Prevalence of cerebral palsy in extremely premature infants (20 to 27 weeks’ gestational age with birth weight between 500 and 1,249 g) coincided with population-based survival as it increased from the years 1974-1976 until 1992-1994, according to a study of births in Northern Alberta in the June 27 JAMA. For infants born at 20 to 25 weeks, population-based survival increased from 4% to 31%, and cerebral palsy prevalence increased from 0 to 110 per 1,000 live births; for infants born at 26 to 27 weeks, survival increased from 23% to 75% to 80%, while prevalence increased from 15 to 155. However, by the years 2001-2003, prevalence of cerebral palsy for the two groups had decreased to 22 and 19 per 1,000 live births, respectively. They were “steady reductions … with stable or reducing mortality, reversing trends prior to 1992-1994,” stated the authors. They suggested that changes in the use of bovine surfactant, indomethacin, and individualized developmental care following clinical trials may have contributed to the reduction.

Coffee drinking may be inversely associated with the development of primary blepharospasm, as reported in the August Journal of Neurology, Neurosurgery, and Psychiatry. For the 166 patients with primary blepharospasm, odds ratios of being an ever coffee-drinker were 0.37, compared with 228 hospital control patients and 0.44 compared with 187 population control patients. “The strength of the inverse association between blepharospasm and coffee intake tended to increase with the average number of cups drunk per day,” noted the authors. In addition, age at onset of blepharospasm increased by an average 1.7 years for each single-unit increase in cups per day, suggesting “that coffee in some way protects against the development of blepharospasm.” The researchers also analyzed the relationship between cigarette smoking and blepharospasm, but the association was not statistically significant after adjustment for confounders.

Cerebral ischemic preconditioning may help preserve neurovascular function by improving cerebral blood flow during a stroke, according to a report in the July 4 Journal of Neuroscience. Mice that received lipopolysaccharide 24 hours before a middle cerebral artery occlusion had a 68% reduction in infarct intensity, the researchers reported, and those areas spared from infarction showed a 114% improvement in ischemic cerebral blood flow. Lipopolysaccharide also prevented the dysfunction in cerebrovascular regulation induced by the occlusion. “These beneficial effects of lipopolysaccharide were not observed in mice lacking inducible nitric oxide synthase or the nox2 subunit of the superoxide-producing enzyme [nicotinamide adenine dinucleotide phosphate] oxidase,” noted the authors. Further studies may focus on identification of a concentration safe for human use, or description of the signaling mechanism to create a pharmaceutical mimic to protect stroke patients.

The FDA has approved the Exelon® Patch (rivastigmine transdermal system) for the treatment of mild to moderate Alzheimer’s disease. This method of drug delivery, applied to the back, chest, or upper arm of the patient, was preferred to capsules by 70% of caregivers, reported Novartis. Clinical trials included nearly 1,200 patients, and the rivastigmine transdermal system showed significant benefits over placebo and had similar efficacy to the highest doses of rivastigmine capsules. The recommended maintenance dose of 9.5 mg/24 h, while well tolerated by patients, must be titrated up from 4.6 mg/24 h due to adverse events including nausea, vomiting, diarrhea, anorexia, decreased appetite, and weight loss, recommended researchers. The rivastigmine transdermal system is also approved for the treatment of patients with mild to moderate Parkinson’s disease dementia.

Disruption of the interaction between b-amyloid and amyloid-binding alcohol dehydrogenase (ABAD) in a mouse model of Alzheimer’s disease halted the progression of the disease and even reversed some of the changes that had already begun, reported researchers in the June Molecular and Cellular Neuroscience. As use of a decoy protein that bound to b-amyloid in place of ABAD was initiated, expression levels of peroxiredoxin II—a marker of b-amyloid–induced toxicity—returned to normal. This indicated that the b-amyloid–ABAD interaction is a suitable drug target, stated the authors, and they reported that refinement of the inhibitor into a potential drug is being continued.

Methylphenidate use among young children may have long-term effects in the brain, according to a study in the July 4 Journal of Neuroscience. The researchers administered methylphenidate (5 mg/kg bid) to young rats until they were 35 days old. Changes linked to treatment were found in the striatum and in the hypothalamus, and there were alterations in catecholamines and norepinephrine in the prefrontal cortex. “These findings suggest that developmental exposure to high therapeutic doses of methylphenidate has short-term effects on select neurotransmitters in brain regions involved in motivated behaviors, cognition, appetite, and stress,” the researchers concluded. “Although the observed neuroanatomical changes largely resolve with time, chronic modulation of young brains with [methylphenidate] may exert effects on brain neurochemistry that modify some behaviors even in adulthood.”

Sun exposure during childhood may have a protective effect against multiple sclerosis (MS), reported researchers in the July 24 Neurology. The investigators assessed 79 pairs of identical twins in which one of the twins had MS; the twin pairs ranked themselves on nine childhood sun-exposure activities. Results showed that the twin who had spent less time in the sun was the twin who had MS. The twin who spent more hours outside had a 25% to 57% reduced risk of MS, depending on the activity. There was a 49% lower risk for twins who spent more time suntanning compared with twins who did not, for example. “This protective effect is independent of genetic susceptibility to MS,” the investigators concluded.

According to a study published in the August 1 Sleep, levels of serotonin may be significantly lower in rotating-shift workers than in day workers. The researchers compared 437 day workers with 246 rotating-shift workers and found that platelet serotonin content and 5-hydroxyindolacetic acid levels were significantly higher in day workers than in rotating-shift workers. Among rotating-shift workers, the investigators also found a nearly twofold increase in metabolic risk factors, including abdominal obesity, diastolic blood pressure hypertension, high triglyceride levels, and insulin resistance, possibly due to circadian rhythm disturbance. “These findings may be important for targeting effective therapeutic strategies to ameliorate the associated comorbidities and behavioral problems in rotating shift workers,” the investigators stated.

Medication management alone or in combination with behavior therapy for childhood ADHD may not be more beneficial than either behavior therapy or usual community care alone, according to a study in the August Journal of the American Academy of Child and Adolescent Psychiatry. The investigators examined 36-month outcomes two years after the Multimodal Treatment Study of Children with ADHD ended, in 485 out of the original 579 participants. Treatment groups received medication management, behavior therapy, the combination of medication management and behavior therapy, or usual community care. While all groups showed symptom improvement over baseline, the initial advantage of having had 14 months of the combination treatment or medication management alone was no longer apparent by 36 months, which could be explained by age-related decline in ADHD symptoms, changes in medication management intensity, or starting or stopping medication.

Coronary artery bypass graft patients may be at risk for early cognitive dysfunction if their mean arterial pressure drops from a preoperative baseline, as reported June 11 in the online Archives of Neurology. Fifteen patients at a quaternary care facility who were undergoing coronary artery bypass graft operations and were at high risk for postoperative stroke were studied. A preoperative to intraoperative drop in mean arterial pressure predicted a decrease in Mini-Mental State Examination score. After dichotomization of change in mean arterial pressure, patients with a small decrease improved by 1 point on the Mini-Mental State Examination, while patients with a large decrease worsened by 1.4 points.           

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