Neurosurgery Blog: October 2014

Monday, October 27, 2014

Magnetic Resonance Imaging Measures of Posterior Cranial Fossa Morphology and Cerebrospinal Fluid Physiology in Chiari Malformation Type I

Neurosurgery - Current Issue

BACKGROUND: It has been well documented that, along with tonsillar herniation, Chiari Malformation Type I (CMI) is associated with smaller posterior cranial fossa (PCF) and altered cerebrospinal fluid (CSF) flow and tissue motion in the craniocervical junction. OBJECTIVE: This study assesses the relationship between PCF volumetry and CSF and tissue dynamics toward a combined imaging-based morphological-physiological characterization of CMI. Multivariate analysis is used to identify the subset of parameters that best discriminates CMI from a healthy cohort. METHODS: Eleven length and volumetric measures of PCF, including crowdedness and 4th ventricle volume, 4 measures of CSF and cord motion in the craniocervical junction, and 5 global intracranial measures, including intracranial compliance and pressure, were measured by magnetic resonance imaging (MRI) in 36 symptomatic CMI subjects (28 female, 37 ± 11 years) and 37 control subjects (24 female, 36 ± 12 years). The CMI group was further divided based on symptomatology into "typical" and "atypical" subgroups. RESULTS: Ten of the 20 morphologic and physiologic measures were significantly different between the CMI and the control cohorts. These parameters also had less variability and stronger significance in the typical CMI compared with the atypical. The measures with the most significance were clival and supraocciput lengths, PCF crowdedness, normalized PCF volume, 4th ventricle volume, maximal cord displacement (P < .001), and MR measure of intracranial pressure (P = .007). Multivariate testing identified cord displacement, PCF crowdedness, and normalized PCF as the strongest discriminator subset between CMI and controls. MR measure of intracranial pressure was higher in the typical CMI cohort compared with the atypical. CONCLUSION: The identified 10 complementing morphological and physiological measures provide a more complete and symptomatology-relevant characterization of CMI than tonsillar herniation alone. ABBREVIATIONS: CCJ, craniocervical junction CMI, Chiari Malformation Type I ICC, intracranial compliance ICV, intracranial volume MRICP, MR measure of intracranial pressure PCF, posterior cranial fossa PCFV, PCF volume

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/11000/Magnetic_Resonance_Imaging_Measures_of_Posterior.4.aspx

The Role of Antiplatelet Medications in Angiogram-Negative Subarachnoid Hemorrhage

Neurosurgery - Current Issue

BACKGROUND: The use of antiplatelet medications has greatly expanded and this has been associated with an increased rate of complications after aneurysmal subarachnoid hemorrhage (SAH). The influence of antiplatelet medications on outcomes after non-aneurysmal SAH is unknown. OBJECTIVE: To analyze the frequency and impact on outcome of antiplatelet medication use among patients with angiogram-negative SAH. METHODS: An analysis of patients within the Columbia University SAH Outcomes Project database was performed. All patients who underwent catheter cerebral angiography after presenting with nontraumatic SAH between 1996 and 2013 were included. Outcomes were assessed by using the modified Rankin Scale. RESULTS: A total of 1351 patients underwent catheter angiography for evaluation of SAH. Of these, 173 (13%) were designated angiogram-negative. The fraction of patients presenting with angiogram-negative SAH as well as the frequency of antiplatelet use among these patients significantly increased during the study period. Antiplatelet use was more commonly associated with angiogram-negative SAH than with angiogram-positive SAH (27% vs 14%, P = .001). At 14 days after presentation, poor outcome was significantly more frequent among patients who took antiplatelet agents than among those who did not (38% vs 20%, P = .017). This effect was also seen after multivariate analysis (odds ratio, 2.58; P = .034), although no difference was observed by 12 months (P > .05). CONCLUSION: Antiplatelet medication use is associated with poor early, but not late, outcomes after angiogram-negative SAH. Corresponding increased rates of antiplatelet medication use and angiogram-negative SAH may be related. Additional studies are needed to confirm this association. ABBREVIATIONS: CI, confidence interval mRS, modified Rankin Scale SAH, subarachnoid hemorrhage

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/11000/The_Role_of_Antiplatelet_Medications_in.6.aspx

Phase I Clinical Trial for the Feasibility and Safety of Remote Ischemic Conditioning for Aneurysmal Subarachnoid Hemorrhage

