Marital status is a risk factor for dementia and Alzheimer's disease, according to a French population-based study. Persons who never married had a two-fold higher risk of dementia and a three-fold higher risk of Alzheimer's disease than married or widowed subjects. Results were not influenced by education or wine consumption, nor explainable by differences in leisure activities or depressive symptoms, the researchers wrote in the December 10 Neurology.

Advanced age is an important risk factor for severe head injuries, according to a report in the December Journal of the American Geriatrics Society. Severe head injuries increased the risk of cognitive decline and, possibly, dementia among elderly residents of five rural Finnish municipalities. "Strong measures are called for to prevent such injuries," the authors wrote.

Risk factors for stroke differ by stroke subtype, "reflecting different etiopathology," reported researchers in the December Stroke. Elevated systolic blood pressure raised the risk of all subtypes; however, "the associations of serum total and HDL cholesterol are different for different strokes," they wrote. The findings call for individualized approaches to risk modification and for subtype distinctions in epidemiologic studies of stroke, they concluded.

Primary care physicians and surgeons could do a better job of involving patients in clinical decision-making, suggests a report in the December 22/29 issue of JAMA. Analyzing audiotaped appointments of 59 primary care physicians and 65 surgeons, researchers found that only 9% of the encounters met their definition of completeness for informed decision making. "There is simply insufficient time to adopt the shared decision-making approach," contended Michael J. Barry, MD, in an editorial. He concluded that "new strategies, including more efficient use of educational materials and decision aids in office practice, will need to be developed and tested as part of the solution."

Elderly persons who feel that providing primary care for their spouse is a source of mental or emotional strain are 63% more likely to die within four years than others in their age-group, according to a University of Pittsburgh study. The authors of an accompanying editorial in the December 15 JAMA noted that the study sample was considerably less burdened (due to broad definitions of caregiving) than the category most often discussed—caregivers of patients with dementia. They expect the finding will have broad implications—clinical, political, and scientific..

A virtual reality neurosurgical planning system is described in the January Neurosurgery. Known as VIVIAN (Virtual Intracranial Visualization and Navigation), the system allows operators to manipulate a computer-generated, stereoscopic, three-dimensional object, which coregisters MRI, MRA, and CT data, in real time with natural hand movements. Neurosurgical planning is expedited by enhancing the surgeon's conception of spatial relationships, simulating the craniotomy and the cranial base bone work, and simulating intraoperative views.

Age, seizure severity, and symptoms of neurotoxicity were risk factors for self-perceived poor health-related quality of life in a group of 197 adolescents with epilepsy. According to a report in the December Epilepsia, quality-of-life scores were poorer in older (age 14 to 17) than younger (age 11 to 13) adolescents. Girls and boys were sensitive to different domains, and girls showed a trend for poorer overall scores.

An "N of 1" placebo-controlled trial can help families decide whether methylphenidate is the right long-term treatment for their child with attention-deficit/hyperactivity disorder, according to a report in the December Archives of Pediatric and Adolescent Medicine. Forty-three families each received three indistinguishable bottles containing placebo or methylphenidate (0.3 mg/kg and 0.6 mg/kg). After three weeks, responses to each were discussed. Nine of the 43 families chose not to use methylphenidate; however, all said that the novel approach helped them make the decision.

Hypocretin deficiency may induce narcolepsy, a recent study suggests. Hypocretin levels were undetectable in seven of nine patients with narcolepsy, but normal in eight controls. In the January 1 Lancet, the researchers suggested that hypocretin deficiency may lower monoaminergic tone, possibly explaining the beneficial effects of current therapies.

Female sex, primary neurologic dysfunction in the right hemisphere, and onset of seizures after adolescence were associated with nonepileptic seizures developing within six months of resective epilepsy surgery, according to a report in the December Epilepsia. The female-to-male ratio was 17:5 among those with nonepileptic seizures, possibly explained by sociocultural patterns of emotional expression, higher rates of sexual abuse, or higher rates of posttraumatic stress disorder in women, the researchers said. Right-hemispheric damage has been linked with difficulties in interpreting emotional cues, ictal fear, and panic disorder.

The ketogenic diet is "a promising therapy in well-motivated adults with refractory epilepsy," concluded the authors of a report in the December Epilepsia. Six of 11 adults had at least 50% fewer seizures during the eight-month study. The diet was generally well-tolerated; side effects included gastrointestinal complaints and menstrual irregularities. Seven patients reported improved cognition and mood without reduction in antiepileptic medication. The unrandomized, uncontrolled study was preliminary, the authors noted, and future studies should address the ideal duration, long-term metabolic consequences, and risks of the ketogenic diet for epileptic adults.

