Faculty Bibliography

Background/UNASSIGNED:Progressive multifocal leukoencephalopathy (PML), a potentially fatal demyelinating disease caused by the John Cunningham virus (JCV), can occur as a complication of treatment with rituximab, fingolimod, and dimethyl fumarate. The primary objective of this study was to determine changes in anti-JCV antibody index values in multiple sclerosis (MS) patients treated with these three medications. Second, we explored the relationship between absolute lymphocyte count (ALC), anti-JCV antibody index values, and various patient characteristics. Methods/UNASSIGNED:In this retrospective chart review, we evaluated changes in JCV serology and ALC in 172 MS patients treated with fingolimod, rituximab, or dimethyl fumarate (2013-2016). Only those with known anti-JCV antibody and ALC values before starting the study medications were included. Subsequent values were obtained on an ad hoc basis throughout the study. Results/UNASSIGNED:= 0.014, respectively). A non-significant decreasing trend in anti-JCV antibody index values occurred in patients treated with dimethyl fumarate. Notably, there was no relationship between ALC and anti-JCV antibody index values for patients treated with rituximab, fingolimod, or dimethyl fumarate. Conclusions/UNASSIGNED:Anti-JCV antibody index values significantly decreased in MS patients treated with fingolimod and rituximab; however, this did not occur with dimethyl fumarate. Fingolimod and rituximab may impair the humoral response to the JCV. Nevertheless, a declining anti-JCV antibody index in MS patients treated with fingolimod or rituximab should not necessarily be interpreted as correlating with a decreased risk for PML.

Cingulate epilepsy manifests with a broad range of semiologic features and seizure types. Key clinical features may elucidate ictal involvement of certain subregions of the cingulate gyrus. Ictal and interictal electroencephalogram findings in cingulate epilepsy vary and are often poorly localized, adding to the diagnostic challenge of identifying the seizure onset zone for presurgical cases, particularly in the absence of a lesion on imaging. Recent advances in multimodal imaging techniques may contribute to ictal localization and further our understanding of neural and epileptic pathways involving the cingulate gyrus. Beyond medication and surgical resection, new techniques including stereotactic laser ablation, responsive neurostimulation, and deep brain stimulation offer additional approaches for the treatment of cingulate epilepsy.

Musicians' dystonia is an example of a focal task-specific dystonia, i.e., dystonia affecting one part of the body, only when it is engaged in performance of a specific task. Musicians' dystonia may involve the upper extremity (either the hand, arm, or shoulder) or the embouchure (the muscles of lower face, tongue, and pharynx that control the flow of air into a brass or woodwind instrument). Musicians' dystonia typically affects professionals at the peak of their performing careers, often with devastating consequences. Recent work has revealed that both genetic and environmental influences contribute to the development of the condition. Current treatments for musicians' dystonia include instrument modification, physical therapy, oral medication, injection of botulinum toxin, and even stereotactic surgery. Management remains challenging, and there is a need for more innovative approaches for treatment.
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