New and Noteworthy Information—March

Childhood obesity may increase the risk of developing multiple sclerosis (MS) or clinically isolated syndrome (CIS), particularly for adolescent girls, according to a study published in the February 5 issue of Neurology. Researchers identified 75 patients between ages 11 and 18 with newly diagnosed MS or CIS. BMI was obtained before symptom onset for patients with MS or CIS, and through the Kaiser Permanente Southern California children’s health study for the underlying cohort. Obesity was associated with a significantly increased risk of MS or CIS in girls, but not in boys. The risk of CIS or MS was 1.58 among overweight girls, 1.78 among moderately obese girls, and 3.76 among extremely obese girls, compared with girls of normal weight.

Among individuals at high cardiovascular risk, a Mediterranean diet may reduce the likelihood of major cardiovascular events, including stroke, according to research published online in the February 25 New England Journal of Medicine. Researchers randomly assigned 7,447 participants to a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet. Participants’ age ranged from 55 to 80, and 57% were women. A total of 288 participants had myocardial infarction, stroke, or death from cardiovascular causes. The multivariable-adjusted hazard ratios were 0.70 and 0.72 for the group assigned to a Mediterranean diet with extra-virgin olive oil (96 events) and the group assigned to a Mediterranean diet with nuts (83 events), respectively, versus the control group (109 events).

The total level of antioxidants in the diet does not appear to predict a patient’s risks of dementia and stroke, researchers reported in the February 20 online Neurology. The investigators prospectively studied 5,395 participants in the Rotterdam Study. The participants were age 55 and older and dementia-free. The researchers elicited dietary information at baseline using a semiquantitative food-frequency questionnaire and combined it with food-specific ferric-reducing antioxidant power (FRAP) measurements from published tables. During a median 13.8 years of follow-up, the authors identified approximately 600 cases each of dementia and stroke. In multivariable-adjusted models, they observed no associations between dietary FRAP scores and risk of dementia or risk of stroke. Results were similar across subtypes of these outcomes. Dietary FRAP scores were unrelated to brain tissue volumes.

Eating foods high in carotenoids may help prevent or delay the onset of amyotrophic lateral sclerosis (ALS), according to research published online ahead of print January 29 in the Annals of Neurology. Investigators examined data for 1,100,910 participants (562,942 men) in the NIH–Association of American Retired Persons Diet and Health Study, the Cancer Prevention Study II Nutrition Cohort, the Multiethnic Cohort, the Health Professionals Follow-up Study, and the Nurses Health Study. A total of 1,153 deaths related to ALS occurred. Greater consumption of major carotenoids was associated with a reduced risk of ALS. Higher dietary intakes of b-carotene and lutein were inversely associated with ALS risk. Lycopene, b-cryptoxanthin, and vitamin C were not associated with reduced risk of ALS.

A device that delivers supraorbital transcutaneous stimulation may be a safe and effective preventive therapy for migraine, according to research published in the February 19 issue of Neurology. After a one-month run-in, 67 patients with at least two migraine attacks per month were randomized to stimulation or sham stimulation. Participants applied the stimulator daily for 20 minutes over the course of three months. The mean number of migraine days decreased significantly in the stimulation group (ie, from 6.94 to 4.88), but not in the sham group (ie, from 6.54 to 6.22), between the run-in and third month of treatment. Monthly migraine attacks, monthly headache days, and monthly acute antimigraine drug intake were also significantly reduced in the stimulation group, but not in the sham group.

Small-vessel cerebrovascular disease, manifested as white matter hyperintensities (WMHs) on MRI, may contribute independently to the development of Alzheimer’s disease, reported investigators in the February 18 online ahead of print JAMA Neurology. Researchers retrospectively examined baseline amyloid deposits for 21 controls, 59 subjects with mild cognitive impairment, and 20 participants with clinically defined Alzheimer’s disease. The team derived total WMH volume from patients’ MRI data. Amyloid positivity and increased total WMH volume independently predicted a diagnosis of Alzheimer’s disease. Among amyloid-positive patients, subjects with Alzheimer’s disease had greater WMH volume than controls. Among subjects with mild cognitive impairment, WMH and amyloid positivity at baseline conferred risk for a future diagnosis of Alzheimer’s disease. The findings suggest that prevention strategies for Alzheimer’s disease may be possible.