Cluster headaches in childhood may be mistaken for pseudoseizures or a behavioral problem, according to a report in the December Archives of Diseases in Childhood. In four cases, with ages of onset ranging from 6 to 15 years, features accompanying the headaches included flushing, thrashing, and other emotional symptoms. The authors suggested that, in addition to medication, oxygen (inhaled through a high-flow delivery system) may afford some relief.

Extracranial sonography can measure cerebral blood flow (CBF) volume in vascular dementia, according to a research letter in the December 18 issue of Lancet. Global CBF volume was lower in patients with vascular dementia than in controls as measured by color duplex sonography of the extracranial arteries. Volume was even lower in more severely affected patients. Advantages of sonographic measurements include noninvasion and accessibility to equipment, while disadvantages include operator dependency, susceptibility to artifacts, and inability to assess regional blood flow.

Internment in work camps does not seem to have increased susceptibility to neurodegenerative disease among prisoners of war (POWs), according to a report in the December 18 Lancet. Researchers traced 11,134 former British POWs who had been held in Japanese camps, reviewing the death certificates of those who had died between 1952 and 1997. Compared with the general male population of England and Wales, former POWs had lower overall mortality rates. The exception, however, was liver disease, which may have been caused by infection with hepatitis B or C virus during captivity.

Infection with Borrelia burgdorferi did not increase the incidence of musculoskeletal or neurologic abnormalities at six-year follow up in patients who had been treated for Lyme disease, a population-based study has found. According to a report in the December 21 Annals of Internal Medicine, 186 patients with a history of Lyme disease and 167 healthy controls participated in the study on Nantucket Island, Massachusetts. On physical examination, case patients and controls did not differ in musculoskeletal abnormalities, neurologic abnormalities, or neurocognitive performance. However, these results, noted the authors, do not preclude the development of future musculoskeletal or neurocognitive complications.

A direct relationship between migraine and epilepsy was found in 1.7% of an adult epilepsy clinic population, although 14% were diagnosed with both disorders. Researchers from Turkey reported that patients with migraine with aura or catamenial epilepsy were at a higher risk for having both migraine and epilepsy. According to the report in the November Cephalalgia, migraine aura was followed by seizure that was followed by headache in all directly related cases; however, clinical patterns did not predict therapeutic outcome.

Trileptal® (oxcarbazepine) has been approved by the Food and Drug Administration (FDA) for use as monotherapy for partial epileptic seizures in adults and as adjunctive therapy in adults and children as young as 4 years of age. In evaluating the new anticonvulsant, the FDA reviewed results from 34 trials involving more than 2,600 subjects. In total, the safety database included nearly 7,000 patients. "In clinical trials, we've seen excellent seizure-free rates with [oxcarbazepine] and the medication is very well tolerated," said Rajesh Sachdeo, MD. Trileptal will be marketed by Novartis Pharmaceuticals.

The onset of dementia in an elderly combat veteran may trigger symptoms of posttraumatic stress disorder (PTSD), according to a report in the January Journal of the American Geriatrics Society. Deirdre Johnston, MB, described three veterans of WWII and the Korean War whose families had noticed cognitive deterioration in the months preceding a violent outburst. Each veteran had nightmares of wartime experience, physiologic hyperreactivity, exaggerated startle response, and tremulousness and pallor in response to stressful stimuli. Violent outbursts, social withdrawal, dysphoria, tearfulness, and preoccupation with previously unmentioned wartime experience became more frequent. An estimated 25% of American men over the age of 55 served in combat, said the author, and there is a strong association between combat experience and PTSD in WWII veterans.

Pregnancy may exacerbate Parkinson's disease, suggests a case report from the January Movement Disorders. Researchers described a young woman with previously diagnosed Parkinson's disease whose symptoms worsened during and after pregnancy and delivery of a healthy infant. Adjustments in levodopa dosage and addition of pramipexole were required. Reports of healthy infants born to mothers taking carbidopa/levodopa and levodopa/benserazide suggest an absence of teratogenic effects. Since progression of disease varies, it is unclear whether the subject's deterioration was independent from her pregnancy, the researchers acknowledged.

Self-perceived health of patients with well-regulated epilepsy equals that of the general population, a Norwegian study reports. Researchers surveyed 397 patients and 1,663 randomly selected controls. The participants completed a questionnaire measuring physical functioning and pain, general health, vitality, social function, emotional health, and mental health. Although seizure-free patients scored well, "those with continued seizures had worse health status than did the general population," wrote the researchers in the January Epilepsia.

One sixth of epileptic patients failed to report seizures to their physicians, a Norfolk, UK, study found. Patients are motivated to conceal seizures to maintain eligibility for driver's licenses, employment opportunities, and leisure activities, wrote the authors in the January 8 British Medical Journal. The finding could have clinical and legislative implications, they added; physicians might address the consequences of concealment more thoroughly, and legislative bodies might reconsider durations of seizure-free periods required to maintain driving eligibility.

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