| 03/31/2006
10:53 AM
A locus on chromosome 9p confers susceptibility to ALS and frontotemporal dementia
NEUROLOGY 2006;66:839-844
To perform genetic linkage analysis in a family affected with ALS and frontotemporal dementia (FTD).
03/31/2006
10:51 AM
Should we perform ocular fundus in patients with severe brain trauma
Critical Care 2006, 10(Suppl 1):P454
The high incidence of intracraneal lesions of patients with brain trauma (BT) is well known. The aim of this study is to assess the incidence of an extracraneal injury: retinal haemorrhage (RH) in patients after BT.
03/31/2006
10:50 AM
Apparent Diffusion Coefficient Mapping of the Hippocampus and the Amygdala in Pharmac Resistant Temporal Lobe Epilepsy
American Journal of Neuroradiology 27:671-683, March 2006
The purpose of this study is to determine whether interictal apparent diffusion coefficients (ADC) provide a robust means for detecting amygdalo-hippocampal abnormalities in adult patients with localization-related chronic temporal lobe epilepsy (TLE) undergoing presurgical evaluation.
03/31/2006
10:48 AM
Recessive Symptomatic Focal Epilepsy and Mutant Contactin Associated Protein like 2
N E Journal of Medicine Volume 354:1370-1377 March 30, 2006 Number 13
We report a homozygous mutation of CNTNAP2 in Old Order Amish children with cortical dysplasia, focal epilepsy, relative macrocephaly, and diminished deep-tendon reflexes. Intractable focal seizures began in early childhood, after which language regression, hyperactivity, impulsive and aggressive behavior, and mental retardation developed in all children. Resective surgery did not prevent the recurrence of seizures. Temporal-lobe specimens showed evidence of abnormalities of neuronal migration and structure, widespread astrogliosis, and reduced expression of CASPR2.
03/31/2006
10:47 AM
Reversible Cytotoxic Cerebral Edema in Cerebral Fat Embolism
American Journal of Neuroradiology 27:620-623, March 2006
We present a case of cerebral fat embolism (CFE) that demonstrated evidence of diffuse white matter cytotoxic edema on diffusion-weighted magnetic resonance imaging, in addition to punctate hyperintensities on T2-weighted and diffusion-weighted imaging. The case suggests that CFE represents a combination of occlusive arteriolar disease and secondary neurotoxicity.
03/31/2006
10:46 AM
D Dimer Predicts Early Clinical Progression in Ischemic Stroke
Stroke. 2006;37:1113
Plasma D-dimer levels, measured using a research laboratory assay, independently predict progressing ischemic stroke. We wished to confirm these findings using commercially available assays and to provide data to allow the design of intervention studies.
03/31/2006
10:46 AM
Toward a Multimodal Neuroprotective Treatment of Stroke
Stroke. 2006;37:1129
Stroke remains a common medical problem with importance attributable to the demographic changes in industrialized societies.
03/31/2006
10:45 AM
The Risks and Safety of Clopidogrel in Pediatric Arterial Ischemic Stroke
Stroke. 2006;37:1120
The purpose of this study was to determine safety and tolerability of clopidogrel in children with arterial ischemic stroke (AIS). Clopidogrel is the alternative antiplatelet medication when aspirin is not tolerated or fails. The possible risks and safety of clopidogrel in children with AIS have not been assessed.
03/31/2006
10:44 AM
Interferon Fails to Protect in a Model of Transient Focal Stroke
Stroke. 2006;37:1116
Compelling evidence supporting the role of inflammation in the development of cerebral infarction has focused attention on the potential of antiinflammatory treatment strategies for stroke. Interferon (IFN)-ß, an immunomodulatory agent approved for treatment of multiple sclerosis, is being evaluated in a phase I clinical trial in acute ischemic stroke. In the present study, we evaluated the effects of wild-type rat IFN-ß and its pegylated counterpart (PEG-IFN-ß) in a model of focal ischemia and reperfusion.
03/31/2006
10:43 AM
Quality of hospital care in African American and white patients with ischemic stroke and TIA
NEUROLOGY 2006;66:809-814
To examine whether differences exist in the in-hospital diagnostic evaluation and treatment of African American and white patients with ischemic stroke (IS) and TIA.
03/31/2006
10:42 AM
Homonymous hemianopias
NEUROLOGY 2006;66:906-910
To describe the clinical characteristics and clinical-anatomic correlations of homonymous hemianopia (HH).
03/31/2006
10:40 AM
A randomized double blind trial of bromocriptine efficacy in nonfluent aphasia after stroke
NEUROLOGY 2006;66:914-916
The authors assessed the efficacy of bromocriptine in nonfluent aphasia after stroke in a 16-week, randomized, double-blind, placebo-controlled clinical trial conducted from June 2002 to April 2004. In all 38 patients after 4 months of treatment, improvement in both the bromocriptine and placebo treatment groups was observed (p < 0.001). The analysis of repeated-measures analysis of variance revealed bromocriptine did not improve nonfluent aphasia.