Motor benefits may continue for patients with dystonia after deep brain stimulation (DBS) is turned off, according to research published February 11 online ahead of print in Movement Disorders. Two patients with primary generalized dystonia were treated successfully with bilateral DBS: one for 18 months, and one for five years. By accident, DBS was interrupted unilaterally for three and seven months, respectively, and bilaterally for two days and two months, respectively. The patients retained their motor benefits for several months after the inadvertent interruption of stimulation. Symptoms of dystonia partially returned during the period of therapy interruption and rapidly and completely resolved after stimulation resumed. Young age, short duration of disease, and chronic DBS therapy with relatively low stimulation energy may influence whether motor benefits continue for an individual.

Unlike the adult human brain, the neonatal brain may respond to external stimulus with an increase in deoxyhemoglobin, corresponding to a negative blood oxygen level-dependent (BOLD) signal on functional MRI, according to research published February 20 online ahead of print in the Proceedings of the National Academy of Sciences. Researchers studied the evolution of the cortical blood flow response in neonatal rats during postnatal development using exposed-cortex multispectral optical imaging. Day-12–13 rats, which are equivalent to human newborns, exhibited an inverted hemodynamic response with early signs of oxygen consumption, followed by delayed, active constriction of pial arteries. The hemodynamic response matured through the development of an initial hyperemic (ie, positive BOLD) phase that eventually masked oxygen consumption and balanced vasoconstriction toward adulthood.

Neurologists may have an approximately 15-year interval during which to treat patients with amyloid buildup in an attempt to prevent Alzheimer’s disease, according to research published February 27 online ahead of print in Neurology. Investigators studied 260 participants ages 70 to 92, all of whom underwent two or more serial amyloid PET examinations. A total of 205 participants were cognitively normal, 47 had mild cognitive impairment, and eight had Alzheimer dementia. Rates of amyloid accumulation were low among patients who had low or high amyloid levels at baseline, and high among patients with moderate levels of amyloid at baseline. The researchers estimated that the average time required to travel from a low rate of accumulation to a high rate of accumulation is approximately 15 years.

Overexpression of α-synuclein may be associated with hypertrophy of membrane systems of the presynaptic terminal and the disruption of vesicle recycling, according to a study published in the February 6 issue of the Journal of Neuroscience. Progressive degeneration and cell death are the potential consequences of this disruption. Overexpressed α-synuclein was associated with a large and poorly characterized membranous organelle system of the presynaptic terminal, as well as with smaller vesicular structures within these boutons. The α-synuclein was found in several parts of the protein degradation pathway, including multivesicular bodies in the axons and lysosomes within neuronal cell bodies. The data support the conclusion that α-synuclein is involved in processes associated with the sorting, channeling, packaging, and transport of synaptic material destined for degradation, said the investigators.

Patients with multiple sclerosis (MS) and problems with cognition, memory, attention, or concentration have more damage to areas in the brain responsible for cognitive processes than patients with MS who do not have cognitive problems, according to research published in the March 6 Neurology. Investigators used MRI and diffusion tensor imaging to compare brain measurements in 20 patients with MS who had related cognitive problems, 35 patients with MS who did not have cognitive problems, and 30 healthy controls. About 49% of brain white matter examined had impaired integrity in individuals with MS and no cognitive problems, compared with 76% in patients with MS and cognitive problems. White matter dysfunction was particularly evident in the thalamus in individuals with MS-related cognitive problems.

