Going forward then, here are 10 more catchy titles from the recent neurology literature-almost all from the last 12 months.
This is the title of a 2019 editorial in the journal Epilepsy Currents, and FIRES here refers to febrile infection related epilepsy syndrome. FIRES is itself a form of new onset refractory status epilepticus (NORSE) in which there is associated fever. NORSE and FIRES are notoriously resistant to treatment, and the editorial points out the abject failures of steroids, IVIg, and plasma exchange, and the limited benefit of ketogenic diet and anakinra. This is where the hose comes in: it is the interleukin‐6 receptor inhibitor tocilizumab; the original research paper, published in the journal Annals of Neurology in 2018, reported that seven patients treated with Tocilizumab had very good outcomes. Take home messages: perhaps Tocilizumab is the right fire-extinguisher for this blazing inferno, and there must be an acronym-generating machine in the epilepsy universe!
The full title of this paper is “Dosing interval of natalizumab in MS: do good things come to those who wait?” It comes from a 2019 issue of the journal Neurology, and it is itself an editorial on a paper in the same journal which touted the benefits of extended dosing interval of natalizumab in multiple sclerosis. That paper showed that the risk of progressive multifocal leukoencephalopathy (PML) can be reduced by reducing the frequency of Natalizumab infusions. The authors used a 6 weekly, rather than the conventional 4 weekly, dosing interval of Natalizumab, and their gamble had paid off; they reported a “remarkable” risk reduction of developing PML by 88-99%. Enough justification for a catchy title, and proof that procrastination pays off…sometimes.
The full, more intriguing, title of this paper is “Looking for Mr(s) Right: Decision bias can prevent us from finding the most attractive face”. Something for incurable romantics. Published in the journal Cognitive Psychology in 2019, the paper revealed that, when it comes to picking partners, we stick at it much longer than we do when we make other decisions, somehow believing that the best has been saved for the last. The participants in the study kept looking out for “rare, highly-attractive faces“, so much so that many of them couldn’t make any choice at all. Proof that Mr and Mrs Right are hard to find…if they exist at all!
The full title of this paper is “Don’t fear the reefer-evidence mounts for plant-based cannabidiol as treatment for epilepsy”. Published in Epilepsy Currents in 2019, this is an editorial that set out to reassure clinicians that cannabis is OK…sort of. The author referred to several articles to support his assertions, one of which was a double-blind study of 225 people with Lennox-Gastaut syndrome (LGS), the severe epilepsy disorder which manifests with dangerous drop attacks. The subjects of that study were randomised to receive one of two doses of cannabidiol, and their response was compared to a matched control group who were treated with placebo. The good news is that both doses of cannabidiol produced “greater reductions in the frequency of drop seizures than placebo”. Dispel the fear…and embrace the reefer!
This paper has nothing to do with why you can’t get that musical note out of your head, as revealed by the full title which is “Can’t get it off my brain: meta-analysis of neuroimaging studies on perseverative cognition”. But do not panic, at least not yet: perseverative cognition, it turns out, is just a fancy term for worrying or rumination. Published in the journal Psychiatry Research: Neuroimaging in 2020, the paper is a meta-analysis of 43 imaging studies of pathological worriers, those of us who have “intrusive, uncontrollable, repetitive thoughts”. To cut to the chase, and to avoid going round in circles, the centre of our rumination is a part of the brain called the anterior cingulate cortex (ACC). This structure, the authors said, is “critical for the pathological expression of rumination and worry”. You can now panic: you have the ACC to add to your list of things to worry about!
Visual snow syndrome is a relatively new thing for neurologists who are very much in the dark about it. From being a manifestation of migraine, it has climbed up the slippery disease classification ladder and is now a full-fledged syndrome of its own. It is therefore time for neurologists to see the light of visual snow, and what better way to show it than by such a catchy title. The paper, published in the journal Neurology in 2019, calls attention to this enigmatic phenomenon by providing a detailed review of the syndrome. But is the light bright enough for the neurologist?
Things that go twist in neurology are almost always dystonic, and this paper is no exception. Published in the journal Neurology Clinical Practice in 2019, the full title of the paper is “Sternocleidomastoid muscle hypertrophy in cervical dystonia: an unexpected twist”. It is a rather convoluted tale of a patient with Parkinson’s disease (PD) who developed cervical dystonia 10 days after he was treated with quetiapine. However, his sternocleidomastoid muscle was massively enlarged or hypertrophied, an impossible thing to happen within 10 days. You are beginning to get the twist. With their curiosity piqued, and their Sherlock Holmes hat on, the authors discovered that the patient has a previous history of dystonia, and the hypertrophy is really not as new as it first appeared. One surely for Agatha Christie fans, a tale with many unexpected twists. But the catchy title belies an important lesson- Occam’s razor doesn’t always cut sharply.
The idea that multiple sclerosis (MS), the quintessential white matter brain disease, is also a grey matter disease, is a bit of a shock to the traditional neurologist. The grave implication is that MS, the ultimate neuroinflammatory disease, is also a neurodegenerative disorder. This paradigm shift has all to do with the much better imaging tools available which show the grey matter changes in MS. And this editorial, published in the journal Nature in 2019, sums up the situation aptly, and catchily. The paper on which the editorial is based discusses how T cells interact with β-synuclein to cause the grey matter pathology in Lewis rats (rodents susceptible to experimental inflammatory diseases). Catchy editorials like this are doing a good job of taking us into the grey zone, and enabling us to see MS as much more than just relapses and progression.
If this headline doesn’t stop you in your tracks, then nothing ever will. The full title of this editorial is “Don’t just stand there: do something! The case for peri-ictal intervention”, and it comes from the journal Epilepsy Currents published in 2019. The paper it comments on, published in the journal Neurology in 2019, investigated the risk factors and best treatment for post-ictal hypoxaemia, that is low oxygen levels after generalised convulsions. It is not clear that the paper adds any new insights apart from stating the rather obvious fact that generalised convulsions lead to low blood oxygen levels. They however point out that the earlier oxygen is administered, the better the outcome. Not exactly groundbreaking research, but it resulted in an excellent catchy editorial.
This editorial, full title being “Heartbreakers-cardiac stress after uncomplicated generalized convulsive seizures”, is from the journal Epilepsy Currents published in 2019. And it is all about the risk of potentially fatal cardiac complications of epilepsy. The author was commenting on a paper published in the journal Epilepsia in 2019, which investigated the biomarkers of cardiac stress after a generalised convulsion. In essence, they were on the hunt for any red flags of fatal arrythmias, and of Takotsubo cardiomyopathy. And (you may insert drum roll here) the leading heartbreaker turned out to be… high‐sensitive troponin T (hsTNT). A catchy title to remind us that the heart is at risk in epilepsy.
Catchy titles help make the point. And there are more in the pipeline; the next in the series will look at catchy titles from the neurology archives. Watch this space, as they say.