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Spotlight on the October 5 Issue

Merino, Jose G. MD, MPhil; Editor-in-Chief, Neurology(R)

doi : 10.1212/WNL.0000000000012658

Volume 97(14), 5 October 2021, p 655-656

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Climate Change

Merino, Jose G. MD, MPhil

doi : 10.1212/WNL.0000000000012692

Volume 97(14), 5 October 2021, p 657

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Call for Emergency Action to Limit Global Temperature Increases, Restore Biodiversity, and Protect Health: Wealthy Nations Must Do Much More, Much Faster

Atwoli, Lukoye; Baqui, Abdullah H.; Benfield, Thomas; Bosurgi, Raffaella; Godlee, Fiona; Hancocks, Stephen; Horton, Richard; Laybourn-Langton, Laurie; Monteiro, Carlos Augusto; Norman, Ian; Patrick, Kirsten; Praities, Nigel; Olde Rikkert, Marcel G.M.; Rubin, Eric J.; Sahni, Peush; Smith, Richard; Talley, Nick; Turale, Sue; Vazquez, Damian

doi : 10.1212/WNL.0000000000012691

Volume 97(14), 5 October 2021, p 658-660

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Recognition of Movement Disorders as Cardinal Features of Anti-IgLON5 Disease: Expanding the Clinical Spectrum

Atadzhanov, Masharip MD, PhD; Chishimba, Lorraine BScHB, MBChB, MMED

doi : 10.1212/WNL.0000000000012636

Volume 97(14), 5 October 2021, p 661-662

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People With Myasthenia Are Getting Better, but Are They Doing Well?

Atkins, Chloe PhD; Barnett, Carolina MD, PhD

doi : 10.1212/WNL.0000000000012617

Volume 97(14), 5 October 2021, p 663-664

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Investigating Early Neurologic Deterioration in Lacunar Strokes Reveals Need for New Approaches

Jaillard, Assia MD, PhD

doi : 10.1212/WNL.0000000000012657

Volume 97(14), 5 October 2021, p 665-666

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Frequency and Characterization of Movement Disorders in Anti-IgLON5 Disease

Gaig, Carles MD, PhD*; Compta, Yaroslau MD, PhD; Heidbreder, Anna MD; Marti, Maria J. MD, PhD; Titulaer, Maarten J. MD, PhD; Crijnen, Yvette MD; Hogl, Birgit MD; Lewerenz, Jan MD; Erro, Maria Elena MD, PhD; Garcia-Monco, Juan Carlos MD, PhD; Nigro, Pasquale MD; Tambasco, Nicola MD; Patalong-Ogiewa, Maja MD; Erdler, Marcus MD; Macher, Stefan MD; Berger-Sieczkowski, Evelyn MD, PhD; Hoftberger, Romana MD; Geis, Christian MD; Hutterer, Markus MD; Milan-Tomas, Angela MD; Martin-Bastida, Antonio MD; Manzanares, Lydia Lopez MD; Quintas, Sonia MD; Hoglinger, Gunter U. MD; Mohn, Nora MD; Schoberl, Florian MD; Thaler, Franziska S. MD; Asioli, Gian Maria MD; Provini, Federica MD, PhD; Plazzi, Giuseppe MD, PhD; Berganzo, Koldo MD; Blaabjerg, Morten MD; Bruggemann, Norbert MD; Farias, Tarsis MD; Ng, Chen Fei MD; Giordana, Caroline MD; Herrero-San Martin, Alejandro MD; Huebra, Lucio MD; Kotschet, Katya MD; Liendl, Herburg MD; Montojo, Teresa MD; Morata, Carlos MD; Perez-Perez, Jesus MD; Puertas, Inmaculada MD, PhD; Seifert-Held, Thomas MD; Seitz, Caspar MD; Simabukuro, Mateus Mistieri MD; Tellez, Nieves MD; Villacieros-Alvarez, Javier MD; Willekens, Barbara MD; Sabater, Lidia PhD; Iranzo, Alex MD, PhD; Santamaria, Joan MD, PhD; Dalmau, Josep MD, PhD; Graus, Francesc MD, PhD*

doi : 10.1212/WNL.0000000000012639

Volume 97(14), 5 October 2021, p e1367-e1381

Anti-IgLON5 disease is a recently described neurologic disease that shares features of autoimmunity and neurodegeneration. Abnormal movements appear to be frequent and important but have not been characterized and are underreported. We describe the frequency and types of movement disorders in a series of consecutive patients with this disease.

