Duke Neurology Research Round Up, February 2022

By William Alexander

The first month of 2022 saw the publication of 18 new peer-reviewed journal articles from members of the Duke Neurology Department. Highlights include a new article in Lancet Neurology discussing the epidemiology, diagnostics, and  biomarkers of autoimmune neuromuscular junction disorders, case reports describing the progression and treatment options for rare neurological conditions, and a summary of how the first year of the COVID-19 pandemic affects neurology residency programs in the United States. Read the paragraphs below for short summaries of each of these and other articles, and find links to the original articles themselves.

Neuro-Oncology

  • Katherine Peters, MD, PhD, was the first author of a new placebo-controlled, double-blind study examining the effects of low-dose naltrexone on quality of life and fatigue on patients with high-grade glioma. Their study found that the therapy had no effect on quality of life or fatigue for patients with high-grade glioma undergoing concurrent chemotherapy and radiation therapy. Read that article in Supportive Care in Cancer.

Memory Disorders

  • Fatal familial insomnia is an uncommon but fatal genetic condition characterized by severe progressive insomnia, dysautonomia, neuropsychiatric changes, and gait instability. Deborah Rose, MD, and Andy Liu, MD, MS, discuss diagnostic and therapeutic approaches to consider when treating patients with this condition in the latest issue of NeurocaseRead that here.

General and Community Neurology

  • Primary ductal adenocarcinoma of the lacrimal gland is a rare, aggressive malignancy that clinically and histologically resembles salivary duct carcinoma. Joel Morgenlander, MD, contributed to an article discussing the presentation, diagnosis, and treatment of this condition. Read that article in Ophthalmic Plastic and Reconstructive Surgery.

Parkinson’s Disease and Movement Disorders

  • Sneha Mantri, MD, MS, was the first author of a study that advances our understanding of the relationship between fatigue and health-related quality of life in individuals with Parkinson’s disease. Their survey of more than 1,000 patients found that the association between fatigue and lower quality of life was strongest in younger and more depressed symptoms, suggesting that targeted therapies may have the best impact on this group. Read that article in Movement Disorders and Clinical Practice.

Residency and Training

  • The COVID-19 pandemic imposed rapid, significant on neurology residency education and services in the United States, requiring residents to add as frontline providers while protecting themselves and other providers from infection and finding new ways to receive their training. Neuromuscular fellow (and new Duke Neurology faculty member) Yohei Harada, MD, wrote an article summarizing these changes and the adaptations health systems and trainees adapted to compensate for the Japanese journal Brain and NerveRead it here.

Neuromuscular Disease

  • Jeffrey Guptill, MD, MHS, contributed to a new review article which discusses the epidemiology, diagnostics, and biomarkers of autoimmune neuromuscular junction disorders, which are being increasingly recognized in people older than 50 years.The article also discusses treatment options and directions for future research. Read that article in Lancet Neurology.
  • A new expert consensus statement offers clinical guidance on the use of electrodiagnostic tests and neuromuscular ultrasound in the investigation of suspected carpal tunnel syndrome. Lisa Hobson-Webb, MD, was part of a panel of international leaders in neuromuscular ultrasound who contributed to this statement in Clinical Neurophysiology. Read that here.

Multiple Sclerosis and Neuroimmunology

  • Senior authors Christopher Eckstein, MD, and Elijah Lackey, MD, and Ariel Lefland, MD, wrote a case report of a 51-year-old man with known Leber’s hereditary optic neuropathy who also presented with recurring myelopathy from a genetic mutation. Read about the interaction of those symptoms in Case Reports in Neurological Medicine.
  • A new plain-language summary of side effects people with multiple sclerosis experience during their first year of treatment with cladribine tablets appears in the latest issue of Neurodegenerative Disease Management. Bryan Walker, PA-C, MMS, contributed to this summary, which is available here. 