03/30/2006
08:08 AM
Multiparametric monitoring in patients with traumatic brain injury association with outcome
Critical Care 2006, 10(Suppl 1):P453
To investigate the association between multiple monitoring parameters and the outcome in patients with severe brain trauma.
Thirty-one patients with a mean age of 43 ± 18 years were included in this prospective study. All of them had suffered serious traumatic brain damage (GCS = 8 or GCS < 10 accompanied by a mass lesion in the initial CT scan). Their outcome was evaluated with the GOS in 6 months and they were divided according to that into two subgroups (favorable vs unfavorable outcome). During their ICU hospitalization, these patients were under brain function monitoring, consisting of three intra-cranial catheters: two for continuous monitoring of ICP and ptiO2, and a third microdialysis catheter for the measurement of glucose, lactate, pyruvate and glycerol in the interstitial fluid of the brain. The microdialysis samples were collected every 2 hours and were automatically analyzed. The monitoring period lasted for up to 10 days.
03/30/2006
08:18 AM
Endovascular Treatment of Isolated Dissecting Aneurysm of the Posterior Inferior Cerebellar Artery
American Journal of Neuroradiology 27:527-532, March 2006
Isolated dissecting aneurysms of the posterior inferior cerebellar artery (PICA) carry a high risk of rebleeding with an associated increased mortality rate. Although rare, they present a therapeutic challenge. Surgical treatment carries a significant risk of neurologic complications, predominantly lower cranial nerve deficits because of the close relationship of the aneurysm with the brain stem and cranial nerves. The purpose of this article is to show that endovascular treatment of dissecting aneurysms of the PICA can be effective and can allow the patient to avoid the complications associated with surgery.
03/30/2006
08:16 AM
Endovascular Treatment of Middle Cerebral Artery Aneurysms with Electrolytically Detachable Coils
American Journal of Neuroradiology 27:513-520, March 2006
Middle cerebral artery (MCA) aneurysms often have an unfavorable aneurysm geometry that might limit endovascular therapy. Our purpose was to analyze the feasibility, safety, and efficacy of coil embolization in a consecutive series of MCA aneurysms chosen for endovascular treatment.
03/30/2006
08:15 AM
Urgent Stenting of the M2 Superior Division of the Middle Cerebral Artery after Systemic Thrombolysis in Acute Stroke
American Journal of Neuroradiology 27:521-523, March 2006
We report a case of a 54-year-old man who presented with a right middle cerebral artery territory infarct and was treated with systemic thrombolytics. He continued to fluctuate neurologically and, with the use of angiography, was found to have an occlusion of the right M2 artery (superior division). This occlusion was successfully revascularized with a coronary stent.
03/30/2006
08:14 AM
Isolated Posterior Cerebral Artery Dissection: Report of Three Cases
American Journal of Neuroradiology 27:648-652, March 2006
Isolated dissection of the posterior cerebral artery (PCA) is a rare but important cause of stroke in younger patients, particularly women. We present 3 cases of dissection of the P2 segment of the PCA. In 2 patients, an association with minor axial head trauma was documented, suggesting shearing injury of the PCA as it crosses over the free edge of the tentorium. The clinical and imaging findings are discussed, and the therapeutic management is reviewed.
03/30/2006
08:13 AM
The Relation of Stroke Admissions to Recent Weather Airborne Allergens Air Pollution Seasons Upper Respiratory Infections and Asthma Incidence September 11 2001 and Day of the Week
Stroke. 2006;37:951
Some previous research links stroke incidence to weather, some links strokes to air pollution, and some report seasonal effects. Alveolar inflammation was proposed as the mechanistic link. We present a unified model of time, weather, pollution, and upper respiratory infection (URI) incidence.
03/30/2006
08:12 AM
Time to Admission in Acute Ischemic Stroke and Transient Ischemic Attack
Stroke. 2006;37:963
The effect of thrombolysis depends on the time from stroke onset to treatment and therefore also on the time when patients come to the hospital. This study was designed to analyze the variables that influence the time from symptom onset to admission (TTA) to the stroke unit.
03/30/2006
08:11 AM
Extent of Early Ischemic Changes on Computed Tomography CT Before Thrombolysis
Stroke. 2006;37:973
The significance of early ischemic changes (EICs) on computed tomography (CT) to triage patients for thrombolysis has been controversial. The Alberta Stroke Program Early CT Score (ASPECTS) semiquantitatively assesses EICs within the middle cerebral artery territory using a10-point grading system. We hypothesized that dichotomized ASPECTS predicts response to intravenous thrombolysis and incidence of secondary hemorrhage within 6 hours of stroke onset.
03/30/2006
08:10 AM
Influence of Metabolic Syndrome and General Obesity on the Risk of Ischemic Stroke
Stroke. 2006;37:1060
In 2005, the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) guideline lowered the fasting glucose cut point used to define metabolic syndrome (MS). This study investigated the influence of MS on ischemic stroke (IS) risk using both the original and revised definitions. In addition, because abdominal obesity is the measure of obesity used in the guideline to define MS, we also investigated whether general obesity (GOB) should be considered in the definition of MS.
