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Duke Neurology Research Round Up, January 2018

Thursday, February 1, 2018

During the first month of 2018, Duke Neurology faculty and housestaff authored eight new peer-reviewed journals, helping to advance our understanding of neurology from basic science, translational, and clinical perspectives. Here’s a summary of those studies, from new biomarkers that can predict the progression from mild clinical impairment to Alzheimer’s disease to a discussion of the challenges of clinically evaluating therapies for myasthenia gravis.

 

Neurodegeneration and neurotherapeutics

  • Repetitions of the CAG triplet within coding exons are responsible for Huntington’s disease as well as a variety of neurodegenerative disorders. In the latest issue of the Handbook of Clinical Neurology, Al La Spada, MD, PhD, and Colleen Stoyas, PhD, review the clinical and molecular genetic features of each of these disorders, and then discuss the origins and emerging therapies for this condition. Read the full article here.

Neuromuscular Disease

  • Evaluating treatments for myasthenia gravis through clinical trials poses many challenges, from the relative rarity and heterogeneity of the disease to the extended latency period many drugs have before they take effect. In a new article in the Annals of the New York Academy of Sciences, lead author Jeffrey Guptill, MD, MHS, Donald Sanders, MD, Shruti Raja, MD, and Pushpa Narayanaswami, MD (Harvard), discuss these challenge as well as how they can be partially overcome through the use of observational trials and other techniques. Read the full article here.
  • In the same issue of Annals, Sanders and Narayanaswami also contributed to an article about the recent international consensus statement on treatment for myasthenia gravis. Their review article discusses the statement as well as the current evidence for treatment of myasthenia gravis and how the guidance statement will evolve in the future. Read their article here. 

Memory disorders

  • The progression from mild cognitive impairment to Alzheimer’s disease (AD) can be more accurately predicted in patients by incorporating longitudinal profiles of multiple clinical and neuroimaging markers in addition to the baseline information, according to a new Alzheimer’s and Dementia article co-authored by Richard O'Brien, MD, PhD, and Michael Lutz, PhD. Read more about that research here.
  • O’Brien also contributed to a targeted study that looked for blood and brain metabolite signatures of the pathology and progression of Alzheimer’s disease. They found biomarkers that may be useful for detecting Alzheimer’s disease before the development of symptoms. Read their study in PLOS here.
  • Laurie Sanders, PhD, co-authored a study that found  a novel RNA-dependent repair mechanism of double-strand breaks in post-mitotic neurons. The study also found evidence that defects in this pathway may contribute to neuronal genomic instability and consequent neurodegenerative phenotypes such as those seen in Alzheimer's disease. Read the full article in the Journal of Biological Chemistry here.

Epilepsy and Sleep

  • Despite evidence for prompt treatment and shorter status epilepticus duration in pediatric patients, there has not been strong evidence that prompt treatment actually saves lives. Fellow Dmitry Tchapyjnikov, MD, contributed to a JAMA Neurology study that found evidence for prompt treatment reducing the likelihood of death as well as other secondary associations such as the need for continuous infusions. Read that study here.

Stroke

  • Non-vitamin K antagonist oral anticoagulants (NOACs) appear to be a safer choice than warfarin for intracerebral hemorrhage (ICH) patients on oral anticoagulants, according to a new study in JAMA co-authored by Ying Xian, MD, PhD, and colleagues at the Duke Clinical Research Institute (DCRI). Read more about that here.
  • The best form of surgical intervention for spontaneous intracerebral hemorrhage remains controversial, despite this being the most lethal and the second most common type of stroke. In the most recent issue of Frontiers in Neurology, Michael “Luke” James, MD, and former Duke Neurology fellow Marc-Alain Babi, MD, discuss the benefits and risks of various surgical interventions based on the latest medical evidence. Read what they have to say here.