Dee Rapposelli

Although the strongest risk factor for multiple sclerosis (MS) is a family history, which is not modifiable, there is compelling evidence that environmental factors also are at play in MS development. Addressing these risks may potentially result in reduction of disease incidence, reported Alberto Ascherio, MD, DrPH, associate professor of nutrition and epidemiology and director of the Neuroepidemiology Group at Harvard University in Boston.

The FDA has approved less restrictive labeling for the catechol-O-methyltransferase inhibitor tolcapone (Tasmar). The agent has been useful in increasing “on” time in patients with Parkinson disease (PD) when used as an adjunct to levodopa/ carbidopa therapy. Tolcapone has been subject to restrictive labeling because 3 reports of fulminant hepatic failure, resulting in death, were traced to its use.

Intensive Melodic Intonation Therapy (MIT) results in significant gains in speech production, and functional improvements are matched by longlasting neural changes, according to research by a team led by Gottfried Schlaug, MD, PhD, associate professor of neurology at Harvard Medical School and director of neuroimaging at Beth Israel Deaconess Medical Center in Boston.

To kick-start his presentation on reversal of coagulopathy during a symposium at the International Stroke Conference (ISC) that took place in San Francisco in early February, J. Claude Hemphill III, MD, professor of neurology at the University of California, San Francisco, displayed a CT scan illustrating a modest intracerebral bleed in the brain of a 64-year-old woman who had been taking warfarin for the treatment of atrial fibrillation. Hemphill noted that standard care, including administration of vitamin K and fresh frozen plasma (FFP), was given.

The admission that I am not a sports enthusiast will not come as a surprise to readers. However, I have endured baseball, football, and hockey games on occasion. There even was a time in my life when the rainy Saturday afternoon entertainment was watching championship wrestling on the tube.

Is neuromyelitis optica (nmo) igg autoantibody unique to NMO or is it expressed in multiple sclerosis (MS) as well? Recent studies have confirmed the autoantibody’s specificity and are shedding more light on how NMO IgG's autoantigen, the water channel aquaporin-4 (AQP4), uniquely behaves in NMO and MS.

The Science of Sleep. A quirky Indy motion picture by that title was in theaters last year. The plot concerned an odd but wildly creative and endearing fellow who ran into problems in his interpersonal relationships, in part, because he often couldn't distinguish between being awake and asleep. Wake and dream episodes mirrored each other, creating a penchant for the surreal and a personal narrative for the protagonist that wasn't quite in sync with that of the characters around him.

Patients who experience seizure 24 hours after stroke onset may be at increased risk for death, according to Angela Rackley, MD, a clinical neurophysiology fellow in epilepsy, and coresearchers at the University of Cincinnati. Rackley presented an abstract on the incidence of seizures within 24 hours after acute stroke at the annual meeting of the American Epilepsy Society in San Diego this past December. She and colleagues found a higher 30- day mortality rate among patients who had a seizure within hours of stroke compared with patients who did not experience poststroke seizure.

HUMAN RECEPTOR ACTIVITY-MODIFYING PROTEIN-1(hRAMP1) may be the switch that turns up the volumeof calcitonin gene-related peptide (CGRP)expression in migraine, according to researchersfrom the University of Iowa in Iowa City.

Statins, alone or in combination with other agents, promote angiogenesis and significantly enhance neuroregeneration in the aftermath of brain injury, including stroke, according to Michael Chopp, PhD, professor and vice chair of the Department of Neurology at Henry Ford Health Sciences Center in Detroit.

aytime sleepiness is common in patients with parkinsonism but has little to do with the amount of sleep these patients get and everything to do with dopaminergic dysfunction, according to David B. Rye, MD, PhD, associate professor of neurology at Emory University in Atlanta. "The idea is that if I sleep a lot, I shouldn't be so sleepy the next day, and if I sleep little, I should be very sleepy. This is doesn't hold true for patients with Parkinson disease [PD]. The loss of dopamine disrupts that banking system, or the sleep-wake homeostat," he said during a presentation at the 9th annual meeting of the American Society for Experimental Therapeutics, which met March 8 to 10 in Washington, DC. Addressing dopa- minergic tone during sleep might help ameliorate daytime symptoms of parkinsonism in general.

Intensive therapy over short periods provides better outcomes than less intensive regimens performed over longer periods." This was the take-home message about rehabilitation for patients with aphasia from Ronald M. Lazar, PhD, professor of clinical neuropsychology in neurology and neurological surgery, and codirector of the Levine Cerebral Localization Laboratory at the Neurological Institute of New York at Columbia University College of Physicians and Surgeons.

When friends and family need medical advice, they often consult me even though I'm nothing more than a medical news writer. Folks think it is worthwhile to tell me rather than a real medical professional about the curious pain that occasionally shoots through their leg or their heart or their head. They ask my advice about what new intervention they might try for a chronic condition or whether they really need to get that prescribed vaccine or take those antimicrobials before going off to Madagascar or some such place.

