Faculty Bibliography

Background It is uncertain whether there is an association between left ventricular (LV) ejection fraction ( LVEF ) or LV wall motion abnormality and embolic stroke of undetermined source ( ESUS ). Methods and Results We performed a retrospective, cross-sectional study of patients with acute ischemic stroke enrolled in the CAESAR (Cornell Acute Stroke Academic Registry) from 2011 to 2016. We restricted this study to patients with ESUS and, as controls, those with small- and large-artery ischemic strokes. LVEF had to be above 35% to be considered ESUS . In a secondary analysis, we excluded patients with ESUS who had any evidence of ipsilateral carotid atherosclerosis. Multiple logistic regression was used to evaluate whether LVEF or LV wall motion abnormality was associated with ESUS . We performed a confirmatory study at another tertiary-care center. We identified 885 patients with ESUS (n=503) or small- or large-artery strokes (n=382). Among the entire cohort, LVEF was not associated with ESUS (odds ratio per 5% decrement in LVEF , 1.0; 95% CI, 1.0-1.1) and LV wall motion abnormality was not associated with ESUS (odds ratio, 0.9; 95% CI, 0.5-1.6). The results were identical in our confirmatory study. In our secondary analysis excluding ESUS patients with any evidence of ipsilateral carotid atherosclerosis, there was an association between LVEF and ESUS (odds ratio per 5% decrement in LVEF , 1.2; 95% CI, 1.0-1.5; P=0.04). Conclusions Among the entire cohort, no association existed between LVEF or LV wall motion abnormality and ESUS ; however, after excluding ESUS patients with any evidence of ipsilateral carotid atherosclerosis, lower LVEF appeared to be associated with ESUS .

The American Epilepsy Society Meeting in New Orleans attracted more than 5900 attendees. There was a lively exchange of new science, innovation, education, clinical practice, and many other items related to epilepsy. Educational symposia were a major part of the meeting and explored varying topics of interest for all types of epilepsy professionals. This article reviews highlights of the meeting presented in major symposia. Topics ranged from how to treat varying aspects of epilepsy as a consultant in the hospital to finding the scientific underpinning of the interaction between sleep and epilepsy. Pros and cons of novel antiseizure medications, dietary, and stimulation treatments were discussed. Epilepsy may impair memory and we need to learn what is the pathophysiologic relationship. Febrile status epilepticus may have severe consequences for a later life with seizures. Epilepsy professionals should be very well aware of the ethical implications of devasting seizures and their associated disability. These are just a few select topics of the many that we need to study further to archive the final goal to improve the lives of patients with epilepsy.

Background/UNASSIGNED:Freezing of gait (FOG) is one of the most disabling symptoms of Parkinson disease (PD). It has been found that different land-based rehabilitation approaches based on motor and cognitive strategies could be effective for treating FOG. At the same time, there are data about the efficacy of aquatic therapy (AT) in ameliorating this phenomenon. No 1 study has explored the combined effect of land plus AT in patients with PD who have FOG. Objective/UNASSIGNED:The objective was to investigate the effectiveness of a multidisciplinary, intensive, motor-cognitive rehabilitation treatment (MIRT) in improving FOG and whether the implementation with AT (MIRT-AT) adds further benefits. Design/UNASSIGNED:The design consisted of a single-blind, parallel group, 1:1 allocation ratio, randomized trial. Setting/UNASSIGNED:Department of Parkinson disease, Movement Disorders and Brain Injury Rehabilitation - "Moriggia-Pelascini" Hospital (Gravedona ed Uniti, Como-Italy) was used as the setting. Participants/UNASSIGNED:60 hospitalized patients with PD who had FOG in Hoehn & Yahr (H&Y) stage 2 or 5-3 were included. Intervention/UNASSIGNED:60 patients with PD + FOG were randomly assigned to 2 groups. 30 underwent a 4-week MIRT and 30 underwent a 4-week MIRT plus AT (MIRT-AT). Measurements/UNASSIGNED:The primary outcome measure was the Freezing of Gait Questionnaire (FOGQ); secondary outcome measures were total Unified Parkinson Disease Rating Scale (UPDRS), UPDRS II, UPDRS III, Berg Balance Scale (BBS), Timed Up and Go Test (TUG) and 6-Minute Walk Test (6MWT). These measures were assessed both at admission and discharge. Results/UNASSIGNED:Patients in the two groups had similar age, gender distribution, H&Y stage, and most-affected side. At baseline, no difference in outcome measures was observed between the two groups. After treatment, a significant time effect was observed for all variables in both groups. No significant time x-group interaction was observed. A between-group analysis showed non-significant differences between values at T1 and values at T0 for all variables. Limitations/UNASSIGNED:A limitation is that control group and follow-up are lacking. Conclusions/UNASSIGNED:We showed that a multidisciplinary, intensive, and goal-based rehabilitation treatment, such as MIRT, improve FOG in patients with PD. Even though AT could be considered as a useful approach for treating FOG, it does not add further benefits to this kind of motor-cognitive rehabilitation.

