May is Stroke Awareness Month, and members of the Duke Neurology Department were off to an early start. They contributed to six new peer-reviewed journals investigating stroke this April, bringing our total stroke-related articles published this year to more than 20. In addition to this research, our faculty, trainees, and advanced practice providers authored or co-authored 10 other studies and contributed to books advancing our understanding of Alzheimer’s and dementia, brain tumors, epilepsy, and other conditions. Read the paragraphs below for summaries of our research from the past 30 days, as well as links to the complete articles themselves.
Stroke and Vascular Neurology
- Wayneho Kam, MD, contributed to a new study that sheds light on the extent and timeline of recovery from aphasia after stroke. Kam and colleagues followed more than 200 patients with post-stroke aphasia, evaluating their language and speech for a year. They found striking differences between speech/language domains in their rates of recovery and their relationships to overall language function, suggesting that specific domains differ in the extent to which they are redundantly represented throughout the language network, as opposed to depending on specialized cortical substrates. Read that study in Brain.
- Sneha Mantri, MD, MS, was settling into the ICU workroom on the last overnight shift of her residency, when she suddenly had to treat a stroke patient in her nineties who had been treated with tPA. Mantri recalls that night, and her evolving reaction as she got to know the patient in an “Old Lives Tale” for theJournal of the American Geriatrics Society. Read that story here.
- An aging population as well as many key vascular risk factors mean that the burden of stroke will likely increase over the next decade. Brian Mac Grory, MB BCh, MRCP, was the first author of a new article outlines current approaches to the prevention of cardioembolic, cryptogenic, atherosclerotic, and small-vessel disease stroke, with a focus on recent trials of antithrombotic agents. Read that article in Circulation Research.
- Senior author Michael “Luke” James, MD, and Shreyansh Shah, MD contributed to a large multiethnic cohort study examining the effects of initial antihypertensive class on acute blood pressure after intracerebral hemorrhage. The team found that antihypertensive class was associated with reduced acute diastolic, but not systolic blood pressure. Read the full article in Stroke and Vascular Neurology.
- Brian Mac Grory, MB BCh, MRCP, also contributed to a new study examining the global disability status of patients who had a mild ischaemic stroke at 30 and 90 days poststroke. Their analysis of more than 1300 patients found that one in four mild ischaemic stroke participants exhibited functional changes between 30 and 90 days, suggesting that the 30-day outcome may insufficiently represent long-term recovery in mild stroke. Read the full article in Stroke and Vascular Neurology.
- Micheal “Luke” James, MD, was part of a team that examined the effects of postoperative stroke and delirium on postdischarge cognition and patient-centered health outcomes in patients with surgical aortic valve replacement. Read what they found in the Journal of Thoracic and Cardiovascular Surgery.
Translational Brain Science
- Imaging biomarkers to detect early signs of Alzheimer’s disease would be a major step forward in preventing and alleviating a global public health crisis. However, the challenges in finding these biomarkers are many. Alexandra Badea, PhD, discusses these challenges and opportunities in a chapter she wrote in a new book, Magnetic Resonance Microscopy: Instrumentation and Applications in Engineering, Life Sciences, and Energy Research. Read more about that book and chapter here.
- The growing global crisis of dementia demands innovative changes to improve clinical research. Michael Lutz, PhD, and colleagues outline hurdles in the transition from research to practice and ways to overcome them, including reducing communication mismatches and methodological gaps, improved pilot projects, and standardized outcome measures in a new commentary in Alzheimer’s & Dementia. Read that article here.
Parkinson’s Disease and Movement Disorders
- A new pilot trial of combined deep brain stimulation (DBS) therapies shows potential for improved treatment of Parkinson’s disease. First author Kyle Mitchell, MD, Jeffrey Cooney, MD, Sneha Mantri, MD, MS, Burton Scott, MD, PhD, and colleagues from Duke Neurosurgery implanted both subthalamic nucleus and globus pallidus DBS in three patients with Parkinson’s disease, whose symptoms improved to the point where they could reduce their levodopa medication by 80 percent or more. Read that study in Neurosurgery.
- Sneha Mantri, MD, MS, was part of a team that tested and validated a German version of the Moral Injury Symptom and Support Scale for Health Professionals instrument. The team also correlated the instrument with another related German instrument that measured second victim phenomenon. Read the full article in the International Journal of Environmental Research and Public Health.
- Transcranial magnetic stimulation (TMS) offers great potential to neurological conditions and advance our understanding of the brain, but the available software lacks many practical features. Noreen Bukhari-Parlakturk, MD, PhD, Lysianne Beynel, Eleanor Wood, and Ziping Huang, PhD, were part of a team that developed new TMS targeting and analysis software to improve this approach. Their TMS targeting and analysis pipeline (TAP) software uses an MRI/fMRI-derived brain target to optimize coil placement considering experimental parameters such as the subject's hair thickness and coil placement restrictions. Read about it in the Journal of Neural Engineering.
- Radiation necrosis is a rare but serious adverse effect following treatment with radiation therapy, which currently has no standard of care and lacks a clear understanding of its pathomechanics and molecular drivers. Katherine Peters, MD, PhD was the senior author of a new case series describing the outcome of two primary CNS lymphoma patients who developed this condition. Read their article in Oncotarget.
- Atypical and malignant meningiomas have high rates of local recurrence, and questions remain about the role of adjuvant radiation therapy for patients with these conditions. Annick Desjardins, MD, and Katherine Peters, MD, PhD, contributed to a retrospective analysis of long-term outcomes for patients with these conditions treated with surgery and/or radiation therapy, finding that radiation therapy was associated with greater progression-free survival. Read that article in Advances in Radiation Oncology.
Clinical Neurophysiology, Epilepsy, and Sleep
- Andrew Spector, MD, was the senior author of a case study following a 77-year-old woman with obstructive sleep apnea who reported a lifelong difficulty with periods of severe nocturnal insomnia and daytime sleepiness. A review of her CPAP data revealed the diagnosis of non-24-hour sleep-wake rhythm disorder a condition usually, but not always, found in unsighted individuals. Read that case presentation in Neurology.
- Clinical Neurophysiology fellow Yash Shah, MD, contributed to a retrospective, single-center study of cenobamate as an adjunctive medication for children with refractory focal-onset epilepsy. The team found that cenobamate showed similar efficacy rates and safety profile for both populations, making it an effective, safe, and tolerable adjunctive medication for pediatric patients. Read that article in Epilepsy & Behavior.
- A significant number of people experience long-term neuropsychological sequelae after recovery from COVID-19. Andy Liu, MD, MS, was the senior author of a new case report describing symptoms experienced by three of those individuals. Thomas Farrer, PhD, also contributed to that study, which appears in Case Reports in Neurological Medicine. Read it here.
- Thomas Farrer, PhD, is the co-editor of a new book that provides an introduction to dementia and memory disorders for professionals in public health, nursing, social work, gerontology, psychology, and related fields. Sarah Cook, PhD, Allison Allen, MSW, LCSW, Anne Kosem, Burton Scott, MD, PhD, Lacy Rardin, MSW, LCSWA, and Kavya Moravineni, MD, also contributed to Dementia and Memory: Introduction for Professionals in Health and Human Service. Read more about it here.
- Lisa-Hobson-Webb, MD, and Karissa Gable, MD, and Shruti Raja, MD, contributed to a study describing phenotypic, human-on-a-chip electrical conduction model of two rare autoimmune demyelinating neuropathies: chronic inflammatory demyelinating polyneuropathy and multifocal motor neuropathy. Read what they found in Advanced Therapeutics.