Brain regions involved in movement and feeling appear to remain relatively healthy and active years after the body has been paralyzed, researchers reported in the December 24 Proceedings of the National Academy of Sciences. Investigators used functional magnetic resonance imaging to compare patterns of brain activity in one healthy participant versus one participant with quadriplegia due to a severe spinal cord injury. Images were taken to measure the participants’ response to touch and movement. They found that brain activity during movement in the healthy individual was normal, as was the activity in the individual with quadriplegia, though it was slightly more widespread than in the healthy participant. These findings suggest possible preservation of motor and some somatosensory cortical representations in the absence of overt movements or conscious sensations for several years after spinal cord injury.

Patients with HIV and cognitive impairment are more likely to fail to adhere to their medication schedule than those without cognitive impairment, according to the December 24 Neurology. Researchers used pill bottles with computer chips embedded in the caps to monitor medication compliance in 137 adults with HIV; 34% of the patients were cognitively impaired. Researchers discovered that, for patients with cognitive impairment, those who took medications three times a day followed their schedule 52% of the time, compared with patients with no cognitive impairment, who adhered to their schedules 79% of the time. The investigators suggest that patients with HIV and cognitive decline be given simpler dosing schedules to improve the likelihood of compliance.

Hemispherectomy may reduce or eliminate severe seizures in children with Sturge-Weber syndrome, according to the December 10 Neurology. Researchers examined data from questionnaires completed by the families of 32 Sturge-Weber patients identified as having had a hemispherectomy between 1979 and 2001. The children averaged approximately 400 seizures per month and had been unsuccessfully treated with an average of four medications before the surgery was performed. More than 80% of the patients were reported to be seizure-free following the hemispherectomy, and more than half had stopped taking anticonvulsants. Interestingly, researchers found “the child’s cognitive skills were not impacted by the child’s age at operation or delay of surgery.”

The persistence of active neurocysticercosis brain lesions is a key predictor of seizure recurrence in patients infected with the tapeworm Taenia solium, according to the December 10 Neurology. Computerized tomography scans were conducted on 36 men and 41 women to identify cysts caused by the infection, and treatment included the use of steroids, antiepileptic drugs, and in some cases antihelminthics to destroy the tapeworm. By the end of the study period, the overall seizure recurrence risk was 40%. Contrary to previous indications, investigators found no significant decrease in risk for seizure recurrence among patients treated with antihelminthic drugs. Because recurrent seizure risk is substantial as long as lesions are present, researchers recommend computerized tomography scanning for treatment decisions and continued use of antiepileptic drugs until lesions are resolved.

Researchers have developed the Parkinson’s disease sleep scale to be used as a screening instrument for evaluating sleep disturbances in patients with Parkinson’s disease. The instrument assesses 15 commonly reported symptoms associated with sleep disturbance, including nocturnal restlessness, nocturia, and daytime dozing; the scores for each item range from 0 (symptom severe) to 10 (symptom-free). Researchers recruited 143 patients with Parkinson’s disease and 137 controls to complete the scale. The scale showed a significant difference between the scores of those with early or moderate Parkinson’s disease, advanced Parkinson’s disease, and the control subjects. Researchers believe that the scale provides good discriminative power in differentiating between the sleep problems of patients with different stages of Parkinson’s disease. The study appeared in the December Journal of Neurology, Neurosurgery and Psychiatry.

Protein C deficiency, raised lipoprotein (a), and stroke of vascular origin are risk factors for recurrent stroke in children, according to the November 16 Lancet. To determine these risk factors, investigators recruited 301 infants and children between the ages of 6 months and 18 years with a first episode of ischemic stroke; the subjects were followed for a median of 44 months. Within a median of five months, 20 of the children had a second stroke. Researchers observed that while increased lipoprotein (a) and stroke of vascular origin were significant risk factors, patients with familial protein C deficiency had the highest frequency of a second stroke.

Hospital and physician characteristics, particularly case volume and surgeon specialty, play a major role in predicting outcomes after carotid endarterectomy, reported an article in the December Archives of Neurology. After studying a large Canadian hospital discharge database, researchers found that hospitals with low volumes of carotid endarterectomy had significantly higher patient mortality and morbidity than hospitals with higher volumes. Researchers also discovered a strong inverse relationship between surgeon case volume and adverse events, with general surgeons having the worst outcome. The investigators suggest that regionalization should be considered for this type of surgery, and surgeons with low case volumes should refrain from performing this procedure.

The Food and Drug Administration has approved Strattera® (atomoxetine) for the treatment of attention-deficit/hyperactivity disorder (ADHD). Unlike other drugs used to treat ADHD, atomoxetine is not a stimulant. Researchers studied the drug’s safety and effectiveness in six double-blind placebo-controlled studies of children, adolescents, and adults. The studies demonstrated that atomoxetine significantly improved patients’ symptoms compared to placebo; the adverse side effects include decreased appetite, upset stomach, nausea or vomiting, and tiredness. The drug will be marketed by Eli Lilly and Company.

Recalling a melody is a function of the rostromedial prefrontal cortex, which also plays a role in the response and control of emotions, reasoning, and memory retrieval, determined researchers in the December 13 Science. Functional magnetic resonance imaging was used to study eight musicians as they listened to original music, allowing researchers to see where in the brain activity occurred in response to specific musical stimuli. The investigators determined that knowledge about the harmonic relationships of music is maintained in the rostromedial prefrontal cortex; this region is connected to, but different from, the temporal lobe, which is involved in more basic sound processing.

A higher intake of dairy products may increase the risk of Parkinson’s disease in men, researchers stated in the December Annals of Neurology. Participants from two large cohort studies were asked how often they had consumed specific amounts of food during the previous 12 months. Researchers identified 210 cases of Parkinson’s disease in men and 184 cases in women. They determined that compared with men who consumed less than one serving per day of dairy products, those with 2.9 or more servings per day had an 80% increased risk. However, the investigators also found that dairy intake was not associated with Parkinson’s disease risk in women, nor were there any associations with Parkinson’s disease risk for any other food groups.

Gabapentin may reduce symptoms among those with restless leg syndrome, according to an article published in the November 26 Neurology. Researchers performed a double-blind study of gabapentin’s effectiveness in 24 patients with restless leg syndrome; none of the patients had been previously treated with either gabapentin or dopaminergic medications. During two six-week intervals, patients received gabapentin or placebo, alternately. The investigators performed physical and neurologic examinations at baseline, at the first visit (neurologic examination only), and at the end of each treatment period. Using sleep studies, a sleep questionnaire, a restless leg syndrome severity scale, and the patients’ own perceptions of symptom change, researchers concluded that treatment with gabapentin reduced symptoms in the study group.

There is no association between serving in the Gulf War and veterans’ neuromuscular symptoms, British researchers concluded in a report in the November 26 Neurology. One hundred ten men from the Royal Navy, Army, and Air Force were selected for the study. The veterans were classified into four groups: 26 asymptomatic Gulf War veterans, 49 symptomatic Gulf War veterans, 13 symptomatic Bosnian veterans, and 22 symptomatic troops who were not deployed to the Gulf region. The investigators conducted clinical assessments and nerve conduction studies, quantitative sensory and autonomic function tests, and electromyography of all subjects and found that there were no significant differences among the groups. Manual testing of muscle power and coordination, assessment of deep tendon reflexes, and sensory evaluation also revealed no differences.

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