News

Sometimes, medically and scientifically backing up what otherwise would appear to be obvious can take a long time. This is no more evident than in our cover story for this issue, "Heart and Brain: A Clearer Connection." Recently published research is offering evidence that heart health is related to cognitive health and that cognitive decline can be a risk factor for stroke. The implications for neurologists and primary care physicians include potential changes in the way you interact with each other and with your patients. Questions are arising about how primary a neurologist's care should be and about how neurologic a primary care physician's practice should be. We offer a discussion of these issues starting on page 17, and we'd love to hear your thoughts.

With all the talk about electronic medical records (EMR) and hundreds of products flooding the market, why aren't more physicians adopting the technology? The Institute of Medicine's 1991 watershed report on computer-based patient records1 spurred widespread excitement and inspired many information technology (IT) companies to invest in the development of new health care products.

Three recently published studies uncovered some answers to the genetic underpinnings of depression. Familial vulnerability was shown to increase with each generation affected by depression. Two genetic variants pointed in opposite directions: one showed an increase risk of depression and the other predicted responsiveness to antidepressants.

A joint research effort from Japan and the Mayo Clinic has identified an antibody that can help differentiate Devic syndrome-or neuromyelitis optica (NMO)-from multiple sclerosis (MS). NMO is generally considered to be a rare disease, but it may be underrecognized and is often misdiagnosed as MS, although it demands a treatment protocol that differs from that of MS. Indeed, in some countries, misdiagnosis may be as high as 30%, according to Mayo Clinic estimates. A research team hailing from the Department of Immunology and Neurology at the Mayo Clinic in Rochester, NY, led by neuroimmunologist Vanda A. Lennon, MD, PhD, in collaboration with a research team from Tohoku University School of Medicine in Japan, identified the autoantibody NMO-IgG, which appears to be a reliable marker for differentiating NMO from MS.

"No longer a pipe dream," is the suggestive lead-in of a widely distributed press release issued last October touting the potential benefits of cannabinoid compounds in the treatment of Parkinson disease (PD), Lou Gehrig disease-or amyotrophic lateral sclerosis (ALS)-and a number of other debilitating conditions, as reported during last fall's 2004 annual meeting of the Society for Neuroscience. According to Daniele Piomelli, PhD, an expert in cannabinoid research and professor in the Department of Pharmacology at the University of California, Irvine, certain cannabinoid compounds can be harnessed to "provide select benefits to patients while avoiding some of the unwanted effects" associated with marijuana use. Compounds of greatest interest have been WIN 55212-2, delta(9)-tetrahydrocannabinol (THC), and anandamide.

Painstaking elucidation of a patient's symptoms is the key component of the diagnostic workup for dizziness and vertigo. A rational, straightforward, and cost-effective approach that uses minimal, selective diagnostic testing can get to the root of an individual's specific problem.

Long before the term "neurology" was coined and the brain was wholly mapped and labeled in illustrations by Thomas Willis (English anatomist and physician) in the mid-1600s, healers were trying to understand the cause of headaches and bring relief to sufferers. Willow bark, the "natural aspirin," has been in continual use for headache relief for more than 2000 years by Native Americans and Europeans. Once a contemporary of such therapies as the application of an electric catfish to an aching head (Egypt), and cutting a hole in the skull and inserting a clove of garlic for 15 hours (Arabia), it has withstood the test of time.

The post-stroke patient is at significant risk for various psychiatric syndromes. The most commonly reported of these in the literature are post-stroke depression (PSD) and post-stroke dementia (PSDem), which may present simultaneously with overlapping mood and cognitive symptoms. In this article, we offer a review of current literature on post-stroke psychiatric syndromes and an integrated clinical approach to screening, diagnosis, and pharmacologic intervention.

Some patients with epilepsy have more treatment options today because of constantly expanding computer power, the development of model neurons and neuronal networks, and the ability of neurologists and neurosurgeons to translate medical and scientific research into clinical practice.

Given that A. Lee Dellon, MD, has yet to see an ulceration in any of the neuropathic limbs he's treated with surgical decompression, it may not be surprising that most of his patients eventually undergo the procedure in both limbs. But a report by him and colleagues in the December 2004 issue of Annals of Plastic Surgery (about ulceration rates in the contralateral limbs of those treated only once) underscores the effectiveness of the procedure.

Although previous findings have suggested that certain gait impairments in patients with diabetes are specifically linked to neuropathy, researchers from Loma Linda University in California also have found gait abnormalities in patients with type 2 diabetes who did not have neuropathy.

As a blizzard rumbled up the East Coast on Saturday, January 22, about 140 people didn't let its imminent arrival in Boston deter them from meeting with a group of neurologists who had set aside their time for a public forum. It was the first-ever Frontiers in Neurology Town Hall Meeting sponsored by the American Academy of Neurology (AAN). Actress Teri Garr also came, as ambassador for MS Lifelines, to speak about her battle with multiple sclerosis (MS), which she described in her typical humorous way: "MS is to disease what Enron is to accounting." Still, she said, she was there to promote a positive mental attitude and to encourage patients and doctors to keep talking to each other.

Since the 1990s there has been an increase in research on sexual harassment and its mental health consequences. These researchers discuss the use of alcohol to self-medicate harassment-engendered distress and the need for greater attention to potential alcohol-related consequences of harassment experiences.

