Annals of Neurology




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Annals of Neurology: Volume 89, Number 5, May 2021

doi : 10.1002/ana.26077

Annals of NeurologyVolume 89, Issue 5

A photograph of the brain of a mouse perfused with blue latex and clarified to visualize the entire vascular system. This mouse had received an injection of a viral vector targeting vascular endothelium with a mutation of the KRAS gene that was recently implicated in the genesis of arteriovenous malformations (AVMs) in humans. The tangles of blue dye seen in multiple locations in the brain represent AVMs. This method allows the detailed investigation of the development of AVMs. See Park et al., (pp. 926–941, this issue) for details.

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Issue Information

doi : 10.1002/ana.26078

Annals of NeurologyVolume 89, Issue 5 p. i-viii

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Impact of Global Health Electives on Neurology Trainees

Vanessa R. Salasky MD Deanna Saylor MD, MHS

doi : 10.1002/ana.26031

Annals of NeurologyVolume 89, Issue 5 p. 851-855

We surveyed neurologists who completed a global health experience as residents or fellows to assess the impact of the experience. A total of 100% (n = 72) would recommend the experience to others. Most reported improved clinical (86%) and examination (82%) skills. All gained an understanding of different health care systems, and 83% reported deeper commitment to underserved populations. A total of 41 participants (57%) reported more judicious use of resources upon return to the United States. Global health electives had a positive impact on neurology trainees. More attention to the host country perspective and predeparture training may help inform program structure and participant expectations in the future. ANN NEUROL 2021;89:851–855

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ANA Investigates: Neurological Complications of COVID?19 Vaccines

Adeline L. Goss MD Rohini D. Samudralwar MD Rohit R. Das MD, MPH Avindra Nath MD

doi : 10.1002/ana.26065

Annals of NeurologyVolume 89, Issue 5 p. 856-857

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The Changing Face of Cerebral Palsy

Ann H. Tilton MD Jessica S. Sanders MD

doi : 10.1002/ana.26057

Annals of NeurologyVolume 89, Issue 5 p. 858-859

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Adults with Cerebral Palsy Require Ongoing Neurologic Care: A Systematic Review

Sarah E. Smith BS Mary Gannotti PT, PhD Edward A. Hurvitz MD Frances E. Jensen MD Linda E. Krach MD Michael C. Kruer MD Michael E. Msall MD Garey Noritz MD Deepa S. Rajan MD Bhooma R. Aravamuthan MD, DPhil … See fewer authors

doi : 10.1002/ana.26040

Annals of NeurologyVolume 89, Issue 5 p. 860-871

Cerebral palsy (CP) neurologic care and research efforts typically focus on children. However, most people with CP are adults. Adults with CP are at increased risk of new neurologic conditions, such as stroke and myelopathy, that require ongoing neurologic surveillance to distinguish them from baseline motor impairments. Neurologic factors could also contribute to the motor function decline, chronic pain, and chronic fatigue that are commonly experienced by adults with CP. Based on a systematic literature review, we suggest (1) guidelines for neurologic surveillance and neurologist referral and (2) clinical research questions regarding the evolving neurologic risks for adults with CP. ANN NEUROL 2021;89:860–871

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Electroencephalographic Abnormalities are Common in COVID?19 and are Associated with Outcomes

Lu Lin MD, PhD Abrar Al?Faraj MD Neishay Ayub MD Pablo Bravo MD Sudeshna Das PhD Lorenzo Ferlini MD Ioannis Karakis MD, PhD Jong Woo Lee MD, PhD Shibani S. Mukerji MD, PhD Christopher R. Newey DO, MS Jay Pathmanathan MD Myriam Abdennadher MD Charles Casassa MD Nicolas Gaspard MD, PhD Daniel M. Goldenholz MD, PhD Emily J. Gilmore MD Jin Jing PhD Jennifer A. Kim MD, PhD Eyal Y. Kimchi MD, PhD Harshad S. Ladha MD Steven Tobochnik MD Sahar Zafar MD Lawrence J. Hirsch MD M. Brandon Westover MD, PhD Mouhsin M. Shafi MD, PhD

doi : 10.1002/ana.26060

Annals of NeurologyVolume 89, Issue 5 p. 872-883

The aim was to determine the prevalence and risk factors for electrographic seizures and other electroencephalographic (EEG) patterns in patients with Coronavirus disease 2019 (COVID?19) undergoing clinically indicated continuous electroencephalogram (cEEG) monitoring and to assess whether EEG findings are associated with outcomes.