Epidural steroid injections (ESIs) may be associated with significantly less improvement among patients with spinal stenosis, according to a study published in the February 15 Spine. Researchers performed a subgroup analysis of a prospective, randomized database from the Spine Patient Outcomes Research Trial. ESI patients who ultimately underwent surgery had an average 26-minute increase in operative time and an increased length of stay by 0.9 days. Over four years, surgically treated ESI patients had significantly less improvement in 36-Item Short Form Health Survey (SF-36) Physical Function, compared with patients who had not received ESI. Nonsurgically treated patients who received ESI also had significantly less improvement in SF-36 Body Pain and SF-36 Physical Function than patients who did not receive ESI.

C9RANT, an abnormal protein that forms as a result of genetic abnormalities, may play a role in the development of amyotrophic lateral sclerosis (ALS) or frontotemporal dementia (FTD), researchers reported in the February 20 issue of Neuron. Investigators found insoluble accumulations of C9RANT in the brain tissue of patients with ALS or FTD, but not in patients with other neurodegenerative diseases. Repeat expansions in a noncoding region of the C9ORF72 gene are the major cause of C9RANT, and these expansions are the most common cause of ALS and FTD. The investigators found C9RANT in brain tissue after creating a novel antibody to detect it. C9RANT is a potential biomarker for FTD and ALS and a potential target to prevent neuronal loss, according to the researchers.

Childhood obesity may increase the risk of developing multiple sclerosis (MS) or clinically isolated syndrome (CIS), particularly for adolescent girls, according to a study published in the February 5 issue of Neurology. Researchers identified 75 patients between ages 11 and 18 with newly diagnosed MS or CIS. BMI was obtained before symptom onset for patients with MS or CIS, and through the Kaiser Permanente Southern California children’s health study for the underlying cohort. Obesity was associated with a significantly increased risk of MS or CIS in girls, but not in boys. The risk of CIS or MS was 1.58 among overweight girls, 1.78 among moderately obese girls, and 3.76 among extremely obese girls, compared with girls of normal weight.

Among individuals at high cardiovascular risk, a Mediterranean diet may reduce the likelihood of major cardiovascular events, including stroke, according to research published online in the February 25 New England Journal of Medicine. Researchers randomly assigned 7,447 participants to a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet. Participants’ age ranged from 55 to 80, and 57% were women. A total of 288 participants had myocardial infarction, stroke, or death from cardiovascular causes. The multivariable-adjusted hazard ratios were 0.70 and 0.72 for the group assigned to a Mediterranean diet with extra-virgin olive oil (96 events) and the group assigned to a Mediterranean diet with nuts (83 events), respectively, versus the control group (109 events).

The total level of antioxidants in the diet does not appear to predict a patient’s risks of dementia and stroke, researchers reported in the February 20 online Neurology. The investigators prospectively studied 5,395 participants in the Rotterdam Study. The participants were age 55 and older and dementia-free. The researchers elicited dietary information at baseline using a semiquantitative food-frequency questionnaire and combined it with food-specific ferric-reducing antioxidant power (FRAP) measurements from published tables. During a median 13.8 years of follow-up, the authors identified approximately 600 cases each of dementia and stroke. In multivariable-adjusted models, they observed no associations between dietary FRAP scores and risk of dementia or risk of stroke. Results were similar across subtypes of these outcomes. Dietary FRAP scores were unrelated to brain tissue volumes.

Eating foods high in carotenoids may help prevent or delay the onset of amyotrophic lateral sclerosis (ALS), according to research published online ahead of print January 29 in the Annals of Neurology. Investigators examined data for 1,100,910 participants (562,942 men) in the NIH–Association of American Retired Persons Diet and Health Study, the Cancer Prevention Study II Nutrition Cohort, the Multiethnic Cohort, the Health Professionals Follow-up Study, and the Nurses Health Study. A total of 1,153 deaths related to ALS occurred. Greater consumption of major carotenoids was associated with a reduced risk of ALS. Higher dietary intakes of b-carotene and lutein were inversely associated with ALS risk. Lycopene, b-cryptoxanthin, and vitamin C were not associated with reduced risk of ALS.

