To sleep, perchance to dream

Our nearest shared ancestor with the octopus lived 550 million years ago and their brain evolution is therefore independent of ours. Quiet sleep in octopuses is rhythmically interrupted by 60 second long bouts of pronounced body movements and rapid changes in skin patterning and texture. Sleep staging in the octopus is possible by looking at these skin patterns and 'active sleep' resembles the awake patterns. Studying local field potential activity again says that these ‘active sleep’ periods resemble waking and are strongest in superior frontal and vertical lobe, which are connected and have a role in learning and memory function.

Nature 2023;6197968:129–34.

Heads up

Migraine treatment is at risk of getting seriously interesting, seriously quickly. It has been quite some time since AFB was taken out for dinner by the ‘Go have a lie down in a dark room’ medical reps who were pushing their wares. Overlooking the hubris of calling an RCT ‘Progress’ (this looks good when the trial is positive, not so much when it stalls), they studied the utility of atogepant an oral calcitonin gene-related peptide receptor antagonist. A total of 778 people were randomised to placebo, versus drug once a day, versus drug twice a day—and a mean monthly migraine days reduction was the primary end-point. All three groups improved (likely return to the mean) but treatment was better than placebo (and 30 mg twice a day fared better than the 60 mg once daily). Constipation seen in 10% was the most common side effect, followed by weight loss (6%).

Lancet 2023;S0140-6736: 01049–8.

Diet of worms

AFB sometimes stretches for the best header for each Carphology piece, so hats off to the Guardian who lead with ‘Oh my God’ when describing the removal of a live 8 cm roundworm from the brain of an Aussie with ‘forgetfulness’. This type of roundworm had never caused CNS disease and it took an experienced parasitologist in Canberra to identify it, normally seen in pythons (figure 1). Although she had no direct contact with snakes, the 64-year-old patient lived adjacent to an area where carpet pythons live—which sounds very much out of the frying pan and in to the fire from a UK perspective. But a casual ‘business as usual’ or ‘no worries!’ to a typical Aussie.

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Figure 1

The Ophidascaris robertsi larva specimen that was extracted alive from the woman’s brain by surgeons at Canberra Hospital. Composite: Canberra Health.

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A map of drunkenness in England and Wales from 1899 raises more questions than it answers. Does this link to deprivation, or the need for a big winter coat? Where would Scotland place on this boozy competition? And at a time when there are concerns about the potential for valproate’s effects being transgenerational, what about alcohol through the generations?