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Duke Neurology Research Round-Up, November-December 2017

Friday, December 29, 2017

Over the past two months, sixteen new peer-reviewed articles from the Duke Department of Neurology advanced the fields of laboratory neuroscience, clinical neurology care, and medical education. In basic science, the laboratory of Wolfgang Liedtke, MD, PhD, reviewed the role of role of TRP ion channels in the role of pain and itch sensation. Clinical research evaluated therapies for brain tumors, compared the effects of different anesthesias, and found evidence supporting early weaning for some epilepsy medications. And on the educational side, new research evaluated the current state of neurocritical care fellowships and discussed strategies for improving email communication in the medical academic setting.

Epilepsy and Sleep

  • Multiple antiepileptic drugs are often needed to treat nonconvulsive seizures and nonconvulsive status epilepticus, but these drugs can also put patients at risk for harmful side effects. Lead authors Christa Swisher, MD, former Duke resident Jennifer Creed, MD, PhD, and colleagues compared patients who were weaned from these medications early compared to patients who were not, finding that the weaned group were not at risk for recurrent seizures. Read their full story in the latest issue of Seizure here.

General and Community Neurology

  • Keynon Railey, MD, and colleagues discussed the consequences of flawed electronic communication and offer the SURE model (S - spelling and syntax; subject; U - urgency and unprofessional tone; R - recipients and review/reread; E - emotion and ethical situations) as a way to ensure effective communication. Read their article in the Journal of Physician Assistant Education here.
  • Recurrent glioblastoma is a swift and deadly condition, with less than half of patients surviving for six months even with treatment. Lead author Kathleen Peters, MD, PhD, Annick Desjardins, MD, and other Duke colleagues discuss a phase I/II clinical trial for a new form of combination therapy for this condition in the latest issue of the Journal of Neurooncology. Read that article here.

Neurodegeneration and Neurotherapeutics/Parkinson’s Disease and Movement Disorders

Headache and Pain

  • Lead author Carlene Moore, PhD, senior author Wolfgang Liedke, MD, PhD, Yong Chen, and colleagues wrote a review article discussing nociception, the body’s detection of harmful signals and pain perception, with a focus on experimental evidence for TRP ion channels as molecular sensors of stimuli evoking the pain and itch sensations. Read their article in Neuroscience Bulletin here.
  • Head and facial pain is some of the most intense pain that humans can feel. Wolfgang Liedtke, MD, PhD, and colleagues investigated whether different neural circuitry in facial versus body pain account for this discrepancy. Read their article in Nature Neuroscience here.

Memory Disorders

  • Using data from more than 1,000 elderly individuals who died and underwent brain autopsy, team of researchers including Michael Lutz, PhD, confirmed two distinct association signals between late-life cognitive decline and a locus within the TOMM40 gene. Read the full Alzheimer’s and Dementia article here.
  • Older adults often experience postoperative cognitive decline after surgery, yet the extent and specific underlying causes for these declines have remained unexplored. Kathleen Welsh-Bohmer, PhD, and colleagues had a group of cardiac surgery patients perform a working memory task, finding associations between declines and postoperative global cognitive outcomes but independent of perioperative cerebrovascular damage. Read the full study in Human Brain Mapping here.
  • Welsh-Bohmer also contributed to the revised version of the UDSNB, a neuropsychological battery used by the National Institute on Aging to measure cognitive performance in dementia and mild cognitive impairment due to Alzheimer’s disease. Read more about UDSNB 3.0 here.

Neuro-Ophthalmology

  • M. Tariq Bhatti, MD, and colleagues at the Department of Ophthalmology, examined whether the diameter of Bruch's membrane opening could distinguish mild papilledema from pseudopapilledema using optical coherence tomography. Read their article here.
  • Bhatti also co-wrote a response about a recent Journal of Neuro-Ophthalmology article about temporary lumbar drain as treatment for pediatric fulminant idiopathic intracranial hypertension, which is available here.
  • Finally, Bhatti and clinical neurophysiology fellow Dmitry Tchapyjnikov, MD, wrote a case report about a four-year-old with a mild case of episodic ataxia without baseline deficits, along with a literature review of the condition. Read their report in Neurologist here.

Neurocritical Care

  • M. “Luke” James, MD, and colleagues from the Neurocritical Care Society conducted a survey of directors of fellowship programs in neurocritical care. Their analysis of more than half the UCNS-recognized training programs in this area revealed opportunities for harmonizing training standards and for moving to ACGME/ABMS certification. Read the full article in Frontiers in Neurology here.
  • In addition to their direct effects on neurotransmission, anesthetics also have immunomodulatory effects, with some inhibiting and others increasing neuroinflammation in mouse and in vitro studies. M. “Luke” James, MD, and Daniel Laskowitz, MD, MHS, compared the effects of propofol and isoflurane in a group of human patients. Read what they found in the latest issue of Frontiers in Immunology.

Neuromuscular Disorders

  • Fellows (and former residents) Damien Earl, MD, PhD, and Aaron Loochtan, DO, as well as Rick Bedlack, MD, PhD, discussed a case history of an elderly man whose myasthenia gravis came out of remission after he received treatment for metastatic melanoma. Read their case in Muscle and Nerve here.
  • 3,4-diaminopyridine has been used to treat Lambert Eaton myasthenia for 30 years, despite reliable evidence of its efficacy. Lead author Don Sanders, MD, Vern Juel, MD, and colleagues provide this evidence in the latest issue of Muscle and Nerve, with a randomized, double-blind placebo controlled study of LEM patients. Read what they found here.

Image courtesy NIH.