With 18 new peer-reviewed articles from members of our faculty, August 2020 was a record-breaking month for the Duke Neurology Department. Clinical research highlights published in the past 31 days include an analysis of patients presenting with vertigo in Emergency Departments, an essay on the human cost of COVID-19 and how we can help people connect during difficult times, and a study finding new benefits for therapies for myasthenia gravis. On the translational side, a new study by Ornit Chiba-Falek, PhD, reviews genetic associations between gender and late-onset Alzheimer’s disease, while Simon Davis, PhD, contributed to three new studies offering further insights into the potential benefits of transcranial magnetic stimulation. Read the entries below to learn more about each of these studies and find links to the original articles.
Hospital Neurology
- A new case report in the Neurohospitalist highlights the dangers of confirmation bias in treating new onset epilepsy. Senior authors Suma Shah, MD, and Matthew Luedke, MD, as well as Christopher Eckstein and former residents Abigail Berezoski, MD, and Shareena Rahman, MD discuss the case of a 20-year-old man who had a POLG mutation which contributed to his epilepsy. Read that article here.
- In the race to take the best medical care for patients with COVID-19 and keep patients safe, the impact that COVID-19 has on the human spirit often gets overlooked. Yasmin O’Keefe, MD, shares a patient story that allowed her to reflect on this cost, and how reconnecting the patient with her family boosted the patients’ recovery. Read that story in the Journal of Palliative Medicine.
- Vishal Mandge, MD, MHS, was the first author of a new cross-sectional study that offers insights into presentations of vertigo in the emergency department. Mandge and colleagues reviewed data from 505 patients with dizziness or vertigo during 2017. Their results suggest that triage with the VAIN triad offers potential to improve the detection of central vertigo in the emergency department. Read that article in the Journal of Stroke and Cerebrovascular Disease.
Neurocritical Care
- Severe traumatic brain injury (TBI) can result in left ventricular dysfunction, which can lead to hypotension and secondary brain injuries. A team including Daniel Laskowitz, MD, MHS, used the National Trauma Data Bank to describe utilization patterns of echocardiography and examine its association with mortality following severe TBI. Read their article in Anesthesia and Analgesia.
Stroke and Vascular Neurology
- Advances in left atrial appendage closure (LAAC) techniques can avoid the risk for stroke while avoiding long-term oral anticoagulation. Brian Mac Grory, MD, contributed to a new study in Translational Stroke Research that evaluated the safety of this intervention in patients with cerebral amyloid angiopathy (CAA). This observational cohort study provides early evidence of LAAC as a potentially effective alternative to anticoagulation in patients with CAA and atrial fibrillation. Read the full article here.
Neuromuscular Medicine
- Janice Massey, MD, Lisa Hobson-Webb, MD, Vern Juel, MD, and Jeffrey Guptill, MD, MHS, were part of the REGAIN study group, which assessed whether eculizumab improves patient- and physician-reported outcomes in patients with refractory anti-acetylcholine receptor antibody-positive generalized myasthenia gravis across four domains. The study found that eculizumab elicited rapid and sustained improvements in muscle strength and in associated daily activity. Read the full study in Annals of Clinical and Translational Neurology.
- A team including Rick Bedlack, MD, Michael Lutz, PhD, and colleagues examined the effects of a polymorphic short structural variant associated with a form of familial amyotrophic lateral sclerosis (fALS). The team characterized rs573116164 within a cohort of 190 patients with fALS and 560 healthy age-matched controls to assess the variant for association with various measures of disease. Their findings suggest that rs573116164 could have SOD1-independent and broader relevance in ALS, warranting further investigation in other fALS and sporadic ALS cohorts, as well as studies of functional effects of the 18T variant on gene expression. Read the full study here in Neurology Genetics.
