Expanded Clinical Phenotype and Oncologic Associations of Paraneoplastic Kelch-like Protein-11 Encephalitis
This study describes expanding neurologic phenotype, cancer associations, outcomes, and immunopathologic features of Kelch-like protein-11 encephalitis. (Source: JAMA Neurology)
Source: JAMA Neurology - August 3, 2020 Category: Neurology Source Type: research

Prevalence of High-Risk Plaques and Risk of Stroke in Asymptomatic Carotid Stenosis
This meta-analysis examines the prevalence of high-risk plaques and the risk of ipsilateral ischemic events to assess the relevance and feasibility of using multimodal neurovascular imaging to perform risk-oriented selection for revascularization among patients with asymptomatic carotid stenosis. (Source: JAMA Neurology)
Source: JAMA Neurology - August 3, 2020 Category: Neurology Source Type: research

Perioperative Stroke Risk Reduction in Patients With Patent Foramen Ovale
This Viewpoint considers ischemic stroke risk for patients with a patent foramen ovale. (Source: JAMA Neurology)
Source: JAMA Neurology - August 3, 2020 Category: Neurology Source Type: research

Standardizing Brain Death Globally
Neurologists, neurointensivists, neurosurgeons, and intensivists worldwide at times are required to determine brain death/death by neurological criteria (BD/DNC). Variance in the practice of diagnosis is known to vary by country and region, resulting in the uncomfortable status that a patient is considered deceased in one region but not in another. For example, within the US, a patient can be deceased yet transition to alive simply by crossing a state line. Such variations multiply when considering the global scope. To better delineate the range of practice, custom, and legal considerations, more than 50 international medi...
Source: JAMA Neurology - August 3, 2020 Category: Neurology Source Type: research

Is There a Right to Delay Determination of Death by Neurologic Criteria?
The Viewpoint discusses the controversy about whether families should have the right to delay apnea testing to determine death by neurologic critera. (Source: JAMA Neurology)
Source: JAMA Neurology - August 3, 2020 Category: Neurology Source Type: research

Mislabeled Curves in a Figure
This article was corrected online. (Source: JAMA Neurology)
Source: JAMA Neurology - July 27, 2020 Category: Neurology Source Type: research

Continuous Electroencephalogram —Necessity or Luxury?
Before the last decade, the critically ill brain was often neglected with regards to direct monitoring and was subjected to systemic targets driven by broad population-based thresholds. Recently, there has been a concerted push from the critical care community to increase noninvasive (and invasive) monitoring in patients with critical illness, especially those with acute brain injury. With the advent of precision medicine extending beyond the world of oncology, the brain has come into focus as a target for individualizing care with advanced neuromonitoring. Continuous electroencephalogram (cEEG) monitoring is being used wi...
Source: JAMA Neurology - July 27, 2020 Category: Neurology Source Type: research

Longitudinally Extensive Spinal Cord Lesion in Erdheim-Chester Disease
This case report describes a 67-year-old man with 4 years of progressive quadriparesis and dysarthria, progressive right more than left lower limb weakness, and difficulty walking. (Source: JAMA Neurology)
Source: JAMA Neurology - July 27, 2020 Category: Neurology Source Type: research

Continuous vs Routine Electroencephalogram in Critically Ill Adults With Altered Consciousness
This randomized clinical trial investigates whether continuous electroencephalogram is associated with reduced mortality compared with routine electroencephalogram. (Source: JAMA Neurology)
Source: JAMA Neurology - July 27, 2020 Category: Neurology Source Type: research

Sustained Immunotherapy and Disability Accumulation in Secondary Progressive Multiple Sclerosis
This cohort study uses data from the MSBase international registry to examine the association of demographic and clinical factors, including the presence of relapses and exposure to immunotherapy, with the rate of disability accumulation in patients with secondary progressive multiple sclerosis. (Source: JAMA Neurology)
Source: JAMA Neurology - July 27, 2020 Category: Neurology Source Type: research

