Duke Neurology Research Round Up, July 2019
July 2019 saw new peer-reviewed journal articles from members of the Duke Neurology Department published on a nearly daily basis. Ornit Chiba-Falek, PhD, and Michael Lutz, PhD, were the lead authors of an Alzheimer’s and Dementia story that advances our understanding of late-onset Alzheimer's disease and genetics in general. Meanwhile at the clinical end, Matthew Luedke, MD, and colleagues wrote an important systematic review for self-management strategies for epilepsy. And Ying Xian, MD, PhD, contributed to studies published in JAMA, Neurology, and the Journal of the American Heart Association, which examined stroke at the population level. Read about these and the 13 other studies published this month below.
- Dysregulation of alpha-synuclein expression has been linked to Parkinson's disease, dementia with Lewy bodies, and other synucleinopathies. In a new article for Frontiers in Genetics, senior author Ornit Chiba Falek, PhD, Julio Barrera, and colleagues demonstrate that long gDNA and cDNA reads have the potential to reveal long-range information about this expression not previously accessible using traditional sequencing methods. This approach provides new insights into the genetic etiologies of complex human diseases. Read that article here.
- Genome-wide association studies have discovered multiple single nucleotide polymorphisms (SNPS) associated with late-onset Alzheimer's disease (LOAD); however, the actual causal genes have not yet been identified. Lead authors Ornit Chiba-Falek, PhD, and Michael Lutz, PhD, and the Center for Genomic and Computational Biology’s Daniel Sprague, PhD, used a new computational strategy to identify causal genes for LOAD and to guide further laboratory experiments. Read their Alzheimer’s and Dementia story here.
- James Burke, MD, PhD, Kathleen Welsh-Bohmer, PhD, Brenda Plassman, PhD, and colleagues used magnetic resonance imaging to examine the effects of a low dose of pioglitazone on hippocampal function. They found significant increases in right hippocampal activation for the medication compared to placebo at 7 and 14 days. Read about that study in Alzheimer’s & Dementia: Translational Research & Clinical Interventions here.
- The National Academy of Sciences-National Research Council’s twin registry is one of the oldest, population-based twin registries in the United States and includes nearly 16,000 white mail twin pairs born between 1917 and 1927. Brenda Plassman, PhD, contributed to the first major update to the registry in more than a decade. Read that article in Twin Research and Human Genetics.
Epilepsy, Sleep, and Clinical Neurophysiology
- Clinicians often recommend self-management to patients with epilepsy, but the best types and strategies for self-management are uncertain. First author Matthew Luedke, MD, Saurabh Sinha, MD, PhD, Tung Tran, MD, Aatif Husain, MD, and colleagues performed a systematic review of this area for Annals of Internal Medicine. Their review found evidence for improvement in some important patient outcomes but also shows the need for further research in this area as well as interventions more tailored to the needs of patients with epilepsy. Read that study here.
- Aatif Husain, MD, recently delivered the Ellen Grass Memorial Lecture, where he discussed the past, present and future of clinical neurophysiology techniques in diagnosing and properly treating neurological disease. The full text of that lecture is available in the latest issue of the Neurodiagnostic Journal. Read the text of that lecture here.
- Obstructive sleep apnea is typically diagnosed by distinguishing between obstructive apneas (blocked or no breathing) versus hypopneas (slow or shallow breathing). However, there is no established clinical benefit for distinguishing between the two. Andrew Spector, MD, was the first author of a retrospective study that examined 351 patients polysomnograms, finding no significant differences in comorbidities between the two. Read that study in Cureus here.
- Neuromuscular ultrasound has become an essential tool for diagnosing and evaluating neuromuscular disorders. A team of 18 global experts, including Lisa Hobson-Webb, MD, developed a set of consensus‐based guidelines for neuromuscular ultrasound training courses. Read these guidelines in Muscle & Nerve.
- Vern Juel, MD, wrote a chapter reviewing single fiber electromyography for the 162nd edition of the Handbook of Clinical Neurology. His chapter reviews this highly selective technique as well as its benefit for patients with myasthenia gravis, Lambert Eaton myasthenia, and other neuromuscular conditions. Read that chapter here.
