JNS.jpgThe May issue of the Journal of the Neurological Sciences Vol 412 is now available online.


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Issue highlights

Further evidence for shared genetic susceptibility in both sporadic and Thyrotoxic periodic paralysis

Periodic paralysis is a disorder of skeletal muscle that presents with transient weakness lasting hours to a day or more, followed by spontaneous recovery. Several variants of periodic paralysis have been clinically delineated and have correspondingly varied pathogenic mechanisms.

In this issue of JNS, Nakaza and colleagues report that nine previously identified single nucleotide variants (SNVs) variably associated with thyrotoxic periodic paralysis (TPP) and/or sporadic periodic paralysis (SPP) were all confirmed to show susceptibility to SPP in a Japanese cohort of 43 individuals]. These data add to the growing body of evidence that SNVs on chromosome 17 downstream of KCNJ2 confer risk for periodic paralysis, and imply that SPP and TPP may share a common genetic etiology.

 Open Access

The impact of external trigeminal nerve stimulator (e-TNS) on prevention and acute treatment of episodic and chronic migraine: A systematic review

The aim of this systematic review was to analyze the effectiveness and safety of the external trigeminal nerve stimulator (eTNS) for the prevention and acute treatment of migraine attacks in episodic and chronic migraine patients.

While e-TNS has the potential to improve migraine symptoms, for its establishment in the standard practice, high quality comparative data, studies with larger sample sizes, and studies with standard and relevant primary outcome parameters are needed.

Metabolic stroke or stroke-like lesion: Peculiarities of a phenomenon

One of the most frequent cerebral lesions in mitochondrial disorders(MIDs) on imaging is the stroke-like lesion(SLL) clinically manifesting as stroke-like episode (SLE, metabolic stroke).

This review aims at discussing recent advances concerning the presentation, diagnosis, and treatment of SLLs.

SLLs are the hallmark of MELAS but occasionally occur in other MIDs. SLLs are best identified on multimodal, cerebral MRI. SLLs may present as uni−/multilocular, symmetric/asymmetric, cortical/subcortical, supra−/infratentorial condition, initially resembling a cytotoxic edema and later a vasogenic edema, or a variable mix between them.

SLLs run through an acute and a chronic stage. The acute stage is characterised by a progressively expanding lesion over days, weeks, or months, showing up as increasing hyperintensity on T2/FLAIR, DWI, and PWI and by hyperperfusion, that does not conform to a vascular territory. ADC maps are initially hypointens to become hyperintens during the course. More rarely, a variable mixture of hyper- and hypointensities may be found. The chronic stage is characterised by hypoperfusion, gadolinium enhancement, and regression of hyperintensities to various endpoints.

SLLs originate from an initial cortical lesion due to focal metabolic breakdown, which either remains stable or expands within the cortex or to subcortical areas. Some SLLs show spontaneous reversibility (fleeing cortical lesions) suggesting that neuronal/glial damage does not reach the threshold of irreversible cell death.


Near-infrared spectroscopy as a quantitative spasticity assessment tool: A systematic review

The purpose of this paper is to systematically review the literature on the use of near-infrared spectroscopy (NIRS) for assessing spasticity. MEDLINE, CINAHL, and EMBASE were searched for human and/or animal studies written in the English language published until November 2018. that used NIRS to examine the hemodynamics and/or metabolism of spastic musculature were included. Of the 35 articles identified, five met the inclusion criteria.

Two reviewers independently extracted spasticity outcomes, NIRS instrumentation specifications, and NIRS hemodynamic and metabolic measures from each article.

Owing to the small number and diverse nature of the studies, statistical comparison was deemed inappropriate. Rather, descriptive comparisons were drawn and levels of evidence were assigned based on the modified Sackett Scale.

Future research studies should use a validated definition of spasticity for inclusion criteria, a control group, and standardized NIRS variables.