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This Month in Archives of Neurology
December 2002

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Copyright 2002 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2002

Arch Neurol. 2002;59(12):1861-1862. doi:10.1001/archneur.59.12.1861
Spontaneous Recanalization

In the first 6 to 8 hours of stroke onset, spontaneous recanalization occurs at a rate of about 17%, and nonocclusion at about 28%—up to 50% by 4 days. Kassem-Moussa and Graffagnino provide this highly informative systematic review, which puts into perspective the natural history of renewed vascular patency in the course of occlusive cerebrovascular disease and acute ischemic stroke.

Picking the Right Surgeon

Feasby and colleagues have assessed associations between hospital case volume, teaching status, clinical trial participation, surgeon specialty, and case volume and the outcome from carotid endarterectomy (CEA) in a Canadian nationwide database analysis from 1994-1997. Low hospital and surgeon case volumes, in particular, had a negative effect on outcomes. Regionalization should be strongly considered for CEA, and surgeons with low case volumes should not be performing this procedure. Editorial perspective is provided by H. J. M. Barnett, MD.

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Surgeon case volume and service specialty.

Metabolic Dysfunction in Temporal Lobe Epilepsy

Knowlton and colleagues measured hippocampal metabolic abnormalities in mesial temporal lobe epilepsy using positron emission tomography and proton magnetic resonance spectroscopic imaging to determine the relationship of N-acetylaspartate disturbances to those of glucose metabolism. Previously unknown mechanisms of biochemical dysfunction that contribute to altered temporal lobe function were identified using these 2 techniques.

Hippocampal Sclerosis in Relatives of Patients With Temporal Lobe Epilepsy

Hippocampal atrophy and other magnetic resonance imaging (MRI) signs of hippocampal sclerosis (HS) were identified in asymptomatic relatives of patients with familial mesial temporal lobe epilepsy. The evidence of HS on MRI was not directly related to seizures and was found in persons who had never had seizures. Hippocampal sclerosis is determined by a strong genetic predisposition. These findings by Kobayashi et al offer new insights into the pathogenesis of HS and the need to find a genetic marker for determination of the at-risk status of first-degree relatives of patients with temporal lobe epilepsy.

Memory After Temporal Lobectomy

Patients were studied for acquisition, retrieval, and recognition components of verbal memory after undergoing unilateral anterior temporal lobectomy (ATL) for epilepsy with hippocampal sclerosis. The left ATL group (n = 68) showed significant decline across all 3 verbal memory components compared with the right ATL group (n = 47). This risk seems to be selective for the retrieval-based aspect of verbal memory. These findings by Martin and colleagues point out the range of individual variation found in verbal memory following ATL and the asymmetric differences.

Levetiracetam for Late-Onset Partial Epilepsy

Bazil et al conducted a retrospective medical record analysis of patients with refractory epilepsy for their response to levetiracetam. Older patients with temporal lobe epilepsy responded more favorably. Their results suggest that certain subpopulations may be particularly likely to respond to this new agent.

Rectal Diazepam

Cereghino and colleagues have shown that diazepam gel in adults significantly reduced seizure recurrence for acute repetitive seizures, with minimal adverse effects. Thus, there is clinical value for this form of therapy in treating seizure emergencies.

Kennedy Disease

In 34 patients with Kennedy disease (KD), the earliest symptoms, signs on clinical investigation, electrophysiologic and muscle biopsy findings, and creatine kinase levels are reviewed by Sperfeld and colleagues. Their findings support the view that KD is a multisystem disorder with clinical onset in adolescence. They found a correlation of the number of CAG repeats to age at onset of weakness but not to age at onset of disease. Environmental or other genetic factors may be contributing to the specific features of this X-linked disorder.

Genetic Cell Death

Richardson-Burns and colleagues examined archival autopsy and surgical pathologic specimens from 8 cases of progressive multifocal leukoencephalopathy (PML), including 6 patients with human immunodeficiency virus (HIV)–associated PML and 2 patients with non–HIV-associated PML, for evidence of apoptosis. Apoptosis of JC virus–infected oligodendrocytes was a prominent feature in all cases of both HIV and non–HIV-associated PML. These findings support the hypothesis that if caspase activation could be inhibited at an early stage, thus preventing apoptosis, then some JC virus–infected oligodendrocytes may be able to recover and survive.

Rasagiline for Parkinson Disease

Rasagiline is effective as monotherapy for patients with early Parkinson disease (PD). The Parkinson Study Group evaluated more than 400 patients with early PD who did not require dopaminergic therapy. Using the United Parkinson Disease Rating Scale, efficacy was measured between baseline and 26 weeks of treatment. Additional studies are indicated to evaluate rasagiline's longer-term effects in PD.

Ataxia in Monozygotic Twins

Anderson and colleagues have characterized ocular motor function and postural control in 2 sets of identical twins, one set with spinocerebellar ataxia type 2 and the other with episodic ataxia type 2. They found significant differences in saccade velocity and saccade metrics, as well as postural stability, between each monozygotic twin. Environmental or other genetic factors probably produce these individual characteristics.