Bilateral arm training with rhythmic auditory cueing (BATRAC) is a potential therapy for patients with residual upper-extremity hemiparesis following ischemic stroke, according to a report in the October 20 JAMA. Researchers assigned 21 patients to BATRAC or standardized therapeutic exercises. Both therapies were conducted for one hour, three days a week, for six weeks. Results indicated that patients who received BATRAC had increased hemispheric activation in the contralesional cerebrum and ipsilesional cerebellum during paretic arm movement. In addition, researchers found that BATRAC was associated with increased activation in precentral and postcentral gyri. No changes were observed in patients who received standardized therapeutic exercises.

Use of vitamin E supplements in excess of 400 IU/day is associated with a higher overall risk of dying, according to research presented at the American Heart Association’s Scientific Sessions 2004 in New Orleans. Study results were also published in the November 10 Annals of Internal Medicine. Researchers analyzed data from 19 clinical trials—nine of the trials tested vitamin E alone and 10 tested its use in combination with other vitamins. Results indicated that nine of the 11 trials involving a high dose of vitamin E—400 IU/day or more—showed an increased risk of death. Researchers were unsure of the effects of low doses of vitamin E. They recommended that the intake limit of vitamin E, set forth by US dietary guidelines, be lowered from 1,500 IU/ day to 400 IU/day.

Patients with early symptoms of multiple sclerosis (MS) who were given 22 mg interferon beta-1a once a week were less likely to progress to full clinical disease after two years’ follow-up, according to a study in the October 23 Lancet. Results of the study indicated that after two years, 47% of patients who received placebo progressed to clinically definite MS, compared with only 31% of patients who received interferon beta-1a. Furthermore, MRI scans showed that patients who received placebo had a greater degree of brain tissue loss than did patients who received interferon beta-1a.

Peripheral neuropathy occurs more often after bariatric surgery than after cholecystectomy, according to a study in the October 26 Neurology. In the study, 435 patients undergoing bariatric surgery were compared with 300 age- and gender-matched obese patients undergoing cholecystectomy. Researchers found that 16% of patients undergoing bariatric surgery developed peripheral neuropathy, compared with only 3% of patients undergoing cholecystectomy. The clinical patterns of peripheral neuropathy after bariatric surgery were sensory-predominant polyneuropathy, mononeuropathy, and radiculoplexus neuropathy. The investigators said malnutrition was a risk factor and suggested that patients attend nutritional clinics. The research team also speculated that “inflammation and altered immunity may play a role in the pathogenesis, but further study is needed.”

Substitution between brand and generic phenytoin should not be permitted without consultation with a physician, according to an article in the October 26 Neurology. During a five-month period, researchers observed increased seizures requiring hospitalization, emergency department visits, or urgent clinic visits in 11 patients after their health plans switched their medication from brand phenytoin to generic phenytoin. According to the researchers, “substitution of brand for generic or generic for brand phenytoin was associated with an approximately 30% decrease in both total and free phenytoin concentrations.”

Children who have problems breathing during sleep seem to score lower on tests of mental development and intelligence, according to two studies in the October Journal of Pediatrics. In the first study, researchers evaluated 256 infants at age 1 year and found that those who had multiple, brief breathing pauses or slow heart rates during sleep scored lower on mental development tests. In the second study, they examined 205 children at age 5 and found that those who reported frequent snoring; heavy, loud, or noisy breathing during sleep; or observed apneas during sleep scored lower on tests measuring executive function, memory, and general intelligence. The researchers concluded, “Parents need to be aware that their child’s snoring could signal serious problems.”

Enlarged perivascular spaces are associated with worse mental function, according to a study in the November Journal of Neurology, Neurosurgery, and Psychiatry. Researchers evaluated 100 healthy elderly men and found that men with more enlarged perivascular spaces had worse mental ability. They asserted, “These findings mean that we should certainly be looking more closely at enlarged perivascular spaces as a cause of dementia and other mental decline in old age. They raise the interesting possibilities that there may be substances in the blood, such as cholesterol or sugar levels, or even blood pressure itself, that may contribute to memory decline as people become older.”

Doctors working in medical wards with acutely ill and predominantly elderly patients need to be more aware of the mental incapacity of their patients when evaluating their ability to give informed consent about treatments, according to a study in the October 16 Lancet. Researchers found that 31% of 159 patients lacked the mental capacity to make treatment decisions. Furthermore, they found that recognition of incapacity by hospital staff was low—only a quarter of patients identified by the researchers as not having the mental capacity to make treatment decisions were identified by clinicians. Researchers emphasized that accepting “the passive acquiescence of such patients as evidence of true consent would be dangerous when important and irreversible decisions need to be made. Before making such decisions, the clinician should have considered the possibility that the patient is unable to give valid consent.”

Women with endometriosis are at a higher risk of having migraine, according to a study in the October 28 online edition of Human Reproduction. Researchers studied 133 women with endometriosis as well as a control group of 166 women. They found that a third of women with endometriosis had migraine, while only 15% of women in the control group had migraine. They also found no evidence that women with endometriosis had more frequent attacks or more intense pain than did women in the control group who had migraine. However, they determined that women with endometriosis reported a lower age at onset of migraine symptoms. The researchers said it is possible that systemic spreading of prostaglandins, or even upregulation or dysregulation of nitric oxide synthesis, might play a role in endometriosis and migraine.

Researchers have found that implanting electrical stimulators on one side of a Parkinson’s disease patient’s brain could alleviate symptoms on both sides of the patient’s body, according to a study in the October Motor Control. Ten patients with advanced Parkinson’s disease underwent tests designed to mimic everyday activities while the stimulator was on and again three hours after it was turned off. Results showed a 30% improvement in motor performance of the upper extremity, at the opposite side of stimulation, as well as a 14% to 17% improvement on the same side of the body. No significant difference was found between patients who received stimulation in the subthalamic nucleus, compared with those who received stimulation in the global pallidus interna. This is the first study to show an improvement of symptoms on the same side of the body following implantation of the device.

Contrary to findings in previous studies, most patients with epilepsy do not need to excessively restrict their daily activities to avoid injury. A study published in the November 9 Neurology examined the records of 247 epilepsy patients and found that “people with well-controlled epilepsy should not arbitrarily be considered at higher risk of injury than those without epilepsy.” Researchers said, “Unnecessary restrictions of activity can adversely affect quality of life, often to a more serious extent than what seizure attacks can do.” In order to minimize risk of injury from seizures, the researchers recommended that epilepsy patients practice general safety rules when outdoors, take medications regularly as prescribed by a doctor, report medication side effects to a doctor, try to remain physically fit, and have a companion while engaged in high-risk activities.

A protein produced by the Notch2 gene promotes cancer cell growth by 27% in children with medulloblastoma, according to a study in the November 1 Cancer Research. Researchers also found that children with high Notch2 activity fared worse in the course of their disease than did those with low Notch2 activity. After studying 35 patients with medulloblastoma, researchers found that of 11 patients with high levels of a protein marker for Notch2, seven had died; of 24 patients with no detectable protein, only six had died. “We’d like to develop a drug that only affects the Notch2 pathway, since blocking other members of the Notch family may actually have the opposite effect and encourage cancer growth,” the investigators said.

NR