Most epilepsy-associated genes encode ion channels. George has defined the recent advances in the molecular basis of inherited epilepsies and highlights the conditions caused by dysfunctional ion channels.
Hess and colleaguesreview the evidence in mice and humans that bone marrow cells contribute to the neuronal population. According to existing data, it is possible that bone marrow cells—either by direct generation or by cell fusion—play a role in the repair of central nervous system damage. In the near future, stem cells may indeed enter the therapeutic regimen for neurological disease.
Migraine may be prevented using topiramate, as shown by Silberstein and colleaguesin an open-label randomized clinical trial.
Voetsch and colleaguesstudied the clinical and vascular features, stroke mechanisms, etiologies, and outcomes of basilar artery occlusive disease in patients enrolled in the New England Medical Center Posterior Circulation Stroke Registry. Specific patient groups were identified, which provided reliable factors for measuring and predicting clinical outcome.
Editorial perspective is provided by Bartlomiej Piechowski-Józwiak, MD, and Julien Bogousslavsky, MD.
Multiphasic helical computed tomography, as described by Lee and colleagues, is a highly useful diagnostic imaging technique for showing and predicting severe brain edema in acute middle cerebral artery stroke.
Acute stroke due to dissection of the internal carotid artery with multiple brain infarctions was confirmed using diffusion-weighted imaging in a series of patients described by Koch and colleagues.
Bang and colleagues categorized patients with lacunar stroke into those with small or large artery disease according to clinical and imaging criteria. Clinical outcome and specific therapy for intracranial stenosis are related to large or small vessel disease and are of diagnostic value in clinical management.
There is a significant correlation in patients with multiple sclerosis between fatigue and disrupted sleep or abnormal sleep cycles, as described in this study by Attarian and colleagues.
Ordoñez and colleagues report DNA of varicella-zoster virus in mononuclear cells from 87% of patients with multiple sclerosis tested during an acute relapse. The results of all patients tested during remission were negative. These data indicate that varicella-zoster virus correlates with acute multiple sclerosis relapses, but the important issue of its being directly involved in disease causation or only an epiphenomenon remains to be resolved.
The presence of significant brain volume decreases in patients in the group with relapsing-remitting multiple sclerosis and carrying the apolipoprotein E (ApoE) ϵ4 genotype reported by DeStefano and colleagues provides new evidence that links ApoE ϵ4–related impaired mechanisms of cell repair and severe tissue destruction in multiple sclerosis. This negative influence of the ApoE ϵ4 genotype may be active from the earliest disease stages.
N-acetylaspartate–choline ratios measured in patients with traumatic brain injury showed decreased values in both the basal ganglia and medial temporal lobe according to magnetic resonance spectroscopy, which correlated with measures of speed, motor scanning, and attention as reported by Ariza and colleagues. These studies move forward our ability to quantify and functionally correlate noninvasively altered regional brain activity.
Morgello and colleagues report that in contrast to populations before the era of highly active antiretroviral therapy, distal sensory polyneuropathy is not associated with an increased viral load or decreased CD4 counts in this cross-sectional analysis of patients enrolled in the Manhattan HIV Brain Bank. Substance abuse is being documented as an associated additional factor in neuropathy causation.
Patients with Alzheimer disease were evaluated for executive dysfunction with a battery of neuropsychological tests by Swanberg and colleagues, and almost two thirds had evidence of executive dysfunction. The association between executive dysfunction, as measured by these tests, and performance on the activities of daily living scales will provide additional means of assessing relationships among cognitive, functional, and behavioral changes in response to therapy.
The Parkinson Study Group compared the effects of early and later initiation of rasagiline on the progression of disability in Parkinson disease. Subjects treated with rasagiline at a dosage of 2 mg/d or 1 mg/d for 12 months showed less functional decline than subjects whose treatment was delayed for 6 months. As with other therapies, the sooner the better to obtain the optimal outcome.
This Month in Archives of Neurology. Arch Neurol. 2004;61(4):468-469. doi:10.1001/archneur.61.4.468