JNS.jpgThe December issue of the Journal of the Neurological Sciences Vol 407 is now available online.


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Issue highlights

Optic neuritis: Both eyes improve after corticotropin

In this issue, Bryan and Sergott present extended follow-up of isolated, acute optic neuritis (AON) following treatment with repository corticotropin injection (RCI). Employing modern techniques measuring low contrast visual acuity (LCVA) and retinal anatomy with spectral domain optical coherence tomography (SDOCT), this small, observational, uncontrolled, single-arm study, is significant in scope and findings, enlarging our concept of the events surrounding recovery from optic neuritis.

To understand the significance of this report's findings, we review salient anatomy, pathology, prior clinical AON studies, and pharmacology.

Genetic risk of Spontaneous intracerebral hemorrhage: Systematic review and future directions

Although highly heritable, few genes have been linked to spontaneous intracerebral hemorrhage (SICH), which does not currently have any evidence-based disease-modifying therapy. Individuals of African ancestry are especially susceptible to SICH, even more so for indigenous Africans.

We systematically reviewed the genetic variants associated with SICH and examined opportunities for rapidly advancing SICH genomic research for precision medicine.

  • Only few genetic variants have been significantly associated with SICH.
  • All but 11 genetic studies were in Caucasians and none included indigenous Africans.
  • More genomic studies are needed to provide insight into the pathophysiology of SICH.
  • Indigenous Africans provide an opportunity to explore genetic basis of SICH.

Change in visual acuity and retinal structures following Repository Corticotropin Injection (RCI) therapy in patients with acute demyelinating optic neuritis: Improvement in low contrast visual acuity in both affected and contralateral eyes in a single-armed open-label study

Current treatments after an episode of optic neuritis have limited success protecting the retinal nerves and restoring visual function. This study assesses the effectiveness of Repository Corticotropin Injection (RCI) after the onset of optic neuritis.

  • RCI is associated with improved high and low-contrast visual acuity in the affected eye of MS patients after an episode of ON
  • The contralateral eye also showed improvement in low contrast visual acuity with treatment.
  • These functional changes occurred parallel with characteristic structural changes in the retinal layers.

Altered hypothalamic metabolism in early multiple sclerosis – MR spectroscopy study

Multiple sclerosis (MS) is a disease characterized by overlapping processes of neuroinflammation and neuro-axonal degeneration. Disturbances of the hypothalamo-pituitary axis in MS are supposed to modulate neuroinflammatory circuits, however, there is insufficient knowledge about the hypothalamic metabolism alterations in early MS.

This 1H MRS study performed on a 1.5 T MR-scanner was focused on the hypothalamus of 31 pre-treatment patients after their first clinical MS episode/s, compared to 31 healthy controls. The metabolite ratios of N-acetyl-aspartate & N-acetyl-aspartyl-glutamate (tNAA), glutamate & glutamine (Glx), myo-Inositol (mIns), choline- and creatine-containing compounds (tCho, tCr) were further correlated with the Expanded Disability Status Scale (EDSS).

In the hypothalamus of early MS patients compared to controls, we found decreased tNAA/tCr and increased tCho/tNAA, mIns/tNAA, Glx/tCr, and Glx/tNAA. In addition, tCho/tNAA, Glx/tNAA, and mIns/tNAA were positively and tNAA/tCr was negatively correlated with EDSS. Results suggest that the decline of the tNAA ratio, indicating neuro-axonal dysfunction in the hypothalamus, may be linked with glutamate excitotoxicity. Excessive glutamate concentrations may cause microglial activation and myelinated tracts degradation with subsequent gliosis, paralleled by increased mIns and tCho ratios. This indicates that glutamate excitotoxicity can play an important role in MS from its earliest stages.