A device that delivers supraorbital transcutaneous stimulation may be a safe and effective preventive therapy for migraine, according to research published in the February 19 issue of Neurology. After a one-month run-in, 67 patients with at least two migraine attacks per month were randomized to stimulation or sham stimulation. Participants applied the stimulator daily for 20 minutes over the course of three months. The mean number of migraine days decreased significantly in the stimulation group (ie, from 6.94 to 4.88), but not in the sham group (ie, from 6.54 to 6.22), between the run-in and third month of treatment. Monthly migraine attacks, monthly headache days, and monthly acute antimigraine drug intake were also significantly reduced in the stimulation group, but not in the sham group.

Small-vessel cerebrovascular disease, manifested as white matter hyperintensities (WMHs) on MRI, may contribute independently to the development of Alzheimer’s disease, reported investigators in the February 18 online ahead of print JAMA Neurology. Researchers retrospectively examined baseline amyloid deposits for 21 controls, 59 subjects with mild cognitive impairment, and 20 participants with clinically defined Alzheimer’s disease. The team derived total WMH volume from patients’ MRI data. Amyloid positivity and increased total WMH volume independently predicted a diagnosis of Alzheimer’s disease. Among amyloid-positive patients, subjects with Alzheimer’s disease had greater WMH volume than controls. Among subjects with mild cognitive impairment, WMH and amyloid positivity at baseline conferred risk for a future diagnosis of Alzheimer’s disease. The findings suggest that prevention strategies for Alzheimer’s disease may be possible.

Motor benefits may continue for patients with dystonia after deep brain stimulation (DBS) is turned off, according to research published February 11 online ahead of print in Movement Disorders. Two patients with primary generalized dystonia were treated successfully with bilateral DBS: one for 18 months, and one for five years. By accident, DBS was interrupted unilaterally for three and seven months, respectively, and bilaterally for two days and two months, respectively. The patients retained their motor benefits for several months after the inadvertent interruption of stimulation. Symptoms of dystonia partially returned during the period of therapy interruption and rapidly and completely resolved after stimulation resumed. Young age, short duration of disease, and chronic DBS therapy with relatively low stimulation energy may influence whether motor benefits continue for an individual.

Unlike the adult human brain, the neonatal brain may respond to external stimulus with an increase in deoxyhemoglobin, corresponding to a negative blood oxygen level-dependent (BOLD) signal on functional MRI, according to research published February 20 online ahead of print in the Proceedings of the National Academy of Sciences. Researchers studied the evolution of the cortical blood flow response in neonatal rats during postnatal development using exposed-cortex multispectral optical imaging. Day-12–13 rats, which are equivalent to human newborns, exhibited an inverted hemodynamic response with early signs of oxygen consumption, followed by delayed, active constriction of pial arteries. The hemodynamic response matured through the development of an initial hyperemic (ie, positive BOLD) phase that eventually masked oxygen consumption and balanced vasoconstriction toward adulthood.

Neurologists may have an approximately 15-year interval during which to treat patients with amyloid buildup in an attempt to prevent Alzheimer’s disease, according to research published February 27 online ahead of print in Neurology. Investigators studied 260 participants ages 70 to 92, all of whom underwent two or more serial amyloid PET examinations. A total of 205 participants were cognitively normal, 47 had mild cognitive impairment, and eight had Alzheimer dementia. Rates of amyloid accumulation were low among patients who had low or high amyloid levels at baseline, and high among patients with moderate levels of amyloid at baseline. The researchers estimated that the average time required to travel from a low rate of accumulation to a high rate of accumulation is approximately 15 years.

