Stroke outcomes are influenced by the type of stroke and initial blood pressure, according to research in the January 27 Archives of Internal Medicine. Researchers examined the medical records of 92 consecutive patients with acute ischemic stroke and recorded their blood pressure for seven days. They also noted the region of the brain damaged by the stroke and the pathogenesis of the stroke. The investigators determined that lacunar stroke and the highest blood pressure upon admission to the hospital carried the best prognosis. Researchers found no evidence that hypertension is harmful to the stroke patients and that its lowering is beneficial.

Intrathecal IgM synthesis predicts a worse evolution in the first stages of multiple sclerosis, reported a study in the February Annals of Neurology. Researchers performed oligoclonal band analysis in 29 patients with relapsing-remitting multiple sclerosis who were followed up for a period of time that spanned five to 16 years. The investigators determined that 70.8% of patients with intrathecal IgM progressed to secondary-progressive multiple sclerosis, while none of the patients lacking intrathecal IgM did. At the end of the study, patients with intrathecal IgM had a mean Expanded Disability Status Scale score of 4.64; the mean score for those without intrathecal IgM was 1.31.

The US Food and Drug Administration (FDA) has granted marketing clearance for Lamictal® (lamotrigine) tablets as add-on therapy in partial seizures in children ages two years and older, expanding its indications for adjunctive use in adults with partial seizures and for the generalized seizures of Lennox-Gastaut Syndrome. Approval of Lamictal was based on a clinical study that showed significant reductions in the frequency of all partial seizures in children and adolescents when it was added to their drug regimen. Lamictal is being marketed by GlaxoSmithKline.

The inability to quickly bring down high levels of blood sugar is associated with poor memory, according to an article in the February 18 Proceedings of the National Academy of Sciences. Researchers measured how well blood glucose was regulated and performed magnetic resonance imaging scans to measure the size of the hippocampus in 30 healthy middle-age and elderly men and women, who were also given a series of tests to assess memory and overall cognition. The investigators found that those with impaired glucose tolerance had a smaller hippocampus and scored worse on tests for recent memory. However, the study also raises the possibility that exercise and weight loss may be able to reverse some of the memory loss that accompanies aging.

Three key areas of the brain adversely affected by aging show the greatest benefit when a person stays physically fit, stated research in the February Journal of Gerontology: Medical Sciences. Investigators used high-resolution magnetic resonance imaging to observe tissue atrophy in the frontal, temporal, and parietal cortexes in adults ages 55 to 79 whose fitness ranged from sedentary to competitive-ready athletes. Fitness was measured by the results of one-mile walking and treadmill stress tests. The researchers determined that “fitness as it interacts with age” is beneficial, and that fitness slows the decline in brain density in white and gray matter that older adults exhibit.

A common genetic variant influences individual responses and adaptation to pain and other stressful stimuli and may underlie vulnerability to many psychiatric and other complex diseases, according to research in the February 21 Science. Investigators used positron emission tomography to examine the effects of the cathechol-O-methyltransferase (COMT) gene variant val158met on neurochemical brain responses to sustained pain. Fifteen men and 14 women genotyped with respect to the val158met polymorphism were randomized and blinded during an infusion of painful and nonpainful saline solutions. The researchers found that compared with heterozygotes, individuals who were homozygous for the allele and had the lowest COMT enzyme activity showed diminished m-opioid system responses, higher sensory and affective ratings of pain, and a more negative internal state.

A small amount of multidisciplinary rehabilitation may improve the mobility of patients with Parkinson’s disease, but significant decline still appears after six months, according to a study in the February Journal of Neurology, Neurosurgery and Psychiatry. Researchers employed a randomized, single blind controlled crossover design comparing patients and caregivers who had received rehabilitation for four months with those who had not. Treated patients attended group educational activities and individual rehabilitation once a week for six weeks, and all patients were assessed with a battery of tests upon entry and at six months. The researchers found that those who had attended rehabilitation had better stand-walk-sit scores but had worse general and mental health; those who cared for the treated patients showed greater strain.

Multifactorial intervention, including physiotherapy, occupational therapy, and medical and cardiovascular assessment, is not effective in preventing falls in older people with cognitive impairment and dementia, according to the January 11 BMJ. Researchers recruited older patients with cognitive impairment and dementia admitted to an emergency department following a fall. Patients were randomized either to an intervention group, who received intervention for identified risk factors for falls, or a control group, who received conventional care from health professionals. The investigators found that approximately 10% fewer patients fell in the intervention group than in the control group during the one-year follow up. They found no significant differences between the groups for any study outcomes.