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Patient-Reported Symptom Severity in a Nationwide Myasthenia Gravis Cohort: Cross-sectional Analysis of the Swedish GEMG Study

Petersson, Malin MD; Feresiadou, Amalia MD; Jons, Daniel MD; Ilinca, Andreea MD, PhD; Lundin, Fredrik MD, PhD; Johansson, Rune MD; Budzianowska, Anna MD; Roos, Anna-Karin MD; Kagstrom, Viktor MD; Gunnarsson, Martin MD, PhD; Sundstrom, Peter MD, PhD; Piehl, Fredrik MD, PhD; Brauner, Susanna MD, PhD

doi : 10.1212/WNL.0000000000012604

Volume 97(14), 5 October 2021, p e1382-e1391

To describe myasthenia gravis activities of daily living (MG-ADL) in relation to clinical characteristics in a large Swedish nationwide cohort.

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Pure Motor Onset and IgM-Gammopathy Occurrence in Multifocal Acquired Demyelinating Sensory and Motor Neuropathy

Beecher, Grayson MD*; Shelly, Shahar MD*; Dyck, P. James B. MD; Mauermann, Michelle L. MD; Martinez-Thompson, Jennifer M. MD; Berini, Sarah E. MD; Naddaf, Elie MD; Shouman, Kamal MD; Taylor, Bruce V. MD; Dyck, Peter James MD; Engelstad, JaNean HT; Howe, Benjamin M. MD; Mills, John R. PhD; Dubey, Divyanshu MD; Spinner, Robert J. MD; Klein, Christopher J. MD

doi : 10.1212/WNL.0000000000012618

Volume 97(14), 5 October 2021, p e1392-e1403

To longitudinally investigate patients with multifocal acquired demyelinating sensory and motor neuropathy (MADSAM), quantifying timing and location of sensory involvements in motor onset patients, along with clinicohistopathologic and electrophysiologic findings to ascertain differences in patients with and without monoclonal gammopathy of uncertain significance (MGUS).

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Perception and Use of Compensation Strategies for Gait Impairment by Persons With Parkinson Disease

Tosserams, Anouk MD; Wit, Lisanne BSc; Sturkenboom, Ingrid H.W.M. PhD; Nijkrake, Maarten J. PT PhD; Bloem, Bastiaan R. MD PhD; Nonnekes, Jorik MD PhD

doi : 10.1212/WNL.0000000000012633

Volume 97(14), 5 October 2021, p e1404-e1412

Gait impairments are common and disabling in Parkinson disease (PD). Applying compensation strategies helps to overcome these gait deficits. Clinical observations suggest that the efficacy of different compensation strategies varies depending on both individual patient characteristics and the context in which the strategies are applied. This has never been investigated systematically, hampering the ability of clinicians to provide a more personalized approach to gait rehabilitation. We had 3 aims: (1) to evaluate patients' awareness and actual use of compensation categories for gait impairments in PD, (2) to investigate the patient-rated efficacy of the various compensation strategies and whether this efficacy depends on the context in which the strategies are applied, and (3) to explore differences in the efficacy between subgroups based on sex, age, disease duration, freezing status, and ability to perform a dual task.

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Changes in Cortical Excitability and Parkinson Tremor After Botulinum Toxin Therapy

Samotus, Olivia MSc; Chen, Robert MBBChir, MSc; Jog, Mandar MD

doi : 10.1212/WNL.0000000000012662

Volume 97(14), 5 October 2021, p e1413-e1424

To investigate the relationship between botulinum toxin type A (BoNT-A) administration, tremor amplitude, and modulation of intracortical excitability and sensorimotor processing using paired-pulse transcranial magnetic stimulation (pp-TMS) in patients with early, tremor-dominant Parkinson disease (PD).