Overexpression of α-synuclein may be associated with hypertrophy of membrane systems of the presynaptic terminal and the disruption of vesicle recycling, according to a study published in the February 6 issue of the Journal of Neuroscience. Progressive degeneration and cell death are the potential consequences of this disruption. Overexpressed α-synuclein was associated with a large and poorly characterized membranous organelle system of the presynaptic terminal, as well as with smaller vesicular structures within these boutons. The α-synuclein was found in several parts of the protein degradation pathway, including multivesicular bodies in the axons and lysosomes within neuronal cell bodies. The data support the conclusion that α-synuclein is involved in processes associated with the sorting, channeling, packaging, and transport of synaptic material destined for degradation, said the investigators.

Patients with multiple sclerosis (MS) and problems with cognition, memory, attention, or concentration have more damage to areas in the brain responsible for cognitive processes than patients with MS who do not have cognitive problems, according to research published in the March 6 Neurology. Investigators used MRI and diffusion tensor imaging to compare brain measurements in 20 patients with MS who had related cognitive problems, 35 patients with MS who did not have cognitive problems, and 30 healthy controls. About 49% of brain white matter examined had impaired integrity in individuals with MS and no cognitive problems, compared with 76% in patients with MS and cognitive problems. White matter dysfunction was particularly evident in the thalamus in individuals with MS-related cognitive problems.

Epidural steroid injections (ESIs) may be associated with significantly less improvement among patients with spinal stenosis, according to a study published in the February 15 Spine. Researchers performed a subgroup analysis of a prospective, randomized database from the Spine Patient Outcomes Research Trial. ESI patients who ultimately underwent surgery had an average 26-minute increase in operative time and an increased length of stay by 0.9 days. Over four years, surgically treated ESI patients had significantly less improvement in 36-Item Short Form Health Survey (SF-36) Physical Function, compared with patients who had not received ESI. Nonsurgically treated patients who received ESI also had significantly less improvement in SF-36 Body Pain and SF-36 Physical Function than patients who did not receive ESI.

C9RANT, an abnormal protein that forms as a result of genetic abnormalities, may play a role in the development of amyotrophic lateral sclerosis (ALS) or frontotemporal dementia (FTD), researchers reported in the February 20 issue of Neuron. Investigators found insoluble accumulations of C9RANT in the brain tissue of patients with ALS or FTD, but not in patients with other neurodegenerative diseases. Repeat expansions in a noncoding region of the C9ORF72 gene are the major cause of C9RANT, and these expansions are the most common cause of ALS and FTD. The investigators found C9RANT in brain tissue after creating a novel antibody to detect it. C9RANT is a potential biomarker for FTD and ALS and a potential target to prevent neuronal loss, according to the researchers.

Childhood obesity may increase the risk of developing multiple sclerosis (MS) or clinically isolated syndrome (CIS), particularly for adolescent girls, according to a study published in the February 5 issue of Neurology. Researchers identified 75 patients between ages 11 and 18 with newly diagnosed MS or CIS. BMI was obtained before symptom onset for patients with MS or CIS, and through the Kaiser Permanente Southern California children’s health study for the underlying cohort. Obesity was associated with a significantly increased risk of MS or CIS in girls, but not in boys. The risk of CIS or MS was 1.58 among overweight girls, 1.78 among moderately obese girls, and 3.76 among extremely obese girls, compared with girls of normal weight.

Among individuals at high cardiovascular risk, a Mediterranean diet may reduce the likelihood of major cardiovascular events, including stroke, according to research published online in the February 25 New England Journal of Medicine. Researchers randomly assigned 7,447 participants to a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet. Participants’ age ranged from 55 to 80, and 57% were women. A total of 288 participants had myocardial infarction, stroke, or death from cardiovascular causes. The multivariable-adjusted hazard ratios were 0.70 and 0.72 for the group assigned to a Mediterranean diet with extra-virgin olive oil (96 events) and the group assigned to a Mediterranean diet with nuts (83 events), respectively, versus the control group (109 events).

