Major depression and attempted suicide are both independently associated with an increased risk of epilepsy, according to a study in the October 10 online Annals of Neurology. Investigators assessed 324 Icelanders age 10 or older with epilepsy and 647 controls. They found that a history of major depression was 1.7-fold more common among those with epilepsy than among controls. A history of attempted suicide was 5.1-fold more common among people with epilepsy than among controls. In addition, attempted suicide increased the risk of epilepsy even after adjustment for age, gender, cumulative alcohol intake, and major depression or number of depressive symptoms. Major depression and attempted suicide independently increased the risk for unprovoked seizure. The researchers said that the findings suggest “that depression and suicide attempt may be due to different underlying neurochemical pathways, each of which is important in the development of epilepsy.”

Patients with symptoms consistent with spinal stenosis may benefit from having both a needle electromyography (EMG) examination and MRI, according to findings presented at the 52nd Annual Meeting of the American Association of Neuromuscular and Electrodiagnostic Medicine. Thirty-eight people ages 55 to 79 with suspected spinal stenosis underwent both needle EMG and MRI studies. Disagreements between the two tests in 16 to 18 of the 38 subjects suggest that needle EMG is a complementary test for patients with spinal stenosis, providing different diagnostic information to the physician than MRI alone. If a patient’s symptoms “are not classic in nature, or if the findings of either MRI or needle EMG are uncertain, then the physician and the patient may benefit from proceeding with the other test,” said researchers.

Among people age 65 or older, recurrent strokes were nearly twice as frequent as coronary heart disease events during the first year following initial stroke, according to a report in the September 27 Neurology. Investigators assessed 546 people with first ischemic stroke for death, recurrent strokes, and coronary heart disease events during a period of 3.2 years. They found that during the first year of follow-up, rates for recurrent stroke and coronary heart disease events were 105.4/1,000 and 59.3/1,000, respectively. However, after the first year, rates for stroke and coronary heart disease events were not significantly different (52.0/1,000 and 46.5/1,000, respectively), the investigators noted. Cardioembolic strokes had the highest mortality and recurrence rates, while lacunar strokes had the lowest mortality and recurrence rates. According to the researchers, age and male gender predicted death and coronary heart disease, but recurrence did not.

Elevations in blood pressure are associated with poorer cognitive performance, and this correlation appears to be stronger in African-Americans compared with Caucasian-Americans. As detailed in a report in the September-October Psychosomatic Medicine, questionnaires, medical interviews, and physical examinations for 1,563 participants, 147 of whom were African-Americans, were assessed. Significant inverse associations between blood pressure indices and cognitive performance were obtained for both racial cohorts, but the researcher team found that for every incremental increase of 10 mmHg in diastolic blood pressure, the decrease in total cognitive performance for African-Americans was twice that in Caucasian-Americans. For systolic blood pressure, the decrease in cognitive performance of African-Americans was 1.5 times that in Caucasian-Americans. No significant differences were seen between older and younger people.

Exposure to lead in early childhood and adolescence may contribute to hypertension-related cognitive impairment, according to findings presented at the 2005 American Heart Association’s High Blood Pressure Research meeting. Investigators used the Digit Symbol Substitution, a complex test of mental abilities that considers time and accuracy in completing a task, to determine cognitive ability in 4,835 people (average age, 35.8). They found that “there was an inverse relationship between the mental tests and the highly significant and adverse effects on performance of the digit task pulse pressure, blood lead level, and C-reactive protein.” This interaction was significant after other variables were controlled for, they added.

Central and autonomic nervous system symptoms are common in infants exposed to cocaine, according to a report in the September Archives of Pediatrics and Adolescent Medicine. Investigators studied a total of 717 cocaine-exposed infants and 7,442 nonexposed infants. They found that cocaine-exposed infants were about 1.2 weeks younger, weighed approximately 536 g less, measured 2.6 cm shorter, and had head circumference 1.5 cm smaller than nonexposed infants. Central and autonomic nervous system symptoms—including jitteriness/tremors, high-pitched cry, irritability, excessive suck, hyperalertness, and autonomic instability—were more frequent in the exposed group. These symptoms were usually transient and may be a true cocaine effect, the investigators reported. Cocaine-exposed infants also had more infections and experienced increased involvement with child protective services and more out-of-home placement.

