Neurology

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Spotlight on the January 11 Issue

José G. Merino

doi : 10.1212/WNL.0000000000013062

vol. 98 no. 2 51-52

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What's Left in Neglect Research?

Amy Brodtmann, Tobias Loetscher

doi : 10.1212/WNL.0000000000013051

vol. 98 no. 2 53-54

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Disruptions of the Human Connectome Associated With Hemispatial Neglect

Sadhvi Saxena, Zafer Keser, Chris Rorden, Leonardo Bonilha, Julius Fridriksson, Alexandra Walker, Argye Elizabeth Hillis

doi : 10.1212/WNL.0000000000013050

vol. 98 no. 2 e107-e114

Hemispatial neglect is a heterogeneous and complex disorder that can be classified by frame of reference for “left” vs “right,” including viewer-centered neglect (VCN, affecting the contralesional side of the view), stimulus-centered neglect (SCN, affecting the contralesional side of the stimulus, irrespective of its location with respect to the viewer), or both. We investigated the effect of acute stroke lesions on the connectivity of neural networks that underlie VCN or SCN.

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Risk of Stroke in Nasopharyngeal Cancer Survivors

Teng Hwee Tan, Huili Zheng, Timothy Cheo, Jeremy Tey, Yu Yang Soon

doi : 10.1212/WNL.0000000000013058

vol. 98 no. 2 e115-e124

We aim to determine the risk of stroke and death within 30 days after stroke in nasopharyngeal cancer (NPC) survivors.

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Effect of Levetiracetam Use Duration on Overall Survival of Isocitrate Dehydrogenase Wild-Type Glioblastoma in Adults

Johan Pallud, Gilles Huberfeld, Edouard Dezamis, Sophie Peeters, Alessandro Moiraghi, Martine Gavaret, Eléonore Guinard, Frédéric Dhermain, Pascale Varlet, Catherine Oppenheim, Fabrice Chrétien, Alexandre Roux, Marc Zanello

doi : 10.1212/WNL.0000000000013005

vol. 98 no. 2 e125-e140

The association between levetiracetam and survival with isocitrate dehydrogenase (IDH) wild-type glioblastomas is controversial. We investigated whether the duration of levetiracetam use during the standard chemoradiation protocol affects overall survival (OS) of patients with IDH wild-type glioblastoma.

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Association Between Anatomical Location of Surgically Induced Lesions and Postoperative Seizure Outcome in Temporal Lobe Epilepsy

Ezequiel Gleichgerrcht, Daniel L. Drane, Simon S. Keller, Kathryn A. Davis, Robert Gross, Jon T. Willie, Nigel Pedersen, Christophe de Bezenac, Jens Jensen, Ruben Kuzniecky, Leonardo Bonilha

doi : 10.1212/WNL.0000000000013033

vol. 98 no. 2 e141-e151

To determine the association between surgical lesions of distinct gray and white structures and connections with favorable postoperative seizure outcomes.

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Bilateral Structural Network Abnormalities in Epilepsy Associated With Bottom-of-Sulcus Dysplasia

Remika Mito, David N. Vaughan, Mira Semmelroch, Alan Connelly, Graeme D. Jackson

doi : 10.1212/WNL.0000000000013006

vol. 98 no. 2 e152-e163

To identify white matter fiber tracts that exhibit structural abnormality in patients with bottom-of-sulcus dysplasia (BOSD) and investigate their association with seizure activity.

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Evaluating the Efficacy of an Online Learning Tool for EEG Teaching

Melody Tunsubilege Asukile, Charle A. Viljoen, Edward Lee Pan, Roland Eastman, Lawrence Maskew Tucker

doi : 10.1212/WNL.0000000000012996

vol. 98 no. 2 e164-e173

To determine the effectiveness of a 6-month, interactive, multimodal, Web-based EEG teaching program (EEGonline) in improving EEG analysis and interpretation skills for neurologists, neurology residents, and technologists, particularly in resource-limited settings.

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N-of-1 Trials in Neurology

Bas C. Stunnenberg, Joost Berends, Robert C. Griggs, Jeffrey Statland, Gea Drost, Jane Nikles, Hans Groenewoud, Baziel G.M. van Engelen, Gert Jan van der Wilt, Joost Raaphorst

doi : 10.1212/WNL.0000000000012998

vol. 98 no. 2 e174-e185

To perform a systematic review of published N-of-1 trials (e.g., single patient crossover trials) in neurologic disorders, including an assessment of methodologic quality and reporting.

