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Krauss et al. surveyed laws, regulations, and practices restricting driving in 50 states and the District of Columbia. They found wide variations among states: seizure-free restrictions from 3 to 12 months vs medical panel determination or other individualized approaches. They also note that states do not effectively monitor whether patients have seizure-related crashes.
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see page 1780
The accompanying editorial by UK epileptologist Chadwick notes the equally
wide variation in international driving restrictions, and points out that licensing
authorities are in the best position to collect the data needed to produce reliable
information on accident risks for drivers with epilepsy.
see page 1749
Optical filters protect photosensitive individuals from seizures
Takahashi et al. found that special optical filters can inhibit photoparoxysmal responses to intermittent photic stimulation and photic stimulation with cathode ray tubes (CRT) such as television. These filters may be useful to prevent seizures induced by television in photosensitive persons with and without epilepsy.
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see page 1767
The accompanying editorial by Erba notes that most epilepsies can be triggered by reflex stimuli. He proposes that it is the responsibility of manufacturers of devices with CRT to provide adequate filters to prevent reflex epilepsy.
see page 1747
Genetic contribution to hippocampal sclerosis (HS)
HS is often associated with acquired injury to the brain. Briellmann et al. found evidence for a significant genetic component; family history of seizures was more frequent in patients with HS, compared with controls. Seizure types in relatives were heterogeneous, so different epilepsy genes may contribute to a susceptibility to HS.
see page 1800
Ischemic stroke and active migraine
Milhaud et al. found that among 3,502 patients with acute ischemic stroke, 15.8% younger than 45 years and 2.1% 45 years or older were migraineurs. The proportion of women was significantly higher in both groups of migraine patients (74% and 63%) than in controls. In young migraineurs, posterior circulation involvement and presence of patent foramen ovale were characteristic. In the older group, surprisingly, absence of vascular risk factors was characteristic.
see page 1805
Effects of deep brain stimulation (DBS) on the response to L-dopa in PD
Nutt et al. show that DBS of globus pallidus interna and subthalamic nucleus ameliorates motor fluctuations by improving the off-drug motor function and not by increasing the peak response or duration of response to L-dopa.
see page 1835
Episodic ataxia 2 (EA2) manifesting as congenital myasthenic syndrome
In three patients with EA2 and fluctuating weakness, Jen et al. identified nonsense and missense mutations in a calcium-channel gene CACNA1A, causing channel dysfunction with increased jitter and blocking on single-fiber EMG. This is the first report of impaired neuromuscular transmission in patients with EA2.
see page 1843
Measuring the effects of surgery on tremor in MS
Matsumoto et al. studied the effect of surgery on severe tremor of MS with a range of outcomes measures, including movement analysis. Improvement in tremor could be quantified, but disability scales were insensitive to the functional improvements that may follow surgery. Movement analysis may predict surgical response.
see page 1876
Can anti–tumor necrosis factor (TNF) therapy trigger MS?
Sicotte and Voskulh report a case of new-onset MS associated with anti-TNF treatment for rheumatoid arthritis. Worsening MS and isolated episodes of demyelination have previously been reported with these agents.
see page 1885
Catastrophic reaction in acute stroke
The catastrophic reaction is a highly emotional avoidance behavior in patients faced with an unsolvable task. Carota et al. describe such patients with nonfluent aphasia and consider the role of left operculum–insular–limbic connections in the catastrophic reaction.
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see page 1902
Transcallosal bands: A sign of neuronal tract degeneration in early MS?
Simon et al. describe T2-hyperintense bands that originate from acute focal MS-like lesions and extend across the corpus callosum. These transcallosal bands may result from neuronal tract degeneration even in early MS.
see page 1888
Episodic weakness in CMT: C164T mutation of connexin 32 (Cx32)
Panas et al. describe episodes of generalized weakness in two sibs with CMT disease and findings of CNS involvement. The disorder was caused by a C164T mutation of the Cx32 gene, suggesting that this one mutation can result in a combination of different phenotypes.
see page 1906
Efficacy of epidural blood patch in spontaneous CSF leaks
Sencakova et al. studied 25 consecutive patients with spontaneous CSF leaks treated with epidural blood patch (EBP). In symptomatic spontaneous CSF leaks, the likelihood of durable positive response for the first, second, and perhaps the third EBP, was approximately one-third for each. Targeted EBP at the level of the leak appeared more effective than a distant one.
see page 1921
50th Anniversary Supplements
Accompanying this issue is the first supplement celebrating the 50th Anniversary of Neurology. This supplement, edited and with commentary by Joseph Jankovic, is a compilation of notable articles regarding Parkinson’s disease published in Neurology since the journal’s inception in 1951.
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