Top 6 Neurology News Stories

Cannabidiol, a medicinal liquid form of marijuana, shows promise as a treatment for children with severe epilepsy that is not responding to other treatments. Details of this study will be presented at the AAN 2015 Annual Meeting, which takes place April 18-25 at the Walter E. Washington Convention Center in Washington, DC.

The dream enactment of rapid eye movement sleep behavior disorder (RBD) often is the first indication of Parkinson disease, multiple-system atrophy, or dementia with Lewy bodies. In RBD, α-synuclein abnormalities in the brainstem disinhibit REM sleep motor activity, leading to dream enactment. The behaviors often are theatrical, with complexity, aggression, and violence. About half of patients with spontaneous RBD will convert to a parkinsonian disorder within a decade. Eventually, a neurodegenerative disorder will develop in almost all patients.
• RBD treatment can prevent injury to patients and bed partners. Low-dose clonazepam and high-dose melatonin taken orally at bedtime are used most frequently.

Children who have a neurological disorder, such as epilepsy or cerebral palsy, are no more likely to get vaccinated than other children, even though their risk of flu complications is higher, says a CDC survey. Of the parents who did not have their children vaccinated against the flu, 38% said they had concerns about how the vaccine would affect their child and one-third had safety concerns. Awareness of increased risk of flu complications among surveyed doctors was about 75% for cerebral palsy, 51% for epilepsy, and 46% for intellectual disability. Rates of influenza vaccination in children with neurological or neurodevelopmental disorders are suboptimal, the researchers suggested.

In exploding head syndrome (EHS), a rare parasomnia, patients awaken from sleep with the sensation of a loud bang. The cause is unknown. The differential diagnosis includes nocturnal headache syndromes-hypnic headache, cluster headaches, and migraine-that usually cause the patient to awaken with an actual headache. EHS often is benign and self-limited, but in some patients it can cause sleep-onset insomnia. Medications may reduce the frequency or resolution of the symptoms.

Evaluation and management (E/M) is the dominant source of payment to most neurologists, a study shows, providing information that may help neurology define its position on proposed payment reform. Of $1.15 billion paid to neurologists by Medicare in 2012, 60% was for E/M, a lower proportion than for primary providers (about 85%) and higher than for surgical subspecialties (range, 9% to 51%). Neurologists in the highest payment category performed more services, of which a lower proportion were E/M, and performed at a facility, compared with neurologists in lower payment categories.

On the Move, a new memoir by Oliver Sacks in which he recounts his experiences as a young neurologist in the early 1960s, will be released in early May. Dr Sacks, “the poet laureate of medicine,” is a physician, best-selling author, and professor of neurology at the NYU School of Medicine. His publications include collections of neurological case histories-The Man who Mistook his Wife for a Hat, Musicophilia, and An Anthropologist on Mars-and the book Awakenings.