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January 15 Highlights

Buschke et al. (p. 231) describe a test they developed to improve discrimination in screening for AD and dementia. Their Memory Impairment Screen (MIS) was assessed on its reliability, construct validity with respect to a standard memory test, and discriminative validity as a screening test for dementia and AD. In their accompanying editorial, Gifford and Cummings (p. 224) note that the MIS appears reliable and valid but caution that more data on its ease of use in clinical practice and a more in-depth evaluation are needed. Gifford et al. (p. 238) describe the use of tacrine in nursing home residents using data from a clinically based resident assessment instrument used by all US nursing homes. They conclude that a minority of nursing home residents received tacrine, but of those who did, a significant proportion were unlikely to derive benefit because of the low dosages used and the patients’ advanced clinical state. They suggest that data collected and assessed in this fashion may prove useful in monitoring the use of new medications as they become available for dementia. In their accompanying editorial, Phillips and Knopman (p. 227) provide perspective on the use of such a database to contrast efficacy with effectiveness.

Traumatic brain injury

In their prospective study of 69 survivors of traumatic brain injury, Friedman et al. (p. 244) demonstrate a strong association between the apoE 4 allele and poor clinical outcome. The study suggests a genetic susceptibility to the effect of brain injury.

Movement disorders

Kuopio et al. (p. 302) investigated the epidemiology of PD in southwestern Finland in 1992, and drew comparisons between this study and a similar one made 20 years earlier in the same area. They found a significant male and a significant rural predominance not seen in 1971, suggesting a possible environmental causative factor to which men may be more exposed or more susceptible.Lichter et al. (p. 308) used family history methodology, supported by direct examination of affected relatives, to determine the influence of family history on clinical expression of Tourette syndrome (TS). They documented bilineal transmission, unilineal transmission, and sporatic TS, concluding that obsessive-compulsive behavior is less prominent in sporadic than in familial TS, perhaps reflecting a more restricted pathophysiology in the former. They conclude that genetic heterogeneity, epigenetic factors, and gene–environment interactions may play a more important role than genetic dosage effects in determining tic severity in TS.

Stroke

Qureshi et al. (p. 266) used an animal model to test the hypothesis that ischemia is responsible for acute neuronal injury in cases of intracerebral hemorrhage. Despite prominent increases in intracranial and mean arterial pressure following intracerebral hemorrhage, there was no evidence of an ischemic penumbra in the first 5 hours after intracerebral hemorrhage. Zhang et al. (p. 273) examined the efficacy of an antileukocyte adhesion antibody (anti-CD18) as an adjuvant for delayed (2 hour and 4 hour) thrombolytic therapy in middle cerebral artery occlusion in rats. They found that the combination of antileukocyte adhesion antibody and thrombolytic therapy may increase the therapeutic window for the treatment of stroke. Bruno et al. (p. 280) analyzed the relationship between admission blood glucose level (within 24 hours from ischemic stroke onset) and clinical outcome in 1,259 patients involved in a controlled trial of a low molecular weight heparinoid. They conclude that during acute ischemic stroke, hyperglycemia may worsen the clinical outcome in nonlacunar stroke (but not lacunar stroke), and that it is not associated with an increased risk of hemorrhagic transformation of the infarct.

Epilepsy

Mitchell et al. (p. 327) examined the nature and frequency of anterior temporal lobe abnormalities occurring in intractable temporal lobe epilepsy as evidenced by MR scans, clinical history, and histopathology. The frequently seen MR changes were not predictive of pre- or postoperative neuropsychology or seizure outcome following surgery. Thus, these changes are not due to gliosis and reflect an unexplained increase in water content in the temporal lobe. Martin et al. (p. 321) studied the cognitive effects of topiramate, gabapentin, and lamotrigine in healthy young adults. They demonstrated adverse cognitive effects for topiramate but minimal effects for either of the other new antiepileptic agents. Selwa (p. 426) reports a case in which N-acetylcysteine reduced action myoclonus and seizures in a patient with Unverricht-Lundborg disease, confirming a single previous report.

Multiple sclerosis

Corona et al. (p. 425) report severe anaphylaxis with interferon beta in a patient who had been treated with the drug for 6 months. They review other common and uncommon side effects reported with this agent.

This Article Full Text (PDF) Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content