| In Focus |
spotlight on the february 26 issue.
- Gross, Robert, MD, PhD, Editor-in-Chief, Neurology. Pages: 779
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| Editorial |
trigeminal stimulation: a superhighway to the brain?.
- Faught, Edward, Tatum, William. Pages: 780-781
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impulse control disorders in parkinson disease: is cognitive-behavioral therapy worth a wager?.
- Macphee, Graeme, Carson, Alan, MD, FRCPsych. Pages: 782-783
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dopaminergic treatment and nonmotor features of parkinson disease: the horse lives.
- Antonini, Angelo, MD, PhD, Albin, Roger. Pages: 784-785
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| Article |
randomized controlled trial of trigeminal nerve stimulation for drug-resistant epilepsy.
- DeGiorgio, Christopher, Soss, Jason, Cook, Ian, Markovic, Daniela, Gornbein, Jeffrey, Murray, Diana, Oviedo, Sandra, Gordon, Steven, Corralle-Leyva, Guadalupe, Kealey, Colin, Heck, Christi, MD, MMM. Pages: 786-791
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Objective: To explore the safety and efficacy of external trigeminal nerve stimulation (eTNS) in patients with drug-resistant epilepsy (DRE) using a double-blind randomized controlled trial design, and to test the suitability of treatment and control parameters in preparation for a phase III multicenter clinical trial.Methods: This is a double-blind randomized active-control trial in DRE. Fifty subjects with 2 or more partial onset seizures per month (complex partial or tonic-clonic) entered a 6-week baseline period, and then were evaluated at 6, 12, and 18 weeks during the acute treatment period. Subjects were randomized to treatment (eTNS 120 Hz) or control (eTNS 2 Hz) parameters.Results: At entry, subjects were highly drug-resistant, averaging 8.7 seizures per month (treatment group) and 4.8 seizures per month (active controls). On average, subjects failed 3.35 antiepileptic drugs prior to enrollment, with an average duration of epilepsy of 21.5 years (treatment group) and 23.7 years (active control group), respectively. eTNS was well-tolerated. Side effects included anxiety (4%), headache (4%), and skin irritation (14%). The responder rate, defined as >50% reduction in seizure frequency, was 30.2% for the treatment group vs 21.1% for the active control group for the 18-week treatment period (not significant, p = 0.31, generalized estimating equation [GEE] model). The treatment group experienced a significant within-group improvement in responder rate over the 18-week treatment period (from 17.8% at 6 weeks to 40.5% at 18 weeks, p = 0.01, GEE). Subjects in the treatment group were more likely to respond than patients randomized to control (odds ratio 1.73, confidence interval 0.59-0.51). eTNS was associated with reductions in seizure frequency as measured by the response ratio (p = 0.04, analysis of variance [ANOVA]), and improvements in mood on the Beck Depression Inventory (p = 0.02, ANOVA).Conclusions: This study provides preliminary evidence that eTNS is safe and may be effective in subjects with DRE. Side effects were primarily limited to anxiety, headache, and skin irritation. These results will serve as a basis to inform and power a larger multicenter phase III clinical trial.Classification of evidence: This phase II study provides Class II evidence that trigeminal nerve stimulation may be safe and effective in reducing seizures in people with DRE.(C)2013 American Academy of Neurology
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trial of cbt for impulse control behaviors affecting parkinson patients and their caregivers.
- Okai, David, Askey-Jones, Sally, Samuel, Michael, O'Sullivan, Sean, Chaudhuri, K., Martin, Anne, Mack, Joel, Brown, Richard, David, Anthony. Pages: 792-799
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Objective: To test the effects of a novel cognitive-behavioral therapy (CBT)-based intervention delivered by a nurse therapist to patients with Parkinson disease (PD) with clinically significant impulse control behaviors (ICB).Methods: This was a randomized controlled trial comparing up to 12 sessions of a CBT-based intervention compared to a waiting list control condition with standard medical care (SMC). A total of 27 patients were randomized to the intervention and 17 to the waiting list. Patients with a Mini-Mental State Examination score of <24 were excluded. The coprimary outcomes were overall symptom severity and neuropsychiatric disturbances in the patients and carer burden and distress after 6 months. Secondary outcome measures included depression and anxiety, marital satisfaction, and work and social adjustment in patients plus general psychiatric morbidity and marital satisfaction in carers.Results: There was a significant improvement in global symptom severity in the CBT intervention group vs controls, from a mean score consistent with moderate to one of mild illness-related symptoms ([chi]2 = 16.46, p < 0.001). Neuropsychiatric disturbances also improved significantly (p = 0.03), as did levels of anxiety and depression and adjustment. Measures of carer burden and distress showed changes in the desired direction in the intervention group but did not change significantly. General psychiatric morbidity did improve significantly in the carers of patients given CBT.Conclusions: This CBT-based intervention is the first to show efficacy in ICB related to PD in terms of patient outcomes. The hoped-for alleviation of carer burden was not observed. The study demonstrates the feasibility and potential benefit of a psychosocial treatment approach for these disturbances at least in the short term, and encourages further larger-scale clinical trials.Classification of evidence: The study provides Class IV evidence that CBT plus SMC is more effective than SMC alone in reducing the severity of ICB in PD, based upon Clinical Global Impression assessment ([chi]2 = 16.46, p < 0.001): baseline to 6-month follow-up, reduction in symptom severity CBT group, 4.0-2.5; SMC alone group, 3.7-3.5.(C)2013 American Academy of Neurology
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nonmotor fluctuations in parkinson disease: severity and correlation with motor complications.