Antihypertensive Medication Use Among Individuals With a History of Stroke and Hypertension, 2005 to 2016
This cross-sectional study investigates the adequacy of blood pressure control among stroke survivors and antihypertensive treatment trends using National Health and Nutrition Examination Survey data. (Source: JAMA Neurology)
Source: JAMA Neurology - July 27, 2020 Category: Neurology Source Type: research

New Horizons in Pharmacologic Therapy for Secondary Stroke Prevention
This narrative review summarizes the results of recent and ongoing randomized clinical trials of drugs for secondary stroke prevention. (Source: JAMA Neurology)
Source: JAMA Neurology - July 27, 2020 Category: Neurology Source Type: research

Time for a New Image of Parkinson Disease
This Viewpoint discusses an updated image of Parkinson disease that more accurately reflects the heterogeneity in age at onset, sex, race/ethnicity, and disease experience. (Source: JAMA Neurology)
Source: JAMA Neurology - July 27, 2020 Category: Neurology Source Type: research

Error in Author Names and Figure Labels
This article was corrected online. (Source: JAMA Neurology)
Source: JAMA Neurology - July 20, 2020 Category: Neurology Source Type: research

Spontaneous Intracranial Hypotension With Brain Sagging Attributable to a Cerebrospinal Fluid –Venous Fistula
This case report describes a 44-year-old man who presented with positional headaches and other symptoms and was found to have spontaneous intracranial hypotension because of a cerebrospinal fluid –venous fistula. (Source: JAMA Neurology)
Source: JAMA Neurology - July 20, 2020 Category: Neurology Source Type: research

Hypoxic-Ischemic Encephalopathy Evaluated by Brain Autopsy and Neuroprognostication
This cohort study compares the parameters used for prognosis after cardiac arrest with the severity of hypoxic-ischemic encephalopathy shown on autopsy. (Source: JAMA Neurology)
Source: JAMA Neurology - July 20, 2020 Category: Neurology Source Type: research

Diffusion-Weighted Imaging Lesions in Patients With Acute Intracerebral Hemorrhage
This meta-analysis evaluates which factors are associated with diffusion-weighted imaging lesions and whether these lesions are associated with functional outcomes among patients with intracerebral hemorrhage. (Source: JAMA Neurology)
Source: JAMA Neurology - July 20, 2020 Category: Neurology Source Type: research

Stroke Thrombolysis With Tenecteplase to Reduce Spread of Coronavirus Disease 2019 and Alteplase Shortage
This Viewpoint advocates for expanded usage of tenecteplase in patients with stroke as a means of avoiding coronavirus disease 2019 spread and easing potential shortages of alteplase. (Source: JAMA Neurology)
Source: JAMA Neurology - July 20, 2020 Category: Neurology Source Type: research

Error in the Biomarker Subsection
This article was corrected online. (Source: JAMA Neurology)
Source: JAMA Neurology - July 13, 2020 Category: Neurology Source Type: research

Spinal Cord Involvement in Adult-Onset Leukoencephalopathy With Axonal Spheroids and Pigmented Glia
This case report describes novel magnetic resonance imaging findings in a man with adult-onset leukoencephalopathy with axonal spheroids and pigmented glia. (Source: JAMA Neurology)
Source: JAMA Neurology - July 13, 2020 Category: Neurology Source Type: research

Association of Delirium With Long-term Cognitive Decline
This meta-analysis seeks to determine if an episode of delirium is an independent risk factor for long-term cognitive decline. (Source: JAMA Neurology)
Source: JAMA Neurology - July 13, 2020 Category: Neurology Source Type: research

Assessment of 18 F-PI-2620 as a Biomarker in Progressive Supranuclear Palsy
This cross-sectional study investigates the potential of novel tau radiotracer 18F-PI-2620 as a biomarker in patients with clinically diagnosed progressive supranuclear palsy. (Source: JAMA Neurology)
Source: JAMA Neurology - July 7, 2020 Category: Neurology Source Type: research