Neurosurgery - Current Issue

BACKGROUND: Remote ischemic conditioning (RIC) is a powerful endogenous mechanism whereby a sublethal ischemic stimulus confers a protective benefit against a subsequent severe ischemic insult. RIC has significant potential clinical implications for the prevention of delayed ischemic neurological deficit after aneurysmal subarachnoid hemorrhage (aSAH). Although RIC has been extensively investigated in animal models, it has not been fully evaluated in humans. OBJECTIVE: To assess the feasibility and safety of RIC for aSAH in a phase I clinical trial. METHODS: Consecutive patients hospitalized for treatment of an aSAH who met the inclusion/exclusion criteria were approached for consent. Enrolled patients received up to 4 RIC sessions on nonconsecutive days. Primary end points were the development of a symptomatic deep venous thrombosis, bruising, or injury to the limb and request to stop by the patient or surrogate. The secondary end points were the development of new neurological deficits or cerebral infarct, demonstrated by brain imaging after enrollment, and neurological deficit and condition at follow-up. RESULTS: Twenty patients were enrolled and underwent 76 RIC sessions, 75 of which were completed successfully. One session was discontinued when the patient became confused. No patient developed a deep venous thrombosis or injury to the preconditioned limb. No patient developed delayed ischemic neurological deficit during enrollment. At follow-up, median modified Rankin Scale score was 1 and Glasgow Outcome Scale score was 5. CONCLUSION: The RIC procedure was well tolerated and did not cause any injury. RIC for aSAH warrants investigation in a subsequent pivotal clinical trial. ABBREVIATIONS: aSAH, aneurysmal subarachnoid hemorrhage DIND, delayed ischemic neurological deficit RIC, remote ischemic conditioning TCD, transcranial Doppler

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/11000/Phase_I_Clinical_Trial_for_the_Feasibility_and.13.aspx

Can ADHD Really Be Diagnosed by EEG?

Medscape NeurologyHeadlines

Selim R. Benbadis about the clinical utility of using electroencephalography to diagnose ADHD.
Medscape Neurology

Original Article: http://www.medscape.com/viewarticle/833407?src=rss

ICU Physician-Based Determinants of Life-Sustaining Therapy During Nights and Weekends: French Multicenter Study From the Outcomerea Research Group*

Critical Care Medicine - Most Popular Articles

Objective: Patient- and organization-related factors are the most common influences affecting the ICU decision-making process. Few studies have investigated ICU physician-related factors and life-sustaining treatment use during nights and weekends, when staffing ratios are low. Here, we described patients admitted during nights/weekends and looked for physician-related determinants of life-sustaining treatment use in these patients after adjustment for patient- and center-related factors. Design: Multicenter observational cohort study of admission procedures during nights/weekends shifts. Subjects: ICU physicians working nights/weekends in 6 French ICUs. Interventions: None. Measurements and Main Results: Patient characteristics and intensity of care were extracted from the prospective Outcomerea database. Physician characteristics were age, gender, religion and religiosity, ICU experience, specialty, being a permanent ICU staff member, degree in ethics, and degree in intensive care. We used hierarchical mixed models to adjust on center, physician random effects, and admission patient characteristics. Of 156 physicians contacted, 119 (77%) participated. Patients admitted during nights/weekends were younger and had fewer comorbidities and lower treatment intensity during the shift. ICU physicians who are younger than 35 years used more renal replacement therapy (odds ratio, 1.04; 95% CI, 1–1.07; p = 0.04), invasive mechanical ventilation (odds ratio, 1.09; 95% CI, 1.1–1.19; p = 0.04), and vasopressors (odds ratio, 1.16; 95% CI, 1.09–1.23; p < 0.0001). Internal or emergency medicine as the primary specialty was associated with invasive mechanical ventilation (odds ratio, 1.14; 95% CI, 1.04–1.24; p = 0.004) and vasopressor use (odds ratio, 1.09; 95% CI, 1.02–1.17; p = 0.01). Noninvasive ventilation was used less often by physicians with more than 10 years of night/weekend shifts and more often by those with religious beliefs (odds ratio, 1.05; 95% CI, 1.01–1.08; p = 0.008). Conclusions: Patients admitted during nights/weekends were younger and had fewer comorbidities. Age, specialty, ICU experience, and religious beliefs of the physicians were significantly associated life-sustaining treatments used.

