Vitamin E supplements do not protect women against heart attack and stroke, according to data from the Women’s Health Study. A total of 39,876 women were randomized to receive vitamin E (600 IU) or placebo and low-dose aspirin or placebo on alternate days. Researchers reported 184 nonfatal heart attacks in the vitamin E group, compared with 181 in the placebo group. They also observed 220 nonfatal strokes in the vitamin E group, compared with 222 in the placebo group. Vitamin E also had no significant effect on death from all causes. Reporting their findings in the July 6 JAMA, the researchers advised that “women should focus on well proven means of heart disease prevention, including leading a healthy lifestyle and controlling risk factors such as high blood pressure and high cholesterol.” They noted that women 65 and older who received vitamin E had a 26% decrease in heart attacks and cardiovascular deaths. “These intriguing findings deserve further study,” they said.

Results of the REST (RLS Epidemiology, Symptoms, and Treatment) General Population Study suggested that restless legs syndrome (RLS) is common and underdiagnosed and can significantly impact sleep and daily activities. The analysis was based on 15,391 individuals who completed telephone and face-to-face interviews. According to the researchers, 7.2% of participants reported having RLS symptoms at any frequency; 2.7% of participants, defined as RLS sufferers, reported having moderately or severely distressing symptoms that occurred two to three times per week. The frequency of RLS symptoms was higher in women than in men (9.0% vs 5.4%). Eighty percent of RLS sufferers reported discussing their symptoms with a primary care physician, though only 6.2% said they had received a diagnosis of RLS. The findings were published in the June 13 Archives of Internal Medicine.

A noninvasive MRI technique called arterial spin labeling is just as accurate as invasive scanning techniques in distinguishing patients with Alzheimer’s disease from those with frontotemporal dementia or those without dementia, according to findings presented at the International Conference on Prevention of Dementia. In arterial spin labeling, blood flow, and thus neuron activity, can be calculated by measuring the intensity of magnetic signals from inversely polarized protons as they enter the brain. Researchers measured brain perfusion in 24 Alzheimer’s disease patients, 21 frontotemporal dementia patients, and 25 controls, all between ages 62 and 90. They found that arterial spin labeling was successful in replicating PET and SPECT data. The researchers noted, however, that because the aim of the study was to accurately replicate imaging data, further research would be needed to demonstrate that perfusion abnormalities, as seen with arterial spin labeling, correlate with specific clinical symptoms.

Researchers have learned more about the possible brain pathways involved in absence seizures. Results of a study in the July Journal of Neurophysiology indicate that in addition to releasing glutamate, thalamus cells also contain a glutamate receptor that slows the release of glutamate during a seizure. “This receptor appears to slow down the rate at which glutamate is released across the synaptic gap, and may protect the cells from becoming overexcited,” stated the investigators. They theorized that in epilepsy patients, the protective receptors may not function well or that glutamate production may be abnormal. The researchers also believe that a treatment that targets the glutamate receptors might have the potential to block seizures from occurring.

Pregnant women at risk of premature delivery may be able to reduce the degree of hypoxic ischemic brain injury in their babies by drinking pomegranate juice, suggested a study in the June Pediatric Research. Using a mouse model that produced brain injuries similar to those seen in human infants, researchers demonstrated that mice whose mothers drank pomegranate juice had brain injuries less than half the size of those found in other mice. Pregnant mice were given pomegranate juice, plain water, sugar water, or vitamin C water during pregnancy and while they suckled their pups for seven days after birth. Researchers found that caspase-3, an enzyme linked to apoptosis, was 84% less active in mice whose mothers drank pomegranate juice. They suggested that drinking pomegranate juice might provide an alternative to consuming red wine during pregnancy, which increases the risk of birth defects.