Should Neurologists Be Concerned With REM Sleep Quantity?
The association between sleep and overall health and well-being has long been of interest to physicians, researchers, and the general public. At the highest level, a simple U-shaped association between total sleep time and mortality has been described from as early as 1964. Those who sleep approximately 7 hours are at the lowest point in the curve, with the lowest mortality risk. Mortality increases incrementally as one moves in either direction on the curve, with a marked rise for those sleeping less than 4 hours or more than 10 hours. This association holds true for both sexes and across races/ethnicities and continents....
Source: JAMA Neurology - July 6, 2020 Category: Neurology Source Type: research

Tattoo Reaction —a Diagnostic Clue in Neurosarcoidosis
This case report details a man who experienced neurosarcoidosis for which an early diagnostic clue was a skin reaction to a tattoo. (Source: JAMA Neurology)
Source: JAMA Neurology - July 6, 2020 Category: Neurology Source Type: research

Prognosis of Cryptogenic Stroke With Patent Foramen Ovale at Older Ages and Implications for Trials
This systematic review and meta-analysis examines the recurrence of ischemic stroke and possible use of patent foramen ovale closure in patients aged 60 years or older. (Source: JAMA Neurology)
Source: JAMA Neurology - July 6, 2020 Category: Neurology Source Type: research

Characteristics of Recurrent Ischemic Stroke After ESUS
This secondary analysis of a randomized clinical trial assesses the subtype of recurrent ischemic stroke after embolic stroke of underdetermined source, the interaction with treatment assignment, and the consistency of cerebral location of the qualifying and recurrent strokes in the study population of the NAVIGATE-ESUS trial. (Source: JAMA Neurology)
Source: JAMA Neurology - July 6, 2020 Category: Neurology Source Type: research

Association of Rapid Eye Movement Sleep With Mortality in Middle-aged and Older Adults
This cross-sectional study investigates whether rapid eye movement sleep is associated with greater risk of mortality in 2 independent cohorts and explores whether another sleep stage could be driving these findings. (Source: JAMA Neurology)
Source: JAMA Neurology - July 6, 2020 Category: Neurology Source Type: research

Risk of Ischemic Stroke in Patients With Coronavirus Disease 2019 (COVID-19) vs Patients With Influenza
This cohort study compares the rate of ischemic stroke among patients with COVID-19 vs patients with influenza in 2 hospitals in New York City, New York. (Source: JAMA Neurology)
Source: JAMA Neurology - July 2, 2020 Category: Neurology Source Type: research

JAMA Neurology
Mission Statement: The mission of JAMA Neurology is to publish scientific information primarily important for those physicians caring for people with neurologic disorders but also for those interested in the structure and function of the normal and diseased nervous system. These specific aims are (1) to make timely publication of original research of the nervous system, (2) to record observations of single patients or groups of patients that will provide new information and insights, (3) to report more basic research that is pertinent to the understanding of disease, (4) to introduce topics of practice, ethics, teaching, a...
Source: JAMA Neurology - July 1, 2020 Category: Neurology Source Type: research

Neurologic and Radiographic Findings Associated With COVID-19 Infection in Children
This case series presents the clinical findings of 4 children who experienced neurological manifestations of coronavirus disease 2019. (Source: JAMA Neurology)
Source: JAMA Neurology - July 1, 2020 Category: Neurology Source Type: research

Modifiable Lifestyle Factors in Alzheimer Disease
While the field of Alzheimer disease (AD) continues to evaluate therapeutic regimens that begin decades before clinical symptoms, results from Oveisgharan et al reported in this issue of JAMA Neurology add to a growing body of evidence suggesting that modifiable lifestyle factors in childhood may provide some protection against disease. In 1996, Snowdon et al published data from the Nun Study highlighting that early-life linguistic ability was strongly associated with late-life cognitive decline and AD neuropathology. This transformative work demonstrated that in a largely homogenous sample with shared environmental risk f...
Source: JAMA Neurology - June 29, 2020 Category: Neurology Source Type: research