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Proteomic Discovery of Noninvasive Biomarkers Associated With Sport-Related Concussions

Cassandra C. Daisy, Speros Varinos, David R. Howell, Katherine Kaplan, Rebekah Mannix, William P. Meehan, Francis Wang, Brant Berkstresser, Richard S. Lee, John W. Froehlich, David Zurakowski, Marsha A. Moses

doi : 10.1212/WNL.0000000000013001

vol. 98 no. 2 e186-e198

Sport-related concussions affect millions of individuals across the United States each year, and current techniques to diagnose and monitor them rely largely on subjective measures. Our goal was to discover and validate objective, quantifiable noninvasive biomarkers with the potential to be used in sport-related concussion diagnosis.

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GGC Repeat Expansion of NOTCH2NLC in Taiwanese Patients With Inherited Neuropathies

Yi-Chu Liao, Fu-Pang Chang, Han-Wei Huang, Ting-Bing Chen, Ying-Tsen Chou, Shao-Lun Hsu, Kang-Yang Jih, Yi-Hong Liu, Cheng-Tsung Hsiao, Hiromi Fukukda, Takeshi Mizuguchi, Kon-Ping Lin, Chou-Ching K. Lin, Naomichi Matsumoto, Marina Kennerson, Yi-Chung Lee

doi : 10.1212/WNL.0000000000013008

vol. 98 no. 2 e199-e206

The GGC repeat expansion in the 5? untranslated region of NOTCH2NLC was recently identified as the cause of neuronal intranuclear inclusion disease (NIID), which may manifest with peripheral neuropathy. The aim of this study is to investigate its contribution to inherited neuropathy.

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Comment: Introducing Neuromodulation in 2035

Lyell K. Jones, Robert A. Gross

doi : 10.1212/WNL.0000000000013064

vol. 98 no. 2 64

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Neuromodulation in 2035

Tim Denison, Martha J. Morrell

doi : 10.1212/WNL.0000000000013061

vol. 98 no. 2 65-72

Neuromodulation devices are approved in the United States for the treatment of movement disorders, epilepsy, pain, and depression, and are used off-label for other neurologic indications. By 2035, advances in our understanding of neuroanatomical networks and in the mechanism of action of stimulation, coupled with developments in material science, miniaturization, energy storage, and delivery, will expand the use of neuromodulation devices. Neuromodulation approaches are flexible and modifiable. Stimulation can be targeted to a dysfunctional brain focus, region, or network, and can be delivered as a single treatment, continuously, according to a duty cycle, or in response to physiologic changes. Programming can be titrated and modified based on the clinical response or a physiologic biomarker. In addition to keeping pace with clinical and technological developments, neurologists in 2035 will need to navigate complex ethical and economic considerations to ensure access to neuromodulation technology for a rapidly expanding population of patients. This article provides an overview of systems in use today and those that are anticipated and highlights the opportunities and challenges for the future, some of which are technical, but most of which will be addressed by learning about brain networks, and from rapidly growing experience with neuromodulation devices.

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Consent Issues in the Management of Acute Ischemic Stroke

Justin A. Sattin, Winston Chiong, Richard J. Bonnie, Matthew P. Kirschen, James A. Russell, on behalf of the Ethics, Law, and Humanities Committee, a joint committee of the American Academy of Neurology, American Neurological Association, and Child Neurology Society

doi : 10.1212/WNL.0000000000013040

vol. 98 no. 2 73-79

This position statement briefly reviews the principle of informed consent, the elements of decisional capacity, and how acute stroke may affect this capacity. It further reviews the role of surrogate decision-making, including advance directives, next of kin, physician orders for life-sustaining treatment, and guardianship. In some cases of acute stroke in which the patient lacks decisional capacity and no advance directives or surrogates are available, consent to treatment may be presumed. The document describes the rationale for this position and various considerations regarding its application to IV thrombolysis, neuroendovascular intervention, decompressive craniectomy, and pediatric stroke. The document also reviews consent issues in acute stroke research.

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