Paper of the Month

For February 2016 we have selected: Siegal DM, Curnutte JT, Connolly SJ, et al. Andexanet alfa for the reversal of factor Xa inhibitor activity. N Engl J Med 2015;33:2413-2424. There is an increased use of direct factor Xa inhibitors (like apixaban, rivaroxaban, and edoxaban) to prevent stroke in patients with nonvalvular atrial fibrillation since these medications have several advantages compared to vitamin K antagonists.

For January 2016 we have selected: Buettner C, Rony-Reuven N, Bernstein C, et al. Simvastatin and vitamin D for migraine prevention: A randomized, controlled trial. Ann Neurol 2015 Sept 29;doi: 10.1002/ana.24534. Migraine is a worldwide primary headache disorder that can be highly disabling and with an important impact on quality of life. Migraine has been linked to an increased risk for vascular diseases by sharing the same ethiopathogenesis, related to alterations mediated by the endothelium.

For December 2015 we have selected: Ramanujam R, Hedstrom A-K, Manouchehrinia A, et al. Effect of smoking cessation on multiple sclerosis prognosis. JAMA Neurol 2015; 72(10):1117-1123. The usual course of multiple sclerosis (MS) is characterized by the conversion to secondary progressive disease within about 20 years from the first attack. Great efforts are currently made to modify the disease progression with the use of aggressive and expensive medical treatments.

For November 2015, we have selected: Kalra L, Irshad J, Simpson J, et al., on behalf of the STROKE-INF Investigators. Prophylactic antibiotics after acute stroke for reducing pneumonia in patients with dysphagia (STROKE-INF): a prospective, cluster-randomised, open-label, masked endpoint, controlled trial. Lancet Neurology 2015; September 4. Dysphagia is common after a stroke, and associated with an increased risk of pneumonia and mortality. However, the use of antibiotics to prevent post-stroke pneumonia has been controversial.

For October 2015, we have selected: M. Goedert. Alzheimer’s and Parkinson’s disease: The prion concept in relation to assembled Aβ, tau, and α-synuclein. Science 2015;349(6248):1255555. Doi: 10.1126/science.12555550. In this review of Michel Goedert, the pathophysiology of the two most frequent neurodegenerative disorders, Alzheimer’s disease (AD) and Parkinson’s disease (PD), is unified in a common process that shares the prion-like spreading of abnormal protein assemblages inside the brain.

For September 2015 we have selected: The Cancer Genome Atlas Research Network. Comprehensive, integrative genomic analysis of diffuse lower-grade gliomas. N Engl J Med 2015;372:2481-2498. There are currently several limitations with the histopathological classification of lower-grade gliomas, mainly related to high interobserver variability and insufficient prediction of clinical outcome.

For August 2015, we have selected: Ngandu T, Lehtisalo J, Solomon A, et al. A 2-year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomized controlled trial. The Lancet Neurology 2015;385:2255-2263. The progressive aging of the world population and the related increased number of people with neurodegenerative disorders such as Alzheimer disease (AD) and other dementias, urge to find new and effective prevention strategies.

For July 2015, we have selected: Kazui H, Miyajima M, Mori E, Ishikawa M, for the SINPHONI-2 Investigators. Lumboperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (SINPHONI-2): an open-label randomized trial. Lancet Neurology 2015;14:585-594. The decision to refer patients with idiopathic normal pressure hydrocephalus (NPH) for surgery can be challenging for the neurologist, especially due to the lack of high-level evidence supporting the beneficial use of CSF shunts.

For June 2015 we have selected: Menon P, Geevasinga N, Yannikas C, Howells J, Kiernan MC, Vucic S. Sensitivity and specificity of threshold tracking transcranial magnetic stimulation for diagnosis of amyotrophic lateral sclerosis: a prospective study. Lancet Neurology 2015;14:478-484. The early diagnosis of amyotrophic lateral sclerosis (ALS) and its atypical phenotypes may be particularly challenging.

For May 2015 we have selected: The CADISS trial investigators. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomized trial. Lancet Neurology 2015;14:361-367. The treatment of extracranial carotid and vertebral artery dissection is still empirical. There is not enough data currently supporting the efficacy of antiplatelet or anticoagulant treatment to prevent a secondary cerebral ischemic event, estimated around 15-20% in some observational studies.

The wealth of scientific information is increasing and there are many ways to cope with this. Some of us are screening the most important journals for interesting papers as their way to keep up to date with the news in the field. Most of them give up after some time. Others restrict this to reading their specialty journals only or leave it to specific questions which they have to solve.

We are very excited to start The Paper of the Month new heading with this Neuropenews issue of April. The main purpose of this new column is to provide our readers with some hints about the most relevant papers published over the last months in the neurology field. For March 2015 we have selected: Kuramatsu JB, Gerner ST, Schellinger PD, et al. Anticoagulant reversal, blood pressure levels, and anticoagulant resumption in patients with anticoagulation-related intracerebral hemorrhage. JAMA 2015;313:824-836.