Interferons may have no proven effect on relapsing-remitting multiple sclerosis beyond one year of treatment, according to research published in the February 15 Lancet. After reviewing seven trials published between 1993 and 2002, researchers determined that interferon seemed to reduce the number of patients who had exacerbations during the first year of treatment by about one quarter. However, results at two years’ follow-up were not clear.

Transcranial ultrasound may aid in the differential diagnosis of idiopathic Parkinson’s disease and atypical parkinsonian syndromes, according to a study published in the January 14 Neurology. Using the transcranial ultrasound, researchers examined 25 patients with atypical parkinsonian syndromes (nine with progressive supranuclear palsy and 16 with multiple-system atrophy) and 25 patients with Parkinson’s disease. They found that the substantia nigra in the Parkinson’s patients was more likely to be hyperechoic. The investigators also found that the positive predictive value for Parkinson’s disease was 100% when the substantia nigra was markedly hyperechoic. The differential diagnosis of Parkinson’s disease and atypical parkinsonian syndromes at early stages, when the diseases are difficult to distinguish clinically, may help improve both therapy management and prognosis.

Clopidogrel, when used with aspirin, reduced the risk of subsequent heart attack, stroke, and death in patients entering the emergency department with new or increasing chest pain or heart attack, stated a report in the February 17 rapid access issue of Circulation. Researchers also found that the drug’s benefits for patients with acute coronary syndromes emerged within hours of administration and continued for up to a year when patients took it daily after hospital discharge. Additionally, the investigators noted that within the first 30 days, clopidogrel users had a 21% reduction in major events; after 30 days, patients taking the blood thinner saw an 18% reduction in events.

A new statistical method has allowed researchers to harvest an elusive autism gene, reported a study in the March American Journal of Human Genetics. The gene, which encodes part of the neurotransmitter receptor gamma-Aminobutyric Acid Receptor beta3-subunit (GABRB3), had been implicated in autism, but never positively linked to the disorder. Investigators reorganized data collected from families in which more than one child is affected by autism and grouped together all the families that reported their autistic child had the character trait insistence on sameness, or IS. The researchers applied the statistical method called ordered subset analysis to the families whose children scored high in the IS category. They discovered a strong link to the GABRB3 gene on chromosome 15q, where no such link had appeared before.

According to a report in the March Journal of Neurology, Neurosurgery and Psychiatry, [123I]ß-CIT single photon emission computed tomography (SPECT) appears to be a useful marker of Parkinson’s disease progression. Investigators obtained two SPECT imaging series, taken 12 months apart, for 50 patients with early stage Parkinson’s disease. They used the mean annual change in the ratio of specific to nonspecific [123I]ß-CIT binding to the striatum, putamen, and caudate nucleus as the outcome measure. The investigators observed a decrease in binding ratios between the two images in all regions of interest, also noting that short-term treatment with a D2 agonist does not have a significant effect on the binding ratios.

The FDA has approved Relpax® (eletriptan hydrobromide) for the treatment of migraine. In clinical trials involving more than 9,000 patients and more than 70,000 migraine attacks, Relpax was shown to relieve migraine pain and associated symptoms. The most common side effects reported in clinical trials included fatigue, somnolence, nausea, and dizziness; it should not be used by patients with hepatic impairment, or those older than 65 or younger than 18. Relpax is being marketed by Pfizer Inc.

Levodopa can elevate body levels of homocysteine, and may thereby be associated with an increased risk of heart disease and stroke, according to a study reported in the January Archives of Neurology. Researchers measured homocysteine levels in blood samples of 235 patients with Parkinson’s disease, 201 of which had been treated with levodopa. They found that participants who had been treated with levodopa showed significantly higher levels of homocysteine than patients who were not taking the drug. Patients with the highest levels of homocysteine had an increased prevalence of coronary artery disease, the researchers reported—however, because of the retrospective nature of their study, they could not determine conclusively if levodopa therapy was responsible for the increased prevalence of vascular disease.

Researchers have discovered a key cellular mechanism in the brain possibly involved in mental retardation. The study, published in the February 18 Proceedings of the National Academy of Sciences, examined mice lacking the WAVE-1 protein; the animals were found to have balance, motor, learning, and memory deficits. The researchers believe the absence of the protein causes a partial breakdown of the brain cell communication system, resulting in reduced learning abilities and other effects associated with mental retardation. After observing that the WAVE-1 protein is present throughout the brain, the investigators concluded that mental retardation involves many more areas of the brain than first expected.

NR