Faculty Bibliography

OBJECTIVE:To investigate clinical characteristics and treatment patterns in persistent post-traumatic headache attributed to mild traumatic brain injury. METHODS:A total of 100 individuals with persistent post-traumatic headache attributed to mild traumatic brain injury were enrolled between July 2018 and June 2019. Deep phenotyping was performed using a semi-structured interview while allodynia was assessed using the 12-item Allodynia Symptom Checklist. RESULTS:In 100 subjects with persistent post-traumatic headache, the mean headache frequency was 25.4 ± 7.1 days per month. The most common headache phenotype was chronic migraine-like headache (n = 61) followed by combined episodic migraine-like and tension-type-like headache (n = 29) while nine subjects reported "pure" chronic tension-type-like headache. The most frequent trigger factors were stress, lack of sleep, and bright lights. A history of preventive medication use was reported by 63 subjects, of which 79% reported failure of at least one preventive drug, while 19% reported failure of at least four preventive drugs. Cutaneous allodynia was absent in 54% of the subjects, mild in 23%, moderate in 17%, and severe in 6%. CONCLUSIONS:The headache profile of individuals with persistent post-traumatic headache most often resembled a chronic migraine-like phenotype or a combined episodic migraine-like and tension-type-like headache phenotype. Migraine-specific preventive medications were largely reported to be ineffective. Therefore, there is a pressing need for pathophysiological insights and disease-specific therapies.

INTRODUCTION/BACKGROUND:Horner's syndrome has been reported after carotid artery endarterectomy (CEA) and carotid artery stenting (CS). This study evaluates pupillary changes after these procedures using automated pupillometry. METHODS:Retrospective analysis from a prospective database of pupillometry readings. Cases (14 patients with CEA/CS) were matched to controls (14 patients without CEA/CS). t test models were constructed to examine pupillary light reflex measures for CEA, CS, and controls. RESULTS:The 28 subjects had a mean age of 70 years, 50% were male, and 96% were Caucasian. There was no significant difference in the mean pupil size, constriction velocity (CV), dilation velocity (DV) between the procedural side compared to the contralateral side. However, the mean DV in the left eye after a left sided procedure among CS patients (.67) was lower than mean DV in left eye among controls (.88; P < .0001) and patients undergoing CEA (1.03; P < .0001). DISCUSSION/CONCLUSIONS:CS may result in disruption of the carotid artery plexus and decreased sympathetic response thereby reducing DV in the ipsilateral pupil. In addition, decreased CV can also been seen. CONCLUSION/CONCLUSIONS:The findings confirm and extend those of previous authors suggesting that pupillary changes may be seen after CS and automated handheld pupillometry may aid in the detection of Horner Syndrome.

OBJECTIVE:Individuals with a diagnosis of multiple sclerosis (MS) often present with cognitive and motor deficits, and thus the ability to perform tasks that rely on both domains may be particularly impaired. Yet, dual-task walking studies yield mixed results. Individual variance in the ability to cope with brain insult and mobilize additional brain resources may contribute to mixed findings. METHODS:To test this hypothesis, we acquired event-related potentials (ERP) in individuals with MS and healthy controls (HCs) performing a Go/NoGo task while sitting (i.e., single task) or walking (i.e., dual-task) and looked at the relationship between task related modulation of the brain response and performance. RESULTS:On the Go/NoGo task the MS group showed dual-task costs when walking, whereas HCs showed a dual-task benefit. Further, whereas the HC group showed modulation of the brain response as a function of task load, this was not the case in the MS group. Analysis for the pooled sample revealed a positive correlation between load-related ERP effects and dual-task performance. CONCLUSIONS:These data suggest a neurophysiological marker of cognitive-motor dysfunction in MS. SIGNIFICANCE/CONCLUSIONS:Understanding neural processes underlying dual-task walking will help identify objective brain measurements of real-world issues and may improve assessment of MS.

Medicines currently used in the management of epilepsy have been developed to suppress seizures, and they have no known impact on the underlying disease. Using the term "antiepileptic" to describe these compounds is misleading because it suggests an action on the epilepsy itself. Pharmacological agents that have a merely symptomatic effect should be referred to as antiseizure medicines. Using appropriate terminology is especially important at a time innovative treatments targeting the development of epilepsy and its comorbidities are being actively pursued.

There has been considerable public interest in the topic of traumatic brain injury (TBI) as a risk factor for development of late-life dementia. A review was performed on empirical studies examining the relationship between these two conditions. Although results from a number of studies clearly demonstrate that TBI is a positive risk factor for developing dementia, there are an equivalent number of studies that obtain inconclusive or negative findings. Inconsistencies across studies are often the result of methodological findings including the nature of the investigational design, choice of comparison groups, and criteria used to define cases. In many studies, the diagnosis of TBI is obtained retrospectively in a manner that is subject to bias. Accurate identification of dementia cases is often compromised by the use of inappropriately brief follow-up periods and variations in diagnostic methods. There remains no universally accepted neurobiological mechanism to explain the transition from acute TBI to the chronic effects of dementia. Studies of specialty populations, including athletes and military personnel are beset by secular and cohort effects, raising questions about the applicability of findings to the general population. No existing studies have been able to exclude the possible effects of confounding medical or lifestyle factors in facilitating the onset of dementia following TBI. Although the research findings suggest a general association between TBI and dementia, the specifics of the relationship remain poorly defined.

