NeurologyLive® Year in Review 2021: Top Features

2021 has been a year full of exciting and engaging discourse in the field of neurology and around the care and management of patients with neurologic disease. In an effort to capture some of these conversations that have led to larger trends in the field, the NeurologyLive^® team and a group of leaders in the field have authored pieces that take a deeper look into the driving challenges and decisions that have pushed these discussions forward.

These conversations have included looks back on the past and what can be learned as the field continues to advance, deep dives into new and pertinent societal guidances on care approaches, and explorations of individuals and institutions that are making their marks, among others. Some are part of larger content series and others are featured in our bimonthly print publication, but all of them are available to view on this very site.

Look back on some of the most-read feature stories from 2021 by clicking the buttons below:

Sonja W. Scholz, MD, PhD, on Advancing Genomics Against Complex, Polygenic Neurodegenerative Disorders

By Kenneth Bender, PharmD

Sonja W. Scholz, MD, PhD, an investigator in the Neurodegenerative Diseases Research Unit in the Division of Intramural Research at the National Institute of Neurological Disorders and Stroke (NINDS) of the National Institutes of Health (NIH), was the recipient of the annual Soriano Lectureship Award at the 2020 American Neurological Association (ANA) virtual meeting. The award acknowledges, according to the ANA, a “brilliant lecture delivered by an outstanding scientist.”

Scholz was recognized for her application of advanced genetic techniques to the study of neurodegenerative disorders, including dementia with Lewy bodies, multiple system atrophy, frontotemporal dementia, progressive supranuclear palsy, and corticobasal degeneration. She welcomed the opportunity, utilizing the occasion to describe how advances in genetics are likely to impact daily clinical practice with patients afflicted with these types of disorders.

While much of the recent excitement in this field has resulted from the identification of single-gene defects or deficiencies underlying rare monogenic disorders such as Batten disease and Rett syndrome...

Neurosurgery and Parkinson Disease: Past, Present, and Future of Deep Brain Stimulation

By Atom Sarkar, MD, PhD

For as long as humans have coalesced as communities, beginning nearly 10,000 years ago in the Neolithic period, there has been a fascination with the skull and brain. From here emerged the rudiments of neurosurgery. In regions ranging from the Ensisheim in Alsace, France, to the Peruvian Altiplano, we know trepanation was practiced. In trepanation, a hole is scraped or drilled into the human skull, and it is the oldest documented surgical procedure performed by man. While we can only speculate about the millennia-old reasons for such “procedures”—spanning from the mystical to spiritual and ritual—they must be favored over any current-day notion of medicinal. Nevertheless, such experiences of the shaman and healers of lore should not be discounted, because some of our current neurosurgical practices, in particular the practice of minimal-access surgery, harken back to their legacy of transcalvarial access.

In general, neurosurgical interventions can be considered corrections of structural deformities. For instance, FIGURE 1 depicts a disc herniation impinging on a nerve root. Here, a right-sided C6/7 disc herniation causes a right C7 radiculopathy, with associated pain and triceps weakness. Since an adequate trial of conservative care failed, our solution was to remove the pathology...

Holding On to Hope in Huntington Disease

By Daniel O. Claassen, MD, MS

The disappointing news of 2 halted programs reverberated around the Huntington disease (HD) community in late March. Tominersen (Roche), WVE-120101, and WVE-120102 (both Wave Life Sciences) were proposed as antisense oligomer (ASO) treatments for HD patients. These treatments do not currently appear to be viable options for therapy, but for different reasons. It’s difficult to express the profound hype and the hope that accompanied these trials. ASO treatments appear promising for neurologic disease: Nusinersen (Spinraza; Biogen) was approved for the treatment of spinal muscular atrophy, and the videos of children who can now walk are miraculous to see. I was at a European HD program and when watching these videos, I remember a comment from the audience microphone: “Can we imagine a world where HD patients will have a treatment like this?”

Fast forward to 2021, and the mood is—flat...

Love and a Lab Coat: One Couple’s Quest to Treat Alzheimer Disease

By Matt Hoffman

The successful treatment of Alzheimer disease (AD) has eluded scientists and physicians for decades, with efforts to develop disease-modifying therapies for the complex neurodegenerative disease culminating mostly in failures. Despite this, much of the field remains highly motivated on the overall quest to provide patients with options that can quell the devastation of AD’s progression. Although those labors have so far fallen short of providing effective therapies, they have led to a better understanding of the pathogenesis of AD as well as advances in imaging and detection.

Among this group of physician-scientists aiming to change the course of AD treatment are a unique pair operating out of Northwell Health’s Feinstein Institutes for Medical Research in Manhasset, New York...