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Placebo-Controlled Clinical Trial of IncobotulinumtoxinA for Sialorrhea in Children: SIPEXI

Berweck, Steffen MD; Bonikowski, Marcin MD, PhD; Kim, Heakyung MD; Althaus, Michael MD, FFPM; Flatau-Baque, Birgit; Mueller, Daniela PhD; Banach, Marta Dagmara MD, PhD

doi : 10.1212/WNL.0000000000012573

Volume 97(14), 5 October 2021, p e1425-e1436

To investigate the efficacy and safety of repeated injections of incobotulinumtoxinA (incoBoNT/A) for treatment of chronic sialorrhea (drooling) associated with neurologic disorders (e.g., cerebral palsy, traumatic brain injury) or intellectual disability in children and adolescents in a prospective phase III study (SIPEXI [Sialorrhea Pediatric Xeomin Investigation]).

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Early Neurologic Deterioration in Lacunar Stroke: Clinical and Imaging Predictors and Association With Long-term Outcome

Vynckier, Jan MD; Maamari, Basel MD; Grunder, Lorenz MD; Goeldlin, Martina Beatrice MD; Meinel, Thomas Raphael MD; Kaesmacher, Johannes MD; Hakim, Arsany MD; Arnold, Marcel MD; Gralla, Jan MD, MSc; Seiffge, David Julian MD*; Fischer, Urs MD, MSc*

doi : 10.1212/WNL.0000000000012661

Volume 97(14), 5 October 2021, p e1437-e1446

To determine the rate and predictors of early neurologic deterioration (END) in patients with lacunar strokes and its implications for management and outcome.

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Colorectal Cancer Survival in Multiple Sclerosis: A Matched Cohort Study

Marrie, Ruth Ann MD, PhD; Maxwell, Colleen PhD; Mahar, Alyson PhD; Ekuma, Okechukwu MSc; McClintock, Chad MSc; Seitz, Dallasl MD, PhD; Groome, Patti PhD

doi : 10.1212/WNL.0000000000012634

Volume 97(14), 5 October 2021, p e1447-e1456

We tested the hypothesis that overall and cancer-specific survival after a colorectal cancer diagnosis is lower in persons with multiple sclerosis (MS) than in those without MS using a retrospective matched cohort design.

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Contemporary Neuroscience Core Curriculum for Medical Schools

Gelb, Douglas J. MD, PhD, FAAN*; Kraakevik, Jeff MD*; Safdieh, Joseph E. MD, FAAN; Agarwal, Sachin MD, MPH; Odia, Yazmin MD, MS, FAAN; Govindarajan, Raghav MD, FAAN; Quick, Adam MD; Soni, Madhu MD, FAAN[S]; and the AAN Undergraduate Education Subcommittee (UES); Bickel, Jennifer MD, FAAN+; Gamaldo, Charlene MD, FAAN+; Hannon, Peter MD+; Hatch, Hayden A.M. MS+; Hernandez, Christian MD+; Merlin, Lisa R. MD, FAAN+; Noble, James M. MD, FAAN+; Reyes-Iglesias, Yolanda MD+; Salas, Rachel Marie E. MD, FAAN+; Sandness, David James MD+; Treat, Lauren MD+; and the AAN Education Committee; Benameur, Karima MD++; Brown, Robert D. Jr MD, FAAN++; DeLuca, Gabriele C. MD, PhD, FAAN++; Garg, Neeta MD++; Goldstein, Larry B. MD, FAAN, FAHA++; Gutmann, Laurie MD, FAAN++; Henchcliffe, Claire MD, PhD, FAAN++; Hessler, Amy DO, FAAN++; Jordan, Justin T. MD, MPH, FAAN++; Kilgore, Shannon M. MD, FAAN++; Khan, Jaffar MD, FAAN++; Levin, Kerry H. MD, FAAN++; Mohile, Nimish A. MD, FAAN++; Nevel, Kathryn S. MD++; Roberts, Kirk MD, FAAN++; Said, Rana R. MD, FAAN++; Simpson, Ericka P. MD, FAAN++; Sirven, Joseph I. MD, FAAN++; Smith, A. Gordon MD, FAAN++; Southerland, Andrew Mebane MD++; Wilson, Rujuta B. MD++