Rotigotine is effective for the treatment of early-stage Parkinson’s disease, as well as the adjunctive treatment of advanced-stage Parkinson’s disease, according to findings from two studies presented at the Ninth Congress of the European Federation of Neurological Societies. In the first study, 273 patients with early-stage Parkinson’s disease were randomly assigned to treatment with either rotigotine (2 mg/day increased to 6 mg/day by week 3) or placebo for six months. The patients in the rotigotine group showed an average improvement of 3.8 points on Unified Parkinson’s Disease Rating Scale (UPDRS) scores, whereas those in the placebo group showed an average decline of 1.5 points. In the second study, 341 patients with advanced-stage Parkinson’s disease who were already receiving levodopa therapy were randomly assigned to adjunctive treatment with rotigotine (8 or 12 mg/day) or placebo. Patients assigned to either dose of rotigotine experienced greater reductions in “off” time during a 24-hour period compared with those assigned to placebo.

Treatment with Flurizan^TM (R-flurbiprofen) appears to halt cognitive decline in patients with mild Alzheimer’s disease, according to results of a follow-up study of a phase II trial. The findings were presented at the 12th Congress of the International Psychogeriatric Association. Upon completion of the 12-month phase II trial, participants were given the option to continue in a follow-up study. Those who had received placebo in the phase II trial were randomly assigned to treatment with one of two doses of R-flurbiprofen (400 or 800 mg twice daily). Patients treated with 800 mg of R-flurbiprofen twice daily appeared to stabilize and experienced no further decline in cognitive function from months 12 to 15, as measured by the Alzheimer’s Disease Assessment Scale– Cognitive subscale.

Ortho-McNeil Neurologics, Inc, has launched an educational campaign to alert health care professionals to the potential for medication errors due to confusion between its product, TopamaxM^® (topiramate) tablets, and Toprol-XL^® (metoprolol succinate) extended-release tablets—a β-blocker approved to treat high blood pressure, angina, and heart failure. Patients who receive the incorrect medication risk experiencing potentially serious health consequences associated with either unintended exposure to medication or lack of needed therapy. The campaign includes a letter to health care professionals nationwide, recommendations to drug information database providers to establish computer “pop-up” alerts, pharmacy shelf-talkers, and direct contact with national pharmacy chains as well as national and state pharmacy boards and associations. Additional information can be located on the following Web sites: www.rxforsafety.com, www.topamax .com, and www.topamax-epilepsy.com.

The Epilepsy Foundation has issued recommendations for reducing the risk of seizures triggered by flashing images and patterns on television, video game, computer, and other video screens. Researchers from the Epilepsy Foundation’s Task Force on Photosensitivity said that children and young adults age 7 to 19 are especially susceptible to visually induced seizures; one in 17,500 in this age-group is photosensitive, compared with one in 91,000 in the overall US population. They noted that exposure to flashing light and repetitive patterns does not cause epilepsy but rather reveals the vulnerability of individuals who carry the photosensitive trait. The group also issued recommendations for industry personnel concerning technical characteristics of light and patterns that might pose a risk to people who are photosensitive. Their recommendations were based on guidelines in the United Kingdom and Japan and are detailed in the September Epilepsia.

People with signs of retinopathy are more likely to experience a stroke or stroke-related death, according to a study in the October 11 Neurology. Researchers took retinal photographs of 3,654 people age 49 and older without diabetes and retinal arteriolar signs. During a seven-year period, 859 participants had died, 97 of whom died of cerebrovascular causes. Of those who survived, 24 had incident stroke and 11 had incident transient ischemic attack. “Combined stroke events were more frequent in participants with retinopathy (5.7%), with moderate/severe arteriovenous nicking (4.2%), or with focal arteriolar narrowing (7.2%) compared with those without (1.9%),” said the researchers. They noted that the association between retinopathy and stroke events was strongest in those without severe hypertension or with two or more retinal microvascular signs.