NYU Langone’s Comprehensive Epilepsy Center Elevates Care Standards, Drug Development

By Marco Meglio

Driven by a core mission to provide excellence in patient care, NYU Langone’s Comprehensive Epilepsy Center has established itself as a powerhouse in advancing the standards of epilepsy management and research. Among one of the largest epilepsy treatment programs in the world, the center is home to both budding talents and experienced clinician experts, whose expertise shines from the top down.

The center is led by Orrin Devinsky, MD, a world-renowned epilepsy researcher and activist within the community. Devinsky holds several roles within the program, including lead investigator for the Cannabidiol Trials for Epilepsy, as well as principal investigator of the SUDC Registry and Research Collaborative, a multisite collaborative that studies sudden unexplained death in children (SUDEP)...

Preventing Secondary Stroke: Practical Application of Updated Guidelines

By Sana Somani, MD, MBBS, and Prachi Mehndiratta, MBBS, FAHA

Stroke continues to be the fifth-leading cause of death in the United States. High blood pressure, diet, physical inactivity, smoking, and abdominal obesity were the top 5 risk factors associated with ischemic and hemorrhagic stroke incidence observed in the INTERSTROKE study. Targeting multiple risk factors has a combined benefit for secondary prevention— medications combined with diet modification and exercise can result in an 80% cumulative risk reduction in recurrent vascular events, according to findings from Hackam et al.

The recent American Heart Association (AHA)/ American Stroke Association guideline on secondary stroke prevention provides comprehensive practical guidance for the prevention of recurrent ischemic stroke and transient ischemic attack (TIA). The TABLE provides a few of the major practice changes based on the guidelines...

Accessible Stroke Care for Diverse Populations: The Montefiore Approach

By Marco Meglio

In the heart of The Bronx, New York, lies Stern Stroke Center at Montefiore—a leader in stroke services and care with an emphatic mission to provide quality access, raise stroke awareness, and improve poststroke outcomes in diverse populations.

According to a 2020 census report, the Bronx is primarily made up of individuals identifying as Hispanic, accounting for 56% of the population; Black (29%); and White (9%). Of the 1,418,207 people in the borough, 26.4% live below the poverty line, almost double the rate for the state of New York (13%) and more than double that of the United States. Additionally, 33.7% of the population are foreign-born, about 1.5 times the rate of New York and more than double the rate of the United States.

The stroke-related disparities these individuals face have been well documented...

Disproportionate Neurodegeneration in Black Patients With MS: The Need for Stratified Treatments

By Darin T. Okuda, MD, FAAN, FANA

Tailoring treatment and surveillance recommendations to the individual patient serves as an attractive goal in the effective management of any medical condition. Commonly, therapeutic approaches and preventive measures are recommended based on patient age with the hope that these interventions will help to improve long-term outcomes. Other key factors include disease severity, genetic markers from tumors that may inform on therapeutic response, and comorbid conditions. The incorporation of such data aims to improve our ability to more effectively deliver care that minimizes morbidity and mortality. Yet despite all the advances in modern medicine up to this point, very few treatment recommendations are stratified based on race and ethnicity. Ethnicity is a much deeper issue than it may seem, representing more than who people are, going beyond genetics and involving shared cultural, behavioral, or religious characteristics...

Advancing a New Era for Parkinson Disease: Cleveland Clinic’s Palliative Care Approach

By Marco Meglio

Palliative care, also known as supportive care, is an interdisciplinary approach that addresses physical, spiritual, emotional, and functional sources of distress. For patients with Parkinson disease (PD), the integration of this type of care can be used to help treat nonmotor symptoms such as pain, fatigue, and depression.

Despite its effectiveness, there are only a handful of institutions that provide this unique care, one of which is located at Cleveland Clinic. The Care PD Clinic, headed by Adam Margolius, MD, is revolutionizing the way clinicians can treat patients with PD, and aims to set the standard for what a specialized clinic such as this could look like going forward.

In November 2019, Margolius and colleague Renato Samala, MD, traveled to Alberta, Canada, to meet with palliative care expert Janis Miyasaki, MD, FRCPC, FAAN...

A Practical Approach to Chronic Immunosuppression in Myasthenia Gravis

By Jessica Yi, MD, and Ericka Wong, MD

Myasthenia gravis (MG) is an autoimmune disorder caused by the presence of autoantibodies against the neuromuscular junction, which results in fatigable weakness. Chronic immunosuppression is among the mainstays of long-term therapy in MG. This article offers a practical approach to initiating and tapering corticosteroids, in addition to reviewing some of the considerations in the selection and monitoring parameters of steroid-sparing agents. We will also briefly introduce some novel therapies for MG.

Per international consensus, corticosteroids (specifically prednisone) comprise first-line immunosuppressive therapy for all patients who have not achieved disease control with pyridostigmine. Efficacy trials have shown marked improvement (45%) or remission (30%) in most MG patients initiated on corticosteroids.

There are 2 treatment approaches to the initiation of corticosteroids, and the choice of approach is dependent upon the patient’s level of disability at presentation...