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In Focus

Spotlight on the February 14 Issue

Robert A. Gross, MD, PhD


Incidence and prevalence of epilepsy among older US Medicare beneficiaries cme icon A nationwide analysis of claims data for Medicare beneficiaries 65 years old and older revealed that epilepsy was very common among older Americans. Certain populations, especially African Americans, were more at risk. A strong suspicion of seizures should be entertained as a cause of altered behavior in older people. See p. 448; editorial p. 444

"On" state freezing of gait in Parkinson disease: A paradoxical levodopa-induced complication video icon The authors present a diagnostic approach to "on" freezing of gait (FOG) during the "on state." Four patients with Parkinson disease (PD) with suspected "on" FOG were examined in the "off state," "on state," and "supra-on state." True "on" FOG exists as a rare phenotype in PD, unassociated with cognitive impairment or a predating "off" FOG. See p. 454

From editorialist Robert Chen: The different clinical features of "on" state freezing compared to the more commonly recognized forms of gait disturbance in PD may be helpful in identifying patients with this phenomenon. See p. 446

Fatal PML associated with efalizumab therapy: Insights into integrin L2 in JC virus control The authors examined 2 patients with severe psoriasis treated with efalizumab, a neutralizing antibody to L2-leukointegrin and fatal progressive multifocal leukoencephalopathy (PML). They found that inhibition of T-cell activation (peripheral and intrathecal) as well as suppression of CNS effector-phase migration characterizes anti-LFA1 (efalizumab)-associated PML. See p. 458; Comment p. 465

Age and diagnostic performance of Alzheimer disease CSF biomarkers This paper reports the effects of age on the diagnostic performance of CSF biomarkers in 529 patients with Alzheimer disease (AD) dementia, 304 controls, and 750 subjects without dementia with mild cognitive impairment, followed for at least 2 years. CSF AD biomarkers have high diagnostic accuracy in all age groups, but their performance was best in younger cases. See p. 468

Accelerated cortical atrophy in cognitively normal elderly with high B-amyloid deposition This study showed that asymptomatic individuals with significant AB deposition, as demonstrated by in vivo PiB-PET imaging, had accelerated atrophy over a period of 18 months. The presence of brain AB was associated with accelerated atrophy, suggesting that therapy aimed at reducing the neurodegenerative process should be commenced in individuals with high PiB. See p. 477

Role of obesity, metabolic variables, and diabetes in HIV associated neurocognitive disorder Obesity (body mass index) and specifically central obesity (waist circumference) were associated with neurocognitive impairment in patients with HIV as in other populations. Other components of metabolic syndrome (hypertension, hyperlipidemia, and generalized obesity) were not. Central obesity may contribute to vulnerability to neurocognitive impairment, a common problem in patients with HIV. See p. 485

Levels of heparin-releasable TFPI are increased in firstever lacunar stroke patients The authors determined antigen levels of total and free full-length tissue factor pathway inhibitor (TFPI) using ELISA in 149 lacunar stroke patients and 42 controls. While ambient plasma levels of total TFPI were not different in subtypes of lacunar stroke, the increased levels of heparin-releasable TFPI in patients suggest a role of endothelial activation in the pathogenesis of lacunar stroke. See p. 493

VIEWS & REVIEWS: Multimodal endovascular reperfusion therapies: Adjunctive antithrombotic agents in acute stroke The evolving field of endovascular techniques for acute stroke includes multimodal therapies. The authors review the role of adjunctive agents in thrombolysis and emphasize the need for further rigorous appraisal of these methods. See p. 501

NB: Resident & Fellow "Right Brain: The case library as a tool to enhance clinical observations" appears in print (see p. 512). To check out other Resident & Fellow submissions, point your browser to and click on the link to the Resident & Fellow Section.

See future Table of Contents

Neurology Podcasts™

Neurology& Podcast Cover

NEW CME Opportunity: Listen to this week's Neurology Podcast and earn 0.5 AMA PRA Category 1 CME Credits by answering the multiple-choice questions in the online Podcast Quiz

This Week's Podcast

This podcast for the Neurology Journal begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discusses highlighted articles from the February 14 issue.

In the second segment Dr. Ted Burns interviews Dr. Shin Chien Beh about his paper on a 41-year-old comatose man. Dr. Jennifer Fugate is reading our e-Pearl of the week about gait freezing. In the next part of the podcast Dr. Chafic Karam interviews Dr. Josep Dalmau about common central nervous system paraneoplastic disorders. Over the next two weeks, Dr. Karam will interview Dr. Dalmau about other paraneoplastic syndromes in neurology.

  • The participants had nothing to disclose except Drs. Burns, Fugate, Karam and Dalmau. Dr. Burns serves as Podcast Editor for Neurology; performs EMG studies in his neuromuscular practice (30% effort); and has received research support from the Myasthenia Gravis Foundation of America and Knopp Neurosciences Inc.. Dr. Fugate serves on the editorial team for the Neurology Resident and Fellow Section. Dr. Karam serves on the editorial team for the Neurology Resident and Fellow Section. Dr. Dalmau serves on the editorial board of Neurology; receives royalties from the editorial board of Up-To-Date; has filed a patent application for the use of LGI1 as a diagnostic test; has received royalties from Athena Diagnostics, Inc. for a patent re: Ma2 autoantibody test and has patents pending re: NMDA and GABAB receptor autoantibody tests (license fee payments received from EUROIMMUN AG); and receives research support from funding from EUROIMMUN AG, the NIH/NCI, and a McKnight Neuroscience of Brain Disorders award.


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