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Kobylarz and Schiff review recent functional brain imaging studies of patients in the vegetative state and studies of patients meeting diagnostic criteria for the newly formulated minimally conscious state. Editorial perspective is provided by Joseph J. Fins, MD, and Fred Plum, MD.
One Epilepsy Drug at a Time
Vazquez emphasizes monotherapy as the goal for pharmacological treatment of epilepsy. A MEDLINE database was searched for clinical trials with the newer antiepileptic drugs. She finds that efficacy is particularly well established for lamotrigine and oxcarbazepine, and compared with conventional antiepileptic drugs, such as carbamazepine, phenytoin, and valproate, both lamotrigine and oxcarbazepine are equally effective at controlling seizures and are better tolerated.
Migraine and White Matter Changes
Swartz and Kern review the ongoing controversy as to whether migraine is associated with white matter abnormalities. A meta-analysis demonstrates that subjects with migraine are at a higher risk of having white matter abnormalities on magnetic resonance images than those without migraine. It is now of importance to study whether the increased risk of stroke in migraine is mediated or foreshadowed by the presence of white matter abnormalities.
Homocysteine and White Matter Hyperintensities
Total homocysteine is related to leukoaraiosis in middle-aged men after correcting for folate, thyrotropin, vitamin B12, creatinine, hypertension, smoking, and diabetes. As reported by Sachdev and colleagues, homocysteine is a risk factor for microvascular disease before it contributes to increased strokes or Alzheimer disease. Its correction needs to begin early in life to prevent its effects.
Gray Matter Atrophy in Temporal Lobe Epilepsy
Voxel-based morphometry in patients with drug-refractory medial temporal lobe epilepsy showed gray matter network atrophy in the hippocampus ipsilateral to the seizure origin. Further, as reported by Bonilha and colleagues, gray matter concentration reduction was found in the thalamus, caudate, and cerebellum, in the midbrain, and in the parieto-occipital regions. These data provide evidence for an anatomical route for atrophy.
Ten Years After Optic Neuritis
Gal and The Optic Neuritis Study Group assessed neurologic disability 10 to 12 years after an initial episode of optic neuritis. Most patients who develop clinically definite multiple sclerosis following an initial episode of optic neuritis will have a relatively benign course for at least 10 years.
Restless Legs Syndrome and Dopamine Therapy
Ondo and colleagues find that dopamine agonist therapy is effective treatment for restless legs syndrome.
Natural History of Optic Neuritis
Optic neuritis may occur in isolation or may herald multiple sclerosis or neuromyelitis optica. Pirko and colleagues studied the clinical course and prognosis of patients with recurrent optic neuritis. They find that patients with rapid succession of severe optic neuritis events are more likely to develop a generalized demyelinating disease. Patients with neuromyelitis optica have a worse visual outcome.
Intravenous Immunoglobulin in Multiple Sclerosis
Filippi and colleagues investigated the effect of intravenous immunoglobulin treatment of patients with secondary progressive muliple sclerosis, as measured by magnetization transfer magnetic resonance imaging. A positive result of this study was the finding of a different percentage of change of the normal-appearing brain tissue histogram across time between placebo and treated patients, which supports the role of intravenous immunoglobulin treatment in preventing the loss of normal brain tissue in secondary progressive multiple sclerosis.
Botulinum Toxin for Voice Tremor
Adler and colleagues find that botulinum toxin type A improves voice tremor.
Myeloma Invasion of the Brain
Direct central nervous system invasion by multiple myeloma is rare. Schluterman and colleagues describe patients with leptomeningeal myelomatosis. Although rare, leptomeningeal myelomatosis should be considered in patients with multiple myeloma and symptoms suggestive of widespread central nervous system involvement.
APOE and APOC1 Polymorphisms and Alzheimer Disease
Tycko and colleagues report data that exclude a strong or independent influence of APOE or APOC1 promoter polymorphisms on the variation in APOE-related risk of Alzheimer disease in African American and Caribbean Hispanic individuals.
This Month in The Archives of Neurology. Arch Neurol. 2004;61(9):1350–1351. doi:10.1001/archneur.61.9.1350
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