People who have had a transient ischemic attack or a minor ischemic stroke have a 42.7% risk of death within 10 years, according to a report in the July 7 Lancet. Researchers assessed the survival status and occurrence of vascular events in 2,473 patients in the Netherlands. Ten years after patients had a transient ischemic attack or minor ischemic stroke, 60% had died, and 54% had had at least one vascular event. The researchers found that a 10-year risk of another vascular event was 44.1%. Yearly risk of a vascular event declined in the first three years but increased thereafter. “These findings imply that further improvement can still be established on long-term secondary prevention of vascular disease in patients with cerebral ischemia,” concluded the researchers.

The FDA has requested that Purdue Pharma LP withdraw Palladone™ (hydromorphone hydrochloride) extended release capsules from the market. A study testing the effects of alcohol use found that when Palladone is taken with alcohol, the extended release mechanism is harmed, resulting in rapid release of the drug into the blood stream. Rapid release of Palladone at the lowest marketed dose (12 mg) could lead to serious, or even fatal, adverse events in some patients, and risk is even greater for higher doses. The current labeling for Palladone, approved in September 2004, includes the standard opioid warning against the combined use of alcohol and Palladone; however, the FDA believes that risks of serious, or even fatal, adverse events cannot be effectively managed by label warnings alone. The agency noted that although there have not been any reports of serious problems thus far, even one alcoholic beverage could have fatal implications.

Improved training and supervision of emergency medical staff is needed to reduce the number of deaths in children with meningococcal disease, suggested a study in the June 25 BMJ. Researchers identified 143 deaths due to meningococcal disease and 355 survivors matched by age. Cases and controls were 16 and younger. Failures in management were significantly more common in children who died than in controls. Independent risk factors for death included lack of consultation with a pediatrician, insufficient supervision of junior medical staff, and failure to administer adequate drugs to treat shock and organ damage. Investigators said that improved training of medical staff, adherence to published protocols, and increased supervision might improve the outcome for these children, as well as for those with other life-threatening illnesses.

Researchers have discovered that the enzyme gamma-secretase, which contributes to the development of amyloid plaques, is part of a family of enzymes. Furthermore, only some family members actually play a role in the progression of Alzheimer’s disease. The findings were published in the June 21 Proceedings of the National Academy of Sciences. Gamma-secretase enzymes have also been thought to be involved in healthy functioning of other tissues. Using a mouse model, the researchers were able to demonstrate that they could separate the toxic activities of gamma-secretase from its other benign activities. “This finding provides hope that Alzheimer’s treatments can be developed that reduce the toxic activity of certain gamma-secretases while still maintaining the beneficial activities of other family members,” stated the researchers.

The FDA has approved Topamax® (topiramate) Tablets and Topamax Sprinkle Capsules as initial monotherapy in patients 10 and older with partial onset or primary generalized tonic-clonic seizures. The approval is based on results of a double-blind clinical trial in which 470 patients were given either 50 or 400 mg/day of topiramate. When comparing Kaplan-Meier survival curves of time to first seizure, the researchers found that the 400-mg dose was superior to the 50-mg dose. The recommended dose for monotherapy in patients ages 10 and older is therefore 400 mg/day in two divided doses. The safety and effectiveness in patients who were converted to monotherapy from a previous regimen of anticonvulsant drugs have not yet been established in controlled trials.

High school and college athletes with characteristics of post-traumatic migraine headache following a concussion might have increased neurocognitive impairment, according to a study in the May Journal of Neurosurgery. A total of 261 high school and college athletes who had sustained a concussion underwent postinjury neurocognitive testing. Seventy-four athletes had posttraumatic migraine, 124 complained of headache, and 63 did not have headaches. Compared with athletes in the headache and nonheadache groups, those in the posttraumatic migraine group had significantly greater neurocognitive deficits. Athletes in the posttraumatic migraine group had lower verbal and visual memory, motor speed, and reaction time scores. “The findings strongly support the need for clinicians to exercise increased vigilance in making decisions about managing a concussed athlete with posttraumatic migraine and extreme caution as to when that athlete should be allowed to return to play,” concluded the research team.