- Storch, Alexander, Schneider, Christine, Wolz, Martin, Sturwald, Yannic, Nebe, Angelika, Odin, Per, MD, PhD, Mahler, Andreas, Fuchs, Gerd, Jost, Wolfgang, Chaudhuri, K., Ray DSc, MD, Koch, Rainer, MD, PhD, Reichmann, Heinz, MD, PhD, Ebersbach, Georg. Pages: 800-809
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Objective: To evaluate frequency, severity, and correlation of nonmotor symptoms (NMS) with motor complications in fluctuating Parkinson disease (PD).Methods: The Multicenter NonMotor Fluctuations in PD cross-sectional study used clinical examination of 10 NMS (dysphagia, anxiety, depression, fatigue, excessive sweating, inner restlessness, pain, concentration/attention, dizziness, bladder urgency) quantified using a visual analogue scale (VAS) in motor-defined on (NMSOn) and off state (NMSOff) combined with motor assessments and self-ratings at home in 100 patients with advanced PD.Results: All NMS except dysphagia, excessive sweating, and bladder urgency fluctuated in conjunction to motor fluctuations with more frequent and severe symptoms in off compared to on state. The proportions of patients experiencing autonomic/sensory NMS in both motor states were similar to those with these NMS exclusively in off state (ratios 0.4-1.3), while for mental/psychic NMS the proportions with exclusive manifestation in off state were higher (ratios 1.8-3.1). Demographic and clinical characteristics correlated neither with NMS frequency patterns and severities nor with [DELTA]NMSOn/Off severities (defined as the differences of VAS scores between on and off). Severities of NMSon, NMSOff, and [DELTA]NMSOn/Off did not correlate with motor function. Presence of anxiety, depression, fatigue, and pain had negative impact on health-related quality of life (HRQOL) measured by Parkinson's Disease Questionnaire-8 scoring independent of their occurrence with respect to motor state. Fluctuations of these NMS but not of fatigue deteriorated HRQOL.Conclusion: Patterns of NMS fluctuations are heterogeneous and complex, but psychic NMS fluctuate more frequently and severely. Demographic parameters and motor function do not correlate with NMS or nonmotor fluctuation severities in fluctuating PD.(C)2013 American Academy of Neurology
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[alpha]-synuclein pathology is related to postoperative delirium in patients undergoing gastrectomy.
- Sunwoo, Mun, Hong, Jin, Choi, Junjeong, Park, Hyun, Kim, Se, Lee, Phil, Hyu MD, PhD. Pages: 810-813
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Objective: The clinical characteristics of postoperative delirium are similar to core features of [alpha]-synuclein-related cognitive disorders, such as dementia with Lewy bodies or Parkinson disease dementia. We therefore investigated the [alpha]-synuclein pathology in patients who experienced postoperative delirium after gastrectomy for stomach cancer.Method: Patients with and without postoperative delirium were selected among patients undergoing total gastrectomy for primary gastric cancer from 2007 to 2011 (each n = 16) at the university hospital. Immunohistochemical staining for [alpha]-synuclein of both normal and phosphorylated form was performed in the myenteric plexus. A logistic regression analysis was applied to identify independent predictors of postoperative delirium.Results: No significant differences were observed for age, sex, operation time, or onset of delirium after total gastrectomy between patients with and without postoperative delirium. Patients with postoperative delirium had a higher frequency of intensive care unit admissions (43.8 vs 6.3%, p = 0.037) and [alpha]-synuclein-positive pathologies of normal (56.3 vs 12.5%, p = 0.023) and phosphorylated form (43.8 vs 6.3%, p = 0.037) compared with those without postoperative delirium. A logistic regression analysis revealed that immunoreactivity for normal [alpha]-synuclein (odds ratio [OR] 9.20) and intensive care unit admission (OR 11.97) were independently associated with postoperative delirium.Conclusion: These results suggest that underlying [alpha]-synuclein pathologies in the stomach are associated with postoperative delirium, implying that postoperative delirium represents a preclinical stage of [alpha]-synuclein related to cognitive disorders.(C)2013 American Academy of Neurology
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structural and functional brain connectivity in presymptomatic familial frontotemporal dementia.