Decreased cAMP-responsive element–binding protein (CREB) function may be associated with anxiety and alcoholism, according to a report in the October 1 Journal of Clinical Investigation. Investigators found that levels of CREB, phosphorylated CREB, and neuropeptide Y were lower in the central amygdala and medial amygdala, but not in the basolateral amygdala, of rats that preferred alcohol compared with those that did not. Rats that preferred alcohol had higher baseline anxiety-like behaviors and consumed greater amounts of alcohol compared with rats that did not prefer alcohol. According to the investigators, ethanol injection reduced anxiety and also increased CREB function in the central amygdala and medial amygdala, but not the basolateral amygdala of rats that preferred alcohol.

Clioquinol may one day become a treatment for Huntington’s disease, suggest results of a study in the August 16 Proceedings of the National Academy of Sciences. Researchers examined the effects of clioquinol on mutant huntingtin in vitro and in vivo. In vitro analyses revealed that “not only did cells look better and survive a bit longer when exposed to the drug, but they also seemed to make less of the toxic protein.” The researchers then found that when mice bred to express the huntingtin protein were given approximately 1 mg/day of clioquinol in water, they had accumulated four times less huntingtin protein in their brains by week 8 than mice given water alone. “Together, the in vitro and in vivo results suggest that clioquinol has an effect of decreasing the symptoms of Huntington’s [disease], its pathology, and perhaps even the actual production of the toxic protein,” said the researchers.

Epigallocatechin-3-gallate (EGCG), an antioxidant found in green tea, may decrease the production of beta-amyloid in the brain, according to results of a study in the September 21 Journal of Neuroscience. In both in vivo and in vitro examinations, EGCG appeared to decrease the production of beta-amyloid—by as much as 54%—by blocking the initial process by which the protein is made. “If beta-amyloid pathology in this Alzheimer’s [disease] mouse model is representative of Alzheimer’s disease pathology in humans, EGCG dietary supplementation may be effective in preventing and treating the disease,” said the research team. They estimated that humans would likely need 1,500 to 1,600 mg/day of EGCG—a dose that has already been studied in healthy humans and found to be safe and well tolerated—to match the injection dose that benefited mice with Alzheimer’s disease.

Quantitative EEG (QEEG) can be used to predict future cognitive decline in healthy elderly individuals with subjective cognitive complaints, according to a report in the October 4 online Neurobiology of Aging. Forty-four people ages 64 to 79 who felt that their memories were faltering underwent a battery of clinical, neurocognitive, and QEEG examinations. Participants were reevaluated during a seven- to nine-year follow-up period. Of the 44 participants, 27 developed mild cognitive impairment or dementia, and 17 remained stable. Researchers found that QEEG was almost 95% accurate in identifying those who would experience cognitive decline and those who would not. QEEG results suggestive of cognitive decline were characterized by increases in theta power, slowing of mean frequency, and changes in covariance among regions, especially in the right hemisphere, they said.

Nerve conduction tests can provide consistent and reliable measures of early diabetic sensorimotor polyneuropathy, according to a study in the September Diabetes Care. Researchers used various techniques to measure nerve changes, including patient exams, reflex and strength tests, and nerve conduction tests. They focused especially on a subgroup of 90 patients who at first evaluation did not have nerve damage and who had been reevaluated at least six times at annual or biannual intervals. Of the five tests used to measure neuropathy, only nerve conduction showed an unequivocal, highly significant, steady worsening over time. “Subtle and latent functional worsening of nerve conduction can be demonstrated even before nerve conduction test criteria for diabetic sensorimotor polyneuropathy have been met,” said researchers.

Researchers have demonstrated that interleukin-6 (IL-6) may be responsible for spinal cord injury found in patients with transverse myelitis, according to details of a report in the October 1 Journal of Clinical Investigation. The investigators analyzed 42 inflammatory proteins in the cerebrospinal fluid both of patients with transverse myelitis and of healthy controls. Results indicated that IL-6 was consistently elevated in the cerebrospinal fluid of patients with transverse myelitis. Rats intrathecally infused with IL-6 developed weakness and spinal cord inflammation, demyelination, and axonal damage. The researchers also found that addition of IL-6 into brain organotypic cultures or the cerebral ventricles of rats did not activate the Janus kinase-signal transducer and activator of transcription (JAK/STAT) pathway, which is involved in cellular injury. They explained that “the spatially distinct responses to IL-6 may underlie regional vulnerability of different parts of the central nervous system to inflammatory injury.”

NR