Paper of the Month

For May 2018, we have selected: Kappos L, Bar-Or A, Cree BAC, et al., for the EXPAND Clinical Investigators. Siponimod versus placebo in secondary progressive multiple sclerosis (EXPAND): a double-blind, randomized, phase 3 study. Lancet Neurol 2018;391:1263-1273. Secondary progressive multiple sclerosis (SPMS) is characterized by a previous history of relapsing remitting MS (RRMS) and the continuous progression of disability over the years typically without relapses.

For April 2018, we have selected: Whelan CD, Altmann A, Botia JA, et al., for the ENIGMA-Epilepsy Working Group. Structural brain abnormalities in the common epilepsies assessed in a worldwide ENIGMA study. Brain 2018;141:391-408. Epilepsy affects 0.6-1.5% of the population worldwide with one-third of patients being resistant to antiepileptic treatment. Nowadays epilepsy is considered a network disorder in which several structural changes are involved.

by Elena Moro For March 2018, we have selected: Honig LS, Vellas B, Woodward M, et al. Trial of solanezumab for mild dementia due to Alzheimer’s disease. N Engl J Med 2018;378:321-330. Alzheimer’s disease (AD) pathology can be related to either excessive production or reduced elimination of beta amyloid (Aβ), which eventually results in oligomers, fibrils, and neuritic Aβ plaques.

For February 2018, we have selected: Feneberg E, Oeckl P, Steinacker P, et al. Multicenter evaluation of neurofilaments in early symptom onset amyotrophic lateral sclerosis. Neurology 2018;90:e22-30. doi:10.1212/WNL.0000000000004761. Amyotrophic lateral sclerosis (ALS) is a devastating neurological disorder affecting motor neurons. The course of the disease is progressive with life span of 3 to 5 years from the onset of the symptoms.

For January 2018, we have selected: Mendell JR, Al-Zaidy S, Shell R, et al. Single-dose gene-replacement therapy for spinal muscular atrophy. NEJM 2017;377:1713-1722. Spinal muscular atrophy (SMA) is caused by loss or dysfunction of the gene encoding survival motor neuron 1 protein (SMN1). Disease severity is also influenced by a second gene, SMN2, which can produce smaller amounts of this protein.

For December 2017, we have selected: Dwivedi R, Ramanujam B, Chandra PS, et al. Surgery for drug-resistant epilepsy in children. NEJM 2017;377:1639-1647. Drug-resistant epilepsy can be particularly devastating in children due to the heavy impact on psychosocial aspects and quality of life of these little patients and their family.

For November 2017, we have selected: Mittal S, Bjørnevik K, Im DS, et al. ß2-Adrenoreceptor is a regulator of the α-synuclein gene driving risk of Parkinson’s disease. Science 2017;140:2295-2305. Disturbed proteostasis of α-synuclein is now thought to play a critical role in the pathogenesis of Parkinson’s disease (PD). Physiological functions of this protein include synaptic transport as well as involvement in the metabolism of membrane phospholipids, and in the differentiation and survival of dopaminergic neurons.

For October 2017, we have selected: Andersen G, Hedermann G, Witting N, Duno M, Andersen H, Vissing J. The antimyotonic effect of lamotrigine in non-dystrophic myotonias: a double-blind randomized study. Brain 2017;140:2295-2305. Patients with myotonia congenita and paramyotonia congenita can be disabled by the myotonic phenomenon in the activities of daily living, with a huge impact on their quality of life.

For September 2017, we have selected: Hoffman EM, Watson JC, St Sauver J, Staff NP, Klein CJ. Association of long-term opioid therapy with functional status, adverse outcomes, and mortality among patients with polyneuropathy. JAMA Neurology 2017;74:773-779. Neuropathic pain is a common symptom in polyneuropathy that can be difficult to manage. Opioids are usually recommended as second-line treatment, with primary care physicians being mainly involved in opioid prescription.

or August 2017, we have selected: The Writing Group on behalf of the Edaravone (MCI-186) ALS 19 Study Group. Safety and efficacy of edaravone in well defined patients with amyotrophic lateral sclerosis: a randomized, double-blind, placebo-controlled trial. Lancet Neurol 2017;16:505-512. There is evidence that oxidative stress induced by free radicals is a key factor of progression in amyotrophic lateral sclerosis (ALS).

For July 2017, we have selected: Fernandez HH, Factor SA, Hauser RA, et al. Randomized controlled trial of deutetrabenazine for tardive dyskinesia. Neurology 2017;88:2003-2010. Tardive dyskinesia (TD) is a relatively frequent complication of antipsychotic treatment. TD can be observed in any part of the body, can be very disabling, and often persists even after stopping the causative medication.

For June 2017, we have selected: Breitenstein C, Flöel A, Ziegler W, et al., for the FCET2EC study group. Intensive speech and language therapy in patients with chronic aphasia after stroke: a randomized, open-label, blinded-endpoint, controlled trial in health-care setting. Lancet Neurol 2017;389:1528-1538. Speech and language impairments are among the most disabling symptoms after a stroke. Patients with aphasia persisting 6 months (chronic aphasia) after a stroke are not infrequent (20%). Hence, the social and economic impact of chronic aphasia is substantial.

or May 2017 we have selected: Kermer P, Eschenfelder CC, Diener H-C, et al.  Antagonizing dabigatran by idarucizumab in cases of ischemic stroke or intracranial hemorrhage in Germany – A national case collection. International Journal of Stroke 2017; doi: 10.1177/1747493017701944. The use of non-vitamin-K-antagonist oral anticoagulants (NOACs) to prevent stroke in patients with atrial fibrillation is increasing worldwide.

For April 2017, we have selected: Chen H, Kwong JC, Copes R, et al.  Living near major roads and the incidence of dementia, Parkinson’s disease, and multiple sclerosis: a population-based cohort study. Lancet 2017:389;718-726. Some studies have suggested that smog and noise can play a role in the pathogenesis of neurodegenerative disorders by inducing oxidative stress, neuroinflammation, microglia and neuronal antibody activation.