- Dopper, Elise, Rombouts, Serge, Jiskoot, Lize, Heijer, Tom, den MD, PhD, Graaf, J., Koning, Inge, Hammerschlag, Anke, Seelaar, Harro, Seeley, William, MD, PhD, Veer, Ilya, van Buchem, Mark, MD, PhD, Rizzu, Patrizia, van Swieten, John, MD, PhD. Pages: 814-823
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Objective: We aimed to investigate whether cognitive deficits and structural and functional connectivity changes can be detected before symptom onset in a large cohort of carriers of microtubule-associated protein tau and progranulin mutations.Methods: In this case-control study, 75 healthy individuals (aged 20-70 years) with 50% risk for frontotemporal dementia (FTD) underwent DNA screening, neuropsychological assessment, and structural and functional MRI. We used voxel-based morphometry and tract-based spatial statistics for voxelwise analyses of gray matter volume and diffusion tensor imaging measures. Using resting-state fMRI scans, we assessed whole-brain functional connectivity to frontoinsula, anterior midcingulate cortex (aMCC), and posterior cingulate cortex.Results: Although carriers (n = 37) and noncarriers (n = 38) had similar neuropsychological performance, worse performance on Stroop III, Ekman faces, and Happe cartoons correlated with higher age in carriers, but not controls. Reduced fractional anisotropy and increased radial diffusivity throughout frontotemporal white matter tracts were found in carriers and correlated with higher age. Reductions in functional aMCC connectivity were found in carriers compared with controls, and connectivity between frontoinsula and aMCC seeds and several brain regions significantly decreased with higher age in carriers but not controls. We found no significant differences or age correlations in posterior cingulate cortex connectivity. No differences in regional gray matter volume were found.Conclusions: This study convincingly demonstrates that alterations in structural and functional connectivity develop before the first symptoms of FTD arise. These findings suggest that diffusion tensor imaging and resting-state fMRI may have the potential to become sensitive biomarkers for early FTD in future clinical trials.(C)2013 American Academy of Neurology
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dnmt1 mutation hot spot causes varied phenotypes of hsan1 with dementia and hearing loss.
- Klein, Christopher, Bird, Tom, Ertekin-Taner, Nilufer, MD, PhD, Lincoln, Sarah, Hjorth, Robert, Wu, Yanhong, Kwok, John, Mer, Georges, Dyck, Peter, Nicholson, Garth, MD, ME. Pages: 824-828
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Background: Mutations in DNA methyltransferase 1 (DNMT1) have been identified in 2 autosomal dominant syndromes: 1) hereditary sensory autonomic neuropathy with dementia and hearing loss (HSAN1E); and 2) cerebellar ataxia, deafness, and narcolepsy. Both syndromes have mutations in targeting sequence (TS) domain (exons 20-21), which is important in mediating DNA substrate binding to the DNMT1 catalytic domain. Frontal lobe hypometabolism has been documented in an HSAN1E family, but memory loss has been the primary cognitive complaint. The chromosomal location of the DNMT1 gene at 19p13.2 has been linked to familial late-onset Alzheimer disease.Methods: We sequenced 41 exons of DNMT1 and their flanking regions in 1) 2 kindreds with HSAN1E; 2) 48 patients with HSAN1 alone without dementia and hearing loss; and 3) 5 probands of familial frontotemporal dementia (FTD) kindreds. We also sequenced exon 20 and 21 in 364 autopsy-confirmed late-onset Alzheimer disease cases.Results: Mutations in DNMT1 were specific to 2 HSAN1E kindreds with dementia and hearing loss (no narcolepsy). One family carried previously identified mutation Tyr495Cys; the other carried a novel Tyr495His, both in the TS domain. The symptoms of these patients include prominent personality, psychiatric manifestations, and seizures in one and the onset time is later than the previously reported cases.Conclusion: Clinicians should consider DNMT1 mutations in patients presenting with FTD or primary memory decline who also have sensory neuropathy and hearing loss. Amino acid Tyr495 is a hot spot for HSAN1E, distinct from exon 21 mutations associated with narcolepsy.(C)2013 American Academy of Neurology
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prediagnostic body fat and risk of death from amyotrophic lateral sclerosis: the epic cohort.