- Urinary tract infections are a frequent complication of stroke, where they increase costs and patients’ length of stay. Our new Stroke and Vascular Neurology Division Chief Wuwei “Wayne” Feng, MD was the senior author of a study reviewing the literature about UTI in stroke patients. His study confirmed that UTIs are associated with increased length of stay and greater costs, but not with poorer long-term clinical outcomes. Read that study here.
- Direct oral anticoagulants (DOACs) improve outcomes for patients with acute ischemic stroke and atrial fibrillation compared to warfarin, according to a new JAMA Neurology story by first author Ying Xian, MD, PhD, Shreyansh Shah, MD, and colleagues at the DCRI. Their observational study of nearly 12,000 ischemic stroke patients with atrial fibrillation found that patients receiving DOACs had more days at home after discharge, were less likely to die or be readmitted, and had a lower risk of other complications. Read that full study here.
- Only 7% of patients hospitalized with acute ischemic stroke currently receive recommended treatment with tPA. Ying Xian, MD, PhD, and Shreyansh Shah, MD, contributed to a new study in Neurology that examined two potential risk factors associated with reduced access: lower socioeconomic status (SES) and a longer driving distance to the hospital. Their analysis of data from nearly 120,000 stroke patients found that driving time, but not SES, was associated with lower odds of tPA and longer time until administration. Read that article in Neurology here.
- Xian also contributed to a recent JAMA article that examined the association of speed of treatment with outcome in patients with acute ischemic stroke among patients with acute ischemic stroke who were undergoing endovascular-reperfusion therapy. The team’s analysis of nearly 7,000 patients found faster treatment times were associated with a lower in-hospital mortality and hospice discharge, a higher likelihood of being discharged to home, and other outcomes, with improved outcomes associated with each 15-minute increment of faster treatment. Read that study here.
- A new study in the Journal of the American Heart Association evaluates the safety of recombinant tissue‐type plasminogen activator (rtPA) in ischemic stroke patients with recent myocardial infarction. Senior author Ying Xian, MD, PhD, and colleagues from the Duke Clinical Research Institute examined data from more than 40,000 patients, finding an increased risk for myocardial infarction for older patients treated with rtPA as well as showing the need for further research to determine whether the benefit of rtPA outweighs its risk for this patient group. Read the study here.
- An evaluation of the PILLAR (Extracorporeal Filtration of Subarachnoid Hemorrhage via Spinal Catheter) study shows the innovative therapy appears to be safe for patients with aneurysmal subarachnoid hemorrhage. Authors tested a novel filtration system which rapidly remove blood and blood breakdown products from cerebrospinal fluid after securement of a ruptured aneurysm. Co-author Christa Swisher, MD, contributed to the study, which appears in the latest issue of Stroke.
- Another Stroke study investigated with the effect of blood pressure on clinical outcomes on patients with successful mechanical thrombectomy. Residents Ovais Inamullah, MD, and Shareena Rahman, MD, contributed to this multicenter study which included 1245 patients from 10 comprehensive stroke centers. They found that higher blood pressure within the first 24 hours after successful mechanical thrombectomy was associated with a higher likelihood of sICH, mortality, and requiring hemicraniectomy. Read that study here.
- Michael “Luke” James, MD, contributed to a study examining a “paradox of age” associated with anesthesia: older patients typically receive higher minimum alveolar concentration fractions of volatile anaesthetics, but they also display higher bispectral index values. Their study examined the relationship between end-tidal MAC fraction, BIS values, and age in almost 4,700 patients in a single health center. Read what they found here.
Parkinson’s Disease and Movement Disorders
- Early and accurate identification and management of veterans at risk for Parkinson disease is an important priority area for the US Department of Veterans Affairs. Snhea Mantri, MD, MS, was the first author of a study that reviewed the importance of early identification, risk factors associated with military service, methods for early identification, and other topics. Read that study here.