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This Month in Archives of Neurology
Arch Neurol. 2002;59:354-355.
Cortical Development and Epilepsy
Brenda E. Porter, MD, PhD, and colleagues (SEE ARTICLE) have reviewed disorders of cortical development that may lead to epilepsy, as well as current and future potential therapies. The cell biology and neurophysiology of these events are brought up-to-date for the physician.
Posterior Circulation Disease
Thomas A. Glass, PhD, and colleagues (SEE ARTICLE) present their experience with 407 patients entered into the New England Medical Center Posterior Circulation Registry (Table 1). Their statistical analyses show the mortality rate at 30 days after onset of vertebrobasilar distribution stroke to be 3.6%. Thirty days after stroke, 28% of patients had no disability and 51% had only minor disability. They provide important correlations among stroke location, stroke mechanism, and predicted outcome. A comprehensive assessment is provided in an editorial by H. J. M. Barnett, MD. (SEE ARTICLE)
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Frequency of Poor Outcome at 30 Days After Stroke (Mortality or Major Disability) by Primary Mechanism*
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Statins and Cognition
Kristine Yaffe, MD, and colleagues (SEE ARTICLE) followed 1037 postmenopausal women without dementia with coronary artery disease for 4 years to determine whether serum lipoprotein levels and use of statin drugs were associated with alterations in cognition. In general, lower lipoprotein levels during the 4 years were associated with less cognitive impairment. Compared with statin nonusers, statin users had higher cognitive scores and a lower likelihood of cognitive impairment, even independent of lipid levels. These are provocative and important findings that require further scrutiny and larger clinical trials.
Estrogen and Cognition
V. Senanarong, MD, et al (SEE ARTICLE) studied an association between endogenous estradiol and cognition in 135 men and women aged 52 through 85 years in Bangkok. Lower estradiol levels were found to be correlated with impaired cognitive, behavioral, and functional status. These results support the view that endogenous estrogen has protective effects on cognition.
Multiple Sclerosis Lymphocytes
Alexandre Prat, MD, PhD, et al (SEE ARTICLE) have studied the issue that T lymphocyte migration through the blood-brain barrier is a central event in the process of lesion formation in multiple sclerosis (MS). They find that the rate of migration of lymphocytes obtained from patients with acutely relapsing and active secondary progressive MS was significantly increased compared with controls and patients with MS with inactive disease. Migration was dependent on the chemokine monocyte chemoattractant protein 1 and matrix metalloproteinases. These observations are important to show the trafficking events of lymphocytes and their chemokines that underlie disease activation.
Seeing Basilar Artery Occlusion
Richard du Mesnil de Rochemont, MD, and colleagues (SEE ARTICLE) have used magnetic resonance imaging angiography and diffusion-weighted imaging sequences between 3.5 and 11.5 hours after symptom onset in 4 patients with basilar artery occlusion. Thrombolysis was initiated in 3 patients, with successful recanalization in 2 patients. Diffusion-weighted imaging lesions were associated with a favorable outcome if reperfusion was achieved. This useful and descriptive study shows that this most serious stroke syndrome can be monitored and treated effectively with acute active intervention.
Ciliary Neurotrophic Factor and Multiple Sclerosis
Ralf Giess, MD, and colleagues (SEE ARTICLE) found that patients having the homozygous CNTF null mutation had a significantly earlier onset of multiple sclerosis (MS) than patients not having this mutation. The null mutation was not a risk factor, however, for the development of MS. This observation supports the growing literature showing that trophic factors play a role in the overall expression of MS.
Tremor and Cerebellar Stimulation
Alexandre Gironell, MD, and colleagues (SEE ARTICLE) demonstrate that essential tremor can be successfully treated with low-frequency repetitive transcranial magnetic stimulation (rTMS) in a double-blind, crossover, placebo-controlled study. Compared with sham rTMS, on the +5-minute assessment, active rTMS produced a notable improvement in tremor. This informative, well-designed study offers the methodology to pursue the neurophysiological mechanism involved and an approach to provide longer lasting benefit.
Botulinum Toxin A for Hemifacial Spasm
Giovanni Defazio, MD, et al (SEE ARTICLE) studied 65 patients with primary hemifacial spasm treated with botulinum toxin A for at least 10 years. In general, they found it to be highly effective in reducing symptoms with minimal and transient adverse reactions.
Restless Legs and Parkinson Disease
William G. Ondo, MD, et al (SEE ARTICLE) find that restless legs syndrome is common in patients with Parkinson disease but believe the association is a secondary phenomenon. They find no evidence that restless legs syndrome symptoms early in life predispose individuals to the subsequent development of Parkinson disease.
Magnetic Resonance Imaging, Prediction of Stroke, and Leukoariosis
Dong-Eog Kim, MD, et al (SEE ARTICLE) find that a multifocal signal loss lesion on gradient echo magnetic resonance imaging (MRI) is a predictor of intracerebral hemorrhage vs infarction in patients with no or mild leukoariosis but not with advanced leukoariosis. This elegant study provides a quantitative means to evaluate and predict potential stroke syndromes in patients based on specific MRI criteria.
Aquaporin 4 and Duchenne Dystrophy
Yoshihiro Wakayama, MD, PhD, and colleagues (SEE ARTICLE) convincingly show that the muscles of patients with Duchenne muscular dystrophy (DMD) contain markedly decreased amounts of aquaporin 4 molecules, a member of the water channel protein family. The molecular biological basis of this finding is reviewed and adds to our understanding of the subsequent molecular defects owing to dystrophin deficiency in DMD.
Intravascular Lymphomatosis
Beristain and Azzarelli (SEE ARTICLE) describe 8 patients with pathologically confirmed intravascular lymphomatosis. All patients had focal neurological deficits, 7 had encephalopathy or dementia, 5 had seizures, and 2 had myelopathy. Death occurred at 7.6 months after onset of symptoms (range, 1-24 months). Intravascular lymphomatosis is a serious neurological syndrome with high morbidity and mortality but if diagnosed early can be effectively treated with chemotherapy.
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