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Genetic Variation in WNT9B Increases Relapse Hazard in Multiple Sclerosis

Marijne Vandebergh MSc Till F. M. Andlauer PhD Yuan Zhou PhD Klara Mallants BSc Friederike Held MD Lilian Aly MD Bruce V. Taylor MD, PhD Bernhard Hemmer MD, PhD Bénédicte Dubois MD, PhD An Goris PhD … See fewer authors

doi : 10.1002/ana.26061

Annals of NeurologyVolume 89, Issue 5 p. 884-894

Many multiple sclerosis (MS) genetic susceptibility variants have been identified, but understanding disease heterogeneity remains a key challenge. Relapses are a core feature of MS and a common primary outcome of clinical trials, with prevention of relapses benefiting patients immediately and potentially limiting long?term disability accrual. We aim to identify genetic variation associated with relapse hazard in MS by analyzing the largest study population to date.

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Serum Glial Fibrillary Acidic Protein: A Neuromyelitis Optica Spectrum Disorder Biomarker

Orhan Aktas MD Michael A. Smith PhD William A. Rees PhD Jeffrey L. Bennett MD, PhD Dewei She PhD Eliezer Katz MD Bruce A. C. Cree MD, PhD, MAS on behalf of the N?MOmentum scientific group and the N?MOmentum study investigators

doi : 10.1002/ana.26067

Annals of NeurologyVolume 89, Issue 5 p. 895-910

Blood tests to monitor disease activity, attack severity, or treatment impact in neuromyelitis optica spectrum disorder (NMOSD) have not been developed. This study investigated the relationship between serum glial fibrillary acidic protein (sGFAP) concentration and NMOSD activity and assessed the impact of inebilizumab treatment.

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Noninvasive Mapping of Ripple Onset Predicts Outcome in Epilepsy Surgery

Eleonora Tamilia PhD Margherita A. G. Matarrese MSc Georgios Ntolkeras MD P. Ellen Grant MD Joseph R. Madsen MD Steve M. Stufflebeam MD Phillip L. Pearl MD Christos Papadelis PhD

doi : 10.1002/ana.26066

Annals of NeurologyVolume 89, Issue 5 p. 911-925

Intracranial electroencephalographic (icEEG) studies show that interictal ripples propagate across the brain of children with medically refractory epilepsy (MRE), and the onset of this propagation (ripple onset zone [ROZ]) estimates the epileptogenic zone. It is still unknown whether we can map this propagation noninvasively. The goal of this study is to map ripples (ripple zone [RZ]) and their propagation onset (ROZ) using high?density EEG (HD?EEG) and magnetoencephalography (MEG), and to estimate their prognostic value in pediatric epilepsy surgery.

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Selective Endothelial Hyperactivation of Oncogenic KRAS Induces Brain Arteriovenous Malformations in Mice

Eun S. Park PhD Sehee Kim PhD Shuning Huang PhD Ji Young Yoo PhD Jakob K?rbelin PhD Tae Jin Lee PhD Balveen Kaur PhD Pramod K. Dash PhD Peng R. Chen MD Eunhee Kim PhD

doi : 10.1002/ana.26059

Annals of NeurologyVolume 89, Issue 5 p. 926-941

Brain arteriovenous malformations (bAVMs) are a leading cause of hemorrhagic stroke and neurological deficits in children and young adults, however, no pharmacological intervention is available to treat these patients. Although more than 95% of bAVMs are sporadic without family history, the pathogenesis of sporadic bAVMs is largely unknown, which may account for the lack of therapeutic options. KRAS mutations are frequently observed in cancer, and a recent unprecedented finding of these mutations in human sporadic bAVMs offers a new direction in the bAVM research. Using a novel adeno?associated virus targeting brain endothelium (AAV?BR1), the current study tested if endothelial KRASG12V mutation induces sporadic bAVMs in mice.