doi : 10.1212/WNL.0000000000012664

Volume 97(14), 5 October 2021, p 675-684

Medical students need to understand core neuroscience principles as a foundation for their required clinical experiences in neurology. In fact, they need a solid neuroscience foundation for their clinical experiences in all other medical disciplines also because the nervous system plays such a critical role in the function of every organ system. Because of the rapid pace of neuroscience discoveries, it is unrealistic to expect students to master the entire field. It is also unnecessary, as students can expect to have ready access to electronic reference sources no matter where they practice. In the preclerkship phase of medical school, the focus should be on providing students with the foundational knowledge to use those resources effectively and interpret them correctly. This article describes an organizational framework for teaching the essential neuroscience background needed by all physicians. This is particularly germane at a time when many medical schools are reassessing traditional practices and instituting curricular changes such as competency-based approaches, earlier clinical immersion, and increased emphasis on active learning. This article reviews factors that should be considered when developing the preclerkship neuroscience curriculum, including goals and objectives for the curriculum, the general topics to include, teaching and assessment methodology, who should direct the course, and the areas of expertise of faculty who might be enlisted as teachers or content experts. These guidelines were developed by a work group of experienced educators appointed by the Undergraduate Education Subcommittee (UES) of the American Academy of Neurology (AAN). They were then successively reviewed, edited, and approved by the entire UES, the AAN Education Committee, and the AAN Board of Directors.

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Ethical Perspectives on Costly Drugs and Health Care: AAN Position Statement

Tsou, Amy Y. MD, MSc; Graf, William D. MD; Russell, James A. DO, MS; Epstein, Leon G. MD; on behalf of the Ethics, Law, and Humanities Committee, a joint committee of the American Academy of Neurology (AAN), American Neurological Association (ANA), and Child Neurology Society (CNS); on behalf of the Ethics, Law, and Humanities Committee, a joint committee of the American Academy of Neurology (AAN), American Neurological Association (ANA), and Child Neurology Society (CNS)

doi : 10.1212/WNL.0000000000012571

Volume 97(14), 5 October 2021, p 685-692

High drug prices have created substantial challenges for patients, physicians, health systems, and payers. High drug prices can affect patient care in many ways, including limiting access to treatment, increasing the burden of administrative tasks, and contributing to physician burnout. Exorbitant drug pricing poses direct challenges for distributive justice, which is concerned with fairly distributing benefits and burdens across society. In this position statement, we discuss ethical concerns raised by high drug costs, primarily focusing on concerns around distributive justice. We consider forms of rationing, approaches to allocation, potential complexities in real-life application, and structural forces contributing to high drug costs. Finally, we consider potential policy solutions and ramifications for individual clinicians.

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Scalloping Spine in a Patient With Type 1 Neurofibromatosis

Soni, Aayesha MBBCh (Wits) DipPEC (SA) DA (SA)

doi : 10.1212/WNL.0000000000012556

Volume 97(14), 5 October 2021, p 693

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Leukoencephalopathy With Calcifications and Cysts Associated With SNORD118 Variants

Francis, Anna G. BMBCh, MSc; Boca, Mihaela MD; Urankar, Kathryn BSc; Cox, Anthony MBBS; Clatworthy, Philip PhD; Rice, Claire PhD

doi : 10.1212/WNL.0000000000012635

Volume 97(14), 5 October 2021, p 694-695

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Child Neurology: Recurrent Brainstem Strokes and Aphthous Ulcers in a Child With Mutations in the ADA2 Gene

