Theories about the causes of Parkinson disease (PD) are as tangled as the neurofilament proteins of Lewy bodies. However, investigators are teasing out threads of evidence that increasingly implicate environmental factors--perhaps aided and abetted by genetics--as contributors to this common neurodegenerative disorder.
Patients with established epilepsy may have a 48% chance of becoming seizure-free, according to research by Nathan B. Fountain, MD, associate professor of neurology, and colleagues at the University of Virginia (UVA), Charlottesville. Although the rate of freedom from seizure is unknown except for in a few specific epilepsy syndromes, the authors hypothesized that the rate may be higher than expected.
Poetry of the Times
Up to 30% of patients for whom opioids are prescribed for chronic pain show an escalating pattern of opioid abuse characterized by taking more opioids than prescribed, seeking early refills, and finding additional sources of opioids. Although many of these drug-seeking patients are addicted to opioids, some are suffering not from addiction but from inadequate pain management, according to Martha Wunsch, MD, chair of Addiction Medicine and associate professor of pediatrics at Edward Via Virginia College of Osteopathic Medicine (VCOM) in Blacksburg.
The second report from the Alzheimer's Disease Cholesterol-Lowering Treatment (ADCLT) trial was recently published, along with several reviews of clinical and laboratory investigations of the statins, in a theme issue of Acta Neurologica Scandinavica. The accumulated data reflect the potential of the agents to affect the onset or course of Alzheimer disease (AD), with contradictory or insufficient evidence of treatment effect.
The ideal medication for Parkinson disease (PD) would reduce disability and halt or slow disease progression without intolerable adverse effects. Although such an agent is not yet available, current treatments offer significant symptom control for most patients. The decision about when to start therapy is highly individual; however, delaying treatment because of fear of adverse effects may not be in the patient's best interest.
Parkinson disease (PD) is the second most common neurodegenerative disorder among elderly persons (after Alzheimer disease [AD]), and the incidence is expected to double in the next 15 to 20 years. About a million Americans have PD which means that it is about 3 times as common as multiple sclerosis and half as common as epilepsy.
Psychiatric Times Archives 2002
The reason a person has a stroke is no mystery. Results of a Danish study, reported at the 10th Congress of the European Federation of Neurological Societies in Glasgow, Scotland, held September 2 to 5, confirmed that risk factors could be identified in 98.5% of acute ischemic stroke patients.
The effects of antidepressants and other medications on a person's driving ability have been debated for some time. A recent German study by Dr Alexander Brunnauer and associates adds to the evidence that antidepressants impair driving.
Until recently, there has been a relative paucity in the selection of comprehensive child psychiatry textbooks for clinicians. Child and Adolescent Psychiatry: The Essentials finds a place in this special niche by providing comprehensive yet practical information that can be used in a variety of settings.
Ronald Pies, MD, has been named Editor in Chief of Psychiatric Times.
I met Wally for the first time when he was in the ICU. He was 14 years old and fighting a losing battle against rhabdomyosarcoma. Wally greeted me with a look of silent despair. His right arm had been amputated just above his elbow and he was on a ventilator. This was my first experience with a dying child and, seeing Wally in his shocking state, I felt totally overwhelmed.
In many jurisdictions, children and adolescents are currently being treated with cocktails of various psychotropic medications, the vast majority of which have never been empirically tested or validated in the age group in which they are being prescribed. Stating otherwise is being disingenuous. Medications are prescribed so often that one frequently cannot discern which symptoms are clinically derived and which are iatrogenic.
Persons who have anxiety disorders commonly self-medicate with alcohol and other drugs, a recent survey confirmed. The results were published in the November 2006 issue of The Journal of Nervous and Mental Disease.
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.
According to data published by the American Heart Association (AHA) in their 2006 update of heart disease and stroke statistics, "on average, someone in the United States suffers a stroke every 45 seconds."1 Furthermore, the AHA reports, approximately 700,000 persons annually experience a new or recurrent stroke, 88% of which are ischemic: however, only "8% to 12% of ischemic strokes result in death within 30 days." Because the majority of persons survive ischemic stroke, there is a need for a broader armamentarium of thrombolytic therapies than that which currently exists.
Intravenous recombinant tissue plasminogen activator (alteplase [Activase]; rt-PA) for the treatment of acute stroke has been shown to increase the likelihood of recovery. A number of studies are examining whether combination therapy with other agents, such as the direct thrombin inhibitor argatroban; the glycoprotein IIb/IIIa inhibitors abciximab (ReoPro), eptifibatide (Integrilin), and tirofiban (Aggrastat); and activated protein C (APC), may be safer and more effective.
Observation that an excess of cholesterol, mediated by interaction between the mutant huntingtin protein (mHtt) and a protein associated with cholesterol transport-that accumulates in the brain may eventually guide researchers in how to intervene in Huntington disease (HD) pathology.
Rehabilitative therapy may be effective in patients many months after stroke. Patients who underwent constraint-induced movement therapy (CIMT) within 3 to 9 months after stroke showed significant rehabilitation of the affected limb in a study led by Steven Wolf, PhD, professor of rehabilitation medicine at Emory University in Atlanta
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.
On December 8, 1995, Jean-Dominique Baubyshaved, dressed, drank a cup of hot chocolate,and spent the day conducting business as theeditor-in-chief of Elle magazine. By the end ofthat day, 43-year-old Bauby was in a coma,the result of a massive brain stem stroke.
Human herpesviruses 6B and 7 (HHV-6B, HHV-7) may be implicated in some forms of epilepsy. Steven Jacobson, PhD, a senior investigator at the National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, led a team of researchers who identified HHV-6B in the hippocampus of a substantial proportion of resections from patients with mesial temporal lobe epilepsy (MTLE) but not in tissue from neocortical resections. He reported his findings at the 2006 annual meeting of the American Epilepsy Society (AES), which met in San Diego from December 1 to 5.
Just before it left Washington at the tail end of the December lame-duck session, Congress gave physicians a last-minute reprieve from the 5% Medicare pay cut that would have gone into effect on January 1, 2007. Moreover, the House and Senate approved a 1.5% bonus to be added to Medicare reimbursement in the second half of 2007 for physicians who voluntarily report quality-of-care measures.
Is there something to the adage, laughter is the best medicine? Dr Marc Gelkopf and associates in Israel studied a different treatment approach for patients with schizophrenia using funny movies.
Psychotic disorders are a group of syndromes characterized by positive symptoms, including hallucinations, delusions, and thought disorder; and negative symptoms, including mood symptoms, social withdrawal, and reduced motivation. Cognitive deficits also appear with psychotic disorders. Psychotic disorders rank 22nd in the World Health Organization's list of worldwide causes of disability. This ranking is adjusted for the relatively low lifetime prevalence rate for psychosis; the perceived burden of the disease on those affected with psychotic disorders, as well as their relatives and caregivers, is much higher.
Intermittent explosive disorder (IED) is not yet on the radar screens of many psychiatrists, but it is more prevalent than panic disorder and warrants extensive research and attention, 2 experts on IED said recently.
Once reflected on, the concept of acceptance has multifarious implications for modern mental health care. My own work with patients and trainees has convinced me of the significance of acceptance, and I want to illustrate a few examples that may move readers to recognize similar echoes in their own practice