Duke Neurology Research Round Up, June 2020

New research from the Duke Neurology Department advanced our understanding of neurological diseases and patient care at the basic science, translational, and clinical levels. Among other topics, our faculty, trainees, and staff found evidence for virtual reality’s potential in neurorehabilitation, tested a wearable device that can help better identify seizures, and reviewed how our understanding of the hippocampus has evolved over the past generation. Read the short paragraphs below to learn more about these and other topics, and find links to the original journal articles themselves.

Translational Brain Sciences

• Late‐onset Alzheimer’s disease (LOAD) manifests comorbid neuropsychiatric symptoms and posttraumatic stress disorder (PTSD) is associated with an increased risk for dementia in late life, suggesting the two disorders may share genetic etiologies. Lead authors Ornit Chiba-Falek, PhD, and Michael Lutz, PhD, and colleagues performed genetic pleiotropy analysis using LOAD and PTSD genome‐wide association study  datasets from white and African‐American populations, followed by functional‐genomic analyses. They found common genetic signatures for LOAD and PTSD and suggested immune response as a common pathway for these diseases. Read that study in Alzheimer’s & Dementia here.
• Over the past four decades, memory researchers have greatly expanded our understanding of the hippocampus, the horse-shaped region deep in the human brain. Simon Davis, PhD, was the senior author of a new study in the Proceedings of the National Academy of Sciences that summarizes and discusses these findings, including evidence that the hippocampus is involved in implicit and working memory as well as episodic memory, and a developing hypothesis that the hippocampus’ main purpose is to associate different kinds of information. Read that study here.
• A new Heliyon study by senior author Al La Spada, MD, PhD, found that over-expression of normal Senataxin (SETX) protein, but not enzymatically-dead SETX, is associated with S-phase cell-cycle arrest in HEK293A cells. Read that study here.

Multiple Sclerosis and Neuroimmunology

• Twitter is a tool that offers enormous potential for providers and people living with multiple sclerosis to quickly share data, best practices, tips, and other information. In a letter to the editors of Multiple Sclerosis Journal, Suma Shah, MD, discusses this potential, both as it relates to the ongoing COVID-19 pandemic and in general. Read that letter here.

Stroke and Neurocritical Care

• A new Stroke study co-authored by Michael “Luke” James, MD, evaluated both MRI markers and APOE genotype predicted recurrence of intracerebral hemorrhage. They then developed a preliminary classification system to use this data to stratify patients’ likelihood of recurrence into low, medium or high risk. Read that study here.
• A new randomized controlled trial co-authored by Wuwei “Wayne” Feng, MD, examined the benefits of cathodal transcranial direct current stimulation (c-tDCS)  in reducing motor impairment and improving upper limb function and quality of life in stroke patients. Forty stroke patients were assigned to either c-tDCS with virtual reality (VR) or, as a control group, VR alone. While both groups saw improvement, improvements in the experimental group were significantly higher. Read the article in the Journal of Neuroengineering and Rehabilitation.
• James also contributed to a Neurocritical Care study that examined whether reductions in systolic blood pressure after intracerebral hemorrhage affected patient outcomes. Their results suggest that for early SBP reduction to have an effective therapeutic effect, both target levels and optimum SBP reduction goals vis-à-vis hematoma volume should be considered. Read that study here.

Clinical Neurophysiology

• Aatif Husain, MD, was the senior author of a new study in the Journal of Clinical Neurophysiology that offers a potential pathway to better differentiate between epileptic seizures and psychogenic nonepileptic seizures: a surface electromyography device patients can wear on their arms. Their analysis of 17 patients experiencing 34 events found that the wearable device offers potential for differentiation both by automated and expert review. Read that article here.

Memory Disorders

• A new systematic review protocol outlined by senior author Brenda Plassman, PhD, aims to identify risk and protective factors of dementia among adults with post-traumatic stress disorder. Read more in the British Medical Journal Open.

Stroke and Neurocritical Care

• A new JAMA article co-written by Ying Xian, MD, PhD, found that longer door-to-needle times were associated with higher all-cause mortality and higher likelihood of all-cause readmission among patients with acute ischemic stroke treated with intravenous tissue plasminogen activator. Read this retrospective cohort study of more than 60,000 patients here.
• Xian also contributed to a systematic review and network meta-analysis that compared and ranked all available treatment interventions for depressive disorders in children and adolescents. Their analysis found that fluoxetine (alone or with cognitive and behavioral therapy) appeared in general to be the best choice for acute treatment of moderate-to-severe depressive disorder in children and adolescents. The authors cautioned however, that the effects of these interventions varied between individuals, so decision should be made on a case-by-case basis. Read that study here.
• Senior author Jeffrey Guptill, MD, MHS, as well as Daniel Laskowitz, MD, MHS, Shruti Raja, MD, and colleagues, contributed to the first-in-human, randomized, double-blind, placebo-controlled phase 1 studies to evaluate the safety, tolerability, and pharmacokinetics of MW189, a novel central nervous system-penetrant small-molecule drug with potential to help patients with intracerebral hemorrhage or traumatic brain injury. Read about that trial in Clinical Pharmacology in Drug Development.
• Autoimmune encephalitis (AE) is a group of disorders causing synaptic receptor dysfunction with a broad range of neurological symptoms that has been historically difficult to differentiate clinically. In the latest issue of Neurotherapeutics senior authors Brad Kolls, MD, PhD, and graduating Neurocritical Care Fellow Alok Saghal, MD, as well as Yasmin O’Keefe, MD, review the epidemiology, clinical features and treatments, and basic science tools and techniques relevant to a subtype of this condition, NMDA receptor mediated autoimmune encephalitis (NMDAr-AE). Read that article here. 

Other topics

• Thomas Farrer, PhD is a co-author of a new workbook, Essentials of the California Verbal Learning Test: CVLT-C, CVLT-2, & CVLT3. This book covers the administration, scoring, and interpretation of those three tests. It also includes a discussion of the strengths and weaknesses of the assessment, a review of the CVLT’s performance in clinical populations, and illustrative case reports. Read more about the book here.