Neurology Alert – October 1, 2022

Improvement of Memory with Transcranial Electrical Brain Stimulation in Patients with Alzheimer’s Disease

The authors showed that gamma frequency transcranial alternating current stimulation targeting the precuneus in patients with Alzheimer’s disease improved measures of immediate and delayed verbal memory as well as associative memory for faces. Additionally, neurophysiological measurements of cholinergic transmission improved. Apolipoprotein E genotype and baseline cognitive performance were correlated with treatment response. Memory improvement was correlated both with increases in gamma frequency power in posterior cortical regions and spatial overlap between the modeled electric field distribution and the precuneus target site.

Magnetic Resonance Imaging Evaluation of Perivascular Space Abnormalities in Neuromyelitis Optica

Perivascular space (PVS) abnormalities were demonstrated in two cohorts of patients with neuromyelitis optica spectrum disorder (NMOSD) as compared to healthy controls. Magnetic resonance imaging provided visualization of PVS enlargement, and quantification of reduced flow in NMOSD patients, both of which were found to be associated with disease outcomes.

COVID-19 Vaccination in Patients with Autoimmune Neuromuscular Diseases

In a population-based, self-reporting survey of patients with immune-mediated myopathy and myasthenia gravis, the frequency of both mild and severe acute adverse events appeared to be no more frequent than in the general population. COVID-19 vaccinations are safe for this population of patients.

Benefits and Risks of Dual Antiplatelet Therapy After Acute Ischemic Stroke or TIA

Secondary prevention of acute ischemic stroke is continuing to evolve with great interest in the use of dual antiplatelet treatment early in the course. A complicating factor has been the role of the CYP2C19 loss-of-function gene that interferes with the conversion of clopidogrel to its active antiplatelet metabolite.

Long-Term Outcome in Patients with Intracerebral and Intraventricular Hemorrhage

Intracerebral hemorrhage continues to be a major cause of mortality and long-term disability. Early in the course of this severe disease prognosis is based on early characteristics, and care may be withdrawn at an early stage. The natural history and long-term recovery of survivors is uncertain because of withdrawal of care at an early time, resulting in a “self-fulfilling prophecy.”

Should Endovascular Thrombectomy Be Performed With or Without Intravenous Alteplase?

With the widespread adoption of endovascular thrombectomy for the treatment of acute ischemic stroke caused by large vessel occlusion, a debate has raged about the role of intravenous thrombolysis. None of the clinical trials published to date have given us a clear evidence-based answer regarding the relative risks and benefits of this approach.