Parents who lose a child have an increased risk of developing multiple sclerosis (MS), according to a report in the March 9 Neurology. The study found that parents whose child died were 50% more likely to develop MS than parents who did not lose a child and supports the hypothesis that psychological stress might play a role in the development of MS, the investigators said. The study was conducted using Danish national registers. There were 21,062 parents who lost a child of 18 or younger and 293,745 parents who did not lose a child. During a 9.5 year follow-up, the investigators found 28 cases of MS among parents who had lost a child and 230 cases among other parents. The risk of developing MS was the same regardless of the age or gender of the parent or of the child who died. Parents of a child who died unexpectedly were more than twice as likely to develop MS as were parents who did not lose a child.

The enzyme cytosolic phospholipase A2 (cPLA2) may play a key role in the pathogenesis of multiple sclerosis (MS), according to a study published in the March Neuron. Investigators examined mice with experimental autoimmune encephalomyelitis and found that cPLA2 was expressed at high levels in endothelial cells and immune cells at lesion sites. Blocking the enzyme with an arachidonic acid analogue “led to a dramatic reduction in the onset and progression of experimental autoimmune encephalomyelitis,” they reported. Additionally, inhibiting cPLA2 “led to a decrease in the expression of many mediators of inflammation, including chemokines and cytokines known to induce the expression of cPLA2.” These results suggest that cPLA2 “could serve as the common link by which various factors trigger the inflammatory and axonal pathologies characteristic of experimental autoimmune encephalomyelitis and MS,” the investigators concluded.

Early neuroimaging tests for children with suspected cerebral palsy, as well as early screening for related disorders, were recommended in new practice guidelines published in the March 23 Neurology. The guidelines, compiled by members of the American Academy of Neurology and the Child Neurology Society, were based on evidence supporting the use of MRI over CT when cerebral palsy is suspected. Metabolic and genetic testing are not routinely indicated, according to the guidelines, unless the cause of the brain abnormality is not evident from MRI or clinical history and examination. Early diagnosis will assist physicians, as well as parents and caregivers of children with cerebral palsy, in understanding the cause of the disorder and making informed decisions on treatment, the authors said.

Acupuncture can help patients with chronic headache and is relatively cost effective, according to a study published in the March 15 BMJ. Researchers identified 401 patients who reported headache—mostly migraine-type—on several days every week. Patients were randomized to receive up to 12 acupuncture treatments over three months or usual care. Follow-up continued for one year. Patients receiving acupuncture experienced 22 fewer days of headache per year, used 15% less medication, made 25% fewer visits to their general practitioner, and took 15% fewer sick days than did patients in the usual care group, the investigators reported. In a separate analysis, acupuncture improved quality of life at a small additional cost and was “relatively cost effective compared with a number of other interventions,” the researchers noted.

Smoking accelerates cognitive decline in the elderly, according to a large, multicenter study by researchers in several European countries. The investigators studied smoking habits and change in cognitive function in a cohort of 9,209 men and women without dementia (65 and older). The group was followed for a mean 2.3 years. Cognitive function was assessed with the Mini-Mental State Examination (MMSE). Among those who never smoked (41%), MMSE score declined 0.03 points per year. Scores of current smokers (22%) declined 0.16 points per year—a rate of decline about five times higher than those who never smoked. MMSE scores of former smokers (37%) declined 0.06 points per year. Family history of dementia did not impact the significance of the results, the investigators noted. The study was published in the March 23 Neurology.

New research estimated the relative contributions of genetic and environmental factors in determining the age of onset in Huntington’s disease. Researchers from Columbia University in New York City examined the genetic mutations, onset ages, family trees, and life histories of 443 Venezuelans who belong to an extended, multigenerational family with the disease. In general, the investigators reported, the average age of onset for Huntington’s disease is 34. A higher number of CAG repeats in the mutated gene leads to earlier age at onset and greater disease severity. Their research, published in the March 8 Proceedings of the National Academy of Sciences, showed that after controlling for the effect of the huntingtin gene itself, 40% of the remaining variation in onset age is due to genetic factors and 60% is due to environmental effects. Finding the genes that contribute to this variation and studying patients’ environments may reveal what triggers, worsens, or improves the symptoms of Huntington’s disease, leading to treatments that slow disease onset or progression, the researchers said.