Causal Structure Discovery (CSD) is the problem of identifying causal relationships from large quantities of data through computational methods. With the limited ability of traditional association-based computational methods to discover causal relationships, CSD methodologies are gaining popularity. The goal of the study was to systematically examine whether (i) CSD methods can discover the known causal relationships from observational clinical data and (ii) to offer guidance to accurately discover known causal relationships. We used Alzheimer's disease (AD), a complex progressive disease, as a model because the well-established evidence provides a "gold-standard" causal graph for evaluation. We evaluated two CSD methods, Fast Causal Inference (FCI) and Fast Greedy Equivalence Search (FGES) in their ability to discover this structure from data collected by the Alzheimer's Disease Neuroimaging Initiative (ADNI). We used structural equation models (which is not designed for CSD) as control. We applied these methods under three scenarios defined by increasing amounts of background knowledge provided to the methods. The methods were evaluated by comparing the resulting causal relationships with the "gold standard" graph that was constructed from literature. Dedicated CSD methods managed to discover graphs that nearly coincided with the gold standard. For best results, CSD algorithms should be used with longitudinal data providing as much prior knowledge as possible.

OBJECTIVE:We consider the cross-subject decoding problem from local field potential (LFP) signals, where training data collected from the prefrontal cortex (PFC) of a source subject is used to decode intended motor actions in a destination subject. APPROACH:We propose a novel supervised transfer learning technique, referred to as data centering, which is used to adapt the feature space of the source to the feature space of the destination. The key ingredients of data centering are the transfer functions used to model the deterministic component of the relationship between the source and destination feature spaces. We propose an efficient data-driven estimation approach for linear transfer functions that uses the first and second order moments of the class-conditional distributions. MAIN RESULTS:We apply our data centering technique with linear transfer functions for cross-subject decoding of eye movement intentions in an experiment where two macaque monkeys perform memory-guided visual saccades to one of eight target locations. The results show peak cross-subject decoding performance of [Formula: see text], which marks a substantial improvement over random choice decoder. In addition to this, data centering also outperforms standard sampling-based methods in setups with imbalanced training data. SIGNIFICANCE:The analyses presented herein demonstrate that the proposed data centering is a viable novel technique for reliable LFP-based cross-subject brain-computer interfacing and neural prostheses.

OBJECTIVE:It is unknown whether patients with atrial fibrillation (AF) with ischaemic stroke despite oral anticoagulant therapy are at increased risk for further recurrent strokes and how ongoing secondary prevention should be managed. METHODS:). Time to recurrent ischaemic stroke (AIS) was analysed using multivariate competing risk Fine-Gray models to calculate hazard ratios (HR) and 95% confidence intervals (95%CI). RESULTS:(n=585). INTERPRETATION/CONCLUSIONS:-Vasc score to those without prior oral anticoagulation. Better prevention strategies are needed for this high risk patient group. This article is protected by copyright. All rights reserved.

Cognitive functions, for example speech processing, are distributed asymmetrically in the two hemispheres that mostly have homologous anatomical structures. Dichotic listening is a well-established paradigm to investigate hemispherical lateralization of speech. However, the mixed results of dichotic listening, especially when using tonal languages as stimuli, complicates the investigation of functional lateralization. We hypothesized that the inconsistent results in dichotic listening are due to an interaction in processing a mixture of acoustic and linguistic attributes that are differentially processed over the two hemispheres. In this study, a within-subject dichotic listening paradigm was designed, in which different levels of speech and linguistic information was incrementally included in different conditions that required the same tone identification task. A left ear advantage (LEA), in contrast with the commonly found right ear advantage (REA) in dichotic listening, was observed in the hummed tones condition, where only the slow frequency modulation of tones was included. However, when phonemic and lexical information was added in simple vowel tone conditions, the LEA became unstable. Furthermore, ear preference became balanced when phonological and lexical-semantic attributes were included in the consonant-vowel (CV), pseudo-word, and word conditions. Compared with the existing REA results that use complex vowel word tones, a complete pattern emerged gradually shifting from LEA to REA. These results support the hypothesis that an acoustic analysis of suprasegmental information of tones is preferably processed in the right hemisphere, but is influenced by phonological and lexical semantic processes residing in the left hemisphere. The ear preference in dichotic listening depends on the levels of speech and linguistic analysis and preferentially lateralizes across the different hemispheres. That is, the manifestation of functional lateralization depends on the integration of information across the two hemispheres.