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This Month in Archives of Neurology |

This Month in Archives of Neurology FREE

Arch Neurol. 2011;68(11):1371-1372. doi:10.1001/archneurol.2011.1499.
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CHRONIC CEREBROSPINAL VENOUS INSUFFICIENCY AND MULTIPLE SCLEROSIS

Chronic cerebrospinal venous insufficiency has recently been proposed to be etiologic to multiple sclerosis. Bagert et alArticle indicate that an independent investigation into this theory during the past 2 years has not succeeded in verifying this relationship. A critical analysis of the scientific methods used in the original studies of chronic cerebrospinal venous insufficiency in multiple sclerosis reveals several methodological problems with regard to potential bias and confounding. The current evidence calls into question whether chronic cerebrospinal venous insufficiency in multiple sclerosis exists at all.

CHOLESTEROL LEVEL AND STATIN USE IN ALZHEIMER DISEASE: II. REVIEW OF HUMAN TRIALS AND RECOMMENDATIONS

Shepardson and colleaguesArticle identify several confounding factors among the human studies, including differing blood-brain barrier permeabilities among statins, the stage in Alzheimer disease at which statins were administered, and the drugs' pleiotropic metabolic effects, all of which contribute to the substantial variability observed to date.

COPING WITH DEATH AND DYING ON A NEUROLOGY INPATIENT SERVICE: DEATH ROUNDS AS AN EDUCATIONAL INITIATIVE FOR RESIDENTS

Khot et alArticle developed Death Rounds to provide emotional support and end-of-life care teaching for residents caring for dying patients on the inpatient neurology service. Death Rounds are monthly 1-hour clinical case discussions where residents identify issues through shared experiences. Death Rounds afford an opportunity for physicians-in-training to process as a group their feelings, intense emotions, and insecurities while learning from the dying process. Most residents found it a rewarding and valuable experience.

ASSOCIATION BETWEEN IN VIVO FLUORINE 18–LABELED FLUTEMETAMOL AMYLOID POSITRON EMISSION TOMOGRAPHY IMAGING AND IN VIVO CEREBRAL CORTICAL HISTOPATHOLOGY

Wolk and colleaguesArticle demonstrate the concordance of fluorine 18–labeled flutemetamol amyloid positron emission tomography imaging with histopathology, supporting its sensitivity to detect amyloid and potential use in the study and detection of Alzheimer disease. Editorial perspective is provided by William Jagust, MDArticle.

USING POSITRON EMISSION TOMOGRAPHY AND FLORBETAPIR F 18 TO IMAGE CORTICAL AMYLOID IN PATIENTS WITH MILD COGNITIVE IMPAIRMENT OR DEMENTIA DUE TO ALZHEIMER DISEASE

The findings of the analysis by Fleisher and colleaguesArticle confirm the ability of florbetapir F 18 positron emission tomographic standard uptake value ratios to characterize amyloid levels in clinically probable Alzheimer disease, mild cognitive impairment, and older healthy control groups using continuous and binary measures of fibrillar Aβ burden. Editorial perspective is provided by William Jagust, MDArticle.

 Image not available.

Percentages of florbetapir positivity by diagnostic group. The percentages of positivity in all 3 diagnostic groups and in 2 subgroups of older healthy controls (APOE ε4 carriers [OHC E+] and noncarriers [OHC E4−]) are based on meeting criteria for florbetapir F 18 levels associated with intermediate or high likelihood neuropathological Alzheimer disease (AD) (hereafter referred to as PATHAMY levels, with a standard uptake value ratio [SUVR] of ≥1.17) or the presence of any identifiable cortical Aβ (hereafter referred to as any-amyloid levels, with SUVR > 1.08). The probable AD (PAD), mild cognitive impairment (MCI), and OHC diagnostic groups differed significantly in their percentage of positivity for both thresholds (P < 1.0 × 10−7) but not between the 2 OHC subgroups, likely owing to the small sample size. Only the full OHC group shows significant differences in their percentage of positivity based on threshold used (P = .03).

REPEATED TREATMENT WITH RITUXIMAB BASED ON THE ASSESSMENT OF PERIPHERAL CIRCULATING MEMORY B CELLS IN PATIENTS WITH RELAPSING NEUROMYELITIS OPTICA OVER 2 YEARS

Kim et alArticle show that repeated treatment with rituximab appeared to produce consistent and sustained efficacy over 24 months with good tolerability in patients with neuromyelitis optica.

INTERFERON BETA-1B FOR THE TREATMENT OF PRIMARY PROGRESSIVE MULTIPLE SCLEROSIS: FIVE-YEAR CLINICAL TRIAL FOLLOW-UP

Tur and colleaguesArticle find that modest but beneficial effects of interferon beta-1b on clinical variables and brain atrophy development were observed 5 years after trial termination.

NATALIZUMAB AND IMPEDANCE OF THE HOMING OF CD34+ HEMATOPOIETIC PROGENITORS

Saure et alArticle report that natalizumab mediates an increase in circulating CD34+ cells by interfering with homing to the bone marrow. Thus, CD34+ cells appear unlikely to represent a source mobilizing JC virus out of the bone marrow in patients treated with natalizumab.

BRAIN INVOLVEMENT IN NEUROMYELITIS OPTICA SPECTRUM DISORDERS

Chan and colleaguesArticle show that brain involvement manifesting clinically as brainstem encephalitis is common among Hong Kong Chinese patients with neuromyelitis optica spectrum disorders.

SQSTM1 MUTATIONS IN FAMILIAL AND SPORADIC AMYOTROPHIC LATERAL SCLEROSIS

Using candidate gene identification based on prior biological knowledge and the functional prediction of rare variants, Fecto et alArticle identified several novel SQSTM1 mutations in patients with amyotrophic lateral sclerosis. Their findings provide evidence of a direct genetic role for p62 in amyotrophic lateral sclerosis pathogenesis and suggest that regulation of protein degradation pathways may represent an important therapeutic target in motor neuron degeneration.

PREFRONTAL CORTEX AND EXECUTIVE FUNCTION IMPAIRMENTS IN PRIMARY BREAST CANCER

Kesler and colleaguesArticle provide further evidence of neurologic impairment associated with primary breast cancer irrespective of treatment history.

RELATIONSHIP BETWEEN CHRONIC ATRIAL FIBRILLATION AND WORSE OUTCOMES IN STROKE PATIENTS AFTER INTRAVENOUS THROMBOLYSIS

Seet et alArticle find that patients with chronic atrial fibrillation have worse stroke outcomes than do patients without atrial fibrillation, and the risk for worse outcomes was greater in patients with a longer duration of atrial fibrillation.

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