The total level of antioxidants in the diet does not appear to predict a patient’s risks of dementia and stroke, researchers reported in the February 20 online Neurology. The investigators prospectively studied 5,395 participants in the Rotterdam Study. The participants were age 55 and older and dementia-free. The researchers elicited dietary information at baseline using a semiquantitative food-frequency questionnaire and combined it with food-specific ferric-reducing antioxidant power (FRAP) measurements from published tables. During a median 13.8 years of follow-up, the authors identified approximately 600 cases each of dementia and stroke. In multivariable-adjusted models, they observed no associations between dietary FRAP scores and risk of dementia or risk of stroke. Results were similar across subtypes of these outcomes. Dietary FRAP scores were unrelated to brain tissue volumes.

Eating foods high in carotenoids may help prevent or delay the onset of amyotrophic lateral sclerosis (ALS), according to research published online ahead of print January 29 in the Annals of Neurology. Investigators examined data for 1,100,910 participants (562,942 men) in the NIH–Association of American Retired Persons Diet and Health Study, the Cancer Prevention Study II Nutrition Cohort, the Multiethnic Cohort, the Health Professionals Follow-up Study, and the Nurses Health Study. A total of 1,153 deaths related to ALS occurred. Greater consumption of major carotenoids was associated with a reduced risk of ALS. Higher dietary intakes of b-carotene and lutein were inversely associated with ALS risk. Lycopene, b-cryptoxanthin, and vitamin C were not associated with reduced risk of ALS.

A device that delivers supraorbital transcutaneous stimulation may be a safe and effective preventive therapy for migraine, according to research published in the February 19 issue of Neurology. After a one-month run-in, 67 patients with at least two migraine attacks per month were randomized to stimulation or sham stimulation. Participants applied the stimulator daily for 20 minutes over the course of three months. The mean number of migraine days decreased significantly in the stimulation group (ie, from 6.94 to 4.88), but not in the sham group (ie, from 6.54 to 6.22), between the run-in and third month of treatment. Monthly migraine attacks, monthly headache days, and monthly acute antimigraine drug intake were also significantly reduced in the stimulation group, but not in the sham group.

Small-vessel cerebrovascular disease, manifested as white matter hyperintensities (WMHs) on MRI, may contribute independently to the development of Alzheimer’s disease, reported investigators in the February 18 online ahead of print JAMA Neurology. Researchers retrospectively examined baseline amyloid deposits for 21 controls, 59 subjects with mild cognitive impairment, and 20 participants with clinically defined Alzheimer’s disease. The team derived total WMH volume from patients’ MRI data. Amyloid positivity and increased total WMH volume independently predicted a diagnosis of Alzheimer’s disease. Among amyloid-positive patients, subjects with Alzheimer’s disease had greater WMH volume than controls. Among subjects with mild cognitive impairment, WMH and amyloid positivity at baseline conferred risk for a future diagnosis of Alzheimer’s disease. The findings suggest that prevention strategies for Alzheimer’s disease may be possible.

Motor benefits may continue for patients with dystonia after deep brain stimulation (DBS) is turned off, according to research published February 11 online ahead of print in Movement Disorders. Two patients with primary generalized dystonia were treated successfully with bilateral DBS: one for 18 months, and one for five years. By accident, DBS was interrupted unilaterally for three and seven months, respectively, and bilaterally for two days and two months, respectively. The patients retained their motor benefits for several months after the inadvertent interruption of stimulation. Symptoms of dystonia partially returned during the period of therapy interruption and rapidly and completely resolved after stimulation resumed. Young age, short duration of disease, and chronic DBS therapy with relatively low stimulation energy may influence whether motor benefits continue for an individual.