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Heritability Enrichment Implicates Microglia in Parkinson's Disease Pathogenesis

Maren Stolp Andersen MD Sara Bandres?Ciga PhD Regina H. Reynolds PhD John Hardy PhD Mina Ryten MD, PhD Lynne Krohn MSc Ziv Gan?Or MD, PhD Inge R. Holtman PhD Lasse Pihlstr?m MD, PhD the International Parkinson's Disease Genomics Consortium

doi : 10.1002/ana.26032

Annals of NeurologyVolume 89, Issue 5 p. 942-951

Understanding how different parts of the immune system contribute to pathogenesis in Parkinson's disease is a burning challenge with important therapeutic implications. We studied enrichment of common variant heritability for Parkinson's disease stratified by immune and brain cell types.

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Apolipoprotein E4 Reduction with Antisense Oligonucleotides Decreases Neurodegeneration in a Tauopathy Model

Alexandra Litvinchuk PhD Tien?Phat V. Huynh MD, PhD Yang Shi PhD Rosemary J. Jackson PhD Mary B. Finn Melissa Manis MS Caroline M. Francis BA Ainsley C. Tran BA Patrick M. Sullivan PhD Jason D. Ulrich PhD Bradley T. Hyman MD, PhD Tracy Cole PhD David M. Holtzman MD

doi : 10.1002/ana.26043

Annals of NeurologyVolume 89, Issue 5 p. 952-966

Apolipoprotein E (ApoE) genotype is the strongest genetic risk factor for late?onset Alzheimer's disease, with the ?4 allele increasing risk in a dose?dependent fashion. In addition to ApoE4 playing a crucial role in amyloid?? deposition, recent evidence suggests that it also plays an important role in tau pathology and tau?mediated neurodegeneration. It is not known, however, whether therapeutic reduction of ApoE4 would exert protective effects on tau?mediated neurodegeneration.

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Assessing Dysferlinopathy Patients Over Three Years With a New Motor Scale

Marni B. Jacobs PhD Meredith K. James PT Linda P. Lowes PT, PhD Lindsay N. Alfano DPT Michelle Eagle PT, PhD Robert Muni Lofra PT Ursula Moore MBBChir Jia Feng MSc Laura E. Rufibach PhD Kristy Rose PT, PhD Tina Duong MPT, PhD Luca Bello MD, PhD Irene Pedrosa?Hern?ndez PT Scott Holsten PT Chikako Sakamoto PT Aurélie Canal PT Nieves Sanchez?Aguilera Pr?xedes PT Simone Thiele PT Catherine Siener PT, MHS Bruno Vandevelde Brittney DeWolf PT, DPT, CCCE Elke Maron PT Michela Guglieri MD Jean?Yves Hogrel PhD Andrew M. Blamire PhD Pierre G. Carlier MD, PhD Simone Spuler MD, PhD John W. Day MD Kristi J. Jones MD, PhD Diana X. Bharucha?Goebel MD Emmanuelle Salort?Campana MD Alan Pestronk MD Maggie C. Walter MD, MA Carmen Paradas MD, PhD Tanya Stojkovic MD Madoka Mori?Yoshimura MD, PhD Elena Bravver MD Jordi D?az?Manera MD, PhD Elena Pegoraro MD, PhD Jerry R. Mendell MD The Jain COS Consortium Anna G. Mayhew PT, PhD Volker Straub MD, PhD

doi : 10.1002/ana.26044

Annals of NeurologyVolume 89, Issue 5 p. 967-978

Dysferlinopathy is a muscular dystrophy with a highly variable clinical presentation and currently unpredictable progression. This variability and unpredictability presents difficulties for prognostication and clinical trial design. The Jain Clinical Outcomes Study of Dysferlinopathy aims to establish the validity of the North Star Assessment for Limb Girdle Type Muscular Dystrophies (NSAD) scale and identify factors that influence the rate of disease progression using NSAD.

