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This Month in Archives of Neurology
October 2000

This Month in Archives of Neurology

Arch Neurol. 2000;57(10):1409. doi:10.1001/archneur.57.10.1409

Imaging: Window on the Brain

MazziottaArticle provides a masterful review of neuroimaging techniques and brain mapping methods important in neurology and neuroscience. Emerging techniques for imaging gene expression, neuronal excitability, and connectivity are presented, describing their current stage of development and clinical potential. As he points out, brain mapping and neuroimaging will continue to be important techniques in clinical neurology and serve as a bridge between molecular and clinical neuroscience disciplines.

Homocysteine and Neurologic Disease

Diaz-ArrastiaArticle describes our current stage of knowledge of homocysteine metabolism and its importance as a risk factor for vascular disease, including stroke, and its role in neurodegenerative disorders. The value of polyvitamin therapy to lower homocysteine levels is discussed, emphasizing the need to reduce the impact of an important disease-causing risk factor.

Thrombolytic Therapy in Acute Stroke

Hinchey and BeneschArticle provide an excellent review citing the merits and demerits of thrombolytic therapy for stroke. A well-focused and candid presentation is provided for clinicians. The therapeutic guidelines for thrombolytic therapy will be of direct interest to neurologists caring for patients with cerebrovascular disease.

Statins Reduce Alzheimer Disease

Wolozin and colleaguesArticle report a lower prevalence of diagnosed probable AD in patients taking 2 different HMG-CoA reductase inhibitors, lovastatin and pravastatin. A similar effect was not found with simvastatin. The findings are provocative and thus reported as an Archives Express publication. These data will be substantial only with prospective rigorous clinical trial as proposed by the authors.

Editorial comment is provided by Haley and Dietschy.Article

Metabolism in Temporal Lobe Epilepsy

Spanaki et alArticle have done comprehensive studies with 18F-FDG-PET. The metabolic changes are described in temporal and frontal lobes and thalamus in patients with temporal lobe epilepsy before and after anterior temporal lobe resection. Of considerable interest, they found increased inferior frontal and thalamic metabolism postoperatively and conclude that seizures may have a reversible effect on brain areas connected with, but remote from, the epileptogenic cortex.

Presenilin 1 Mutations in Alzheimer Disease

Devi and colleaguesArticle describe 2 children of an adult with early-onset, autopsy-confirmed Alzheimer disease (AD) who developed dementia in their late 20s. The children were found to have a novel mutation in codon 434 of the presinilin 1 gene (PS1). Two grandparents also had AD late in life, but neither one had a PS1 mutation. Thus, it is concluded that the affected parent of the proband was a likely recent founder of this novel mutation of PS1. This is a unique and valuable clinical and molecular observation demonstrating the clinical and genetic heterogeneity of AD in a single family.

Dopamine Agonist Hypotension in Parkinson's Disease

Kujawa and colleaguesArticle demonstrate that acute orthostatic hypotension is frequent when starting treatment with a dopamine agonist in patients with Parkinson disease. There was no evidence that orthostatic hypotension was related to the use of a specific dopamine agonist or to the concurrent use of levodopa. Acute blood pressure responses may be useful for making decisions on agonist titration schedules in clinical practice.

Posturography in Progressive Supranuclear Palsy and Parkinson's Disease

Ondo and colleaguesArticle describe the liability and clinical value of computerized posturography to differentiate early progressive supranuclear palsy from early Parkinson disease and from aged-matched controls. It is a useful and practical measurement to aid in clinical diagnosis and management.

Vascular Lesions and Cognitive Decline in Alzheimer Disease

Lee and colleaguesArticle show in a clinicopathologic correlation study that concomitant small cerebral infarcts less than 10 cm3 do not significantly influence the overall rate of global cognitive decline in Alzheimer disease. The degree and location of infarcts in Alzheimer disease do make a difference.