Welcome to the May-June issue of Innovations in Clinical Neuroscience. First, I would like to call your attention to the accompanying supplement to this issue of the journal, a compendium of abstracts from the 2014 CNS Summit poster presentations. Each year, the CNS Summit brings together drug development leaders from pharma, research sites, and related service companies to address key issues in drug development—in a noncompetitive, interactive, collaborative environment. The poster presentations allow CNS Summit participants to share innovations in drug development research and technology as well as their clinical trial successes and lessons learned, and we are pleased to present this compendium of abstracts for the readers of Innovations. To access the 2014 CNS Summit abstract supplement, click here for the E-EDITION (a digital replica of the printed version) or here for the ONLINE version.
We start the issue with an original study by Ramaswamy et al titled, “Effects of Escitalopram on Autonomic Function in Posttraumatic Stress Disorder Among Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF).” In this study, the authors evaluated the effects of escitalopram on autonomic reactivity in posttraumatic stress disorder (PTSD). The study comprised a 12-week, Phase IV, prospective, open-label trial of escitalopram in veterans with combat-related PTSD and comorbid depression. While the authors observed a reduction in PTSD and depression symptoms and that escitalopram was generally well tolerated in their study sample, they also observed a decrease in high frequency heart rate variability and an increase in QT variability, indicating a reduction in cardiac vagal function and heightened sympathetic activation. The authors concluded that escitalopram treatment in patients with PTSD and depression can trigger changes in autonomic reactivity that may adversely impact cardiovascular health.
Next, we present a case report by Rastogi et al titled, “Recurrence of Lobar Hemorrhage: A Red Flag for Cerebral Amyloid Angiopathy-related Inflammation?” The authors present the case of a 68-year-old woman with acute onset of confusion and a history of recurrent lobar intracerebral hemorrhage related to cerebral amyloid angiopathy. In addition to previous sequelae of cerebral amyloid angiopathy, brain imaging revealed a new lobar intracerebral hemorrhage. The authors diagnosed the patient as having cerebral amyloid angiopathy-related inflammation and initiated corticosteroid therapy, to which she responded positively with almost complete resolution of the lesion and significant cognitive improvement at one-month follow-up. The authors hypothesize that cerebral amyloid angiopathy-related inflammation might be the root cause for the lobar intracerebral hemorrhage recurrence in cerebral amyloid angiopathy, and that corticosteroid therapy should perhaps be initiated in patients who exhibit such recurrence. More research will be required to support their hypothesis.
Following this, we present a review article by Ali et al titled, “Conversion Disorder— Mind Versus Body.” In this article, the authors review the symptoms, etiology, prevalence, diagnostic methods, and treatment of conversion disorder. The authors provide recommendations for distinguishing the disorder from organic disease and other psychiatric illnesses as well as discuss current evidence-based treatment options. The authors also explore the emerging neurobiological understanding of conversion disorder.
Next, in this month’s “The Interface” column, Sansone and Sansone examine the relationship between irritable bowel syndrome (IBS) and abuse in childhood. While the literature reveals a possible connection between IBS and emotional and physical abuses in childhood, there appears to be a clear connection between sexual abuse in childhood and the development of IBS. The authors review pathophysiological events that might explain this relationship, including alterations in norepinephrine and serotonin levels and dysregulation of the hypothalamic-pituitary-adrenal axis.
We wrap up the issue with this month’s installment of “Hot Topics in Neuroscience” titled, “Forced Normalization: Epilepsy and Psychosis Interaction” by Loganathan et al. The authors present case vignettes of two individuals with difficult-to-treat epilepsy who, after being newly treated with vagal nerve stimulator implants and pharmacological agents, developed psychosis during neurological stability. The authors acknowledge that it is impossible to know whether the psychotic symptoms were due to ictal psychosis or forced normalization; however, using these cases as examples, the authors describe characteristics of forced normalization and review possible explanations for why forced normalization occurs in some patients.
We hope you enjoy the issue. As always we welcome your feedback and submissions.
Amir Kalali, MD
Editor, Innovations in Clinical Neuroscience