GREEN LIGHT: STOP?

What may be the societal implications of legalising cannabis? The state-by-state variation in the legal status of cannabis in the USA allows for comparison. Using the 2018 roadway fatality data, researchers were able to identify an increase 2.1 (95% CI 1.2 to 2.9; p<0.001) in traffic fatalities in the first four states to legalise the herb. Confounders may abound, but try as they might to correct for important factors, the team could not remove the suspicion that drug-driving may be partially to blame.

JAMA Intern Med 2020;e201769.

SOD1 OFF

The rise of the antisense oligonucleotides continues—this time a phase 1–2 trial of intrathecal tofersen for SOD1-associated amyotrophic lateral sclerosis. Fifty patients were randomised in this safety and pharmacokinetics study, but cerebrospinal fluid concentrations of SOD1 were also assayed. The SOD1 concentration reduced in a dose-dependent manner, 33% lower at day 85 in patients receiving the highest dose. Some things cannot be helped by cutting-edge science; most patients received adverse events from their lumbar punctures.

N Engl J Med 2020;383(2):109–119.

CURRENT BIOLOGY

Patients with Tourette syndrome may have EEG signals prior to their tics, in alpha or mu frequencies, perhaps from hyperexcitability of cortical sensorimotor regions. Researchers gave 16 people with Tourette syndrome a wearable device that could entrain the medial nerve. They hypothesised that rhythmic, but not arrhythmic, right peripheral nerve 12 Hz stimulation could entrain mu-band oscillations over the left sensorimotor cortex. Tic frequency and intensity improved, with the maximal benefit seen in people with more significant symptoms. The next step is the Fit-bit tic-hit?

Curr Biol 2020;30(12):2334–2342.e3.

REPOSSESSED

Is the 2018 paper ‘Resting stated-tractography-fMRI in initial phase of spiritual possession—A case report’ a very detailed description of a young woman with dissociative seizures? A Fo Ben confesses that he found the resting state-functional MRI and diffusion tensor imaging-tractography signal hard to interpret in the context of the five exorcisms; the first priest removed just one possessor, Alito. The second demon, Estencaster, persisted despite the efforts of a further Catholic priest. It was refreshing to see such a detailed description of the exorcisms in the Methods section of this highly unusual paper.

Trends Med 2018;18(2):1–6

At interview, we are often asked to discuss a clinical error and what we learnt from it. Consider the reflections possible from “I forgot a displaced guidewire during haemodialysis catheter insertion, which later came out spontaneously from the skull, 3 years after the event” (figure 1). Figures reproduced under Creative Commons licence.

Indian J Crit Care Med 2020; 24(6):480–482.

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Figure 1

The foreign body (guidewire) seen protruding out of the skull of patient.