In the past decade, important advances have been made in detecting and treating substance abuse disorders. In addition, research has revealed influences on the etiology and course of SUDs. Dr Pettinati introduces this Addictive Disorders Special Report, noting that the articles add to this knowledge base.

Dr. Cummings, the originator of Psychiatric Times' "Brain and Behavior" column, looks back over his career in neurology. Looking forward, he predicts that psychiatry and neurology will become ever-more intertwined.

What actually happens neurochemically in the brain to cause addiction? A well-known researcher discusses her findings on the role that dopamine levels play in addiction and aversion to cocaine.

With the immediate survival needs of tsunami survivors being addressed, international and national organizations and agencies are now tackling mental health concerns. The World Psychiatric Association (WPA) has created a Tsunami Committee, is taking steps to provide technical assistance to the affected areas and has established a disaster fund.

Patients with multiple sclerosis often ask about exercises that may improve their condition, according to research. Here is a review of studies in endurance training, aquatic fitness programs, and progressive resistance exercises to help answer their questions.

Mind-controlled artificial limbs were once the stuff of sci-fi and then were regarded as a concept that would not see clinical application until a far distant future. However, clinical application may be only a few years away.

Neurologists and other physicians can expect Medicare reimbursements, medical liability reform, and prescription drug issues to be revisited this year as President Bush and Republican leaders attempt to leverage the fall election gains in the House and Senate. But enacting key measures is far from certain. Despite titular control of 55 seats in the Senate, Republicans are still shy of the 60 votes needed to overcome a Democratic filibuster. Passing such bills “is not going to be a slam-dunk,” said Jacque J. Sokolov, senior partner of Sokolov, Sokolov, Burgess, a health care consultancy in Scottsdale, Ariz. “But the likelihood of it happening is greater in a Bush- Republican Congress environment than it would have been in a Kerry environment.”

Christopher Reeve’s death this past October from cardiac complications after infection resulting from pressure ulcers is a reminder that patients with spinal cord injury (SCI) are more than their motility impairments. According to the Annual Statistical Report of the National Spinal Cord Injury Statistical Center (NSCISC), published last June, of 3312 patients for whom the cause of death was known, nearly 22% died of respiratory system diseases, 9% of infective and parasitic diseases, 8% of hypertensive and ischemic heart diseases, and 13% of other heart disease.

Neurologists, neurosurgeons, and other physicians are feeling a squeeze, and it isn’t the magical shrinking belts that follow holiday feasting. It is rising medical liability premiums. Some doctors are leaving states where escalating liability rates are making it harder to keep a practice open. In early November, no one was performing brain surgery in southern Illinois because the last holdout, B. Theo Mellion, MD, of Carbondale, left when his malpractice insurance carrier refused to renew his coverage and those carriers willing to provide coverage were quoting annual premiums of $200,000 to $300,000

Early applications ofstem cell medicine arelikely to be neurologic,targeting spinal cord injury,brain tumors, metabolic derangements,and disordersof movement and mood. Althoughtreatments are stillyears away, continual mediacoverage of the fledglingtechnology is fueling questionsin the doctor’s office.“For our patients with devastatingneurological conditions,stem cell researchgives them hope of newtherapeutic measures,” saidSandra Olson, MD, presidentof the American Academyof Neurology (AAN).

It’s a classic risk/benefit dilemma: Does preventing suicidality-assuming suicidality can predict suicide-justify scaring some doctors away from prescribing antidepressants for young patients?

Encouraging research emerged last month regarding vagus nerve stimulation (VNS) for the treatment of epilepsy patients. About 25 different presentations at the American Epilepsy Society’s annual meeting in New Orleans focused on VNS. The FDA approved VNS Therapy in July 1997 as an adjunctive treatment for adults and children older than 12 years with partial-onset seizures and resistance to antiepileptic drugs. Marketed by Cyberonics Inc, of Houston, Tex, VNS Therapy is the only FDA-approved electrical stimulation device for epilepsy. The device, which resembles a pacemaker, provides intermittent electrical stimulation to a patient’s left vagus nerve, which, in turn, activates areas of the brain. It is implanted in the left chest area, and wires run under the skin to the nerve in the neck.

Current therapy for acute ischemic stroke remains limited to intravenous recombinant tissue plasminogen activator (tPA) administered within 3 hours of symptom onset, but despite strong evidence supporting its effectiveness,1-5 only 2% to 4% of all stroke patients currently receive tPA.

Clinical Trial Enrollments

You have a 24-year-old pregnant patient with epilepsy. Which antiepileptic drug do you prescribe for her? Where’s the evidence and what do the guidelines recommend? At the American Epilepsy Society’s annual meeting last month, during a symposium on evidence-based medicine and practice guidelines, a series of speakers spelled out the difficulties in drawing up guidelines based on evidence, or lack thereof.

Gender is an important variable in medicine and psychiatry. The initial interest in gender issues was stimulated by recognition that women were absent from much medical research. Now, however, the field has expanded to include more specific and sensitive attention to men and the role of gender and gender differences.

Telepsychiatry has been hailed as the future of psychiatry. Proponents have claimed that it can reduce costs and allow access to difficult-to-reach patients. What are the promises and pitfalls of this new technology?