- Gallo, Valentina, MD, PhD, Wark, Petra, Jenab, Mazda, Pearce, Neil, Brayne, Carol, MD, FRCP, Vermeulen, Roel, Andersen, Peter, MD, PhD, Hallmans, Goran, MD, PhD, Kyrozis, Andreas, Vanacore, Nicola, MD, PhD, Vahdaninia, Mariam, Grote, Verena, Kaaks, Rudolf, Mattiello, Amalia, Bueno-de-Mesquita, H., Bas MD, MPH, Peeters, Petra, MD, PhD, Travis, Ruth, Petersson, Jesper, Hansson, Oskar, MD, PhD, Arriola, Larraitz, MD, MSc, Jimenez-Martin, Juan-Manuel, Tjonneland, Anne, MD, PhD, Halkjaer, Jytte, Agnoli, Claudia, Sacerdote, Carlotta, MD, PhD, Bonet, Catalina, Trichopoulou, Antonia, Gavrila, Diana, Overvad, Kim, Weiderpass, Elisabete, Palli, Domenico, Quiros, J., Tumino, Rosario, Khaw, Kay-Tee, Wareham, Nicholas, Barricante-Gurrea, Aurelio, MD, PhD, Fedirko, Veronika, Ferrari, Pietro, Clavel-Chapelon, Francoise, Boutron-Ruault, Marie-Christine, MD, PhD, Boeing, Heiner, Vigl, Matthaeus, Middleton, Lefkos, MD, FRCP, Riboli, Elio, MD, PhD, Vineis, Paolo, MD, MPH. Pages: 829-838
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Objectives: The aim of this study was to investigate for the first time the association between body fat and risk of amyotrophic lateral sclerosis (ALS) with an appropriate prospective study design.Methods: The EPIC (European Prospective Investigation into Cancer and Nutrition) study included 518,108 individuals recruited from the general population across 10 Western European countries. At recruitment, information on lifestyle was collected and anthropometric characteristics were measured. Cox hazard models were fitted to investigate the associations between anthropometric measures and ALS mortality.Results: Two hundred twenty-two ALS deaths (79 men and 143 women) occurred during the follow-up period (mean follow-up = 13 years). There was a statistically significant interaction between categories of body mass index and sex regarding ALS risk (p = 0.009): in men, a significant linear decrease of risk per unit of body mass index was observed (hazard ratio = 0.93, 95% confidence interval 0.86-0.99 per kg/m2); among women, the risk was more than 3-fold increased for underweight compared with normal-weight women. Among women, a significant risk reduction increasing the waist/hip ratio was also evident: women in the top quartile had less than half the risk of ALS compared with those in the bottom quartile (hazard ratio = 0.48, 95% confidence interval 0.25-0.93) with a borderline significant p value for trend across quartiles (p = 0.056).Conclusion: Increased prediagnostic body fat is associated with a decreased risk of ALS mortality.(C)2013 American Academy of Neurology
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disparities among asians and native hawaiians and pacific islanders with ischemic stroke.