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Diagnostic Utility of Gold Coast Criteria in Amyotrophic Lateral Sclerosis

Andrew Hannaford MBBS Nathan Pavey MBBS Mehdi van den Bos PhD Nimeshan Geevasinga PhD Parvathi Menon PhD Jeremy M. Shefner MD Matthew C. Kiernan DSc Steve Vucic DSc

doi : 10.1002/ana.26045

Annals of NeurologyVolume 89, Issue 5 p. 979-986

The diagnosis of amyotrophic lateral sclerosis (ALS) remains problematic, with current diagnostic criteria (revised El Escorial [rEEC] and Awaji) being complex and prone to error. Consequently, the diagnostic utility of the recently proposed Gold Coast criteria was determined in ALS.

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Onset of Preclinical Alzheimer Disease in Monozygotic Twins

Elles Konijnenberg MD, PhD Jori Tomassen MSc Anouk den Braber PhD Mara ten Kate MD, PhD Maqsood Yaqub PhD Sandra D. Mulder PhD Michel G. Nivard PhD Hugo Vanderstichele PhD Adriaan A. Lammertsma Charlotte E. Teunissen Bart N. M. van Berckel Dorret I. Boomsma Philip Scheltens Betty M. Tijms PhD Pieter Jelle Visser MD, PhD … See fewer authors

doi : 10.1002/ana.26048

Annals of NeurologyVolume 89, Issue 5 p. 987-1000

The present work was undertaken to study the genetic contribution to the start of Alzheimer's disease (AD) with amyloid and tau biomarkers in cognitively intact older identical twins.

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Leucine Zipper 4 Autoantibody: A Novel Germ Cell Tumor and Paraneoplastic Biomarker

Divyanshu Dubey MD Thomas Kryzer AS Yong Guo MD, PhD Benjamin Clarkson PhD John C. Cheville MD Brian A. Costello MD Bradley C. Leibovich MD Alicia Algeciras?Schimnich PhD Claudia Lucchinnetti MD M. Bakri Hammami MD Andrew M. Knight PhD Charles Howe PhD Vanda A. Lennon MD, PhD Andrew McKeon MD Sean J. Pittock MD

doi : 10.1002/ana.26050

Annals of NeurologyVolume 89, Issue 5 p. 1001-1010

This study was undertaken to describe a novel biomarker of germ cell tumor and associated paraneoplastic neurological syndrome (PNS).

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Early Predictors of 9?Year Disability in Pediatric Multiple Sclerosis

Ermelinda De Meo MD Raffaello Bonacchi MD Lucia Moiola MD Bruno Colombo MD Francesca Sangalli MD Chiara Zanetta MD Maria Pia Amato MD Vittorio Martinelli MD Maria Assunta Rocca MD Massimo Filippi MD

doi : 10.1002/ana.26052

Annals of NeurologyVolume 89, Issue 5 p. 1011-1022

The purpose of this study was to assess early predictors of 9?year disability in pediatric patients with multiple sclerosis.

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Postictal Death Is Associated with Tonic Phase Apnea in a Mouse Model of Sudden Unexpected Death in Epilepsy

Ian C. Wenker PhD Frida A. Teran Eric R. Wengert Pravin K. Wagley MS Payal S. Panchal Elizabeth A. Blizzard Priyanka Saraf Jacy L. Wagnon PhD Howard P. Goodkin MD, PhD Miriam H. Meisler PhD George B. Richerson MD, PhD Manoj K. Patel PhD

doi : 10.1002/ana.26053

Annals of NeurologyVolume 89, Issue 5 p. 1023-1035

Sudden unexpected death in epilepsy (SUDEP) is an unpredictable and devastating comorbidity of epilepsy that is believed to be due to cardiorespiratory failure immediately after generalized convulsive seizures.