Original Article: http://journals.lww.com/ccmjournal/Fulltext/2014/11000/ICU_Physician_Based_Determinants_of.10.aspx

A Review of Episodic and Chronic Pediatric Headaches of Brief Duration

Pediatric Neurology

Headaches that last less than one hour in duration are uncommon, except for atypical migraine, and, without a practitioner's appropriate knowledge, may result in misdiagnosis. Although most of these headaches are classified as primary headache syndromes, some have secondary etiologies such as structural lesions. This pediatric-specific review updates these headache syndromes. Discussed are atypical migraine, the trigeminal autonomic cephalgias (TAC), cranial neuralgias, occipital neuralgia, thunderclap headache, nummular headache, the red ear syndrome and the numbtongue syndrome.

Original Article: http://www.pedneur.com/article/S0887-8994(14)00649-3/abstract?rss=yes

Has Your Smartphone Made Your Other Gadgets Obsolete? [Survey]

Scientific American: Mind and Brain

Tell us how you use your smartphone, which gadgets it has replaced and where you would like to see the technology go

-- Read more on ScientificAmerican.com

Original Article: http://www.scientificamerican.com/article/has-your-smartphone-made-your-other-gadgets-obsolete-survey/

Cerebrovascular regulation, exercise, and mild traumatic brain injury

Neurology recent issues

A substantial number of people who sustain a mild traumatic brain injury report persistent symptoms. Most common among these symptoms are headache, dizziness, and cognitive difficulties. One possible contributor to sustained symptoms may be compromised cerebrovascular regulation. In addition to injury-related cerebrovascular dysfunction, it is possible that prolonged rest after mild traumatic brain injury leads to deconditioning that may induce physiologic changes in cerebral blood flow control that contributes to persistent symptoms in some people. There is some evidence that exercise training may reduce symptoms perhaps because it engages an array of cerebrovascular regulatory mechanisms. Unfortunately, there is very little work on the degree of impairment in cerebrovascular control that may exist in patients with mild traumatic brain injury, and there are no published studies on the subacute phase of recovery from this injury. This review aims to integrate the current knowledge of cerebrovascular mechanisms that might underlie persistent symptoms and seeks to synthesize these data in the context of exploring aerobic exercise as a feasible intervention to treat the underlying pathophysiology.

Original Article: http://www.neurology.org/cgi/content/short/83/18/1665?rss=1

Hospital Case Volume Is Associated With Mortality in Patients Hospitalized With Subarachnoid Hemorrhage

Neurosurgery - Most Popular Articles

BACKGROUND: Prior studies have suggested that hospital case volume may be associated with improved outcomes after subarachnoid hemorrhage (SAH), but contemporary national data are limited. OBJECTIVE: To assess the association between hospital case volume for SAH and in-hospital mortality. METHODS: Using the Get With The Guidelines-Stroke registry, we analyzed patients with a discharge diagnosis of SAH between April 2003 and March 2012. We assessed the association of annual SAH case volume with in-hospital mortality by using multivariable logistic regression adjusting for relevant patient, hospital, and geographic characteristics. RESULTS: Among 31,973 patients with SAH from 685 hospitals, the median annual case volume per hospital was 8.5 (25th-75th percentile, 6.7-12.9) patients. Mean in-hospital mortality was 25.7%, but was lower with increasing annual SAH volume: 29.5% in quartile 1 (range, 4-6.6), 27.0% in quartile 2 (range, 6.7-8.5), 24.1% in quartile 3 (range, 8.5-12.7), and 22.1% in quartile 4 (range, 12.9-94.5). Adjusting for patient and hospital characteristics, hospital SAH volume was independently associated with in-hospital mortality (adjusted odds ratio 0.79 for quartile 4 vs 1, 95% confidence interval, 0.67-0.92). The quartile of SAH volume also was associated with length of stay but not with discharge home or independent ambulatory status. CONCLUSION: In a large nationwide registry, we observed that patients treated at hospitals with higher volumes of SAH patients have lower in-hospital mortality, independent of patient and hospital characteristics. Our data suggest that experienced centers may provide more optimized care for SAH patients. ABBREVIATIONS: GWTG, Get With The Guidelines SAH, subarachnoid hemorrhage LOS, length of stay IQR, interquartile range NIHSS, National Institutes of Health Stroke Scale CI, confidence interval CSC, Comprehensive Stroke Center

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/11000/Hospital_Case_Volume_Is_Associated_With_Mortality.2.aspx

Thursday, October 23, 2014

Brain simulation raises questions

Neurology News & Neuroscience News from Medical News Today

What does it mean to simulate the human brain? Why is it important to do so? And is it even possible to simulate the brain separately from the body it exists in?