Mo, Alisa MD, PhD; Donatelli, Stephanie MD; Benson, Leslie A. MD; Lee, Pui Y. MD, PhD; Rivkin, Michael J. MD

doi : 10.1212/WNL.0000000000012271

Volume 97(14), 5 October 2021, p 696-699

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Pearls & Oy-sters: Trigeminal Nerve Dysfunction as the Key Diagnostic Clue to Listeria Rhombencephalitis

Hue, Christopher Donald MD, PhD; Bullrich, Maria Bres MD; Lam Shin Cheung, Victor Christopher MD; Sharma, Amit Kumar MD; Syed, Asma Saba MD, FRCPC; Pandey, Sachin Kishore MD, FRCPC; Morrow, Sarah Anne MD, FRCPC, MS; Debicki, Derek Brian MD, FRCPC, PhD

doi : 10.1212/WNL.0000000000012273

Volume 97(14), 5 October 2021, p e1457-e1460

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Teaching NeuroImage: Abducens Nerve Palsy With Ipsilateral Excessive Eye Tearing Attributed to an Internal Carotid Artery Sympathetic Plexus Schwannoma

Palaiodimou, Lina MD; Lachanis, Stefanos MD; Bakola, Eleni MD; Zis, Panagiotis MD; Kararizou, Evangelia MD; Papadopoulou, Marianna MD; Tsivgoulis, Georgios MD

doi : 10.1212/WNL.0000000000012183

Volume 97(14), 5 October 2021, p e1461-e1463

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Teaching NeuroImage: Concomitant Brain and Spine Lesions due to Multiple Nutritional Deficiencies

Alshaer, Qasem N. MD; Garcia-Santibanez, Rocio MD

doi : 10.1212/WNL.0000000000012186

Volume 97(14), 5 October 2021, p e1464-e1465

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Editors' Note: What Is the Mechanism of Therapeutic and Adverse Effects of Gabapentinoids?

Ganesh, Aravind MD, DPhil, FRCPC; Galetta, Steven MD

doi : 10.1212/WNL.0000000000012665

Volume 97(14), 5 October 2021, p 700

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Reader Response: What Is the Mechanism of Therapeutic and Adverse Effects of Gabapentinoids?

Gazulla, Jose; Ruiz-Fernandez, Emilio; Berciano, Jose

doi : 10.1212/WNL.0000000000012667

Volume 97(14), 5 October 2021, p 700-701

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Author Response: What Is the Mechanism of Therapeutic and Adverse Effects of Gabapentinoids?

Benarroch, Eduardo E.

doi : 10.1212/WNL.0000000000012668

Volume 97(14), 5 October 2021, p 701

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Editors' Note: Prediction of Long-term Cognitive Function After Minor Stroke Using Functional Connectivity

Ganesh, Aravind MD, DPhil, FRCPC; Galetta, Steven MD

doi : 10.1212/WNL.0000000000012669

Volume 97(14), 5 October 2021, p 702

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Reader Response: Prediction of Long-term Cognitive Function After Minor Stroke Using Functional Connectivity

Lozada-Martinez, Ivan; Prada-Soto, Silvia; Moscote-Salazar, Luis; Pacheco-Hernandez, Alfonso; Lester-Nahar, Bryan

doi : 10.1212/WNL.0000000000012670

Volume 97(14), 5 October 2021, p 702-703

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Author Response: Prediction of Long-term Cognitive Function After Minor Stroke Using Functional Connectivity

Lopes, Renaud; Bournonville, Clement; Kuchcinski, Gregory

doi : 10.1212/WNL.0000000000012671

Volume 97(14), 5 October 2021, p e703

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Video NeuroImages: Idiopathic Recurring Stupor: An Unusual Clinical Condition Responding to Flumazenil

doi : 10.1212/WNL.0000000000012132

Volume 97(14), 5 October 2021, p 704

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AAN's First 21st-Century Position Statement on Ethical Consideration in Dementia Diagnosis and Care

doi : 10.1212/WNL.0000000000012606

Volume 97(14), 05 October 2021, p 704

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