Dopamine Metabolite Biomarkers and Testing for Disease Modification in Parkinson Disease
To the Editor In their randomized, placebo-controlled clinical trial of nilotinib in patients with Parkinson disease (PD), Pagan and colleagues reported dopamine metabolite data as “exploratory biomarkers.” They describe these biochemical findings as providing support for studying nilotinib as a potential disease-modifying therapy. The reasons for their conclusions are largely based on changes in cerebrospinal fluid (CSF) homovanillic acid (HVA) and 3,4-dihydroxyphenylacet ic acid (DOPAC) concentrations (which, from my understanding of the data in Figure 2 A and B in the article, suggest that outlier effects mi...
Source: JAMA Neurology - June 29, 2020 Category: Neurology Source Type: research

Dopamine Metabolite Biomarkers and Testing for Disease Modification in Parkinson Disease —Reply
In Reply LeWitt correctly describes homovanillic acid (HVA) as an unreliable biomarker of Parkinson disease (PD) progression, but our study distinctively evaluated dopamine metabolism in response to nilotinib rather than a biomarker of PD progression, and participants were not taking monoamine oxidase B inhibitors. The hypothesis of this phase 2 study that nilotinib is a disease-modifying drug is based on previous animal data and explored a mix of biomarkers that included dopamine metabolism, α synuclein, and tau proteins. Methodologically, physiologically based population pharmacokinetics/pharmacodynamics studies sh...
Source: JAMA Neurology - June 29, 2020 Category: Neurology Source Type: research

Association of Early-Life Cognitive Enrichment With AD Pathological Changes and Cognitive Decline
This cohort study examines the association of early-life cognitive enrichment with late-life Alzheimer disease and other common dementia-related pathological changes in an autopsy sample. (Source: JAMA Neurology)
Source: JAMA Neurology - June 29, 2020 Category: Neurology Source Type: research

Rethinking Regional Neurologic Care in the Coronavirus Disease 2019 Era
This Viewpoint discusses ways to reduce overtriage for patients with neurologic disease and finding ways to care for patients at a distance during the coronavirus disease 2019 pandemic. (Source: JAMA Neurology)
Source: JAMA Neurology - June 29, 2020 Category: Neurology Source Type: research

Clinical Characteristics and Outcomes in Patients With Coronavirus Disease 2019 and Multiple Sclerosis
This cohort study describes the clinical characteristics and outcomes in patients with multiple sclerosis who contract COVID-19 and identifies factors associated with COVID-19 severity. (Source: JAMA Neurology)
Source: JAMA Neurology - June 26, 2020 Category: Neurology Source Type: research

Spinal Cord Infarction and Metastasis Attributable to Atrial Myxoma
This case report describes spinal cord infarction in a middle-aged man diagnosed with cardiac myxoma. (Source: JAMA Neurology)
Source: JAMA Neurology - June 22, 2020 Category: Neurology Source Type: research

Changing Causes of US Neurological Disease Mortality From 1999 to 2017
This study estimates neurological disease mortality rate trends in the US population from 1999 to 2017 as well as regionalized differences within the US. (Source: JAMA Neurology)
Source: JAMA Neurology - June 22, 2020 Category: Neurology Source Type: research

Prevalence and Clinical Phenotype of Quadruple Misfolded Proteins in Older Adults
This cohort study examines brain autopsy data for the presence of quadruple misfolded proteins (tau, amyloid- β, α-synuclein, and transactive response DNA-binding protein 43) and their association with cognitive decline in older adults. (Source: JAMA Neurology)
Source: JAMA Neurology - June 22, 2020 Category: Neurology Source Type: research