The “first definitive proof” that prions can transfer heritable traits from one living system to another without the help of nucleic acids is being hailed as a breakthrough in the quest to understand the role of these proteins in neurologic diseases. Researchers at Florida State University in Tallahassee isolated and identified three different strains of yeast prions—each of which was found to originate from the same protein molecule—that turned into infectious prions. The investigators found that the prions acted like genes in transferring life-altering information in yeast cells in the absence of nucleic acids. The findings suggest that one of the foundational ideas of genetics—that DNA is the basis of all heredity, including the transmission of diseases—must be revisited, the investigators asserted. Their findings were published in the March 18 Nature.

Carotid endarterectomy could substantially reduce the risk of major strokes in certain patients if it is performed soon after a transient ischemic attack (TIA). Researchers from the University of Oxford, United Kingdom, analyzed data pooled from the European Carotid Surgery Trial and North American Symptomatic Carotid Endarterectomy Trial to assess the risk of stroke without surgery, the risk of stroke and death due to surgery, and the overall benefit from surgery. Data for some 5,900 persons were available from the two trials. Benefit from surgery was greatest in men, patients 75 and older, and those randomized within two weeks after TIA, the investigators reported in the March 20 Lancet. The benefit of carotid endarterectomy in reducing the risk of major stroke declined sharply with increasing delay to surgery, they noted.

Men are more likely than women to develop Parkinson’s disease, according to research published in the March Journal of Neurology, Neurosurgery, and Psychiatry. An analysis of seven population studies from the United States, China, Poland, Italy, Spain, and Finland, each including at least 50 cases of Parkinson’s disease, revealed that, after adjustment for age, men were 1.5 times more likely than women to develop Parkinson’s disease. Male gender could be a risk factor through an X-linked genetic susceptibility, the researchers suggested, or it may be a marker for environmental risk factors such as greater exposure to toxic chemicals and higher rates of head injury. Conversely, the results might be explained through a potential protective effect of estrogen on the nervous system.

A strong association between the use of the inactivated intranasal influenza vaccine and the risk of Bell’s palsy in a Swiss cohort was reported in the February 26 New England Journal of Medicine. Researchers conducted a matched case-control study and a case series analysis of 773 patients with Bell’s palsy identified by primary care physicians, otolaryngologists, and neurologists in German-speaking regions of Switzerland between October 1, 2000, and April 30, 2001. Vaccination information was provided by the physicians. The researchers found that of 250 patients enrolled in the case-control study, 68 patients with Bell’s palsy and eight controls had received the intranasal vaccine. In contrast to the parenteral vaccines, the intranasal vaccine significantly increased the risk of Bell’s palsy (adjusted odds ratio, 84.0). “Even according to conservative assumptions, the relative risk of Bell’s palsy was estimated to be 19 times the risk in controls,” the investigators said. The inactivated intranasal influenza vaccine is no longer in clinical use.

A survey in the March Journal of Neurology, Neurosurgery, and Psychiatry suggests that both the general public and health care professionals need better education about stroke risk factors. An in-hospital survey of patients who had had a stroke or transient ischemic attack, those who were at risk of a stroke, nurses, and the general public revealed that among those at risk for stroke, none or very few properly identified the major stroke risk factors. Nurses listed significantly more risk factors than did the other groups, but only 25% could list more than three factors. Of patients at risk, 75% claimed they would call an ambulance; however, this was not verified by the testimony of those who actually had a stroke. On average, 30 minutes (range, five minutes to six days) elapsed before medical help was called, and in eight of 10 cases, this was the primary care physician rather than an ambulance, thus delaying vital treatment.

NR