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 provides a review directed at establishing clinical trial end points that more accurately reflect the preferences of patients with migraine.
Susan V. Szapiel, MD 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.
Irina A. Staroselskaya, MD, and colleagues 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.
Monika Warmuth-Metz, MD, and colleagues 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.
David C. Mohr, PhD, and colleagues have studied the relationship between depression and multiple sclerosis (MS) disease activity. The production of the proinflammatory cytokine interferon gamma (IFN-γ) by auto-aggressive T cells in MS is related to depression, and the treatment of depression may decrease IFN-γ production. Treatment of depression may provide a new disease-modifying therapeutic strategy for patients with MS.
Kathyrn J. Reid, PhD, and colleagues 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.
Deborah M. Green, MD, and Allan H. Ropper, MD 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.
Bing-wen Soong, MD, PhD, and colleagues 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.
Sara Seneca, PhD, and colleagues 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.
This Month in Archives of Neurology. Arch Neurol. 2001;58(7):1051–1052. doi:10.1001/archneur.58.7.1051