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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
Climate Change
Merino, Jose G. MD, MPhil
doi : 10.1212/WNL.0000000000012692
Volume 97(14), 5 October 2021, p 657
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
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
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
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
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.
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.
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).
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.
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).
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]).
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.
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.
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.
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.
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
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
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
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
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
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
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
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
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
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
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
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
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
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