Original Article: http://www.medicalnewstoday.com/releases/284244.php

Wednesday, October 22, 2014

The Changing Role of Palliative Care in the ICU

Critical Care Medicine - Current Issue

Objectives: Palliative care is an interprofessional specialty as well as an approach to care by all clinicians caring for patients with serious and complex illness. Unlike hospice, palliative care is based not on prognosis but on need and is an essential component of comprehensive care for critically ill patients from the time of ICU admission. In this clinically focused article, we review evidence of opportunities to improve palliative care for critically ill adults, summarize strategies for ICU palliative care improvement, and identify resources to support implementation. Data Sources: We searched the MEDLINE database from inception through January 2014. We also searched the Reference Library of The Improving Palliative Care in the ICU Project website sponsored by the National Institutes of Health and the Center to Advance Palliative Care, which is updated monthly. We hand-searched reference lists and author files. Study Selection: Selected studies included all English-language articles concerning adult patients using the search terms intensive care or critical care with palliative care, supportive care, end-of-life care, or ethics. Data Extraction: After examination of peer-reviewed original scientific articles, consensus statements, guidelines, and reviews resulting from our literature search, we made final selections based on author consensus. Data Synthesis: Existing evidence is organized to address: 1) opportunities to alleviate physical and emotional symptoms, improve communication, and provide support for patients and families; 2) models and specific interventions for improving ICU palliative care; 3) available resources for ICU palliative care improvement; and 4) ongoing challenges and targets for future research. Key domains of ICU palliative care have been defined and operationalized as measures of quality. There is increasing recognition that effective integration of palliative care during acute and chronic critical illness may help patients and families face challenges after discharge from intensive care. Conclusions: Palliative care is increasingly accepted as an essential component of comprehensive care for critically ill patients, regardless of diagnosis or prognosis. A variety of strategies to improve ICU palliative care appear to be effective, and resources including technical assistance and tools are available to support improvement efforts. As the longer-term impact of intensive care on those surviving acute critical illness is increasingly documented, palliative care can help prepare and support patients and families for challenges after ICU discharge. Further research is needed to inform efforts to integrate palliative care with intensive care more effectively and efficiently in and after the ICU and to document improvement using valid and responsive outcome measures.

Original Article: http://journals.lww.com/ccmjournal/Fulltext/2014/11000/The_Changing_Role_of_Palliative_Care_in_the_ICU.13.aspx

Critical Care Telemedicine: Evolution and State of the Art*

Critical Care Medicine - Current Issue

Objectives: To review the growth and current penetration of ICU telemedicine programs, association with outcomes, studies of their impact on medical education, associations with medicolegal risks, identify program revenue sources and costs, regulatory aspects, and the ICU telemedicine research agenda. Data Sources: Review of the published medical literature, governmental documents, and opinions of experts from the Society of Critical Care Medicine ICU Telemedicine Committee. Data Synthesis: Formal ICU telemedicine programs now support 11% of nonfederal hospital critically ill adult patients. There is increasingly robust evidence of association with lower ICU (0.79; 95% CI, 0.65–0.96) and hospital mortality (0.83; 95% CI, 0.73–0.94) and shorter ICU (–0.62 d; 95% CI, –1.21 to –0.04 d) and hospital (–1.26 d; 95% CI, –2.49 to –0.03 d) length of stay. Physicians in training report experiences with telemedicine intensivists that are positive and increased patient safety. Early studies suggest that implementation of ICU telemedicine programs has been associated with lower numbers of malpractice claims and costs. The requirements for Medicare reimbursement and states with legislation addressing providing professional services by telemedicine are detailed. Conclusions: The inclusion of an ICU telemedicine program as a major part of their critical care delivery paradigm has been implemented for 11% of critically ill U.S. adults as a solution for the problem of access to adult critical care services. Implementation of an ICU telemedicine program is one practical way to increase access and reduce mortality as well as length of stay. ICU telemedicine research including comparative effectiveness studies is urgently needed.

Original Article: http://journals.lww.com/ccmjournal/Fulltext/2014/11000/Critical_Care_Telemedicine___Evolution_and_State.14.aspx

Epilepsy surgery in children and adults.

Unbound MEDLINE | Lancet journal articles

Ryvlin P, Cross JH, Rheims S
Epilepsy surgery in children and adults. [REVIEW]
Lancet Neurol 2014 Nov; 13(11):1114-1126.