Clinical Neurophysiology, Epilepsy, and Sleep

  • A new article in Epilepsy and Behavior discussing patient preferences for treatment options for drug-resistant focal epilepsy. Saurabh Sinha, MD, PhD, was the first author of the study, which administered a survey to 400 adult patients with drug resistant epilepsy. Their survey found that patients would be willing to accept lower treatment effectiveness in exchange for a minimally invasive procedure or lowered risk of mortality and neurological deficits. Read that study here.
  • The Journal of Clinical Neurophysiology’s first issue of 2022 marked the end of Aatif Husain’s, MD, eight years as the journal’s editor in chief. In his farewell message he shares how the journal has changed and grown during that time, and thanks the many people who have helped him expand its scope and vision. Read that essay here. 

Stroke and Vascular Neurology

  • Hyperglycemia increases the risk for additional ischemic strokes for patients who have already experienced stroke, according to a new study in the Journal of the American Heart Association. Senior authors Wuwei “Wayne” Feng, MD, MS, Brian Mac Grory,  MB BCh, MRCP, and colleagues examined data from nearly 5,000 patients in the POINT trial. Their analysis found a 1.50 adjusted hazard ratio for subsequent stroke for patients with hyperglycemia compared to patients with normal blood glucose levels. Read the full study here. 
  • In another analysis of the POINT trial, a new study has found that patients with an acute infarct on image imaging have an increased risk of recurring stroke and a pronounced benefit from clopidogrel-aspirin. Brian Mac Grory, MB BCh, MRCP, contributed to this analysis, which appears in JAMA NeurologyRead it here. 
  • People who experience a high-risk non-disabling ischemic cerebrovascular event continue to be at risk for a secondary stroke after this event. Wuwei “Wayne” Feng, MD, MS was the senior author of a four-center, single-arm study investigating whether remote ischemic conditioning (RIC) is effective in preventing recurrent ischemic events within 3 months. The team’s investigation found that RIC is a safe add-on procedure with potential benefit for reducing recurring cerebrovascular events after high-risk events. Read the full study in Frontiers in Neurology.
  • Brian Mac Grory, MB BCh, MRCP, was the first author of a new study that examined data from patients with acute ischemic stroke presented within 24 hours but not treated with IV alteplase. Their analysis found this population had a high unmet need for care, with a high risk of readmission, mortality, and high total in-hospital and post-discharge costs. Read the full article in Stroke: Vascular and Interventional Neurology.
  • One in four patients with acute lacunar infarcts experience early neurologic deterioration, but the underlying pathophysiological features of this condition are poorly understood.  Mac Grory also contributed to an observational study that examined this phenomenon, which found that luminal stenosis may be associated with early neurologic deterioration after an acute lacunar infarct. Read the full study in Stroke: Vascular and Interventional Neurology. 

Translational Brain Sciences

  • Transcranial Magnetic Stimulation (TMS) has become a powerful tool both for exploring cortical function as well as developing therapies for psychiatric and neurological disorders. Unfortunately, much of the inference of the direct effects of TMS has been assumed to be limited to the area a few centimeters beneath the scalp. Simon Davis, PhD, contributed to a new study that examines TMS coil placement to non-invasively achieve activation of specific deep brain targets of relevance to the treatment of psychiatric disorders. Their new paradigm indicates a way to overcome depth limitations and allow noninvasive brain stimulation to influence deep brain structures. Read that study in Neuroimage.
  • Andrew West, PhD, was the senior author of a new article in Molecular Neurodegeneration examining how α-synuclein and LRRK2 interact in monocytes and subsequent neuroinflammatory responses. Their experiments found that Pathologic α-synuclein activates LRRK2 expression and kinase activity in monocytes and induces their recruitment to the brain. Read their full study here.

Neurocritical Care

  • A letter to the editors of Clinical and Translational Medicine discusses the authors’ work identifying the neuronal targets of a clinical‐stage stroke therapeutics CN‐105, and proposes a novel neuroprotective strategy involving the antagonism of nicotinic acetycholinergic receptors. Daniel Laskowitz, MD, MHS, and Brad Kolls, MD, PhD, co-authored this letter. Read it here.

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