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Three articles in this issue deal with the neurobiology of autism, placed into context by an editorial in which Rapin (p. 902) provides an overview of the progress to date and probable future directions of research. DeLong (p. 911) puts forth his hypothesis that there are two distinct forms of autism: one characterized by brain damage in early life (involving both temporal lobes) and a more common idiopathic form involving serotonergic dysfunction. In their study comparing brain weights of autistic and normal individuals, Courchesne et al. (p. 1057) determined that normal brain weight is present in the majority of postmortem cases of autism. Minshew et al. (p. 917) investigated the functional integrity of cerebellar and frontal systems in autistic subjects and normal controls using oculomotor paradigms, and found that neocortical but not cerebellar dysfunction was present in autism.
Pain
Baron et al. (p. 923) studied the effect of cutaneous sympathetic activity on pain induced by primary afferent C-nociceptor sensitization with capsaicin in normal volunteers. The study induced whole-body cooling and warming with a thermal suit, eliminating the potential confounds of pharmacologic techniques used to alter sympathetic tone in prior studies. They concluded that sympathetic vasoconstrictor activity does not influence pain elicited with capsaicin in this experimental setting. In the accompanying editorial, Max and Gilron (p. 905) review the evidence for and against sympathetically maintained pain and discuss this in light of current therapeutic approaches to the management of chronic pain.
Restless legs syndrome
This issue contains five articles about restless legs syndrome (RLS); another six articles have been published in the last 6 months. In their editorial, Chokroverty and Jankovic (p. 907) focus on research aimed at understanding the neurobiological underpinnings of RLS and provide suggestions for areas of future research. Turjanski et al. (p. 932) used PET to study striatal dopaminergic function in RLS; their results support the hypothesis of central dopaminergic dysfunction. Tergau et al. (p. 1060) assessed motor system excitability in patients with RLS using transcranial magnetic stimulation; their results support a subcortical origin of RLS. Two placebo-controlled clinical trials of dopamine agonists are reported. Wetter et al. (p. 944) found pergolide to be effective and Montplaisir et al. (p. 938) found pramipexole to be effective in treatment of RLS.
Behavioral neurology
Ferman et al. (p. 951) compared cognitive performance of patients with degenerative dementia and REM behavior disorder (RBD) and patients with AD. Based on the significantly different pattern of cognitive performance and clinical data, the authors suggest that the dementia associated with RBD may represent dementia with Lewy bodies. Waring et al. (p. 965) studied the association between estrogen replacement and AD using a case-control design. The results suggest that estrogen replacement therapy is associated with a reduced risk of AD in postmenopausal women. Ray et al. (p. 1044) evaluated the physiology of perception via cortical stimulation and recording in epilepsy patients who had grids over their somatosensory or occipital cortex. In agreement with a previous report, early components of primary evoked response were not correlated with conscious sensory awareness. Pujol et al. (p. 1038) assessed cerebral lateralization of language in normal left-handed people using functional MRI. The authors compare their findings with this technique to previously reported results based on Wada testing. Findings indicated that silent word generation lateralizes to left cerebral hemisphere in both handedness groups, but right hemisphere participation is frequent in normal left-handed subjects. Exclusive right hemisphere activation rarely occurred in the frontal lobe region studied.
Neuromuscular disorders
Chou et al. (p. 1015) studied the calpain III gene in 107 muscular dystrophy patient muscle biopsies showing normal dystrophin. They identified nine patients with calpain III mutations, suggesting that about 9% of patients with a limb-girdle phenotype have this calpainopathy.
Stroke
Roob et al. (p. 991) found evidence of past cerebral microbleeds on MRI in neurologically normal elderly individuals. They note that this finding is related, but not restricted, to the presence of other indicators for small vessel disease. In their Brief Communication, Katzan et al. (p. 1081) report their successful experience with intra-arterial thrombolysis in six patients with acute ischemic stroke after recent open-heart surgery.
Epilepsy
Lansberg et al. (p. 1021) report neuroimaging findings in patients with complex partial status epilepticus, noting that MRI and CT findings resemble those of ischemic stroke but can be differentiated based on lesion location and findings on MRA and postcontrast MRI.
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