Heavy alcohol consumption, defined as 35 or more drinks per week, is associated with a greater risk of atrial fibrillation, particularly among men. Researchers studied the association between alcohol consumption and incident atrial fibrillation in 16,415 men and women. Results indicated that among both men and women, alcohol consumption in the moderate range was not associated with risk of atrial fibrillation. However, consumption of 35 or more drinks per week among men was associated with a greater risk of atrial fibrillation (hazard ratio, 1.45). About 5% of atrial fibrillation cases were attributable to heavy alcohol use. According to the researchers, “this relationship does not appear to be related to the adverse effects of heavy drinking on coronary heart disease or blood pressure.” The study was published in the September 12 Circulation.

Type of seizure can be identified using the results of a serum prolactin assay, according to a review article published in the September 13 Neurology. One class I and seven class II studies showed that elevated serum prolactin were highly predictive of either generalized tonic-clonic or complex partial seizures—prolactin increases in blood after these types of seizures. The blood test could also help distinguish between epileptic and psychogenic seizures. However, the test could not distinguish epileptic seizures from syncope. Researchers explained that the blood test must be used within 10 to 20 minutes after a seizure.

A high level of leisure time physical activity reduces the risk of all types of stroke, according to a report in the September Stroke. Furthermore, daily active commuting—walking or biking for up to 29 minutes per day—also reduces the risk of ischemic stroke. For a mean period of 19 years, researchers followed 47,721 people ages 25 to 64 without a history of coronary heart disease, stroke, or cancer. They found that 2,863 strokes had occurred throughout the study period. Hazard ratios associated with low, moderate, and high levels of leisure time physical activity were 1.00, 0.86, and 0.74 for total stroke; 1.00, 0.87, and 0.46 for subarachnoid hemorrhage; 1.00, 0.77, and 0.63 for intracerebral hemorrhage; and 1.00, 0.87, and 0.80 for ischemic stroke, respectively. In addition, the hazard ratios associated with none, one to 29, and 30 or more minutes of active commuting were 1.00, 0.92, and 0.89 for total stroke and 1.00, 0.93, and 0.86 for ischemic stroke, respectively.

The FDA has approved Ambien CR™ (zolpidem tartrate extended-release tablets) C_IV, for the treatment of insomnia. Ambien CR, a nonnarcotic, nonbenzodiazepine hypnotic of the imidazopyridine class, offers a safety profile similar to that of Ambien, with a new indication for sleep maintenance, in addition to sleep induction. The bilayered tablet delivers the medication in two stages: The first layer dissolves quickly to induce sleep, and the second layer releases medication gradually to help maintain continuous sleep. Marketed by Sanofi-Aventis, Ambien CR will be available in a 12.5-mg dose for adults and a 6.25-mg dose for the elderly. The most common side effects observed in clinical trials include drowsiness, dizziness, and diarrhea.

Stroke severity may be a predictor of poststroke epilepsy, according to a study in the August Epilepsia. Of 484 patients with ischemic strokes, 12 (2.5%) and 15 (3.1%) developed poststroke epilepsy during the first year and seven to eight years after stroke, respectively. The mean age of patients who developed poststroke epilepsy was 74.3, whereas the mean age of those who did not develop poststroke epilepsy was 76.3. According to the researchers, a Scandinavian Stroke Scale score less than 30 on admission was a significant predictor for poststroke epilepsy. They noted that treatment in a stroke unit, age at onset of stroke, and geographical location did not seem to influence the risk of poststroke epilepsy.

In patients with ruptured intracranial aneurysms, endovascular detachable-coil treatment might offer better long-term survival than traditional neurosurgical treatment involving craniotomy and clipping. In the September 3 Lancet, researchers reported one-year results of the International Subarachnoid Aneurysm Trial. One-year follow-up data were available for 1,063 of 1,073 patients randomized to endovascular detachable-coil treatment and 1,055 of 1,070 patients allocated to neurosurgical treatment. According to the researchers, 23.5% of patients who received endovascular detachable-coil treatment had died or were dependent at one year, compared with 30.9% of patients who received neurosurgical treatment. They also found that risk of epilepsy was lower in patients who received endovascular detachable-coil treatment; however, the risk of late rebleeding was higher in this group.

An electrocardiogram-based technique, known as sleep spectrography, can be used to assess the stability and quality of sleep, according to a study in the September 1 Sleep. Using this technique, researchers were able to identify two distinct types of sleep behavior—the first is stable and restful, while the second is unstable and aroused. The technique showed that non-REM sleep in adults demonstrates spontaneous abrupt transitions between high- and low-frequency cardiopulmonary coupling regimes. According to the researchers, conventional approaches to categorize non-REM sleep into grades of depth do not capture this important dimension.