Epilepsy surgery is the most effective way to control seizures in patients with drug-resistant focal epilepsy, often leading to improvements in cognition, behaviour, and quality of life. Risks of serious adverse events and deterioration of clinical status can be minimised in carefully selected patients. Accordingly, guidelines recommend earlier and more systematic assessment of patients' eligibility for surgery than is seen at present. The effectiveness of surgical treatment depends on epilepsy type, underlying pathology, and accurate localisation of the epileptogenic brain region by various clinical, neuroimaging, and neurophysiological investigations. Substantial progress has been made in the methods of presurgical assessment, particularly in patients with normal features on MRI, but evidence is scarce for the indication and effect of most presurgical investigations, with no biomarker precisely delineating the epileptogenic zone. A priority for the development of epilepsy surgery is the generation of high-level evidence to promote the harmonisation and dissemination of best practices.

Original Article: http://www.unboundmedicine.com/medline/citation/25316018/Epilepsy_surgery_in_children_and_adults_

Expanding the antibody spectrum of limbic encephalitis!

JNNP blog

Limbic encephalitis (LE) mat have an underlying autoimmune etiologiy. over the last decade numerous antibodies have emerged as potenital causative agents, and the antibodies have been directed against external epitopes of specific receptors. In an upcoming issue of JNNP, Onugoren and colleagues reaffirm the association between GABAB and AMPR receptor antibodies and LE. Importantly neoplastic causes need to be considered.

Typical MRI changes in LE

Original Article: http://blogs.bmj.com/jnnp/2014/10/17/expanding-the-antibody-spectrum-of-limbic-encephalitis/

Carpal tunnel syndrome in a child with Down Syndrome

Pediatric Neurology

Recently, Davis en Vedanarayanan gave an overview of the carpal tunnel syndrome in Pediatric Neurology. (1) This neuropathy of the median nerve causes numbness, paresthesias, and pain in the hands. Symptoms occur mostly during the night and disrupt normal sleep. The carpal tunnel syndrome is present in almost all children with mucopolysaccharidosis, but otherwise it is rare in childhood. Recently we encountered the carpal tunnel syndrome in a child with Down syndrome.

Original Article: http://www.pedneur.com/article/S0887-8994(14)00534-7/abstract?rss=yes

The Value of 3T MRI in Acute Transverse Myelitis

Pediatric Neurology

An 11 year old girl presented with 18 hours of right leg weakness and left leg numbness. Past medical history was significant for a two day viral gastroenteritis 25 days prior and vaccinations 24 days prior (Tetanus, diphtheria, and pertussis; human papilloma virus; influenza; and meningococcal). Initial exam pertinent findings were right leg weakness (0/5 proximally and 3/5 distally), absent left leg temperature sense to the groin area without anesthesia or left hemibody sensory level, and inconsistent decreased right patellar reflex and extensor plantar response.

Original Article: http://www.pedneur.com/article/S0887-8994(14)00462-7/abstract?rss=yes

Pediatric Migraine Prescription Patterns at a Large Academic Hospital

Pediatric Neurology

Here we report the prescription patterns by drug type, age, and sex of patients at a large academic pediatric hospital. Because there are few guidelines based on outcome studies in pediatric migraine, physician treatment approaches in children vary.

Original Article: http://www.pedneur.com/article/S0887-8994(14)00394-4/abstract?rss=yes

Pregabalin Treatment in a Case with Complex Regional Pain Syndrome

Pediatric Neurology

Complex regional pain syndrome (CRPS) is a painful and disabling neurovascular condition. There is no definite consensus on the etiopathogenesis and treatment. We present a case diagnosed with CRPS type 1 accompanied by a psychiatric disorder to discuss the relationship between CRPS and psychiatric disease and to emphasize the response of this case to pregabalin treatment.

Original Article: http://www.pedneur.com/article/S0887-8994(14)00016-2/abstract?rss=yes

Comment: How personal is Alzheimer disease?

Neurology recent issues

Personality has long been recognized as important in Alzheimer disease (AD), although primarily in terms of exaggeration or diminishment of preexisting traits around the clinical onset. The findings reported by Johansson et al. in this issue further suggest that there may be traits, neuroticism in this case, that are associated with increased risk of AD. The long interval (nearly 40 years) between onset of neuroticism and outcome (AD) rules out any effect of early AD pathology, which has been a perennial limitation of shorter-term studies of depressive symptoms as a risk factor. Selective survival is also an unlikely explanation because stress and early cognitive decline are both likely to predict mortality and thus obscure the association of interest—indeed, it is surprising how many risk factors for mortality are also found to be risk factors for AD despite this bias.

