Neurology Alert – December 1, 2019

December 1, 2019

• Stereoelectroencephalography in Surgical Evaluation of Intractable Epilepsy

  Epilepsy surgery is one of the treatment modalities for intractable pharmacoresistent epilepsy. For seizure freedom to be achieved, the epileptogenic zone (EZ) must be resected successfully. Stereoelectroencephalography is one of the invasive intracranial EEG recording techniques used for EZ localization. The technological advancements in the past two decades have made this procedure safer, more accurate, and easier to perform and therefore more readily available.

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• Prognosis in Small Fiber Neuropathy

  Small fiber neuropathy is a common disorder that causes chronic pain, but rarely progresses to disability or more severe neurological disorders. Management of the pain continues to be the major challenge in treatment.

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• Treating Depression in Epilepsy: To Medicate or Not?

  Epileptic patients with major depression were randomized to either cognitive behavioral therapy (CBT) or sertraline. Depression and related secondary health outcomes were analyzed in both groups. Sertraline and CBT were found to be equally efficacious with improvement in mood in just over one-half of the patients.

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• Patients With Stable Coronary Disease and Atrial Fibrillation Are Best Treated With Rivaroxaban, Alone

  Optimal antithrombotic therapy for stroke prevention in patients with atrial fibrillation continues to evolve.Monotherapy with rivaroxiban was noninferior to combination therapy for the primary efficacy endpoint.

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• What Is the Optimal Blood Pressure for Secondary Prevention of Stroke?

  High blood pressure is the most prevalent and important risk factor for stroke, and great efforts have been made to reduce blood pressure for both primary and secondary stroke prevention. However, at this time, we do not have evidence to support a firm recommendation for optimal blood pressure management for secondary stroke prevention.

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• Smartwatches for the Diagnosis of Atrial Fibrillation

  The Apple Heart Study participants were people without atrial fibrillation who purchased a smart phone app and consented to monitoring using a smartwatch-based irregular pulse notification algorithm, which identified possible atrial fibrillation. If notification occurred, the person was mailed an electrocardiography (ECG) patch to be worn for seven days to confirm the findings first identified by the smartwatch. The age distribution of this group is different than the usual cohort at risk for atrial fibrillation: 52% were between the ages of 22 and 39 years of age, and only 5.9% were 65 years or older. A much more useful study would have included an older cohort that carries a higher risk of atrial fibrillation.

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• Dual Antiplatelet Therapy Results in Increase in Serious Hemorrhages Following TIA or Minor Stroke

  The POINT trial showed a 25% reduction in the composite outcome of ischemic stroke, myocardial infarction, or ischemic vascular death in patients treated with clopidogrel plus aspirin for 90 days, immediately following a transient ischemic attack (TIA) or minor acute ischemic stroke. The investigators performed a secondary analysis and found the risk of major hemorrhages was low in both groups, although treatment with clopidogrel and aspirin together increased the risk of major hemorrhages over aspirin alone. Caution should be taken and very close observation of patients maintained when treating with dual antiplatelet therapies.

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