Using a mouse model, researchers have demonstrated that gene therapy is effective in the treatment of congenital muscular dystrophy. They found that somatic gene delivery of a structurally unrelated protein, a miniature version of agrin, functionally compensates for laminin-α2 deficiency in the murine model of congenital muscular dystrophy. Adeno-associated virus-mediated overexpression of miniagrin restored the structural integrity of myofiber basal lamina, inhibited interstitial fibrosis, and ameliorated dystrophic pathology. It also improved whole-body growth and motility and increased the life span of the mice. Results of the study were published in the August 23 Proceedings of the National Academy of Sciences.

Propofol is safe and effective for the treatment of children with refractory status epilepticus, according to a study in the August 23 Neurology. Researchers recommended the use of propofol before that of another drug, thiopental. Results indicated that propofol effectively controlled seizures in 14 out of 22 patients. Two of these patients died; however, their deaths were attributable to severe neurologic damage after bacterial meningitis rather than to treatment with propofol. The team also found that 20 patients were treated with thiopental, including eight who were treated unsuccessfully with propofol. Though 11 of these patients were treated successfully, serious side effects were observed during treatment. Most patients required higher ventilator settings and supplemental oxygen. Two of eight deaths in the thiopental group were attributable to treatment. The researchers noted that average duration of propofol treatment was 2.4 days, whereas the average duration of thiopental treatment was 8.6 days.

Higher insulin secretion may be related to worse cognition, even in people without diabetes, according to a report in the July 25 Archives of Internal Medicine. Investigators measured C peptide levels in blood samples provided by 718 women. An average of 10 years after blood collection, telephone interviews were conducted testing general cognition, verbal memory, category fluency, and attention. A second round of cognitive assessments was conducted two years later. Results indicated that cognitive function was worse among women in the fourth C peptide quartile compared with those in the first quartile. Odds of cognitive impairment were three times higher among women in the fourth quartile compared with women in the first quartile. Also, women in the fourth quartile scored significantly worse on verbal memory than women in the first quartile.

Researchers have identified a set of 12 genes that are expressed at higher levels in people with Huntington’s disease, according to a report in the August 2 Proceedings of the National Academy of Sciences. Furthermore, they found that the expression of these genes increased as the disease progressed from asymptomatic to symptomatic. They noted that patients treated with the histone deacetylase inhibitor sodium phenylbutyrate exhibited reduced expression of these genes. “These biomarkers may be valuable in monitoring patients’ response to experimental treatments,” said the researchers. “Since these changes can be seen at the earliest stages of the disease, they may be particularly helpful in evaluating neuroprotective strategies that could be applied before symptoms develop.”

Observations of more structural brain damage and lower cerebral blood flow in elderly individuals with dementia support the theory that vascular factors contribute to dementia, according to a study in the September Radiology. Using MRI, researchers examined 17 patients 75 or older who had dementia, 16 people of the same ages with optimal cognitive function, and 15 healthy controls. Average total cerebral blood flow in the healthy controls was 742 mL/min, whereas average cerebral blood flow in the two elderly groups was 496 mL/min. In patients with dementia, average cerebral blood flow was 108 mL/min lower than in those of the same age with optimal cognitive function. The researchers said the findings are “highly suggestive that a diminished cerebral blood flow indeed causes brain damage.”

Investigators have determined that cognitive deficits in several domains are characteristic of Alzheimer’s disease several years before clinical diagnosis. A meta-analysis of 47 studies involving 1,207 preclinical Alzheimer’s disease cases and 9,097 controls revealed that people at the preclinical stage showed marked deficits in global cognitive ability, episodic memory, perceptual speed, and executive functioning, and somewhat smaller deficits in verbal ability, visuospatial skill, and attention. No preclinical impairment was observed in primary memory. Results of the study were published in the July Neuropsychology.

Patients with inflammatory bowel disease have a nearly twofold increased risk of multiple sclerosis, according to a report published in the September Gastroenterology. Investigators performed a retrospective cohort study and a retrospective cross-sectional study involving 7,988 patients with Crohn’s disease, 12,185 with ulcerative colitis, and 80,666 controls. Results of both the cohort study and the cross-sectional studies revealed that the incidence of multiple sclerosis, demyelination, and/or optic neuritis was higher in patients with Crohn’s disease and ulcerative colitis compared with controls. “The development of neurologic symptoms in patients with inflammatory bowel disease should prompt their physician to look for evidence of multiple sclerosis and other nervous system disorders,” said the investigators.

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