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Age?Related Cognitive Changes as a Function of CAG Repeat in Child and Adolescent Carriers of Mutant Huntingtin

Jordan L. Schultz PharmD Ellen van der Plas PhD Douglas R. Langbehn MD, PhD Amy L. Conrad PhD Peg C. Nopoulos MD

doi : 10.1002/ana.26039

Annals of NeurologyVolume 89, Issue 5 p. 1036-1040

Limited data exists regarding the disease course of Huntington's Disease (HD) in children and young adults. Here, we evaluate the trajectory of various cognitive skill development as a function of cytosine?adenine?guanine (CAG) repeat length in children and adolescents that carry the mutation that causes HD. We discovered that the development of verbal skills seems to plateau earlier as CAG repeat length increases. These findings increase our understanding of the relationship between neurodegeneration and neurodevelopment and may have far?reaching implications for future gene?therapy treatment strategies. ANN NEUROL 2021;89:1036–1040

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Inflammatory Cytokine Patterns Associated with Neurological Diseases in Coronavirus Disease 2019

Ot?vio M. Esp?ndola PhD Yago C. P. Gomes MSc Carlos Ot?vio Brand?o MD, PhD Rafael C. Torres PhD Marilda Siqueira PhD Cristiane N. Soares PhD Marco Antonio S. D. Lima PhD Ana Claudia C. B. Leite PhD Carolina O. Venturotti MD Ana Julia C. Carvalho MD Guilherme Torezani MD Abelardo Q. C. Araujo MD, PhD Marcus Tulius T. Silva MD, PhD

doi : 10.1002/ana.26041

Annals of NeurologyVolume 89, Issue 5 p. 1041-1045

Patients with coronavirus disease 2019 (COVID?19) can present with distinct neurological manifestations. This study shows that inflammatory neurological diseases were associated with increased levels of interleukin (IL)?2, IL?4, IL?6, IL?10, IL?12, chemokine (C?X?C motif) ligand 8 (CXCL8), and CXCL10 in the cerebrospinal fluid. Conversely, encephalopathy was associated with high serum levels of IL?6, CXCL8, and active tumor growth factor ?1. Inflammatory syndromes of the central nervous system in COVID?19 can appear early, as a parainfectious process without significant systemic involvement, or without direct evidence of severe acute respiratory syndrome coronavirus 2 neuroinvasion. At the same time, encephalopathy is mainly influenced by peripheral events, including inflammatory cytokines. ANN NEUROL 2021;89:1041–1045

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Depression and Nigral Neuron Density in Lewy Body Spectrum Diseases

Laura Saari MD Lauri Heiskanen MD Maria Gardberg MD, PhD Valtteri Kaasinen MD, PhD

doi : 10.1002/ana.26046

Annals of NeurologyVolume 89, Issue 5 p. 1046-1050

Parkinson's disease and other Lewy body spectrum diseases (LBDs) are associated with a specific risk for clinical depression. In the present clinicopathological study with 73 patients with LBD, we observed that the substantia nigra pars compacta dopamine neuron density was markedly lower in patients who had comorbid depression antemortem than in nondepressed patients (1.52 vs 2.32 n/mm2, p = 0.004). There were no differences in cognition, motor disease severity, antiparkinsonian medications, or disease duration between groups. The results implicate the substantia nigra as an important psychomotor modulatory area of mood in patients with Lewy body disorders. ANN NEUROL 2021;;89:1046–1050

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Functional Imaging of Bow Hunter's Syndrome

Menno R. Germans MD, PhD Juliane Schweizer MD Zsolt Kulcsar MD

doi : 10.1002/ana.26024

Annals of NeurologyVolume 89, Issue 5 p. 1051-1052

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Biceps Activity Synchronous with Inspiration After Phrenic Nerve Transfer

Alex Rebello MD, DM Neeraj Balaini MD, DM Sunil Gaba MS, MCh Karthik Vinay Mahesh MD, DM

doi : 10.1002/ana.26025

Annals of NeurologyVolume 89, Issue 5 p. 1053-1054

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Corrigendum for “Vision Therapy: Ocular Motor Training in Mild Traumatic Brain Injury”

Jason J. S. Barton MD, PhD, FRCPC Paul J. Ranalli MD, FRCPC

doi : 10.1002/ana.26058

Annals of NeurologyVolume 89, Issue 5 p. 1055-1055

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