| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Two placebo-controlled clinical trials of topiramate in patients with epilepsy are reported. Topiramate was shown to be effective for the adjunctive treatment of primary tonic-clonic seizures (Biton et al., p. 1330) and for partial onset seizures (Elterman et al., p. 1338). Labar et al. (p. 1510) treated 24 generalized epilepsy patients with vagus nerve stimulation (VNS), comparing seizure rates during a 1-month baseline with 3 months of VNS. They found that patients with higher baseline seizure rates and later ages at epilepsy onset had the best response to treatment. Krauss et al. (p. 1324), in a retrospective case-control study, determined the influence of clinical risk factors associated with seizure-related motor vehicle accidents. They found that long seizure-free intervals, the presence of reliable auras, fewer prior nonseizure-related accidents, and antiepileptic drug therapy modifications all decreased the odds of having motor vehicle crashes due to seizures. The majority of patients who had accidents were driving illegally. In the related editorial, Berg and Engel (p. 1306) discuss Krauss et al.’s article and issues surrounding driving restrictions for epilepsy patients.
Practice patterns
Holloway et al. (p. 1353) surveyed the practice patterns of US neurologists. They found that neurologists are spending more time in administrative activities, performing or interpreting more procedures, and seeing more patients. They note that neurologists’ involvement with capitation is comparable to a nationally representative sample of physicians, and that neurologists are exploring innovative ways to improve the quality and efficiency of care.
Neuroimmunology
Sellebjerg et al. (p. 1479) conducted a randomized, controlled trial of oral high-dose methylprednisolone in acute optic neuritis. Therapy hastened recovery from optic neuritis as assessed at 1 and 3 weeks but by 8 weeks no benefit was evident. Moreover, subsequent attack frequency was not altered by treatment. Patients with severe disease treated early showed a trend suggesting benefits of oral high-dose methylprednisolone.
Movement disorders
Saunders-Pullman et al. (p. 1417) reviewed a computerized database of patients, including only women who had symptoms of presumed PD for less than 5 years and who had not yet been on levodopa at their first visit. They found a positive association between estrogen use and lower symptom severity in these women, suggesting that estrogen replacement therapy does not worsen and may be beneficial in early PD. Lee et al. (p. 1422) used SPECT to measure striatal dopamine transporter in patients with different types of tremor. The uptake in patients with isolated postural tremor was normal. The uptake in patients with PD was decreased. The uptake in the patients with both postural and resting tremor was intermediate between that of PD patients and controls. Late in their clinical course, patients with postural tremor who develop rest tremor have evidence of mild substantia nigra neuronal loss.
Stroke
Tanne et al. (p. 1368) investigated associations between cerebrovascular risk factors and anticardiolipin (aCL) immunoreactivity. They conclude that the presence of multiple cerebrovascular risk factors is associated with higher rates of positive immunoglobulin G isotype of aCL and with higher immunoreactivity. They caution against overdiagnosis of the antiphospholipid syndrome and consequent changes in management among patients with multiple cerebrovascular risk factors. Bushnell et al. (p. 1374) assessed survival and functional outcome in patients with endotracheal intubation following ischemic stroke (IS) or spontaneous intracerebral hemorrhage (ICH). As in previous studies, intubation was associated with a high mortality rate. Glasgow Coma Score (GCS) and absent pupillary light responses influenced survival in ICH; GCS and age influenced survival in IS.
Amyotrophic lateral sclerosis
Ganzini et al. (p. 1434) interviewed 100 ALS patients and 91 caregivers and measured patients’ pain, quality of life, suffering, hopelessness, depression, social support, perception of burden to others, level of disability, desire for life-sustaining medical treatment, and interest in assisted suicide. Caregivers also rated the patients’ quality of life, pain, and suffering. Many ALS patients suffer and their suffering is correlated to pain and hopelessness. There was no correlation between subjects’ rating of pain, suffering, and quality of life and their interest in life-sustaining treatment or physician-assisted suicide. Physicians caring for ALS patients frequently failed to recognize and treat their patients’ pain and depression.
Headache
Ueberall and Wenzel (p. 1507) report a randomized, placebo-controlled, crossover study in which intranasal sumatriptan was an effective and well-tolerated treatment for migraine in children.
| ||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