Investigators have found that many hypertensive strains of Neisseria meningitidis contain a bacteriophage in their genetic material. By studying strains of bacteria isolated from humans, the researchers found that those carrying the bacteriophage were more likely to cause outbreaks of meningitis. How this bacteriophage causes N meningitidis to become more dangerous is unknown. However, the investigators speculated that the bacteriophage helps the bacteria enter the bloodstream either by altering the bacteria or by disrupting the immune response that normally protects against it. Results of the study were published in the June 20 Journal of Experimental Medicine.

The FDA has approved the first blood test designed to identify patients at risk for ischemic stroke. The PLAC™ test measures levels of lipoprotein-associated phospholipase (Lp-PLA2). Results from the National Heart, Lung, and Blood Institute’s Atherosclerosis Risk in Communities study indicated that people with elevated levels of Lp-PLA2 have a twofold risk of suffering an ischemic stroke associated with atherosclerosis. “The PLAC test will help physicians more accurately predict who is at risk for stroke, so that the individual can take proactive and preventative measures, such as lifestyle modification or therapeutic intervention, including statins and daily aspirin,” reported the investigators.

Researchers have discovered a mechanism that causes alpha-synuclein to clump together in brain cells of people with Parkinson’s disease. According to a report in the June 17 Journal of Biological Chemistry, when the enzyme that degrades alpha-synuclein malfunctions, truncated fragments of alpha-synuclein are produced, which encourages clustering of the protein. These clusters then suppress the normal functioning of the enzyme that breaks down alpha-synuclein, which results in even more clustering. The investigators said that future research might involve developing methods to inhibit just the malicious form of the enzyme, while leaving the functions of the normal enzyme unaffected. They also noted that their findings might be applicable to other diseases in which protein clusters form, such as Huntington’s and Alzheimer’s diseases.

Investigators have developed a computer program that enhances the diagnostic accuracy of PET scans when detecting Alzheimer’s disease, according to findings presented at the 52nd Annual Meeting of the Society of Nuclear Medicine. “PET with fluorodeoxyglucose in the hands of the experienced investigator is the most reliable noninvasive test to detect Alzheimer’s disease in the early stage; however, reading these scans depends on the experience of the interpreter,” reported the investigators. Using this system, even inexperienced physicians would be able to reliably diagnose Alzheimer’s disease. The system can be helpful in diagnosing the disease in difficult cases and can also identify various other dementia disorders, such as frontal lobe dementia or Lewy body disease.

The FDA has approved Keppra® (levetiracetam) as add-on therapy for the treatment of partial-onset seizures in children 4 and older. The approval was based on findings from a randomized, double-blind, placebo-controlled trial involving 198 children ages 4 to 16 with partial onset seizures with or without secondary generalization uncontrolled by standard antiepileptic drugs. Patients who received levetiracetam had, on average, a significantly larger reduction (26.8%) in weekly seizure frequency, compared with those who received placebo. Additionally, 44.6% of patients who received levetiracetam achieved a 50% or greater reduction in seizures, compared with only 19.6% of patients who received placebo. Commonly reported adverse events associated with levetiracetam in combination with other antiepileptic drugs included somnolence, accidental injury, hostility, nervousness, and asthenia.

Researchers have identified two cases of gluten sensitivity presenting as neuromyelitis optica. According to a report in the July Journal of Neurology, Neurosurgery, and Psychiatry, neuromyelitis optica has not previously been described in association with gluten sensitivity. In both patients, levels of tissue transglutaminase and immunoglobulin A anti-gliadin antibodies decreased following intravenous methylprednisolone and the introduction of a gluten-free diet. “In the first patient, these titres rose at the time of first relapse, suggesting that there may be a causative association,” said the researchers. “We suggest that patients with myelitis who present with or without optic neuritis should, as part of their work up, also be investigated for possible gluten sensitivity in order to explore this association further.”

NR