This Month in Archives of Neurology

Bronstein and colleagues report the results of a workshop to provide recommendations involving pallidotomy for patients with medically intractable Parkinson disease. Experts in an international consortium have agreed upon specific approaches for this therapy. These guidelines provide consensus for the future treatment of a well-defined subgroup of patients with Parkinson disease.Article

In their concise review, Greenwood and Tennison have summarized the precise criteria for starting, tapering, and stopping anticonvulsant therapy in children. Their views are clear, practical, and valuable.Article

Rudick provides clear and compelling guidelines for the use of specific conventional and new therapies in patients with relapsing-remitting multiple sclerosis. This detailed therapeutic review will be of considerable value for the clinician dealing with these therapeutic issues. Article

Wilterdink and Easton provide a fine review of the second European Stroke Prevention Study (ESPS-2) and previous studies, showing that dipyridamole combined with aspirin therapy demonstrates a substantial benefit compared with aspirin therapy alone in the prevention of stroke. Detailed information with complex nuances is presented in a user-friendly manner. Article

Chamorro and colleagues provide a comprehensive study of the risk-benefit ratio of early vs late administration of heparin for acute stroke with nonvalvular atrial fibrillation. They show that functional recovery is improved if heparin treatment is administered sooner. Their study provides specific criteria that justify the use of heparin treatment in this subset of patients with acute stroke as early in the clinical course as possible.Article

Tomimoto and colleagues present results indicating that the coagulation-fibrinolysis pathway is activated in patients with Binswanger disease. These data provide new insights into this insidious form of cerebrovascular disease and offer potential therapeutic strategies.Article

Lippa and colleagues contribute an elegant study showing that β-amyloid_x-42 plaque density was similar in patients with dementia with Lewy bodies (DLB) and patients with Alzheimer disease (AD), but that β-amyloid_x-40 plaques were more numerous in AD than in DLB. The ratio of β-amyloid_x-40 to β-amyloid_x-42 was significantly reduced in DLB compared with AD. The finding that the relative proportion of the 2 β-amyloid plaque subtypes in patients with DLB is distinguishable from that in patients with AD is an important biological insight into the differential pathogenesis of these similar forms of dementia. These findings may be important in developing future therapies. Article

Baskin and colleagues have studied brain levels of choline acetyltransferase (ChAT) in patients with Alzheimer disease. They determined ChAT levels in freshly biopsied brain tissue from patients with Alzheimer disease. A positive correlation was found between ChAT levels and neuropsychological test scores.Article

Swan et al have studied the relative proportion of genetic and environmental contributions to verbal memory in twins. Verbal learning and memory have a substantial genetic component, while response discrimination has a much smaller though still detectable genetic component. Different subtypes of learning and memory strategies have variable degrees of genetic and environmental influences, providing important data regarding developmental mechanisms during early life and aging.Article

Doody and colleagues show that left-handed patients with Alzheimer disease (AD) do not differ from right-handed patients in the severity or pattern of neuropsychological deficits. However, left-handedness or some factor associated with it may contribute to the early appearance of cognitive deficits during the development of AD. Thus, brain language dominance may have some effect on the natural history of AD expression. Article

Andersson et al have measured specific characteristics of patients with multiple sclerosis to determine whether they have primary progressive multiple sclerosis (PPMS) or progressive relapsing multiple sclerosis (PRMS). They conclude that there is little reason to consider PPMS and PRMS as separate clinical entities. Their conclusions will be of great interest in light of the criteria currently in place for specific immunotherapy. Article