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Federico et al. (p. 1256) studied the effects of IVIg in 16 patients with MMN in a placebo-controlled, crossover trial. They found IVIg of significant benefit: major subjective improvement was noted in 9/16, moderate/ slight improvement in 2/16, and no improvement in 5/16. Objective improvement was also documented.
In an accompanying editorial, van Doorn and van der Meché (p. 1246) note that this well-executed treatment trial provides data only about short-term benefit. Because maintaining improvement requires continuing treatment, the high cost of IVIg makes it important to find treatments that reduce the need for IVIg.
Increasing mortality from ALS
Seljeseth et al. (p. 1262) used 1961 to 1994 death certificate data to compare changes in ALS incidence with that of PD and MG throughout the 33-year period. ALS and PD mortality have nearly doubled in 30 years. The ALS mortality increase was in the age >65 population.
Placebo-controlled trial of treatment of agitation in AD
Teri et al., for the AD Cooperative Study (p. 1271), compared haloperidol, trazodone, and behavior management for agitation in a 16-week trial that included community-based patients. The active treatments did not differ from placebo: about a third improved with each treatment. Drug-treated patients had significant side effects.
The accompanying editorial by Herrmann and Black (p. 1247) notes the excellent statistical methods and design of the study but points out that the medication doses used and the relatively less severe dementia may have made it difficult to detect significant effects of drugs.
Predictors of interictal psychosis in epilepsy
Adachi et al. (p. 1310) compared 246 patients with epilepsy who had interictal psychosis with 658 control epilepsy patients without psychosis. Predictors of psychosis included family history of psychosis, complex partial seizures, generalized tonic/clonic seizures, and decreased intellect.
Seizures in subarachnoid hemorrhage (SAH)
Butzkueven et al. (p. 1315) analyzed 412 patients with SAH. Onset seizures occurred in 32 patients and predicted both a poor outcome and late seizures.
Syndrome of CSF hypovolemia
Chung et al. (p. 1321) reviewed 30 consecutive patients with CSF hypovolemia. Findings included the following: 83% of patients had gadolinium enhancement of pachymeninges; 48% had descent of the brain; and 52% demonstrated the site of leakage (usually lumbar) by radioisotope cisternography, with 91% showing reduced convexity isotope. Epidural blood patches were associated with resolution of headache in 70% of patients.
HMO versus IPA versus fee-for-service (FFS) for management of MS
Vickrey et al. (p. 1341) compared the care of MS patients in three systems: an HMO, an independent practice association (IPA), and FFS. There were no significant differences in the treatment of MS with disease-modifying agents or in the treatment of MS complications. FFS and IPA patients received more attention to their general health. Perceived unmet information needs were noted in all three systems.
Smoking, alcohol, and coffee, and gender: effects on risk of PD
Benedetti et al. (p. 1350) compared 196 subjects who developed PD in Olmsted County from 1976 to 1995 with age–sex-matched controls. Coffee drinking reduced the risk of PD independent of smoking. Cigarette smoking also reduced the risk of PD. Alcohol consumption did not alter the risk of PD.
Baldereschi et al. (p. 1358) followed an Italian population of 4341 subjects for 3 years for various parkinsonian symptoms. Parkinsonism and PD were more common in men than women. Men were at twice the risk for PD.
Tau and progressive supranuclear palsy (PSP)
Higgins et al. (p. 1364) studied 52 patients with PSP versus normal controls to confirm their earlier observation of a chromosome 17q haplotype that included four single nucleotide polymorphisms that segregated with sporadic cases of PSP. All but one of the 52 PSP cases had the distinctive tau haplotype. Although this haplotype is very frequent, the fact that 98% of PSP cases share the same genotype strongly suggests a susceptibility locus.
REM sleep behavior disorder (RBD)
Albin et al. (p. 1410) used PET to confirm reported abnormalities of dopaminergic terminal density in the striatum of patients with RBD. RBD is a disorder that can herald PD and other degenerative disorders. These PET abnormalities may account for the failure of muscle atonia to develop during REM sleep.
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