Association Between Common Variants in RBFOX1 and Brain Amyloidosis in Alzheimer Disease
This genetic association study examines amyloid levels through positron emission tomographic imaging in individuals with or at risk for Alzheimer disease. (Source: JAMA Neurology)
Source: JAMA Neurology - June 22, 2020 Category: Neurology Source Type: research

Association Between Immunosuppressive Treatment and Outcomes of Cerebral Amyloid Angiopathy –Related Inflammation
This cohort study examines the clinical, neuroimaging, laboratory, pathologic, or treatment-related associations with outcomes after an episode of cerebral amyloid angiopathy-related inflammation. (Source: JAMA Neurology)
Source: JAMA Neurology - June 22, 2020 Category: Neurology Source Type: research

Intranasal Insulin for the Treatment of Mild Cognitive Impairment and Alzheimer Disease Dementia
This randomized clinical trial examines the safety, efficacy, and feasibility of intranasal insulin for the treatment of persons with mild cognitive impairment and Alzheimer disease dementia. (Source: JAMA Neurology)
Source: JAMA Neurology - June 22, 2020 Category: Neurology Source Type: research

Encephalomyelitis and Lymphadenopathy in a Man in His Early 40s
A 43-year-old man presents with spinal cord syndrome and generalized lymphadenopathy. Multiple enhancing lesions were detected both in brain and cervical cord. What is your diagnosis? (Source: JAMA Neurology)
Source: JAMA Neurology - June 15, 2020 Category: Neurology Source Type: research

Error in Figure Caption
This article was corrected online. (Source: JAMA Neurology)
Source: JAMA Neurology - June 15, 2020 Category: Neurology Source Type: research

Error in Figure
This article was corrected online. (Source: JAMA Neurology)
Source: JAMA Neurology - June 15, 2020 Category: Neurology Source Type: research

Keep the Worms in the Mud
The hygiene hypothesis postulates that the absence or delay of certain infections, primarily in childhood, results in an increased risk of allergic and autoimmune conditions. Exposure to intestinal colonizers, from microbiota to parasitic organisms, plays a role in the maturation of the immune system and these organisms may have coevolved with us in a way that makes classification as routine parasites untenable. Urbanization and decreased exposure to particular potentially infectious organisms have been implicated in the increasing prevalence of allergic and autoimmune disease. As a consequence, some of these symbiotic rel...
Source: JAMA Neurology - June 15, 2020 Category: Neurology Source Type: research

Hookworm Treatment for Relapsing Multiple Sclerosis
This randomized clinical trial assesses the effect of hookworm treatment on magnetic resonance imaging activity and T regulatory cells in British patients with relapsing multiple sclerosis. (Source: JAMA Neurology)
Source: JAMA Neurology - June 15, 2020 Category: Neurology Source Type: research

Analysis of High-Frequency Intracranial Pressure Data in Neurocritical Care Patients
This study investigates associations between intracranial pressure values and outcomes in neurocritical care patients. (Source: JAMA Neurology)
Source: JAMA Neurology - June 15, 2020 Category: Neurology Source Type: research

Systemic Delivery of rAAVrh74.MHCK7.micro-dystrophin in Duchenne Muscular Dystrophy
This nonrandomized controlled trial analyzes safety, biological, and functional outcomes associated with the infusion of rAAVrh74.MHCK7.micro-dystrophin gene transfer in a small group of patients with Duchenne muscular dystrophy. (Source: JAMA Neurology)
Source: JAMA Neurology - June 15, 2020 Category: Neurology Source Type: research

Association of Circadian Abnormalities in Older Adults With an Increased Risk of Parkinson Disease
This cohort study assesses the association between rest-activity rhythm and risk of incident Parkinson disease and explores whether this association is independent of nighttime sleep disturbances in community-dwelling older men. (Source: JAMA Neurology)
Source: JAMA Neurology - June 15, 2020 Category: Neurology Source Type: research