1.             Al-Okaili RN, Krejza J, Woo JH, Wolf RL, O'Rourke DM, Judy KD, Poptani H, Melhem ER. Intraaxial brain masses: MR imaging-based diagnostic strategy—initial experience. Radiology. 2007 May;243(2):539-50.

Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.

PURPOSE: To develop and retrospectively determine the accuracy of a magnetic resonance (MR) imaging strategy to differentiate intraaxial brain masses, with histologic findings or clinical diagnosis as the reference standard. MATERIALS AND METHODS: The study was HIPAA compliant and was approved by the institutional review board. A waiver of informed consent was obtained. A strategy was developed on the basis of conventional MR imaging, diffusion-weighted MR imaging, perfusion MR imaging, and proton MR spectroscopy to classify intraaxial masses as low-grade primary neoplasms, high-grade primary neoplasms, metastatic neoplasms, abscesses, lymphomas, tumefactive demyelinating lesions (TDLs), or encephalitis. The strategy was evaluated by using data from 111 patients (46 women, 65 men; mean age, 48.9 years) with imaging results available on a departmental picture archiving and communication system from a 5-year search period. Bayesian statistics of the strategy elements and three clinical tasks were calculated. RESULTS: Search results identified 44 patients with high-grade and 14 with low-grade primary neoplasms, 24 with abscesses, 12 with lymphoma, 11 with TDLs, five with metastases, and one with encephalitis who had undergone conventional and advanced MR imaging. However, only 40 patients (25 women, 15 men; mean age, 45 years) had undergone all studies and had data to allow completion of the entire strategy. Accuracy, sensitivity, and specificity of the strategy, respectively, were 90%, 97%, and 67% for discrimination of neoplastic from nonneoplastic diseases, 90%, 88%, and 100% for discrimination of high-grade from low-grade neoplasms, and 85%, 84%, and 87% for discrimination of high-grade neoplasms and lymphoma from low-grade neoplasms and nonneoplastic diseases. CONCLUSION: An integrated MR imaging-based strategy, which is accurate in differentiation of several intraaxial brain masses, was proposed.

2.             Feasby T, Banwell B, Benstead T, Bril V, Brouwers M, Freedman M, Hahn A, Hume H, Freedman J, Pi D, Wadsworth L. Guidelines on the use of intravenous immune globulin for neurologic conditions. Transfus Med Rev. 2007 Apr;21(2 Suppl 1):S57-107.

IVIG Hematology and Neurology Expert Panels.

Canada's per capita use of intravenous immune globulin (IVIG) grew by approximately 115% between 1998 and 2006, making Canada one of the world's highest per capita users of IVIG. It is believed that most of this growth is attributable to off-label usage. To help ensure IVIG use is in keeping with an evidence-based approach to the practice of medicine, the National Advisory Committee on Blood and Blood Products (NAC) and Canadian Blood Services convened a panel of national experts to develop an evidence-based practice guideline on the use of IVIG for neurologic conditions. The mandate of the expert panel was to review evidence regarding use of IVIG for 22 neurologic conditions and formulate recommendations on IVIG use for each. A panel of 6 clinical experts, one expert in practice guideline development and 4 representatives from the NAC met to review the evidence and reach consensus on the recommendations for the use of IVIG. The primary sources used by the panel were 2 recent evidence-based reviews. Recommendations were based on interpretation of the available evidence and, where evidence was lacking, consensus of expert clinical opinion. A draft of the practice guideline was circulated to neurologists in Canada for feedback. The results of this process were reviewed by the expert panel, and modifications to the draft guideline were made where appropriate. This practice guideline will provide the NAC with a basis for making recommendations to provincial and territorial health ministries regarding IVIG use management. Recommendations for use of IVIG were made for 14 conditions, including acute disseminated encephalomyelitis, chronic inflammatory demyelinating polyneuropathy, dermatomyositis, diabetic neuropathy, Guillain-Barré syndrome, Lambert-Eaton myasthenic syndrome, multifocal motor neuropathy, multiple sclerosis, myasthenia gravis, opsoclonus-myoclonus, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, polymyositis, Rasmussen's encephalitis, and stiff person syndrome; IVIG was not recommended for 8 conditions including adrenoleukodystrophy, amyotropic lateral sclerosis, autism, critical illness polyneuropathy, inclusion body, myositis, intractable childhood epilepsy, paraproteinemic neuropathy (IgM variant), and POEMS syndrome. Development and dissemination of evidence-based clinical practice guidelines may help to facilitate appropriate use of IVIG.

3.             Letendre S, Ances B, Gibson S, Ellis RJ. Neurologic complications of HIV disease and their treatment. Top HIV Med. 2007 Apr-May;15(2):32-9.

Department of Medicine, Division of Infectious Diseases, University of California San Diego, San Diego, CA, USA.