- Nakagawa, Kazuma, Koenig, Matthew, Asai, Susan, Chang, Cherylee, Seto, Todd, MD, MPH. Pages: 839-843
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Objectives: To evaluate disparities in cardiovascular risk factors among Asians and Native Hawaiians and other Pacific Islanders (NHPI) in Hawaii who are hospitalized with ischemic stroke.Methods: We performed a retrospective study on consecutive patients hospitalized for ischemic stroke at a single tertiary center in Honolulu between 2004 and 2010. The prevalence of cardiovascular risk factors was compared for NHPI, Asians, and whites who were hospitalized for ischemic stroke.Results: A total of 1,921 patients hospitalized for ischemic stroke were studied. NHPI were less likely to be older (odds ratio [OR] 0.95, 95% confidence interval [CI] 0.94-0.96), more likely to be female (OR 1.55, 95% CI 1.07-2.24), and more likely to have diabetes (OR 2.74, 95% CI 1.87-4.00), hypertension (OR 1.98, 95% CI 1.27-3.10), and obesity (OR 1.82, 95% CI 1.25-2.65) than whites. NHPI had higher low-density lipoprotein levels (114 +/- 50 mg/dL vs 103 +/- 45 mg/dL, p = 0.001) and lower high-density lipoprotein levels (38 +/- 11 mg/dL vs 45 +/- 15 mg/dL, p < 0.0001) than whites. Compared with Asians, NHPI were less likely to be older (OR 0.95, 95% CI 0.94-0.97) and more likely to have diabetes (OR 1.88, 95% CI 1.35-2.61), previous stroke or TIA (OR 1.57, 95% CI 1.09-2.25), and obesity (OR 6.05, 95% CI 4.31-8.48).Conclusions: Asians, NHPI, and whites with ischemic stroke have substantially different cardiovascular risk factors. Targeted secondary prevention will be important in reducing disparities among these racial groups.(C)2013 American Academy of Neurology
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blood-brain barrier disruption is associated with increased mortality after endovascular therapy.
- Desilles, Jean-Philippe, Rouchaud, Aymeric, Labreuche, Julien, Meseguer, Elena, Laissy, Jean-Pierre, Serfaty, Jean-Michel, Lapergue, Bertrand, Klein, Isabelle, MD, PhD, Guidoux, Celine, Cabrejo, Lucie, Sirimarco, Gaia, Lavallee, Philippa, Schouman-Claeys, Elisabeth, Amarenco, Pierre, Mazighi, Mikael, MD, PhD. Pages: 844-851
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Objective: To evaluate the incidence, baseline characteristics, and clinical prognosis of blood-brain barrier (BBB) disruption after endovascular therapy in acute ischemic stroke patients.Methods: A total of 220 patients treated with endovascular therapy between April 2007 and October 2011 were identified from a prospective, clinical, thrombolysis registry. All patients underwent a nonenhanced CT scan immediately after treatment. CT scan or MRI was systematically realized at 24 hours to assess intracranial hemorrhage complications. BBB disruption was defined as a hyperdense lesion on the posttreatment CT scan.Results: BBB disruption was found in 128 patients (58.2%; 95% confidence interval [CI], 51.4%-64.9%). Cardioembolic etiology, high admission NIH Stroke Scale score, high blood glucose level, internal carotid artery occlusion, and use of combined endovascular therapy (chemical and mechanical revascularization) were independently associated with BBB disruption. Patients with BBB disruption had lower rates of early major neurologic improvement (8.6% vs 31.5%, p < 0.001), favorable outcome (39.8% vs 61.8%, p = 0.002), and higher rates of 90-day mortality (34.4% vs 14.6%, p = 0.001) and hemorrhagic complications (42.2% vs 8.7%, p < 0.001) than those without BBB disruption. By multivariable analysis, patients with BBB disruption remained with a lower rate of early neurologic improvement (adjusted odds ratio [OR], 0.28; 95% CI, 0.11-0.70) and with a higher rate of mortality (adjusted OR, 2.37; 95% CI, 1.06-5.32) and hemorrhagic complications (adjusted OR, 6.38; 95% CI, 2.66-15.28).Conclusion: BBB disruption has a detrimental effect on outcome and is independently associated with mortality after endovascular therapy. BBB disruption assessment may have a role in prognosis staging in these patients.(C)2013 American Academy of Neurology
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| Historical Neurology |
juan valverde de hamusco's unauthorized reproduction of a brain dissection by andreas vesalius.
- Lanska, Douglas, MD, MS, MSPH, FAAN, Lanska, John. Pages: 852-856
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Objective: The objective of the present work is to examine images of the brain dissection by Flemish-born anatomist Andreas Vesalius (1514-1564) as originally represented in the Fabrica (1543), and later copied without Vesalius' permission by Spanish anatomist Juan Valverde de Hamusco (c1525-c1587) in Historia de la composicion del cuerpo humano (1556).Methods: Illustrations of the brain dissection in the Fabrica were obtained in digital form, resized, and arranged in a comparable montage to that presented by Valverde. Computer manipulations were used to assess image correspondence.Results: The Valverde illustrations are approximately half the size and are mirror images of those in the Fabrica, but otherwise show the same dissection stages, and identical transverse brain levels and structures. The Valverde illustrations lack shadowing and show minor variations in perspective and fine details (e.g., branching pattern of the middle meningeal artery) from those in the Fabrica.Conclusion: Craftsmen under the direction of Valverde copied the woodcut prints in the Fabrica in close but approximate form by freehand engraving onto copper plates. Differences in the sizes of the images, and in perspective and fine detail, preclude direct tracing of images as the means of copying. Because engravings are in effect "flipped over" to make further prints, subsequent prints made from Valverde's copperplate engravings are mirror images of the prints in Vesalius' Fabrica.(C)2013 American Academy of Neurology
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| Views & Reviews |
diffusion tensor imaging in parkinsonian syndromes: a systematic review and meta-analysis.
