with peripheral neuropathy and 245 control patients were evaluated for restless leg syndrome in order to evaluate whether patient with peripheral neuropathy is more likely to have RLS compared to patients without peripheral neuropathy. Study concludes that patients with hereditary neuropathy is more likely to have RLS than patients with acquired neuropathy.

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Pediatric MS

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Retrospective analysis of MRI scans in children with MS and those with nondemyelinating disease with relapsing neurologic deficits were evaluated for potential imaging criteria for diagnosing pediatric MS. The study shows that the presence of the two of the following criteria helps distinguish MS from other nondemyelinating disease with 85% sensitivity and 98% specificity:

  1. Five or more lesions

  2. Two or more periventricular lesions

  3. Brainstem lesions

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Retrospective MRI analysis of the first attacks from 28 children diagnosed with MS and 20 children with ADEM were performed to evaluate for MRI characterisitcs of children with MS vs ADEM. The study results show that the presence of the following two of the following criteria are helpful in distinguish MS from ADEM with 81% sensitivity and 95% specificity:

  1. Absence of diffused, bilateral lesion pattern

  2. Presence of black holes

  3. Presence of two or more periventricular lesions

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Seizures and Epilepsy

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Case control association analysis of 90 adult epilepsy patients with history of febrile seizure, 486 epilepsy patients without history of febrile seizures, and 701 controls in an attempt to evaluate whether or not common polymorphism in sodium channel gene SCN1A played a role in altering the risk for febrile seizure. The result showed significant association of the splice site interrupting allele with febrile seizures. The authors concluded thatthe A allele of the SCN1A gene single nucleotide polymorphism is a common and relevant risk factor for febrile seizures.

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Intracerebral depth EEG of of 42 patients with intractable focal epilepsy was sampled for analysis. Analysis revealed that high frequency oscillations (HFO) do not increase after seizures, but does increase after medication reduction. The study concludes that the high frequency oscillations (HFO) and spikes have different pathophysiology and that HFO plays a role in seizure genesis and might serve as a clinical marker.

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Survey study was used to evaluate the response of neurology practitioners to the FDA warning of suicide and anti-epileptic medications. The study found that while neurology practitioners routinely counsel patients on behavior changes as a possible side effects from the anti-epileptic medication, suicide was not specifically mentioned.

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Multiple Sclerosis

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Review article with brief discussion of the recent trials of the MS therapeutics.

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Cognitive Disorders

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Longitudinal cohort study of 15 patients with HIV associated dementia (HAD) and 15 HIV positive controls was used to evaluate whether virological or immunological factors after initial initiation of HAART has any influence on the congition. The study found that monocyte HIV DNA level correlates with cognitive performance before HAART and 48 weeks after HAART. The authors suggested that monocyte HIV DNA level might have played a role in the change of cognitive status after HAART initiation.

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Two MRI scans were performed on 64 patients with Alzheimer's disease, 44 patients with mild cognitive impairment, and 34 controls in order to evaluate for the association between hippocampal size and atrophy rate and cognitive decline. The results showed that hippocampal measurements, especially the rate of atrophy, helps distinguish patients with mild cognitive impairment from the control group. Meanwhile, whole brain atrophy rate distinguishes those with Alzheimer's disease from the ones with mild cognitive impairment. Meanwhile, hippocampal volume at baseline and atrophy rate in patients with mild cognitive decline serves as predictor for disease progression. 

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Peripheral Neuropathy

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Serum VEGF level was obtained in 161 patients with neuropathy and other related symptoms. Of the 161 patients, 6 were diagnosed as having POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, M-protein, and Skin changes). Serum VEGF level was elevated in all 6 patients with POEMS compared to patients with neuropathy due to etiology other than POEMS. The author also found that the postive predictive values for POEMS with VEGF level > 3,489 is 100%. If patients with POEMS were excluded, the positive predictive values for immune mediated neuropathy was 86%. The study concluded that markedly elevated VEGF level is associated with POEMS. Further more, the author believes that even mild elevation of VEGF level is consistently find in patients with POEMS. Finally, patients with immune mediated neuropathy were also found to have moderately increased VEGF levels. The author suggests that the physiology role of VEGF might offer insight into the pathogenesis of various neuropathic disorders. 

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Case Report: Two case reports of young adults with stroke, progressive neurological deficits, and meningeal involvement were later diagnosed with neurosarcoidosis. The article states that while the evidence does not currently indicate an increase in stroke in patients with sarcoidosis, it is possible that the amount of strokes contributable to sarcoidosis is being underestimated. As a result, the possibility of sarcoidosis should be entertained in young patients with stroke, progressive neurological decline, and meningeal involvement.

 

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Case Report: 28 year old woman with mild RRMS treated with Fingolimod through a phase III clinical trial presents with headache, nausea, and vomiting that has since progressed right sided hemianopia and severe aphasia. Patient was later diagnosed with hemorrhaging focal encephalitis. The authors suggested that while the cause of the hemorrhaging focal encephalitis is unclear, it is possible that Fingolimod might have played a role in the pathogenesis. Alternatively, infectious and/or autoimmune processes might also played a role in the development of hemorrhagic focal encephalitis in the patient. 

 

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Neuroimaging: Midbrain "panda" sign and Wilson's disease.

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Video Neuroimages: Postinfectious Ocular Flutter