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Duke Neurology Research Round Up, December 2019

Monday, December 2, 2019
By William Alexander
Neuron image courtesy NIH

Six new studies from members of the Duke Department of Neurology advanced the field of clinical and translational neuroscience this November. Wuwei “Wayne” Feng, MD, MS, discussed the potential for brain stimulation technologies for stroke and brain injury, while Kathleen Welsh-Bohmer, PhD, and colleagues wrote an article finding that a healthy diet and regular exercise may improve neurocognition even after these behaviors are stopped. Other studies include a discussion of lessons learned from the innovative TOMMORROW study, a protocol for objectively examining the potential for cannabis for ALS, and an evaluation of a new therapy to help patients dealing with heart failure and central sleep apnea. Read more about these studies, and find links to the original articles, below.

Stroke

  • Brain stimulation technologies have shown potential as a novel treatment approach for stroke or brain injury, that promise has failed so far in clinical trials. Wuwei “Wayne” Feng, MD, MS, was the senior author of a study that discuss an innovative version of this technique that uses electrode-carrying stents implanted within the central venous system. They also discuss the barriers, challenges, and opportunities for this approach in the future. Read that article in Brain Stimulation.

Memory Disorders

  • The TOMMORROW study was an innovative, phase-3 double-blind, clinical study that examined a genetic biomarker risk algorithm for Alzheimer’s disease and the efficacy and safety of low-dose pioglitazone to delay progression of the condition. A team including Kathleen Wesh-Bohmer, PhD, Brenda Plassman, PhD, and Michael Lutz, PhD, discuss the design of the TOMMORROW study and how it addressed many key challenges in designing a clinical trial for Alzheimer’s disease. Read that article in Alzheimer's & Dementia: Translational Research & Clinical Interventions.
  • A healthy diet and regular physical activity show great promise in improving neurocognition over the lifespan, but the extent of these effects need to be more fully documented, especially over the long term. Kathleen Welsh-Bohmer, PhD, and James Burke, MD, PhD, were part of a team that examined the impact of regular exercise and a low-sodium diet one year after these behaviors were discontinued in a group of 160 older adults at risk for heart disease. The team found strong results for the exercise groups and significant, though lesser, results for the low-sodium group at one year of follow up. Read that article in the Journal of the American Geriatric Society.

Neuromuscular Disease

  • Patients living with a diagnosis of amyotrophic lateral sclerosis (ALS) often turn to  complementary medicine, including the use of medicinal cannabis to slow the progression or ease the symptoms for this disease. While this treatment shows anecdotal potential, these claims need to be evaluated with a skeptical eye. A team including Rick Bedlack, MD, PhD, present a new study protocol for a randomised, double-blind, placebo-controlled study evaluating the effects of this treatment on ALS. Read what they wrote in BMJ Open. 

Translational Research

  • A team including Daniel Laskowitz, MD, MHS, invested a potential use of a 3D tetraculture brain microphysiological system (BMPS) for neurotoxic chemical agent screening. Their study in PLoS One shows the  potential utility of a membrane-free tetraculture BMPS that can recapitulate brain complexity as a cost-effective alternative to animal models. Read it here.

Sleep Medicine

  • A procedure known as transvenous phrenic nerve stimulation (PNS) shows promise in reducing symptoms and in improving quality of life for patients with central sleep apnea (CSA), however, further evidence is needed, especially for individuals who are also living with heart failure. A team including Andrew Spector, MD, analyzed data from a group of 208 patients with and without heart failure, finding strong evidence that transvenous improves CSA severity, sleep quality, ventricular function and quality of life for patients with and without heart failure. Read that study in the Journal of Clinical Sleep Medicine.
  • Andrew Spector, MD, also wrote two letters in the “Disputes and Debates” section of the latest issue of Neurology. In this first letter he discusses the similarity of patient-reported outcomes among cerebrovascular event types. Read that letter here. In his second letter Spector discussed the need for medical students to have better education about sleep--as well as changes to their curriculum to actually get that sleep. Read that letter here.