Original Article: http://www.neurology.org/cgi/content/short/83/17/1542?rss=1

Mental rest and reflection 'boost learning'

Neurology News & Neuroscience News from Medical News Today

New research finds that restful reflection can strengthen memories in the mind and forge new mental connections, priming the brain for future learning.

Original Article: http://www.medicalnewstoday.com/articles/284165.php

Can Video Games Diagnose Cognitive Deficits?

Scientific American: Mind and Brain

This blog is the third in a series of guest posts on technology and the brain to celebrate Scientific American Mind's 10-year anniversary.

-- Read more on ScientificAmerican.com

Original Article: http://www.scientificamerican.com/blog/post/can-video-games-diagnose-cognitive-deficits/

Paralyzed Man Walks After Cell Transplant Into Spinal Cord

Medscape NeurologyHeadlines

A man who was paralyzed after a knife stabbing is walking after surgery that involved transplanting cells taken from his olfactory lobe into his severed spinal cord.
Medscape Medical News

Original Article: http://www.medscape.com/viewarticle/833663?src=rss

Congress of Neurological Surgeons (CNS) 2014 Annual Meeting

Medscape NeurologyHeadlines

Read clinically focused news coverage of key developments from CNS 2014.
Medscape Neurology

Original Article: http://www.medscape.com/viewcollection/33234?src=rss

New 3-Minute Delirium Test

Medscape NeurologyHeadlines

The shortened test demonstrates high sensitivity and specificity compared with a longer reference standard, a new study shows
Medscape Medical News

Original Article: http://www.medscape.com/viewarticle/833600?src=rss

Wednesday, October 15, 2014

Injury to brain 'hubs' does more damage

Neurology News & Neuroscience News from Medical News Today

A new study shows that more mental functions are impaired by damage to brain hubs - where several networks come together - compared with brain damage that is far from hubs.

Original Article: http://www.medicalnewstoday.com/articles/283850.php

Dysregulation in orexinergic system associated with Alzheimer disease

Neurology News & Neuroscience News from Medical News Today

In patients with Alzheimer disease (AD), increased cerebrospinal fluid levels of orexin, which helps regulate the sleep-wake cycle, may be associated with sleep deterioration, which appears to be...

Original Article: http://www.medicalnewstoday.com/releases/283805.php

Stenting safe and effective for long-term stroke prevention

Neurology News & Neuroscience News from Medical News Today

Using stents to keep neck arteries open is just as effective as invasive neck surgery for long-term prevention of fatal and disabling strokes, reports an international trial led by UCL (University...

Original Article: http://www.medicalnewstoday.com/releases/283852.php

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Tuesday, October 14, 2014

[Comment] Therapy of amyotrophic lateral sclerosis remains a challenge

The Lancet Neurology

Amyotrophic lateral sclerosis is a devastating fatal disease of motor neurons in the brain, brainstem, and spinal cord. It affects otherwise healthy people and can develop at any point in adulthood. Worldwide, more than 150 000 people die from the disease every year, on average 3 years after symptom onset. Laboratory and patient-oriented research during the past two decades has led to major improvements in our understanding of the pathogenesis of amyotrophic lateral sclerosis, including newly discovered genes, improved in-vitro and in-vivo modelling of the disease, generation of patient-derived motor neurons through induced pluripotent stem cell technology, the discovery of TDP43 protein aggregates in motor neurons, innovative imaging and whole-genome sequencing technology initiatives, the identification of endophenotypes, and the association of the disease with frontotemporal dementia.

Original Article: http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(14)70179-6/fulltext?rss=yes

Concussion: Key Stakeholders and Multidisciplinary Participation in Making Sports Safe

Neurosurgery - Most Popular Articles

As unstructured play declines, organized sports leagues have become a highly popular form of physical activity in young people. As concussive injuries are garnering increased media attention and public awareness, there is a growing concern for athlete safety. Although athletic trainers and physicians play a large role in keeping athletes healthy and safe, this article investigates nontraditional, multidisciplinary teams that are involved in promoting athlete safety, including the role of equipment makers, coaches, referees, governing bodies of sport, lawmakers, and fans. As opposed to a focus on diagnosing or managing concussive injuries, this article seeks to promote injury prevention strategies. ABBREVIATIONS: NCAA, National Collegiate Athletic Association NFL, National Football League NHL, National Hockey League

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/10001/Concussion___Key_Stakeholders_and.11.aspx