Important new information regarding neurologic complications of HIV disease was presented at the 2007 Conference on Retroviruses and Opportunistic Infections. In addition to presentations on pathogenesis and treatment of neurologic complications, the conference included findings that have implications for the management of HIV disease outside the nervous system. Key findings included that the distribution of antiretrovirals into the central nervous system may influence the effectiveness of treatment outside this protected compartment; that postponing initiation of therapy until blood CD4+ counts fall to 300 cells/mm3 may increase the risk for HIV-associated neurocognitive impairment but interruption of antiretroviral therapy in individuals with high CD4+ counts may have neuropsychologic benefits; that substantial changes, including macrophage activation and neuronal injury can occur shortly after HIV transmission; that HIV can influence neural progenitor cells to decrease neuronal differentiation; that newer neuroimaging technologies, such as diffusion tensor imaging and blood oxygen level-dependent functional magnetic resonance imaging can identify important effects of HIV on the brain such as alterations in cerebral oxygen consumption; that serotonin reuptake inhibitors and 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors may reduce HIV RNA levels in cerebral spinal fluid; and that erythropoietin and the non-immunosuppressive immunophilin ligand, GPI-1046, may improve HIV-associated injury of peripheral nerves. The conference also included an important focus on JC virus encephalitis (also known as progressive multifocal leukoencephalopathy).

4.            Sinha S, Satishchandra P. Epilepsia Partialis Continua over last 14 years: experience from a tertiary care center from south India. Epilepsy Res. 2007 Apr;74(1):55-9.

Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560 029, India. sanjib_sinha2004@yahoo.co.in

Epilepsia Partialis Continua (EPC), a subtype of status epilepticus has varied etiology and the outcome depends on the cause. The aim of this study was to analyze the demographic, semiology, etiology, radiological findings, therapeutic response and outcome of EPC. This is a retrospective analysis of 76 patients (M:F: 46:30; mean age: 30.2+/-23.4 years; median age: 26 years) evaluated at our center over last 14 years. Twenty-three subjects (30.3%) had epilepsy for a mean of 25.8+/-52.3 months (range: 1-81 years; median: 14) before developing EPC and in half of them, seizures were controlled with anti-epileptic drugs (AEDs). Rest 53 (69.3%) manifested as de novo. The mean duration of EPC was 47.02+/-188.2 days (range: 1h to 48 months; median: 3 days). One patient of generalized convulsive SE (GCSE) evolved into EPC while five patients of EPC evolved into GCSE. CT scan of brain (n-76) was abnormal in 53 (69.7%) while all the 11 MRI scans which were available were abnormal. EEG (n-21) was abnormal in all but one, however it was non-specific in 7. The diagnoses were-idiopathic: 17, ischemic stroke: 15, meningo-encephalitis: 8, Rasmussen's encephalitis (RE): 7, granuloma: 6, diabetic-non-ketotic-hyperosmolar-coma (DNKHC): 6, CNS malignancies (primary/secondary): 4, birth injury: 4, cerebral venous thrombosis: 3, CNS tuberculosis: 2, and cerebritis, HIV-related, toxemia of pregnancy, and MERRF one each. Patients of >40 years (n=21) had stroke (10), idiopathic (6), DNKHC (4) and metastasis (1) as common causes. Only 12 of them received single AED, while others required 2 or more AEDs to control the seizures. The outcome (n=72) was-controlled: 43 (59.7%); uncontrolled: 26 (36.1%) (RE: 7, idiopathic: 5, birth injury: 4, encephalitis: 3, malignancy: 2, granuloma and MERRF: 1 each) and three patients succumbed (encephalitis: 2, idiopathic: 1). Causes of EPC are varied and it depends on age. Underlying cause determined the outcome and could be refractory in RE, idiopathic, and when associated with birth injury, malignancy and encephalitis. Treatment of underlying cause is essential in addition to AEDs.

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:

16330.  Bien CG. Limbic encephalitis: extension of the diagnostic armamentarium. J Neurol Neurosurg Psychiatry. 2007 Apr;78(4):332-3. 

16331.  Selbst SM. Pediatric emergency medicine: legal briefs. Pediatr Emerg Care. 2007 May;23(5):350-3.

16332.  Vernino S, Geschwind M, Boeve B. Autoimmune encephalopathies. Neurologist. 2007 May;13(3):140-7. Review.

Pathogenesis:

16333. Von Landenberg P, Lehmann HW, Modrow S. Human parvovirus B19 infection and antiphospholipid antibodies. Autoimmun Rev. 2007 Apr;6(5):278-85. 

Chemotherapy, Immunotherapy, Management & Drugs:

16334.  Klegeris A, McGeer EG, McGeer PL. Therapeutic approaches to inflammation in neurodegenerative disease. Curr Opin Neurol. 2007 Jun;20(3):351-7. Review.