Use of the cardiopulmonary bypass pump during coronary artery bypass graft (CABG) surgery does not significantly affect postsurgical performance on cognitive tests, according to a study in the October 11 Neurology. Researchers compared four groups: patients receiving CABG surgery, patients receiving off-pump coronary surgery, nonsurgical patients with coronary artery disease, and healthy controls. Patients and controls were evaluated at baseline, three months, and 12 months. Compared with healthy controls, groups with coronary artery disease had lower cognitive test scores at baseline; however, by three months all groups showed improvement. There was no evidence during a one-year period that cognitive test performance of patients who received CABG surgery differed from that of patients in other groups who had coronary artery disease.

Coexpression of epidermal growth factor receptor deletion mutant variant III (EGFRvIII) and the tumor-suppressor protein PTEN by glioblastoma cells is associated with responsiveness to drugs that block EGFR, according to a report in the November 10 New England Journal of Medicine. Researchers sequenced kinase domains in the EGFR and EGFR type 2 genes and analyzed the expression of EGFR, EGFRvIII, and PTEN in recurrent malignant gliomas. Pretreatment tissue from 26 of 49 patients was available for analysis; seven patients had a response and 19 had rapid progression during therapy. According to the researchers, coexpression of EGFRvIII and PTEN was significantly associated with a clinical response to EGFR kinase inhibitors. The findings were validated in a sample of 33 patients who had received similar treatment for glioblastoma.

Declining body mass index (BMI) is associated with an increased risk of Alzheimer’s disease, according to a study in the September 27 Neurology. Nine hundred eighteen elderly Catholic clergy participating in the Religious Orders Study were assessed. During a mean follow-up period of 5.5 years, 151 people developed Alzheimer’s disease. BMI, which averaged around 27.4 at baseline, declined in almost half the participants during this time. Researchers found that each 1-unit annual decline in BMI was associated with a 35% increased risk of Alzheimer’s disease. Rate of cognitive decline in participants losing 1 unit of BMI per year increased by more than 35% compared with those with no change in BMI. “Loss of BMI may reflect pathologic processes that contribute to the subsequent development of Alzheimer’s disease,” they said.

Rate of cognitive decline in Alzheimer’s disease appears to be slower in African-Americans, according to results of a study published in the November American Journal of Geriatric Psychiatry. Patients with Alzheimer’s disease completed a battery of nine cognitive tests at six-month intervals for up to four years. Complete data were available for a total of 452 people. Although African-American patients had a lower level of global cognition at baseline than did non– African-American patients, they showed decline at a 25% slower rate. Additional models revealed no indication that this association varied by age, gender, or education.

Children with neurologic and neuromuscular disease are at increased risk of respiratory failure due to influenza virus, according to a report in the November 2 JAMA. Researchers conducted a retrospective cohort study of 745 patients 21 and younger who were hospitalized with community-acquired influenza. They found that 322 had one or more Advisory Committee on Immunization Practices–designated high-risk chronic medical conditions. Also, neurologic and neuromuscular disease, GERD, and history of prematurity were present in 12%, 14%, and 3% of participants, respectively. Conditions associated with respiratory failure included neurologic and neuromuscular disease (odds ratio, 6.0), chronic pulmonary disease other than asthma (odds ratio, 4.8), and cardiac disease (odds ratio, 4.0). The researchers suggested that “neurologists and primary care pediatricians should be alerted to the increased risk of respiratory failure and the importance of influenza vaccination in children with neurologic and neuromuscular disease.”

The FDA has approved Trileptal® (oxcarbazepine) tablets and oral suspension as adjunctive therapy for partial seizures in children as young as age 2. The approval is based on results of a randomized trial published in the November 8 Neurology. In the study, 128 children ages 1 month to younger than 4 years who had inadequately controlled partial seizures were randomly assigned to treatment with one of two doses of oxcarbazepine (60 mg/kg/day or 10 mg/kg/ day) oral suspension. High-dose oxcarbazepine was significantly more effective in controlling partial seizures in young children than was low-dose oxcarbazepine. Both treatments were generally well tolerated; the most frequent adverse events were somnolence and pyrexia, and most were mild in severity.

Maternal use of anticonvulsants is associated with infant craniostenosis, according to findings reported in the November Cleft Palate–Craniofacial Journal. Researchers examined 398 cases of craniostenosis, identified from various Swedish databases. Their findings were then validated using data from a French database. They found a statistically significant association between maternal use of anticonvulsants and infant craniostenosis (risk ratio, 6.9). No association was found between craniostenosis and subfertility or infertility treatment. A tentative association, based on only five exposures, was found between three nitrosatable drugs and craniostenosis; no such exposure was reported in the French data.

Variants of the SLITRK1 gene seem to be associated with Tourette’s syndrome, suggest findings from a study published in the October 14 Science. Investigators studied SLITRK1 as a candidate gene on chromosome 13q31.1 because of its proximity to a chromosomal abnormality seen in a child with Tourette’s syndrome. A variant of the gene was identified in two unrelated individuals and one family from a population of 174 patients with Tourette’s syndrome. In the two individuals, the variant was located in a binding site for mRNA. The investigators noted that “these variants were absent from 3,600 control chromosomes.” They commented, “This finding could provide an important clue in understanding Tourette’s [syndrome] on a molecular and cellular level.”

Whole-body hypothermia reduces the risk of death or disability in infants with moderate or severe hypoxic-ischemic encephalopathy. According to a report in the October 13 New England Journal of Medicine, the study included 208 infants with a gestational age of at least 36 weeks who were admitted to the hospital for severe acidosis or perinatal complications and who had moderate to severe encephalopathy. Researchers randomly assigned 102 infants to whole-body cooling to a temperature of 33.5°C for 72 hours, followed by slow rewarming (hypothermia group), while 106 infants were assigned to usual care (control group). Neurodevelopmental outcome at age 18 to 22 months was assessed. Death or severe disability occurred in 44% of infants in the hypothermia group and in 62% of infants in the control group. Twenty-four percent of infants in the hypothermia group died, compared with 37% of those in the control group. In addition, 19% of infants in the hypothermia group had cerebral palsy, compared with 30% in the control group.

Survivors of childhood Hodgkin’s disease are at increased risk of stroke, according to results of a study published in the September 20 Journal of Clinical Oncology. Investigators compared incidence rates of stroke in 1,926 survivors of Hodgkin’s disease with those of 3,846 siblings of cancer survivors. Incidence rates for stroke—8/100,000 person-years among siblings of cancer survivors and 83.6/100,000 person-years among Hodgkin’s disease survivors—suggested that survivors of Hodgkin’s disease were at significantly increased risk of stroke. Investigators also found that mantle radiation exposure was strongly associated with stroke in survivors of Hodgkin’s disease (risk ratio, 5.62). “Potential mechanisms may include carotid artery disease or cardiac valvular disease,” they said.

Deep brain stimulation can help regulate arterial blood pressure, according to a study in the November 7 Neuroreport. Researchers measured cardiovascular responses to electrical stimulation of the periventricular/periaqueductal gray matter in 15 participants following implantation of deep brain– stimulating electrodes for treatment of chronic pain. They found that stimulation of the ventral periventricular/periaqueductal gray matter decreased systolic blood pressure, while stimulation of the dorsal periventricular/periaqueductal gray matter increased systolic blood pressure. “Obviously, as this is brain surgery, we have to proceed with caution,” said the researchers. “[Deep brain stimulation] would initially only be warranted in those patients for whom drug treatments just aren’t working.” They noted that other research groups are working on developing less invasive methods of stimulating precise locations in the brain.

NR