Use of methylenedioxymethamphetamine (MDMA or “ecstasy”) during pregnancy may result in deleterious effects on cognitive function for both the mother and child, according to a study published in the May 1 Journal of Neuroscience. Rats given MDMA at an age analogous to the late human third trimester showed impairments of sequential learning and spatial learning and memory. However, MDMA exposure at an age analogous to the early third trimester had no effect on learning and memory. “The difference between the responses in newborn rats after MDMA administration most likely occurs because of the stage of maturation of the central nervous system at the time of exposure to MDMA,” said researcher Charles V. Vorhees.

The brain continues to develop into the late 40s, according to a magnetic resonance imaging study of 70 adult males that was published in the May Archives of General Psychiatry. Researchers found age-related loss in gray matter volume in both frontal and temporal lobes. However, white matter volume in the frontal and temporal lobes appears to increase until the late 40s and then decline. “Our findings suggest that the timeline for attaining maximal brain development as well as the beginning of degeneration is moved to the late 40s and that, biologically speaking, the societal concept of a stable/unchanging ‘adult’ brain may not be valid,” said lead author George Bartzokis, MD.

Immune cells emigrating into the brain during experimental autoimmune encephalomyelitis may have to cross two distinct barriers, according to a study in the May 28 Journal of Cell Biology. The first, or endothelial, layer contains laminins 8 and 10. The second, or parenchymal, layer contains laminins 1 and 2. Laminin 8, the authors suggest, may play a role in both increasing penetrability as well as signaling the transmigrating T cells.

Almotriptan malate (Axert™) has been approved by the Food and Drug Administration for the treatment of acute migraine with or without aura in adults. Both 12.5- and 6.25-mg doses were superior to placebo in alleviating migraine pain two hours after treatment. The adverse events associated with almotriptan—such as nausea, dry mouth, and paresthesia—were “low and similar to [those associated with] placebo.” Like the other triptans, almotriptan is associated with chest pain and should not be given to patients with documented ischemic or vasospastic coronary artery disease.

A woman’s cardiovascular risk-factor profile prior to menopause may be a more accurate predictor of heart disease than a profile taken shortly after menopause. The researchers, who published their study in the May Stroke, described the substantial changes in cardiovascular risk factors in 372 healthy women during their transition into early menopause. Premenopausal levels of systolic and pulse pressure, low-density lipoprotein and high-density lipoprotein cholesterol, triglycerides, and body mass index all predicted carotid intimal-medial thickness and carotid plaque. However, only pulse pressure in the postmenopausal years was associated with the development of atherosclerosis. The shifting risk-factor profile may be due to increasing age as well as reduced estradiol levels, weight gain, and increased waist circumference that may occur during the perimenopausal period, the researchers said.

White patients are five times more likely than black patients are to receive tissue-type plasminogen activator (t-PA), according to a study of 1,195 ischemic stroke patients admitted to academic medical centers. Among the 49 patients who received t-PA, 1.1% were black and 5.3% were white, the researchers reported in the May Stroke. They noted that 20% of whites and 16% of blacks arrived at the hospital within three hours of stroke onset. Patients with Medicaid or no insurance, they added, were one ninth as likely to receive t-PA as were those with private medical insurance.

Chelation therapy lowers blood lead levels but does not necessarily improve cognition, behavior, or neuropsychologic function, according to a study of 780 children who had been treated for lead exposure. The study, which was published in the May 10 New England Journal of Medicine, described the effects of succimer (dimercaptosuccinic acid) treatment in children with blood lead levels of 20 to 44 mg/dL. During the first six months of the trial, the mean lead level of the children who had received treatment was 4.5 mg/dL lower than the mean level of those who had received placebo. At 36 months, however, the mean IQ score of the children in the treated group was just one point lower than that of the children in the placebo group, and the behavior of the children given succimer was slightly worse, as rated by a parent. Treatment following lead exposure did not undo the damage in these children, the researchers said. More efforts are needed to “protect children from exposure to lead in the first place.”

Exaggerated blood pressure reaction to stress is linked to an increased risk of stroke, according to a prospective study of 2,303 Finnish white men who were enrolled in the Kuopio Ischemic Heart Disease Study. The men who had blood pressure spikes in anticipation of an exercise test carried a risk of stroke that was 72% greater than that of the men with less reactive blood pressures. Each 1-mm Hg increase in systolic pressure corresponded to a 1.5% increased risk of ischemic stroke, the researchers reported in the June Stroke.

Researchers have successfully used a genetically modified poliovirus to target brain tumors in mice, according to a presentation at the 101st General Meeting of the American Society of Microbiology. Mice that harbored large malignant glioma implants completely recovered upon a single-dose treatment with the antitumor virus. This mixed polio/rhinovirus construct targets cells that express CD155, a molecule that is abnormally expressed in brain tumors.

A novel method to deliver site-specific radiation to prevent the regrowth of brain tumors has been approved by the Food and Drug Administration. The device, called GliaSite® Radiation Therapy System, is a balloon catheter that is inserted into the cavity created after surgical removal of the malignant tumor. During a period of three to seven days, the system delivers liquid radiation (lotrex) directly to the tissue where the tumors are most likely to recur. “It’s a significant advancement to be able to offer an improved therapy that delivers radiation directly to the site of the cancer, while maintaining the quality of life for patients by completing the treatment in just one week,” said researcher Stephen B. Tatter, MD, PhD. “The incidence of side effects was low in comparison to other treatment options, such as chemotherapy,” he said.

Mice that have their GABA_B1 subunit “knocked out” quickly develop spasm and convulsive movements that are strikingly similar to those of human grand mal epilepsy, according to a report in the May Molecular and Cellular Neuroscience. This subunit may prove to be a useful target for the treatment of epilepsy or other disorders that are affected by GABA-receptor activity.

The National Cholesterol Education Program issued major new clinical practice guidelines on the prevention and management of high cholesterol in adults. Key changes include the use of a lipoprotein profile as the first test for high cholesterol and a new level at which low HDL becomes a major heart disease risk factor (< 40 mg/dL). A new set of “Therapeutic Lifestyle Changes” was developed, focusing on nutrition, physical activity, and weight control in the treatment of elevated blood pressure. The panel recommended treating even borderline high triglyceride levels as well as the risk factors that make up the “metabolic syndrome.” The guidelines were published in the May 16 JAMA.

The Canadian Computed Tomography (CT) Head Rule can potentially standardize and improve the emergency management of patients with minor head injury, according to a study in the May 5 Lancet. After prospectively examining 3,121 patients with head injury who presented with Glasgow Coma Scale (GCS) scores of 13 to 15, researchers derived a highly sensitive clinical decision rule for the use of CT scanning. Patients who have a high-risk factor—such as failure to reach a GCS score of 15 within two hours, suspected open skull fracture, vomiting more than once, or age older than 64 years—should undergo neurologic intervention and scanning. Patients who have a medium-risk factor—such as amnesia before impact or a head injury due to a motor vehicle accident—could have clinically important lesions that would be seen on a CT scan but are not at risk for neurologic intervention. The researchers plan to prospectively test and validate the rule with hopes of reducing the number of undiagnosed intracranial hematomas as well as the number of patients who undergo unnecessary scans.

NR