How is conflict of interest-or the perception of it-to be addressed when academia and industry collaborate on drug development? This was the question posed by Cheryl Bushnell, MD, assistant professor of neurology at Duke Medical Center in Durham, North Carolina, who chaired a brainstorming session on the issue at the 9th annual meeting of the American Society for Experimental Neurotherapeutics (ASENT), which took place March 8-10 in Washington, DC.

When I was young and attended church services with the family, the sermons of a certain priest, who was a historian, consisted of anecdotes about desperation and compassion that occurred in such places as Nazi concentration camps, Hell's Kitchen or the Bowery in Depression-era New York, or Dickens-like orphanages somewhere. At the end of his anecdote, the priest would dolefully lilt, Examine your own conscience. It was the point during the sermon when a person might startle awake after nodding off.

Childhood survivors of brain tumors and leukemia are at particular risk for stroke later in life, according to research conducted through the University of Texas (UT) Southwestern Medical Center at Dallas.1 The medical center is one of 26 facilities involved in the Childhood Cancer Survivor Study (CCSS), a large, ongoing research investigation on the long-term effects of cancer and its treatment in the pediatric population.

Presenting a diagnosis of amyotrophic lateral sclerosis (ALS) is one of the most difficult tasks that a neurologist may have to undertake. Despite the tragic quality of the news, experts in ALS care are exhorting fellow neurologists not to give up on patients in whom ALS is diagnosed.

PD is a common and challenging neurodegenerativemotor disorder, affecting at least a half millionpersons in the United States, according to the NationalInstitute of Neurological Disorders and Stroke. Withthe aging of the population, incidence is expected toincrease.

In August, I explained in this editorial column why the issue's theme--migraine--was particularly meaningful to me: I had suffered with frequent migraine headaches from childhood up until my mid-thirties. The theme of the current issue is stroke. Why? Namely because Applied Neurology, like dozens of other medical journals, will have a presence at the International Stroke Conference, and this particular issue will be distributed at the conference.

Clinical depression is an increasingly well-recognized sequela of epilepsy (see "Optimizing Treatment of Seizures by Addressing Psychiatric Comorbidities," Applied Neurology, August 2006, pages 41-42). Questions are therefore surfacing as to whether patients with epilepsy are being adequately identified and treated.

Lack of adherence to therapeutic regimens for Parkinson disease (PD) is a serious problem that not only greatly impacts health care utilization resources but also throws a monkey wrench in clinicians' attempts to ameliorate disease progression and maintain patients' function and quality of life (QOL).

Epilepsy affects about 2% of the US population and is a disability fraught with unique psychosocial and health care challenges. Authors of a study appearing in the journal Epilepsy and Behavior note that the ongoing quest of persons with epilepsy is to find informed physicians, effective therapies, and resources to help them achieve an adequate level of normalcy.

Effective antiepileptic therapy depends on balancing seizure control and tolerability, said Manoj Raghavan, MD, PhD, during a presentation at the midyear meeting of the American Epileptic Society in Chicago this past June. Tolerability places a ceiling on how far you can go in controlling seizures using medications alone, he commented.

A team from the The Scripps Research Institute (TSRI) was able to reactivate a gene, the metabolic silencing of which is responsible for Friedreich ataxia, a rare autosomal recessive neurodegenerative disorder that leaves affected persons crippled and vulnerable to scoliosis, diabetes, and heart disease. The research team, led by Joel Gottesfeld, PhD, a professor in the Department of Molecular Biology at TSRI in La Jolla, California, set about identifying and testing compounds that inhibited histone deacetylases in lymphocytes from persons with Friedreich ataxia. They hit upon one-BML-210-that reactivated the frataxin gene.

A small group of patients with treatment-resistant major depression achieved symptom relief within hours of receiving a single low-dose intravenous infusion of ketamine. The low-dose anesthetic apparently triumphed in these patients where other treatments including oral antidepressants, which can take 8 weeks or longer to "kick in" failed.

Hundreds of uniquely adapted venomous marine cone snail species inhabit the coral reefs of the Indian and Pacific oceans. Researchers posit that each may be a virtual neurologic pharmacopoeia with potential value for the treatment of everything from diabetic neuropathy to schizophrenia. The venoms, known as conotoxins, selectively inhibit a wide range of ion channels involved in neuromuscular signaling.

Persons who are occupationally or otherwise regularly exposed to pesticides are at a 70% higher risk for Parkinson disease (PD) than is the general population. The findings were drawn from a subpopulation of 7864 persons who reported pesticide exposure in 1982.

In a presentation given at the midyear meeting of the American Epilepsy Society, Andres Kanner, MD cited studies from the literature showing that the rates of depression, anxiety, psychosis, and attention-deficit/hyperactivity disorder (ADHD) are significantly higher among persons with epilepsy than among the general population

Dolls and other toys, such as teddy bears, can alleviate agitation, reduce withdrawal, help overcome communication challenges, and generally improve the quality of life of patients with Alzheimer disease (AD).

At least 2 agents are being looked at as possible treatments for Huntington disease: eicosapentaenoic acid (EPA) and a poly (ADP-ribose) polymerase (PARP1) inhibitor termed K245-14.