The epidemiology of vasculitis has witnessed extraordinary advances in the past decade influenced by the worldwide increased recognition and accurate classification and diagnosis of the vasculitides, and insights brought by genome-wide association studies and online genetic biological repositories that permit researchers to freely access a wide array of genetic and clinical resources that contribute to the understanding of the heritable factors of the systemic vasculitides. This article reviews the current knowledge of the epidemiology of vasculitides in different global regions.

Depression affects a large proportion of patients with epilepsy, and is likely due in part to biological mechanism. Hormonal dysregulation due to the disruptive effects of seizures and interictal epileptiform discharges on the hypothalamic-pituitary-adrenal axis likely contributes to high rates of depression in epilepsy. This paper reviews the largely unexplored role of neuroendocrine factors in epilepsy-related depression, focusing on Growth Hormone (GH). While GH deficiency is traditionally considered a childhood disorder manifested by impaired skeletal growth, GH deficiency in adulthood is now recognized as a serious disorder characterized by impairments in multiple domains including mood and quality of life. Could high rates of depression in patients with epilepsy relate to subtle GH deficiency? Because GH replacement therapy has been shown to improve mood and quality of life in patients with GH deficiency, this emerging area may hold promise for patients suffering from epilepsy-related depression.

Vasculitis is defined as inflammation of blood vessel walls for at least some time during the course of the disease, and affects arteries and veins of varying caliber. Two Chapel Hill Consensus Conferences, in 1994 and 2012, provide consensus on nosology and definitions for the commonest forms of vasculitis. The category of single-organ vasculitis, suggesting the limited expression of a systemic vasculitis, includes primary central nervous system vasculitis and nonsystemic peripheral nervous system vasculitis. The historical aspects of systemic and limited forms of vasculitis are reviewed in 11 relevant themes.

There have been significant advances in the understanding of the vasculitides in the past several years, leading to more precise classification and nosology. Ophthalmologic manifestations may be the presenting feature of and a clue to the diagnosis of vasculitis, or develop in the course of the illness owing to a common disease mechanism. Precise diagnosis and prompt treatment prevents short- and long-term ophthalmologic sequela.

Background and Aims: Contemplating the use of N-acetylcysteine as a neuroprotectant, with dextran as an antithrombotic for patients with NIHSS less than or equal to 5, we quantified treatment-relevant clinical characteristics of a sample of this patient population at a single stroke center over one year.
Method(s): Patients with NIHSSResult(s): One-hundred twenty-eight of 310 (41%) patients with ischemic stroke had NIHSSConclusion(s): Minor stroke symptoms may not be captured by the current NIHSS. This population rarely had renal or hepatic failure, making them good candidates for combination N-acetylcysteine and dextran

Illicit drug abuse is a common differential diagnosis of acquired central nervous system vasculitis even though there are only a handful of histopathologically confirmed patients in the literature from among the many potential classes of abused drugs traditionally implicated in this disease. This article considers the major classes of illicit drugs in those with and without human immunodeficiency virus type-1 infection and acquired immune deficiency syndrome.