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This Month in Archives of Neurology
July 2002

This Month in The Archives of Neurology

Arch Neurol. 2002;59(7):1072-1073. doi:10.1001/archneur.59.7.1072

Hypothermia for Brain Injury

Harris and colleagues provide a meta-analysis of randomized, controlled trials that suggests that the use of hypothermia in the management of severe head injury is not beneficial. The analysis is rigorous and comprehensive and surely will provoke renewed study and debate.

Mechanisms of Action of the 5-HT1B/1D Receptor Agonists

Tepper and colleagues reviewed the current biochemical and pharmacologic actions of the 5-HT1B/1D receptor agonists, collectively known as triptans, and their role as vasoactive agents. The high affinity of triptans for 5-HT1B/1D receptors and their favorable pharmacologic properties contributed to the beneficial effects of these drugs, including rapid onset of action, effective relief of headache, and associated symptoms.

Brain Damage After Coronary Artery Bypass

Bendszus and colleagues examined a series of patients after coronary artery bypass grafting (CABG) using diffusion-weighted magnetic resonance imaging (DWMRI) and hydrogen 1 magnetic resonance spectroscopy and correlated these results with neurologic and neuropsychologic findings. Results of DWMRI demonstrated new ischemic lesions in 26% of the patients. Magnetic resonance spectroscopy results showed significant alterations in the metabolic ratios of N-acetylaspartate–creatine. Neuropsychological test performance closely correlated with metabolic findings. This is an important study documenting the structural, metabolic, and functional components of the brain in patients after CABG and describing specific quantitative and qualititative changes in patients longitudinally. Editorial comment is provided by Robert Wityk, MD, and Lucas Restrepo, MD.

Hippocampal Sclerosis

Leverenz et al examine the clinical and pathologic characteristics of hippocampal sclerosis (HS) in a community-based case series of patients with dementia and compare these characteristics with those observed in subjects with Alzheimer disease (AD) from the same sample. Patients with HS have similar symptoms on initial examination and similar rates of dementia progression to those with AD and are frequently misclassified as having AD. It is an important emerging clinical diagnosis and one that must be considered in all patients with progressive dementia.

Vascular Dementia in Japan

Meguro and colleagues have considered the prevalence of vascular dementia (VaD) in relation to the prevalence of Alzheimer disease (AD) in Japan. It has been believed that VaD is the most common form of dementing illness in Japan. This study found the overall prevalence of dementia in patients 65 years and older to be 8.5%. They conclude that VaD is not a common disorder in Japan relative to AD with cerebrovascular disease. A reevaluation of the prevalence of VaD in Japan, using a national distribution, is now appropriate and would be of considerable value in determining environmental vs genetic factors.

Interferon Down-Regulates Survivin in T Lymphocytes

Sharief and Semra studied the effect of interferon beta (IFN-β) on the expression of survivin and other apoptosis regulatory molecules in peripheral T lymphocytes in patients with multiple sclerosis (MS). In an elegant and detailed study, they show that IFN-β therapy does exert a regulatory effect on peripheral T lymphocytes through an antiapoptosis mechanism that involves the down-regulation of cellular survivin expression. These observations provide immunologic and biochemical insight as to the mechanism of benefit of IFN-β in treating patients with MS.

Expression of Apoptosis Regulatory Proteins in Mitogen-Stimulated T Cells After 24 Hours of Incubation With Interferon Beta-1a (5 µg/mL) or Culture Medium Alone*
Expression of Apoptosis Regulatory Proteins in Mitogen-Stimulated T Cells After 24 Hours of Incubation With Interferon Beta-1a (5 µg/mL) or Culture Medium Alone*

Vitamin E and Cognitive Decline

Morris and colleagues studied whether the intake of antioxidant nutrients, including vitamin E, vitamin C, and carotene, are associated with reduced cognitive decline with age. Two thousand eighty-nine community residents, aged 65 to 102 years, were studied for 18 months for specific dietary intake of antioxidant nutrients.They found that vitamin E intake was associated with less cognitive decline with normal aging. Thus, it seems that oxidative stress is an important issue for both cognitive decline with normal aging as well as previously described beneficial effects for pathologic states of dementia, including Alzheimer disease.

Down Syndrome and Alzheimer Disease: Response to Donepezil

Lott and colleagues studied individuals with Down syndrome (DS) who developed Alzheimer disease and their response to an acetylcholinesterase inhibitor, donepezil. They found that donepezil, given during a 5-month period, reversed to some degree the symptoms of dementia in the early and middle stages of cognitive decline. An acetylcholinesterase inhibitor may be of benefit for the treatment of dementia superimposed on mental retardation in patients with DS.

γ-Aminobutyric Acid in Epilepsy

Kananura and colleagues have assessed the role of GABRG2 in the genetic predisposition of idiopathic absence epilepsy (IAE). A missense mutation in the GABRG2 gene, which encodes the 2-subunit of the central nervous system γ-aminobutyric acid (GABA) receptor associated with idiopathic epilepsy is described. In one of these families, the affected individuals predominantly exhibited childhood absence epilepsy (CAE) and febrile convulsions (FC). This study identified a splice-site mutation, which probably caused a nonfunctional GABRG2 subunit. This mutation occurred in affected members of a single family exhibiting CAE and FC. Thus, the mutant GABRG2 gene can result in a susceptibility to common IAE syndromes.

Risks Related to Asymptomatic Carotid Stenosis

Nadareishvili and colleagues have evaluated 106 patients with asymptomatic carotid stenosis (ACS) for the risk of stroke and other vascular events. They find that the annual stroke risk in patients with ACS was low and remained stable during long-term follow up. Of note, they found that the high long-term risks of myocardial infarction and non–stroke vascular death suggest that prevention strategies should concentrate on coronary risk more than stroke risk. These findings need to be considered in the overall value of carotid endarterectomy in patients of this type.

Language in Children: A Functional Magnetic Resonance Imaging Study

Balsamo and colleagues, using functional magnetic resonance imaging (fMRI), have clearly demonstrated hemispheric lateralization of language in children. Specifically, anatomical regions of activation are described as are important hemispheric asymmetries. In this elegant functional anatomical correlation study, the authors have demonstrated the clinical utility of fMRI in establishing language functions in children.

Apolipoprotein E ϵ4 and Cognitive Decline

Wilson and colleagues have examined the association of apolipoprotein E (APOE) ϵ4 with decline in different cognitive systems. A comprehensive and detailed neuropsychological assessment was undertaken, and the results indicate that APOE ϵ4 influences risk of Alzheimer disease by a relatively selective effect on episodic memory.

The Genesis of Cortical Malformations

Montenegro and colleagues provide new information related to the genetics and prenatal injury in the genesis of malformations of cortical development (MCD). Their elegant data analysis of 3 groups of patients reflecting a clinical spectrum of MCD offers new pathogenic insight into this important class of congenital cortical deficits.