- While signs and symptoms of peripheral neuropathy may initially appear to be similar among all patients, there are distinct differences in the pattern of certain neuropathies. In the new edition of the Handbook of Clinical Neurology, Janice and Wanye Massey, MD, review the various neuropathy profiles and provide a working knowledge of these differences and of the available tools to distinguish them during pregnancy. Read that chapter here.
Neuro-Oncology
- Katy Peters, MD, PhD, was the senior author of a new study that described the use of RAF and MEK inhibitors in adults with recurrent glioma. Peters and colleagues discuss the utility of these agents, describe their toxicities, and give examples of management strategies. Read the full article in Neuro-Oncology Practice.
Memory Disorders
- Despite an urgent need, African Americans remain underrepresented in clinical research across almost all disciplines. One exception is the Alzheimer’s Disease Prevention Registry, (ADPR), which has successfully recruited a racially diverse and research rady cohort of cognitively health volunteers. Senior author James Burke, MD, PhD, Kathleen Welsh-Bohmer, PhD, Branda Plassman, PhD, and colleagues discuss the ADPR in the latest issue of Alzheimer’s and Dementia. Read that article here.
- Plassman and Burke also contributed to a new Medical Care article about the CAregiver Perceptions About CommunIcaTion with Clinical Team members (CAPACITY) instrument. The CAPACITY instrument measures how care partners perceive themselves to be supported by the patient's health care team and their experiences communicating with the team. Read that article here.
Translational Brain Sciences
- Ornit Chiba-Falek, PhD, was the senior author of a new review article that examines the ways gender and apolipoprotein E (APOE) interact in the development and progression of late-onset Alzheimer’s disease. First author Julia Gamache, PhD, and Young Yun also contributed to the Disease Models & Mechanisms article, which is available here.
- A new method of brain imaging analysis developed by Simon Davis, PhD, and colleagues, offers the potential to greatly improve the effectiveness of noninvasive brain stimulation treatment for Alzheimer’s, obsessive compulsive disorder, depression, and other conditions. Duke researchers developed the new method, which for the first time analyzed the whole brain network rather than a single region of the brain. Read that article in the Journal of Neuroscience.
- Despite the widespread use of transcranial magnetic stimulation (TMS) in research and clinical care, the dose-response relations and neurophysiological correlates of modulatory effects remain relatively unexplored. To fill this gap, a team including Simon Davis, PhD, and colleagues at the Duke Center for Cognitive Neuroscience and Department of Psychiatry and Behavioral Sciences studied modulation of visual processing as a function of TMS parameters. These findings reveal the influence of TMS intensity and timing on visual perception and electrophysiological responses, with optimal facilitation at stimulation intensities below resting motor thresholds. Read that article here.
- Davis also contributed to a Cognitive, Affective, and Behavioral Neuroscience study that tested the contribution of left temporoparietal junction to distancing using repetitive transcranial magnetic stimulation. Their findings help to clarify the role of lateral parietal cortex in distancing and inform applications of distancing and distraction. Read that article here.
- The Study of Oxytocin in Autism to improve Reciprocal Social Behaviors (SOARS-B) is a phase-2 clinical trial evaluating the use of intranasal oxytocin treatment to improve social difficulties in individuals with autism spectrum disorder. Simon Gregory, PhD, contributed to a report describing the rationale, design, and methods of that trial. Read more about it in Contemporary Clinical Trials.
- Al La Spada, MD, PhD, and graduate student Anastasia Gromova wrote aTrends in Neuroscience article discussing the biology of the neuromuscular junction (NMJ), a specialized synapse that connects motor neurons and skeletal muscle, as well as the NMJ’s role in the development of several neurodegenerative disease and potential therapeutic pathways involving the NMJ. Read their article here.
Epilepsy
- Brad Kolls, MD, PhD, MCII, and Deborah Koltai Attix, PhD, contributed a prospective study examining the demographics of people with epilepsy attending hospital-based care in Uganda as well as the epilepsy treatment practices within three of the largest Ugandan public referral hospitals. Read that Epilepsy & Behavior study here.