- Cochrane, Claire, Ebmeier, Klaus. Pages: 857-864
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Objectives: We performed a systematic review to assess alterations in measures of diffusion tensor imaging (DTI) in parkinsonian syndromes, exploring the potential role of DTI in diagnosis and as a candidate biomarker.Methods: We searched EMBASE and Medline databases for DTI studies comparing parkinsonian syndromes or related dementias with controls or another defined parkinsonian syndrome. Key details for each study regarding participants, imaging methods, and results were extracted. Estimates were pooled, where appropriate, by random-effects meta-analysis.Results: Of 333 results, we identified 43 studies suitable for inclusion (958 patients, 764 controls). DTI measures detected alterations in all parkinsonian syndromes, with distribution varying differentially with disease type. Nine studies were included in a meta-analysis of the substantia nigra in Parkinson disease. A notable effect size was found for lowered fractional anisotropy in the substantia nigra for patients with Parkinson disease vs controls (-0.639, 95% confidence interval -0.860 to -0.417, p < 0.0001).Conclusion: DTI may be a promising biomarker in parkinsonian syndromes and have a future role in differential diagnosis. Larger cohort studies are required to investigate some encouraging preliminary findings. Given the complexity of the parkinsonian syndromes, it is likely that any potential DTI biomarker would be used in combination with other relevant biomarkers.(C)2013 American Academy of Neurology
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| Clinical/Scientific Notes |
spinal ischemic stroke following dialysis: clinical and radiologic findings.
- Honig, Asaf, Gomori, John, Schneider, Ronen, Makranz, Chen, Leker, Ronen. Pages: 865-866
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| Reflections: Neurology and the Humanities |
i knew that smile.
- Fleisher, Jori. Pages: e83
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| Video NeuroImages |
isolated ocular flutter.
- Nasu, Saiko, Uzawa, Akiyuki, MD, PhD, Mori, Masahiro, MD, PhD, Kuwabara, Satoshi, MD, PhD. Pages: 867
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| Resident and Fellow Section |
clinical reasoning: a 56-year-old man with progressive spasticity.
- Dhamija, Radhika, Raymond, Gerald, Gavrilova, Ralitza. Pages: e84-e88
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pearls and oy-sters: small but consequential: intracerebral hemorrhage caused by lenticulostriate artery aneurysm.
- Cai, Xuemei, Han, Steve, MD, PhD, Feske, Steven, Chou, Sherry, MD, MMSc. Pages: e89-e91
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teaching neuroimages: wernicke encephalopathy: diagnostically deceptive but treatable.
- Cerejo, Russell, Newey, Christopher, DO, MS, Stillman, Mark. Pages: e92
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teaching neuroimages: lipoid proteinosis (urbach-wiethe disease): typical findings in this rare genodermatosis.
- Quirici, Marcelo, da Rocha, Antonio, MD, PhD. Pages: e93
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teaching neuroimages: gelsolin-related amyloidosis: a rare cause of progressive facial diparesis.
- Karakis, Ioannis, Jones, H., Gajjar, Ashish, MD, MPH, Baharozian, Dwayne, Srinivasan, Jayashri, MBBS, PhD. Pages: e94
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| Patient Page |
trigeminal nerve stimulator: a new treatment for seizures?.
- Karceski, Steven. Pages: e95-e97
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| WriteClick: Editor's Choice |
evidence-based guideline update: nsaids and other complementary treatments for episodic migraine prevention in adults: report of the quality standards subcommittee of the american academy of neurology and the american headache society.
- Mauskop, Alexander. Pages: 868-869
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trick or treat? showing patients with functional (psychogenic) motor symptoms their physical signs.
- Sethi, Nitin. Pages: 869
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evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the quality standards subcommittee of the american academy of neurology and the american headache society.
- Tfelt-Hansen, Peer. Pages: 869-870
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| Correction |
evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the quality standards subcommittee of the american academy of neurology and the american headache society.
Pages: 871
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