All adults should get a blood pressure test from a physician to better ascertain and, if necessary, lower the risk of stroke and other cardiovascular disease, according to a recommendation by the US Preventive Services Task Force. There is “good evidence that blood pressure measurement can identify adults at risk for cardiovascular disease due to high blood pressure, and good evidence that treatment of high blood pressure substantially decreases the incidence of cardiovascular disease,” the authors noted. However, the task force did not say with what frequency adults should be screened for high blood pressure, or whether it would be more effective to screen only adults with preexisting cardiovascular risk factors besides high blood pressure. They did conclude that there is insufficient evidence to recommend high blood pressure screening for children and adolescents. The task force’s recommendations were published in the August American Journal of Preventive Medicine.

Drivers with type 1 diabetes mellitus reported higher numbers of driving mishaps, according to findings from a study led by researchers at the University of Virginia Health System. In these diabetic patients, hypoglycemia induces impaired brain and nervous system functioning, as well as confusion, blurred vision, mood changes, weakness, and poor coordination, the researchers reported in the August Diabetes Care. The study examined patients at diabetes specialty clinics at five US and four European cities. Adults with type 1 or type 2 diabetes and nondiabetic adults completed an anonymous questionnaire about their driving record. The researchers found that drivers with type 1 diabetes reported significantly more crashes, moving violations, and hypoglycemic episodes than drivers with type 2 diabetes, regardless of whether they used insulin.

The presence of a particular protein can predict whether pilocytic astrocytoma—the most common form of pediatric brain tumor—will continue to grow or recur following surgery. Researchers at the University of Texas Southwestern Medical Center reported that the presence of large amounts of Ki-67 antigen in cancer cells increases the likelihood of tumor progression, suggesting that certain tumors are biologically predisposed to progress or reoccur. On cell samples from 118 patients stained with MIB-1 antibody, the researchers found that a 2% positive MIB-1 index was associated with an increased risk of cancer recurrence or growth. The test, although time consuming, is now available and could prove an important prognostic tool for physicians treating patients with a history of pilocytic astrocytomas, they suggested in the August Journal of Clinical Oncology.

Children with music training had significantly better verbal memory than their counterparts without such training, according to a study published in the July Neuropsychology. Psychologists at the Chinese University of Hong Kong studied 90 boys between ages 6 and 15. Half had musical training in the school’s string orchestra program, plus lessons in playing classical music on Western instruments, for one to five years. The other 45 participants had no musical training. Researchers found that students with musical training recalled significantly more words than did untrained students, learned more words, and retained more words after 30-minute delays. Verbal learning rose in proportion to the duration of musical training, leading the researchers to suggest that more training might result in even greater increases in verbal memory. At one-year follow-up, 33 boys were still in the music program. The nine dropouts showed no further improvement in verbal memory, but they also showed no decline in the advantage they had gained prior to stopping musical training.

Drugs that block acetylcholine production may contribute to Alzheimer’s disease. Researchers examined the brains of people who had died with Parkinson’s disease and found that patients who had taken acetylcholine-blocking muscarinic antagonists for more than two years had twice as many of the plaques and neurofibrillary tangles common to Alzheimer’s disease as did patients who took the drugs for less than two years or not at all. “These findings suggest that chronic use of muscarinic antagonist drugs in the elderly should be avoided,” the researchers stated in the August Annals of Neurology. They acknowledged, however, that physicians have recently curtailed their prescribing of muscarinic antagonists in recognition of significant adverse effects such as delirium. The study raises questions about a wide range of drugs—some antidepressants, antihypertensives, antipsychotics, and antihistamines also block acteylcholine, and older patients may be taking several of these drugs simultaneously, the authors noted.

The injection of the gene for insulin-like growth factor-1 (IGF-1) into muscles protected nerve cells, extended survival, and improved strength in mice with the equivalent of amyotrophic lateral sclerosis (ALS), according to investigators at the Salk Institute in La Jolla, California. By using an adeno-associated virus as a vector for gene delivery, the researchers were able to exploit the virus’s ability to migrate from muscle into the nerves that control them. The results were published in the August 8 Science. Researchers reported that the transfer of IGF-1 to ALS-ravaged neurons delayed disease onset by 31 days and expanded the life span of the mice to a maximum of 265 days, compared to 140 days in untreated mice. IGF-1 also extended lifespan by 22 days when administered after symptoms appeared, indicating the method’s potential as a treatment in different disease stages, the researchers said. Additionally, IGF-1 therapy resulted in longer maintenance of physical movement and provided 20% more muscle mass.

The FDA has granted marketing clearance for Trileptal® (oxcarbazepine) tablets and oral suspension for use as monotherapy in children ages 4 and older with partial seizures. The indication is based on data from four multicenter, randomized, double-blind, controlled trials. The safety profile in children was established from data in more than 1,000 children from 20 studies. The most common adverse effects were dizziness, sleepiness, double vision, fatigue, nausea, vomiting, incoordination, abnormal vision, abdominal pain, tremor, indigestion, and abnormal gait—these were typically mild to moderate in severity. There was no association with cosmetic adverse effects or weight gain. In addition, no hepatic, hematologic, or drug-level monitoring is required.

The majority of epilepsy patients who are seizure-free for the first year after surgery will have a favorable long-term outcome, according to a study published in the August 26 Neurology. The study examined 175 patients with intractable epilepsy who had surgery to remove an epileptigenic region of the brain and who were seizure-free for the first year following surgery. Researchers followed up with the patients for an average of more than eight years, and found that 63% remained seizure-free. Among the 65 patients who did relapse, 51% had one or fewer seizures per year. The remaining patients had more than one seizure per year, and 10 of these patients—who relapsed within four years of surgery—had more than one seizure per month. “Little is known about seizure recurrence in patients five, 10, or 20 years after surgery, and one year isn’t enough to follow up a patient who has had surgery,” said Susan S. Spencer, MD, of Yale University School of Medicine in New Haven, Connecticut. “The number of patients who didn’t relapse in this study was larger than we thought it would be.”

The degree of voluntary movement impairment is the best gauge of the progression of Huntington’s disease, according to a study published in the August Annals of Neurology. Other assessments, such as loss of cognitive abilities, were also useful predictors, but the amount of movement lost leading up to death correlated most closely with neurologic damage observed at autopsy. “Imaging tests like MRI are expensive and time-consuming and provide limited information. That makes this relatively simple test of movement a valuable way to measure how rapidly a patient’s disease is progressing, or whether an experimental intervention seems to be altering the expected progression,” said Adam Rosenblatt, MD, of Johns Hopkins University School of Medicine in Baltimore. Dr. Rosenblatt and colleagues correlated autopsy findings with clinical data that had been collected while the subjects were alive, including degree of chorea, movement impairment, and cognitive decline, as well as demographic variables. Among the 100 subjects included in the study, the researchers found that all but one of the various clinical measures—severity of chorea—correlated significantly with the amount of brain damage seen at autopsy. The strongest predictor of degree of brain damage was the loss of voluntary movement. Among demographic variables, the strongest predictor of brain damage was the age at which symptoms of the disease first appeared.

NR

Return to table of contents