The final month of 2023 saw members of the Duke Neurology Department contributing to nine new peer-reviewed journal articles. Highlights include an analysis of symptoms associated with internal tremor for Parkinson’s disease, a trio of population-level studies for stroke, and a new examination of the connections between white matter and executive function. Read short summaries of each of these articles and find links to the original research below.
Epilepsy, Clinical Neurophysiology, and Sleep
- A new article in Epilepsia co-authored by Shruti Agashe, MD, examines the natural history and patterns of antiseizure medication (ASM) use in newly diagnosed focal epilepsy patients who initially started on monotherapy. The team’s analysis of 443 epilepsy patients found that about one third of focal epilepsy patients remain on monotherapy with their first prescribed ASM. Approximately three in five patients transition to monotherapy with another ASM, whereas approximately two in five end up on polytherapy. Read that article here.
Memory Disorders
- Kathleen Welsh Bohmer, PhD, and Thomas Farrer, PhD, were the senior authors of a new study examining the associations between neuropsychologically assessed executive function and clinically identifiable white matter burden from magnetic resonance imaging. Their analysis found that higher white matter lesion burdens were associated with poorer task performance on an executive function composite score of common neuropsychological tests for elderly individuals with and without dementia. Read their full study in Applied Neuropsychology: Adult.
- The Imaging Dementia Evidence for Amyloid Scanning (IDEAS) study found that amyloid PET scans help providers diagnose and manage Alzheimer's disease and related dementias. Emily O’Brien, PhD, Brenda Plassman, PhD, and James Burke, MD, PhD, contributed to a follow-up study that examined the associations between elevated or non-elevated amyloid, patient characteristics, and participant healthcare utilization, finding no difference in change in healthcare use between people with scans showing elevated and non-elevated beta-amyloid. Read the full study in the Journal of the American Geriatrics Society.
Neurocritical Care
- Despite ischemic stroke’s continuing status as a leading cause of death and disability, treatment options for this condition remain limited. Daniel Laskowitz, MD, MHS, was the first author of a new phase-II randomized controlled trial examining the potential of unrelated-donor cord blood infusion for this condition. The results found neither safety concerns nor a measurable clinical benefit for this treatment. Read the full study in Stem Cells Translational Medicine.
Neuromuscular Disease
- Xiaoyan Li, MD, was the senior author of the 73rd entry in the ALSUntangled series, which examined the supplement Lion’s Mane (Hericium erinaceus) as a potential off-label treatment for ALS. Richard Bedlack, MD, PhD, also contributed to the analysis, which found that while Lion’s Mane appears to be safe, no existing evidence shows a potential benefit as a treatment for ALS. Read their article in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration.
Parkinson’s and Movement Disorders
- Sneha Mantri, MD, MS, contributed to a new study that sheds new light on demographic characteristics and associated symptoms among internal tremor in Parkinson’s disease. Mantri and colleagues found a range of associated symptoms, including external tremor, anxiety, and pain, as well as possible sex-based differences. Read their article in Clinical Parkinsonism & Related Disorders.
Stroke and Vascular Neurology
- Brian Mac Grory, MB BCh, MRCP, and James Burke, MD, PhD, contributed to a new article in Stroke examining the associations in hospice use among stroke survivors at the state and national level. Mac Grory, Burke, and colleagues report the proportion and count of Medicare hospice beneficiaries with stroke as well as the stroke death rate among Medicare-eligible individuals, finding that increases in stroke mortality in the Medicare-eligible population accounted for a significant, but not a majority of increases in Medicare hospice beneficiaries from 2013 to 2019. Read the full article here.
- A forthcoming population-based cohort study outlined in PLoS One aims to advance our understanding of risk factors for central retinal artery occlusions (CRAO), or “eye strokes.” The study will evaluate if atrial fibrillation is an independent risk factor for CRAO and also if oral anticoagulation can help reduce that risk. Brian Mac Grory, MB BCh, MRCP, and Jay Lusk, MD, MBA, led the development of that protocol. Read it here.
- Brian Mac Grory, MB BCh, MRCP, was also part of a multicenter, randomized trial examining whether apixaban is superior to aspirin in patients with embolic stroke of undetermined source (ESUS) and known risk factors for cardioembolism. Their analysis found that apixaban was not superior to cardiac monitoring-guided aspirin in preventing new ischemic lesions in an enriched ESUS population. Read the full article in NEJM Evidence.