Duke Neurology Research Round Up, August 2020

Members of the Duke Neurology Department contributed to 14 new peer-reviewed articles published this July, improving our understanding of neuroscience, charting a course for research in a post-COVID-19 world, and offering opportunities for advancing patient care. Simon Gregory, PhD, and Yong Chen, PhD, respectively co-authored articles offering new therapeutic avenues for muscle repair and chronic pain treatment. Wuwei “Wayne” Feng, MD, MS, was part of a consortium examining the impact of COVID-19 on the NIH’s StrokeNet and offering a vision for resuming clinical trials. Suma Shah, MD, contributed to a discussion of the intersection on family planning and other areas of women’s health and multiple sclerosis. And Rick Bedlack, MD, PhD, and baseball author Dan Joseph examined Lou Gehrig's 1938 season to uncover what may be a nearly 100-year-old ALS reversal. Read the summaries below to learn more about these and other studies, and to find links to the original articles themselves.

Neuromuscular Disease

  • Eligible payment information has been made publicly available through the Centers for Medicare and Medicaid services for almost a decade, but data about industry payments to neuromuscular neurologists are lacking. Neuromuscular fellow Yohei Harada, MD, was the senior author of a study that used the CMS open payments program database to examine financial relationships between industry and neuromuscular neurologists, finding that total annual payments increased more than six-fold from 2014-2018, with most of that money going to the top 10% of physician beneficiaries. Read that article in Muscle and Nerve.
  • Karissa Gable, MD, was the senior author of a new Muscle and Nerve article that explored how fatigue and other symptoms relate to disease activity status in chronic inflammatory demyelinating polyneuropathy (CIDP). The team examined data from 85 patients who either had active CIPD or were in remission, finding that fatigue and poor sleep quality were common in both groups. The team also recommended minimizing sedating medications, improving sleep quality and managing depression to improve CIDP-associated fatigue. Read that article here. 
  • In August 1938, baseball great Lou Gehrig experienced a three-week resurgence in his performance after a steady decline. Rick Bedlack, MD, PhD and baseball author Dan Joseph analyze this resurgence in the latest issue of RRNMF Neuromuscular Journal. This three-week stretch, not studied closely by neurologists or baseball historians until now, suggests that the “Iron Horse” may have experienced a temporary ALS reversal. Read their full discussion here.  
  • Bedlack was also the senior author of a study that tested the hypothesis that immunoglobulin A (IgA) levels might help explain phenotypic variability seen in ALS clinical presentations. The team's examination of health records of patients with ALS, chronic autoimmune neurologic disease, and no neurologic conditions found no significant association was found between extremes of IgA serum concentrations and various clinical features of ALS. Read their full study here.

Clinical Neurophysiology, Epilepsy, and Sleep

  • A new Journal of Clinical Neurophysiology study examined if “quadripolar stimulation” (2 electrodes as anodes and 2 as cathodes when using transcranial electrical stimulation) produced higher motor-evoked potentials (MEP). Senior authors Aatif Husain, MD, and Stephanie Schwartz, as well as co-authors Emily Kale and Dennis Madden found that quadripolar stimulation induced higher areas under the curve for right-foot MEP. Read that article here.

Translational Brain Sciences

  • Simon Davis, PhD, contributed to a new Cerebral Cortex study that examined how the functional brain networks mediating episodic memory retrieval differed in younger and older adults. The team found three major findings: that older adults had prefrontal cortex (PFC) regions that were functionally integrated with the rest of the brain; second that older adults’ PFC regions showed stronger performance-related reconfiguration of connectivity patterns;, and third that older adults’ PFC reconfiguration increases tracked reconfiguration reductions in the medial temporal lobe (MTL), suggesting that PFC connectivity in OAs may be compensating for MTL deficits. Read the full story here.
  • Yong Chen, PhD, and colleagues at the Department of Neurobiology advanced our understanding of the underlying mechanisms of general anesthesia in the July issue of Nature Neuroscience. The team found that general anesthesia activates distinct population of GABAergic neurons in the mouse central amygdala. These neurons could be a potential powerful therapeutic target for alleviating chronic pain. Read that article here.
  • This May, Wolfgang Liedtke, MD, PhD was the senior author of a call to action to consider lung edema as a preventable outcome for COVID-19, with inhibition of the TRPV4 ion channel representing a promising, feasible approach for reducing deaths related to the condition.  The American Journal of Physiology-Lung Cellular and Molecular Physiology recently updated that article, which is available here.
  • The immune system plays a multifunctional role throughout the regenerative process, regulating both pro-/anti-inflammatory phases and progenitor cell function. In the latest issue of Nature Metabolism, a team including Simon Gregory, PhD, identifies the myokine/cytokine Meteorin-like (Metrnl) as a critical regulator of muscle regeneration and a potential therapeutic target to enhance tissue repair. Read that article here.


  • In 2013 the National Institutes of Health (NIH) StrokeNet formed to facilitate exploratory and confirmatory clinical trials of stroke prevention, treatment, and recovery, as well as validation studies of biomarkers or outcome measures. A team of national experts including Wuwei “Wayne” Feng, MD, MS contributed to a summary of the first seven years of the network, the recent impact of COVID-19, and a blueprint for reinstituting clinical trial enrollment following the pandemic. Read that article in Stroke here.
  • Clinicians treating patients with oral anticoagulation therapy (OAT)–associated intracerebral hemorrhage (OAT-ICH) must weigh the benefits of OAT resumption must against increased risk of recurrent hemorrhagic stroke. A team including neuromuscular medicine fellow Margaret Bettin, MD, attempted to identify ICH survivors in whom the risks of OAT resumption are highest. By combining MRI markers and APOE genotype, the team was stratify likelihood of ICH recurrence into high, medium, and low risk. Read that Stroke article here.
  • Clinical neurophysiology fellow Derek Neupert, MD, was the senior author of a case study in Neurohospitalist who presented to the emergency department with a large left hemispheric ischemic stroke due to an extensive aortic dissection. Read that article here.

Movement Disorders and Parkinson’s Disease

  • Parkinson’s disease has been hypothesized to be associated with conscientiousness, punctuality, and other personality traits, but this data largely comes from personality inventories rather than real-world observation. Incoming neurocritical care fellow Jeremy Bell, MD, was the first author of a study in the Journal of Parkinson’s Disease which tested this hypothesis by comparing no-show rates of neurology outpatients with and without Parkinson’s disease. Read what they found here. 

Multiple Sclerosis and Neuroimmunology

  • Multiple sclerosis and women’s health intersect in many ways. The proportion of women who have MS has risen in several areas, suggesting a possible environmental factor for this group. For women in their childbearing years, MS affects family planning, choice of disease modifying therapies, risk of sexual dysfunction, and decisions about breastfeeding. Suma Shah, MD, was part of a group of authors who reviewed the condition’s effects across the lifespan for women. Read that article here in Therapeutic Advances in Neurological Disorders.