This Month in The Archives of Neurology

PAIN 2003

This issue of the ARCHIVES is a special issue devoted to pain. Dworkin and colleagues provide a comprehensive review. Current approaches to the diagnosis and assessment of neuropathic pain are described, and the results of recent research on its pathophysiologic mechanisms are discussed. Randomized controlled clinical trials of gabapentin, the 5% lidocaine patch, opioid analgesics, tramadol, and tricyclic antidepressants are reviewed as specific pharmacologic therapies for pain, and specific recommendations are presented for the use of these medications. Giller reviews "The Neurosurgical Treatment of Pain" and includes advances in ablative surgery, stimulation therapies, and the delivery of intraspinal medication. The clinical progress in understanding pain mechanisms and the development of effective pain therapies are in place. Basic neuroscientific understanding of pain generation and its psychological appreciation remain important goals for the future. Editorial perspective is provided by Roger N. Rosenberg, MD.

Tedde and colleagues identified a family carrying the novel Ser130Leu mutation in the presenilin 2 (PS2) gene. In addition, they report 2 novel PS1 mutations: Cys92Ser in exon 4 in 2 unrelated families and the new Leu174Met in exon 6 in the PS1 gene. They describe a fourth Italian family with the β-amyloid precursor protein (βAPP) Val717Ile mutation. Screening for new mutations in presenilin and amyloid precursor protein (APP) genes has resulted in additional characterization of gene expression in early-onset familial Alzheimer disease. Editorial comment provided by Gerard D. Schellenberg, PhD.

Kobayashi and colleagues describe magnetic resonance imaging findings in patients with familial temporal lobe epilepsy (FTLE) with auditory auras. The leucine-rich, glioma-inactivated 1 (LG11) gene was studied in this family, and a nucleotide sequence analysis showed a point mutation (VIIIS7[-2]A-G mutation) in affected individuals. Developmental abnormalities in the lateral cortex of the temporal lobes in 53% of affected individuals were identified. This study provides new and compelling information on the syndrome of FTLE with auditory auras.

Kleiner-Fisman and colleagues evaluated the efficacy of motor cortical stimulation in patients with refractory parkinsonism due to multiple system atrophy (MSA). They found that motor cortical stimulation using specifically defined parameters did not improve motor disability in patients with MSA. These findings are distinctly different from motor cortical stimulation findings in patients with Parkinson disease (PD), who show improvement in bradykinesia and gait function. Thus, it is important to distinguish parkinsonism associated with MSA from PD before considering motor cortical stimulation as a form of therapy.

Intracranial atherosclerosis is common in Korean patients with extracranial carotid occlusive disease. Lee and colleagues compared the vascular risk factors between patients with extracranial carotid occlusive disease alone and those with intracranial arthersclerosis combined with extracranial carotid disease. Of 121 patients with significant extracranial carotid disease, 58% or 47.9% also had significant lesions of intracranial arteries. Statistical analysis showed that diabetes mellitus was the only significant factor associated with combined intracranial and extracranial atherosclerotic disease.

Bang and colleagues reported the molecular analysis of spinocerebellar ataxia (SCA) types 1, 2, 6, and 7, and dentatorubral pallidoluysian atrophy. Magnetic resonance imaging (MRI) was performed in 67 patients. The prevalence rate of SCA7 was 16.4%. The clinical, MRI, and molecular findings in this sample provide an excellent database for the clinical diagnosis of genetically specific forms of SCA.

Jansen and colleagues studied patients with the tuberous sclerosis complex and drug-resistant epilepsy who would be candidates for epilepsy surgery. This approach requires the unambiguous demonstration of the epileptogenicity of one of the tubers. Fluid-attenuated inversion recovery magnetic resonance imaging (MRI) and diffusion-weighed MRI scans were performed. A significant increase in the apparent diffusion coefficient was found in the epileptogenic tubers. Diffusion-weighted MRI is of clinical value for the identification of epileptogenic tubers in patients with tuberous sclerosis and intractable epilepsy.

Martin et al investigated oral and written calculation skills in patients with Alzheimer disease (AD) using quantitative and qualitative methods. Specific calculation alterations are defined in this cohort of patients, and the findings suggest that loss of calculation abilities in AD is hierarchical (by arithmetic operation) and a function of disease severity.

Kwak and colleagues studied the possible association between migraine headache and Tourette syndrome (TS). The frequency of migraine headache in a clinic sample of patients with TS was found to be nearly 4-fold more than the frequency reported in the general population. The occurrence of migraine in TS may thus be attributed to a TS comorbidity other than obsessive-compulsive traits.

Russman and colleagues studied riluzole, a glutamate inhibitor, to determine if it might be tolerated by infants with spinal muscular atrophy and whether it would have an effect on the natural history of disease. None of the 10 patients experienced significant adverse effects or changes in pertinent laboratory test results, and none showed a change in motor ability. Additional, more comprehensive studies of riluzole in pediatric patients with spinal muscular atrophy are needed.