Unlike the adult human brain, the neonatal brain may respond to external stimulus with an increase in deoxyhemoglobin, corresponding to a negative blood oxygen level-dependent (BOLD) signal on functional MRI, according to research published February 20 online ahead of print in the Proceedings of the National Academy of Sciences. Researchers studied the evolution of the cortical blood flow response in neonatal rats during postnatal development using exposed-cortex multispectral optical imaging. Day-12–13 rats, which are equivalent to human newborns, exhibited an inverted hemodynamic response with early signs of oxygen consumption, followed by delayed, active constriction of pial arteries. The hemodynamic response matured through the development of an initial hyperemic (ie, positive BOLD) phase that eventually masked oxygen consumption and balanced vasoconstriction toward adulthood.

Neurologists may have an approximately 15-year interval during which to treat patients with amyloid buildup in an attempt to prevent Alzheimer’s disease, according to research published February 27 online ahead of print in Neurology. Investigators studied 260 participants ages 70 to 92, all of whom underwent two or more serial amyloid PET examinations. A total of 205 participants were cognitively normal, 47 had mild cognitive impairment, and eight had Alzheimer dementia. Rates of amyloid accumulation were low among patients who had low or high amyloid levels at baseline, and high among patients with moderate levels of amyloid at baseline. The researchers estimated that the average time required to travel from a low rate of accumulation to a high rate of accumulation is approximately 15 years.

Overexpression of α-synuclein may be associated with hypertrophy of membrane systems of the presynaptic terminal and the disruption of vesicle recycling, according to a study published in the February 6 issue of the Journal of Neuroscience. Progressive degeneration and cell death are the potential consequences of this disruption. Overexpressed α-synuclein was associated with a large and poorly characterized membranous organelle system of the presynaptic terminal, as well as with smaller vesicular structures within these boutons. The α-synuclein was found in several parts of the protein degradation pathway, including multivesicular bodies in the axons and lysosomes within neuronal cell bodies. The data support the conclusion that α-synuclein is involved in processes associated with the sorting, channeling, packaging, and transport of synaptic material destined for degradation, said the investigators.

Patients with multiple sclerosis (MS) and problems with cognition, memory, attention, or concentration have more damage to areas in the brain responsible for cognitive processes than patients with MS who do not have cognitive problems, according to research published in the March 6 Neurology. Investigators used MRI and diffusion tensor imaging to compare brain measurements in 20 patients with MS who had related cognitive problems, 35 patients with MS who did not have cognitive problems, and 30 healthy controls. About 49% of brain white matter examined had impaired integrity in individuals with MS and no cognitive problems, compared with 76% in patients with MS and cognitive problems. White matter dysfunction was particularly evident in the thalamus in individuals with MS-related cognitive problems.

Epidural steroid injections (ESIs) may be associated with significantly less improvement among patients with spinal stenosis, according to a study published in the February 15 Spine. Researchers performed a subgroup analysis of a prospective, randomized database from the Spine Patient Outcomes Research Trial. ESI patients who ultimately underwent surgery had an average 26-minute increase in operative time and an increased length of stay by 0.9 days. Over four years, surgically treated ESI patients had significantly less improvement in 36-Item Short Form Health Survey (SF-36) Physical Function, compared with patients who had not received ESI. Nonsurgically treated patients who received ESI also had significantly less improvement in SF-36 Body Pain and SF-36 Physical Function than patients who did not receive ESI.

C9RANT, an abnormal protein that forms as a result of genetic abnormalities, may play a role in the development of amyotrophic lateral sclerosis (ALS) or frontotemporal dementia (FTD), researchers reported in the February 20 issue of Neuron. Investigators found insoluble accumulations of C9RANT in the brain tissue of patients with ALS or FTD, but not in patients with other neurodegenerative diseases. Repeat expansions in a noncoding region of the C9ORF72 gene are the major cause of C9RANT, and these expansions are the most common cause of ALS and FTD. The investigators found C9RANT in brain tissue after creating a novel antibody to detect it. C9RANT is a potential biomarker for FTD and ALS and a potential target to prevent neuronal loss, according to the researchers.