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Studying the long-term consequences of coronary artery bypass grafting (CABG) on the brain, Knopman et al. used a case-control design to examine whether CABG was a risk factor for dementia, and found no support for an association.
see page 986
Cognitive performance after coronary artery bypass grafting (CABG)
McKhann et al. compared cognitive test performance of patients undergoing conventional vs off-pump CABG, nonsurgical coronary artery disease controls, and those with no cardiac risk factors at baseline, 3, and 12 months. Patients undergoing CABG did not have cognitive decline up to 1 year after surgery, when compared to these appropriate control groups.
see page 991
The editorial by Wade Smith and Mark Mapstone about these two articles notes that it has been unclear whether extracorporeal circulation during CABG causes cognitive decline or increases risk for degenerative dementia. Moreover, whether CABG surgery, regardless of whether it is performed off-pump or on-pump, underlies cognitive changes cannot be ascertained unless a non-surgical control group is included. The McKhann et al. report of cognitive outcome of these four groups of patients found that cognitive scores of all three cardiac disease groups did not differ from each other at baseline, 3, or 12 months postoperatively, but all cardiac groups scored significantly lower vs healthy controls on global measures of cognitive function preoperatively. Also, the two surgical groups reported significantly more postoperative complaints of worsening memory and personality change than the other two groups. Thus the effects of chronic cardiac disease on cognitive networks are more important than whether CABG is performed with extracorporeal circulation. The Knopman et al. study also shows a lack of association between CABG and later cognitive decline and argues against the idea that CABG surgery increases the risk for dementia.
see page 978
Intracerebral hemorrhage during antiplatelet therapy
Toyoda et al. report that antiplatelet therapy was an independent predictor for the occurrence of hematoma enlargement, emergent death, or the need for evacuation surgery within 2 days after onset of ICH.
see page 1000
Retinopathy in persons without diabetes and risk of stroke
Mitchell et al. investigated the relationship of retinal microvascular signs and 7-year incident stroke or stroke mortality in an Australian population-based cohort study. The presence of retinopathy lesions in persons without diabetes predicted an increased risk of stroke or stroke mortality, independent of traditional vascular risk factors.
see page 1005
Differential AED effects on sexual function and hormones
Herzog et al. compared the effects of various AEDs on sexual function and reproductive hormones in men with epilepsy. Sexual function scores, bioavailable testosterone levels, and gonadal efficiency were significantly greater with lamotrigine vs carbamazepine or phenytoin.
see page 1016
The editorial by Orrin Devinsky notes that the study of health issues for women with epilepsy has increased dramatically during the past decade. However, no registries track the effect of paternal use of AEDs on the fetus, and there has been little attention to health issues for men with epilepsy. Health issues for men with epilepsy is a neglected area of study. The Herzog et al. report shows that carbamazepine and phenytoin decreased testosterone bioactivity in men and that this correlated with, and likely caused, diminished libido and sexual function. AEDs that induce hepatic enzymes enhance synthesis of sex hormone binding globulin and thereby reduce free testosterone levels. Low free testosterone levels were strongly correlated with lower sexual function scores. Notably, 20% of men with localization-related epilepsy on no AEDs had abnormally low sexual function. The lamotrigine-treated patients had only a 4% frequency of abnormally low sexual function. Could lamotrigine improve sexual function? Their data provide strong support to the hypothesis that enzyme-inducing AEDs can impair sexual function. Unanswered is why sexual function is often impaired in men with epilepsy who do not take medications.
see page 980
Preoperative heart rate variability and outcome of epilepsy surgery
Persson et al. assessed heart rate variability before temporal lobe epilepsy surgery in 21 patients. Those with poor surgery outcome had lower heart rate variability than controls and patients rendered seizure free, suggesting an a priori difference in autonomic control that could contribute to sudden unexpected death after surgery.
see page 1021
MRI detected transient splenial lesion and AED withdrawal
Gürtler et al. identified 16 patients with epilepsy who had a transient lesion of the corpus callosum after they had presurgical long term monitoring (LTM). The authors used a case control approach and contrasted this group with 32 epilepsy patients who also had their MRI after LTM, but who had no splenial lesion. Their study suggests that this lesion resulted from AED withdrawal.
see page 1032
What is the risk of sham surgery in PD clinical trials?
Frank et al. summarize adverse events reported in double blind studies using sham surgery. Sham surgery is generally safe based on the small number of studies published to date.
see page 1101
The editorial by Olivier Rascol discusses how one must choose the lesser of two ethical evils: on one hand to rigorously assess the efficacy of a novel surgery and to accept (and measure) the risk of placebo operation—with no short-term individual benefit in a small number of patients carefully informed and monitored in the frame of a placebo-controlled RCT—or, on the other hand, to passively allow a large number of patients to take the same risk in clinical practice without knowing the real efficacy of the procedure. The Frank et al. article opens the way for an attempt to objectively assess the risk of a necessary harm. It is premature to use their report to assert that placebo surgery is safe in PD, but we agree that further investigation to confirm their encouraging preliminary observation.
see page 982
Cognitive deficits in NF-1
Hyman et al. found that 81% of children (n = 81) with NF1 (age 8 to 16 years) have a substantial cognitive deficit: attentional problems in 63% with criteria for ADHD being met in 38%.
see page 1037
Ascertainment of MS
Marrie et al. studied over 16, 000 patients with MS and observed shorter delays in diagnosis and less disability at diagnosis with more recent year of onset. Earlier MS ascertainment has implications for comparing recent vs older clinical studies.
see page 1066
Cervical epidural blood patches for low CSF pressure headaches
Spontaneous low CSF pressure headache is often due to an occult CSF leak. "Sealing" the leak is often difficult. The difficulty lies in finding the site of leak (often lower cervical or upper thoracic). Kantor and Silberstein report four patients who responded dramatically to cervical but not lumbar epidural blood patch.
see page 1138
Acute cerebellar ataxia and autoantibody: Identification of antigen molecule
Uchibori et al. found serum IgM autoantibody against triosephosphate isomerase in 8 of 23 patients with acute cerebellar ataxia. The eight patients all had serologic evidence of recent Epstein-Barr virus infection.
see page 1114
Risk factors for topiramate-related hyperthermia
In a prospective comparative study, Ziad et al. found that risk factors for topiramate-related hyperthermia were dose greater than 6 mg/kg/day, age less than 6 years, and increased environmental temperature of 21 to 27 °C.
see page 1139
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