Editorial Message and Issue Highlights–Vol. 15, No. 1–2, January-February 2018

| February 1, 2018 | 0 Comments

Dear Colleagues:

Welcome to the January-February 2018 issue of Innovations in Clinical Neuroscience (ICNS). This is a milestone year for us as it marks the beginning of our 15th year of publication! We are pleased to continue serving you, our valued readers and colleagues, by providing peer-reviewed, evidence-based information on the latest innovations in both research and clinical practice in the field of neuroscience. We’d like to thank those dedicated readers who have been with us since 2004, the year we launched the journal, and to welcome new readers who are just discovering ICNS and what it has to offer. We’d also like to thank our esteemed editorial advisory board for the years of dedication and hard work they have so graciously donated to the journal. We are looking forward to seeing what exciting advances in neuroscience the next 15 years will bring us.

We start this issue with a review article by Kitten et al titled, “Pimavanserin: A Novel Drug Approved to Treat Parkinson’s Disease Psychosis.” Here, the authors review the safety, efficacy, and pharmacology data for pimavanserin and its role in the treatment of psychosis in Parkinson’s disease. After conducting a literature search using MEDLINE and a reference review and search of FDA.gov and clinicaltrials.gov, the authors primarily focus on four randomized, controlled trials. The authors report that while a Phase II trial displayed a nonsignificant trend toward Scale for Assessment of Positive Symptoms (SAPS) improvement, with significant benefits in secondary efficacy markers, two Phase III trials failed to show significant SAPS improvement. However, a third Phase III trial with an improved research design demonstrated that pimavanserin 40mg was effective in improving Parkinson’s disease psychosis (PDP) compared to placebo, with secondary outcomes also significantly improving. The authors conclude pimavanserin should be considered as a treatment option for PDP symptoms, as it has demonstrated few adverse effects and little risk of worsening motor function.

Next, in a case series by Grover et al titled, “Effectiveness of Electroconvulsive Therapy (ECT) in Parkinsonian Symptoms: A Case Series,” the authors perform a retrospective chart review of patients with Parkinson’s disease (PD) and depression who were treated with ECT in their clinic. Six patients met the inclusion criteria, and the authors report that all six patients demonstrated improvement in symptoms of depression and PD following ECT treatment, improvement that was sustained in four patients for months to years. The other two patients initially showed improvement in their depression and PD symptoms, but then experienced a worsening of PD symptoms 3 to 4 months post-ECT. The authors conclude that ECT is a treatment option that should be considered for certain patients with PD and depression.

Following this, in a study by Robinson-Papp titled, “Lower-extremity Dynamometry as a Novel Outcome Measure in a Double-blind, Placebo-controlled, Feasibility Trial of Intravenous Immunoglobulin (IVIG) for HIV-associated Myelopathy (HIVM),” investigators conducted a randomized, double-blind, placebo-controlled feasibility trial of IVIG for HIVM, using dynamometry as an outcome. Critical impediments to the study were the rarity of patients with new HIVM diagnoses or prior exposure to IVIG with an established diagnosis, thus only 12 participants were enrolled over four years. The authors utilized dynamometry of hip flexion, knee flexion, and ankle dorsiflexion; the HIV Dementia Motor Score (HDMS); and the two-minute timed walk test as measurements. The authors found that dynamometry was generally well-tolerated, had good test-retest reliability, and good inter-item reliability, as judged by the correlations between the muscle groups. It was also valid and clinically meaningful based on its correlations with the HDMS and the two-minute timed walk test. The authors conclude that an adequately powered clinical trial of IVIG for HIVM would likely require a prolonged recruitment period and multiple participating sites; however, limb dynamometry is a useful outcome measure for HIVM and might also be useful in other HIV-related gait disorders.

Next, in a case report titled, “The Benefit of Mirtazapine in the Treatment of Progressive Multifocal Leukoencephalopathy in a Young HIV-positive Patient: A Case Report,” by Mullins et al, the authors describe a case of a young HIV-positive women who was nonadherent to HIV therapy and suffered from progressive multifocal leukoencephalopathy caused by the human John Cunningham virus. The authors report that objective clinical improvement was seen in their patient after reinitiation of highly active antiretroviral therapy (HAART) and the addition of mirtazapine to the treatment regimen. The authors discuss emerging literature that supports mirtazapine’s use with HAART among patients with HIV.

Following this, in a brief review article by Pendergrass, Targum, and Harrison titled, “Cognitive Impairment Associated with Cancer: A Brief Review,” the authors explore areas of cognitive impairment that have been observed in cancer patients and survivors, as well as the cognitive assessment tools used and the management of the observed cognitive changes among this patient population. The investigators report that attention, memory, and executive functioning are the most frequently identified cognitive domains impacted by cancer, and that this cognitive impairment can be related to the direct effects of cancer itself, nonspecific factors or comorbid conditions that are independent of the actual disease, and/or the treatments or combination of treatments administered. The authors discuss how marked differences in methodology, definitions of cognitive impairment, and the assessment measures used make it difficult to determine the prevalence and extent of impairment cognitive impairment in patients with cancer and those in remission. The authors conclude that assessment of cognitive functioning should be considered a necessary part of a comprehensive oncological care plan and that research is needed to establish a better understanding of cognitive changes and impairments associated with cancer.

Next, in a case report by Guina and Guina titled, “Wants Talk Psychotherapy but Cannot Talk: EMDR for Post-stroke Depression with Expressive Aphasia,” the authors present the first known case of the utilization of eye movement desensitization and reprocessing (EMDR) in aphasia, describing psychotherapy of a 50-year-old woman with a history of depression following a left middle cerebral artery stroke. The authors report that they initiated EMDR two years following the patient’s stroke due to expressive aphasia that remained persistent in the patient despite previously completing more than a year of speech therapy. Using the Blind to Therapist Protocol, the authors report that EMDR successfully led to improvement in depressive symptoms and, surprisingly, improvement in her aphasia. Additionally, the authors discuss potential challenges with EMDR and speculate about the potential biopsychosocial explanations for their results. The authors conclude that EMDR might be beneficial for those with mental health concerns who have expressive communication impairments that might prevent treatment with other psychotherapy modalities.

And finally, we wrap up the issue with our “Risk Management” column. In her article, “Vetting Service Dogs and Emotional Support Animals,” McNary provides suggestions on how to successfully navigate the expanding use of service dogs and emotional support animals in mental health, and how we, as clinicians, are involved.

We also have several interesting letters to the editor you’ll want to check out on topics including telemedicine, marijuana, diagnoses in schizophrenia, and pneumocephalus.

We hope you enjoy this issue of ICNS. As always, we welcome your feedback and submissions.

Sincerely
Amir Kalali, MD
Professor of Psychiatry, University of California, San Diego, California; Editor, Innovations in Clinical Neuroscience

Category: Current Issue, Editor's Message: Issue Highlights

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