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This Month in Archives of Neurology
Arch Neurol. 2001;58:1051-1052.
Triptans for Migraine
With the advent of triptans, both patient and physician expectations
for migraine headache relief have changed considerably. Patients are requesting
more rapid relief of symptoms, complete pain relief, and ability to return
to routine duties. Research end points should reflect those factors that are
clinically relevant for patients. Dawn A. Marcus, MD (SEE ARTICLE) provides a review directed at establishing clinical trial
end points that more accurately reflect the preferences of patients with migraine.
Optical Imaging
Susan V. Szapiel, MD (SEE ARTICLE) reviews recent advances and developments in optical imaging technology that
have contributed to the elucidation of brain functional architecture and plasticity
and also our understanding of the temporal and spatial dynamics of cortical
seizure spread. The concepts of cortical columns, ocular dominance columns,
optic flow, orientation columns, and whisker barrels are critically reviewed
as functional entities that have yielded many exciting new insights into the
functional architecture of the cerebral cortex and into neurological disorders.
Mismatches in Acute Stroke
Irina A. Staroselskaya, MD, and colleagues (SEE ARTICLE) have investigated the relationship between magnetic resonance
angiography (MRA) and patterns of diffusion-weighted imaging and perfusion
abnormalities in patients with acute stroke. The concordance between MRA and
the magnetic resonance (MR) perfusion-diffusion mismatch pattern provides
evidence for an arterial vascular basis for this MR signature in acute stroke.
Mismatches may result from arterial branch occlusions undetected by MRA. The
MR patterns identified in this study will lead to a more rational approach
to the management of stroke patients and the design of stroke
trials.
Table 1. Relation Between Mismatch and Arterial Lesions in the First 24 Hours of Ischemic Stroke*
Differentiating Parkinson Disease vs Progressive Supranuclear Palsy
Monika Warmuth-Metz, MD, and colleagues (SEE ARTICLE) measured midbrain diameter using T2-weighted MR images and
found significant differences between patients with Parkinson disease (PD)
and patients with progressive supranuclear palsy (PSP), with the latter having
a significantly smaller midbrain diameter. Magnetic resonance measurement
of the midbrain is a means of differentiating PSP from PD and should be considered
a diagnostic feature.
Depression and Autoimmunity in Multiple Sclerosis
David C. Mohr, PhD, and colleagues (SEE ARTICLE) have studied the relationship between depression and multiple sclerosis (MS)
disease activity. The production of the proinflammatory cytokine interferon
gamma (IFN- ) by auto-aggressive T cells in MS is related to depression,
and the treatment of depression may decrease IFN- production. Treatment
of depression may provide a new disease-modifying therapeutic strategy for
patients with MS.
Sleeping too Well
Kathyrn J. Reid, PhD, and colleagues (SEE ARTICLE) have characterized a familial case of advanced sleep phase syndrome (ASPS).
The syndrome is characterized by persistent early evening sleep onset and
early morning awakening. The ASPS trait has an autosomal dominant form of
inheritance, and the circadian rhythm of patients is disturbed. Thus, the
occurrence of ASPS indicates that human circadian rhythms, similar to those
in animals, are under genetic regulation.
Mild Guillain-Barré Syndrome
Deborah M. Green, MD, and Allan H. Ropper, MD (SEE ARTICLE) have studied the approximate frequency of mild Guillain-Barré
syndrome (GBS) with persistent ability to walk and have analyzed for features
that might predict that the illness would remain mild. Twelve (4.7%) of 254
cases in their series conformed to this definition. Eight patients had been
treated with plasmapheresis or immunoglobulin, and the others were observed
without treatment. There were no distinguishing clinical features or electrophysiologic
features that differentiated treated vs untreated patients. Thus, treatment
may not be necessary in such mild cases; however, close observation is still
required to be certain that the illness does not progress. A significant number
of patients with mild GBS probably never come to the attention of neurologists.
Inherited Ataxias in Taiwan
Bing-wen Soong, MD, PhD, and colleagues (SEE ARTICLE) have characterized families with dominantly inherited ataxia.
Machado-Joseph disease (MJD) was the most common type of autosomal dominant
spinocerebellar ataxia (SCA) in the Taiwanese cohort, accounting for 47.3%
of cases, followed by SCA type 6 (10.8%), SCA type 2 (10.8%), SCA type 1 (5.4%),
SCA type 7 (2.7%), and dentatorubropallidoluysian atrophy (DRPLA) (1.4%).
Thus, autosomal dominant ataxia conforms to clinical-genotype correlations
described elsewhere.
New Mutation in a Kearns-Sayre Syndrome
Sara Seneca, PhD, and colleagues (SEE ARTICLE) describe a causal relationship between a heteroplasmic G-to-A substitution
3249 mutation in the transfer RNALeu gene and a syndrome of progressive
external opthalmoplegia, retinal dystrophy, ataxia, neurosensorial hearing
loss, and muscle wasting. This mutation has never previously been described
and was not detected in controls. Editorial comment by Tetsuo
Ashizawa, MD, and S. H. Subramony, MD. (SEE ARTICLE)
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