The number of stroke survivors taking antidepressants may be low despite a high rate of depression, as reported October 2 in the online Stroke. The researchers assessed depression prevalence in 441 patients at five years poststroke; 49% of the participants were female, and the mean patient age was 74. Results from the Irritability, Depression and Anxiety Scale showed that 17% of participants had depression. Of this subgroup, 22% were taking antidepressant medication; of these patients, 72% were not currently depressed, a possible indication of effective treatment. "Although nearly one fifth of survivors were depressed, few were taking antidepressants," the researchers stated. "Further exploration of this low level of treatment is warranted."

There may be a correlation between dementia of the Alzheimer type and weight loss, according to a report in the September Archives of Neurology. A total of 449 adults ages 65 to 95 without dementia were followed up for an average of six years; at study end, 324 were dementia-free and had lost approximately 0.6 lb per year, while the remaining 125 had developed dementia of the Alzheimer type but had lost 1.2 lb per year at about one year before Alzheimer detection. As a group, before developing dementia these participants weighed approximately 8 lb less than those who did not develop dementia. The researchers noted that their findings suggest that factors contributing to weight loss "operate before the development of dementia of the Alzheimer type. Hence, weight loss may be a preclinical indicator of Alzheimer’s disease."

Joint hypermobility of the cervical spine may predispose patients to new daily persistent headache, according to a study in the October Cephalalgia. The investigators assessed data from 10 women and two men who presented with primary new daily persistent headache, were evaluated by one of two physical therapists, and were screened with the Beighton score. "Each patient was tested for active cervical range of motion and for the presence of excessive intersegmental vertebral motion in the cervical spine," noted the investigators. Results showed that 11 of the patients had cervical spine joint hypermobility, while 10 had evidence of widespread joint hypermobility with the Beighton score.

Researchers reported in the September 26 Neurology that ischemic stroke patients eligible for acute reperfusion therapy but excluded due to rapidly improving or mild symptoms may still display early neurologic deterioration. From a group of 74 patients undergoing multimodal MRI within six hours of stroke onset, 40 had rapidly improving or mild symptoms, and 39 of these patients did not receive acute reperfusion therapy. Four of the 39 patients showed early neurologic deterioration with infarct expansion within 48 hours, eight were discharged with poor outcome (modified Rankin Scale score of 3 or greater), and eight had large-vessel occlusions on magnetic resonance angiography. "Persisting large-vessel occlusion substantially increases the risk of early worsening and poor functional outcome," concluded the researchers.

Even after brief convulsive seizures, prolonged EEG monitoring in pediatric patients may be warranted to exclude nonconvulsive status epilepticus, according to a study in the September Epilepsia. Nineteen patients with nonconvulsive status epilepticus, ages 1 month to 17 years, were studied; five developed the disorder after convulsive status epilepticus, and another 12 developed the disorder following brief convulsions. Two patients in a comatose state experienced nonconvulsive status epilepticus as the first manifestation following hypoxic events. The most frequent etiology of nonconvulsive status epilepticus was acute hypoxic-ischemic injury, which occurred in five patients; neurometabolic disease occurred in four patients, while acute infection occurred in three. With respect to EEG monitoring, the investigators noted, "Prompt recognition and treatment may be necessary to improve neurological outcome."

Botulinum toxin type A may offer safe improvement in the treatment of upper limb spasticity of poststroke patients, as reported at the 2006 Joint Annual Meeting of the American Congress of Rehabilitation Medicine and American Society of Neurorehabilitation. A total of 279 patients with wrist, hand, or elbow spasticity at least six months poststroke received botulinum toxin injections. On a four-point scale that ranged from "no disability" to "severe disability," about half of patients achieved a one-point or greater improvement in the area that was most important to them. Adverse events related to treatment were reported in about 7% of patients, although there were no reports of serious treatment-related adverse events. "The low incidence of adverse events ... in this year long study suggests that botulinum toxin type A may represent a clear advantage over many oral antispasticity medications," the researchers concluded.

Researchers reported in the October 6 issue of Science that they have discovered the major disease protein common to frontotemporal lobar degeneration and amyotrophic lateral sclerosis. The investigators found the protein, TDP-43, by examining postmortem mouse brain tissue samples that had been injected with tissue containing TDP-43, against which antibodies were used. All 72 studied cases of frontotemporal lobar degeneration and amyotrophic lateral sclerosis contained the misfolded protein. "TDP-43 represents the common pathologic substrate linking these neurodegenerative disorders," the investigators concluded. The researchers also noted that this discovery should drive further efforts to uncover more effective treatments for frontotemporal lobar degeneration as well as amyotrophic lateral sclerosis.

NR