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Duke Neurology Research Round Up, March 2019

Tuesday, April 2, 2019

This March saw the publication of 13 journal articles and one book chapter authored by members of the Duke Department of Neurology. This research included analyses of the decades-long effects of school segregation as well as how stroke outcomes differ for Asian Americans compared to other populations. Other studies include the development of an early blood-based test for multiple sclerosis as well as a therapy that improves working memory in younger and older adults.

The following paragraphs offer summaries of these and other articles along with links to the original articles.

Parkinson’s Disease and Movement Disorders

  • Sneha Mantri, MD, was the lead author of a descriptive study that examined state-level variations associated with Parkinson’s disease, including disease prevalence, patient characteristics, Medicare spending, out-of-pocket costs, and health-service use. This study provides data and directions for decision making to improve health-care spending as well as outcomes for patients with Parkinson's. Read that full study here.

Neurocritical Care

  • Clopidogrel is a popular antiplatelet medication for patients with stents and histories of arterial vascular disease. Senior author Keith Dombrowski, MD, former neurocritical care fellow Thomas Christianson, and medical student Stephanie Roses wrote a case report detailing a young immunocompromised patient’s adverse reaction to this medication, which resulted in acute respiratory distress. Read their report here.

Multiple Sclerosis and Neuroimmunology

  • Individuals with multiple sclerosis (MS) typically don’t receive a diagnosis until symptoms and central nervous system lesions have already appeared. Finding a test that could identify the disease earlier could help therapies for this disease make a difference. A study by senior author Simon Gregory, PhD, offers progress on this front. His team developed a metabolite-based test that identified MS in a group of male patients. Read his study in Multiple Sclerosis and Related Disorders here.

Neuromuscular disorders

  • Repetitive nerve stimulation testing is an essential, but technically demanding technique for evaluating patients with potential neuromuscular junction disease. Vern Juen, MD, wrote an editorial for Muscle and Nerve that reviews the advantages and disadvantages of this technique as well as its role in evaluating myasthenia gravis. Read that essay here.

Stroke

  • Roughly one in three stroke-related deaths occur in China, and the number of strokes will only increase as the population ages. Ying Xian, MD, PhD, was part of a team that analyzed China’s response to this burden for the British Medical Journal. Read about the healthcare reforms China has taken in health systems, prevention, education, and other areas here.
  • Xian also contributed to a new JAMA Neurology study that examined ischemic stroke care and clinical outcomes for Asian Americans, and compare those populations to white American patients. Their retrospective study examined patterns in more than 64,000 Asian American and 1,700,000 white American patients, finding that Asian American patient had more severe strokes than white patients, had worse outcomes, and were less likely to receive tPA. Read the full results of that study here.
  • Finally, Xian was part of a team that analyzed how stroke patients in the Medicare Shared Savings Program (MSSP) used palliative care. They found that MSSP was associated with increased hospice enrollment for ischemic stroke patients with severe stroke or indicators of high mortality. Read their full study in the Journal of the American Geriatrics Society here.
  • Hydrocephalus is already known as of the most common and dangerous complications of aneurysmal subarachnoid hemorrhage (aSAH). New research by a team including Christa Swisher, MD, reveals that it also incurs a significant health-care burden. The team analyzed more than 2,000 patients with aSAH, finding that those with hydrocephalus stayed, on average, an extra week in the hospital, and incurred an extra $55,000 in health-care costs. Read that study here.

Neurodegeneration and Neurotherapeutics

  • Al La Spada, MD, PhD, and colleagues identified pathways and genes associated with the neurodegeneration associated with spinal and bulbar muscular atrophy, or Kennedy’s disease. Their research suggests the Chmp7 gene may cause the development o  the disease by disrupting the endosome-lysosome system, and sheds additional light on how this disease develops. Read that article here.

Bioengineering

  • Tatiana Segura, PhD, was the senior author of a chapter of a new textbook, Nanotechnology for Nucleic Acid Delivery.  Her chapter focuses on gene-delivery options incorporating material surfaces or hydrogel scaffolds, including advantages, disadvantages, and protocols. Read more about the book and Segura’s chapter here.

Epilepsy

  • Temporal lobe epilepsy (TLE) is a frequent, devastating form of epilepsy. James McNamara, MD, was the senior author of a Journal of Neuroscience article that examined TrkB, a signaling pathway that can lead prolonged seizures to lead to TLE. The results of their study offer guidance for future therapies that can offer neuroprotective benefits to reduce the harm done by TLE. Read their results here.

Memory Disorders

  • Magnetic stimulation of the brain improves working memory, offering a new potential avenue of therapy for individuals living with Alzheimer’s disease and other forms of dementia, according to a new study by Simon Davis, PhD, and colleagues. Healthy younger and older adult participants who received a therapy called repetitive transcranial magnetic stimulation (rTMS) performed better on a memory task than during an rTMS-like placebo in the study, which was published here in PLoS One.
  • An international team of dozens of researchers, including James Burke, MD, PhD and Kathleen Welsh-Bohmer, PhD, all contributed to a meta-analysis of that identify loci on genes that increase the risk for late-onset Alzheimer’s disease. This large-scale study confirmed 20 previously identified loci and found five new loci that increase risk. The team also identified important genetic correlations between LOAD and traits including education and family history of dementia. Read the study in its entirety in Nature Genetics.