03/30/2006
08:07 AM
Sleep Disordered Breathing and Acute Ischemic Stroke
Stroke. 2006;37:967
Sleep-disordered breathing (SDB) is frequent in stroke patients. Risk factors, treatment response, short-term and long-term outcome of SDB in stroke patients are poorly known.
03/30/2006
08:06 AM
A Placebo Controlled Trial of Constraint Induced Movement Therapy for Upper Extremity After Stroke
Stroke. 2006;37:1045
Constraint-Induced Movement therapy (CI therapy) is a neurorehabilitation technique developed to improve use of the more affected upper extremity after stroke. A number of studies have reported positive effects for this intervention, but an experiment with a credible placebo control group has not yet been published.
03/30/2006
08:05 AM
Angioplasty for Symptomatic Intracranial Stenosis
Stroke. 2006;37:1016
Medical treatment of symptomatic intracranial stenosis carries a high risk of stroke. This study was done to evaluate the clinical and angiographic outcomes after intracranial angioplasty for this disease.
03/30/2006
08:04 AM
Association Between Atherosclerotic Aortic Plaques and Left Ventricular Hypertrophy in Patients With Cerebrovascular Events
Stroke. 2006;37:958
The purpose of this research was to evaluate whether an association exists between the presence of atherosclerotic plaque in the thoracic aorta and left ventricular hypertrophy (LVH) in patients with a cerebrovascular event.
03/30/2006
08:04 AM
Brain Stem and Cerebellar Hyperintense Lesions in Migraine
Stroke. 2006;37:1109
Migraineurs are at increased risk of cerebellar infarcts and supratentorial white matter lesions. The prevalence, frequency, and distribution of infratentorial hyperintense lesions in migraine are unknown.
03/29/2006
09:41 AM
Cognitive Rehabilitation The Role of Theoretical Rationales and Respect for the Maturational Process Needed for Our Evidence
Journal of Head Trauma Rehabilitation. Characterizing Treatments in TBI Rehabilitation: Issues for Research and Practice. 21(2):194-197, March/April 2006
The challenge to presenters at the Galveston Brain Injury Conference held in April 2005 was to discuss examples of the use of theory to motivate the design of treatments for cognitive deficits resulting from traumatic brain injury. This article considers the role of theoretical rationales as well as the new optimism embracing neurorehabilitation today. However, caution to respect the maturational process needed to adequately prepare treatment evidence for clinical application is affected.
03/29/2006
09:40 AM
Practical and Theoretical Considerations in Designing Rehabilitation Trials The DVBIC Cognitive Didactic versus Functional Experiential Treatment Study Experience
Journal of Head Trauma Rehabilitation. Characterizing Treatments in TBI Rehabilitation: Issues for Research and Practice. 21(2):179-193, March/April 2006
This is a descriptive article outlining issues in the development and implementation of a multisite randomized rehabilitation trial for brain injury treatment. The goal of this article is to present practical and theoretical considerations in designing and conducting multicenter rehabilitation trials. Practical issues discussed include (a) treatment setting, (b) patient accessibility in determining the research question of interest, as well as inclusion and exclusion criteria, (c) research protocol development in the context of rehabilitation standard of care, and (d) protocol treatments in the context of realistic cost-benefits analysis. Rehabilitation theory is discussed as playing an important role designing the specifics of the protocol interventions. The Defense and Veterans Brain Injury Center Veterans Health Administration cognitive-didactic versus functional-experiential study methodology is used for illustrative purposes. This study evaluated 2 alternative approaches to treatment: one focusing on underlying cognitive processes and the second on errorless learning in everyday functional situations. Lessons learned over the course of completing the treatment trial are discussed.
03/29/2006
09:39 AM
Two Approaches to Behavior Disorder After Traumatic Brain Injury
Journal of Head Trauma Rehabilitation. Characterizing Treatments in TBI Rehabilitation: Issues for Research and Practice. 21(2):168-178, March/April 2006
A 3-stage model of intervention is used to contrast the philosophy and treatment practices of 2 behavioral approaches to behavior disorder following traumatic brain injury. The first referred to here as the Operant Neurobehavioral Approach developed from neuropsychology and learning theory. The second referred to as the Relational Neurobehavioral Approach builds on the nonaversive behavioral techniques of the Operant Neurobehavioral Approach. It also incorporates principles of motivational interviewing, places more overt emphasis on the therapeutic relationship, and targets staff attributions for aggression in staff training. The strengths and weaknesses of both approaches are discussed. It is suggested that the Relational Neurobehavioral Approach is more likely to engage and/or reengage clients with traumatic brain injury who are resistant to behavior change. Research implications are discussed including the need to measure the fidelity of all intervention variables.
03/29/2006
09:39 AM
Treatment of Post TBI Executive Dysfunction Application of Theory to Clinical Practice
Journal of Head Trauma Rehabilitation. Characterizing Treatments in TBI Rehabilitation: Issues for Research and Practice. 21(2):156-167, March/April 2006
The authors propose a theory-based model for the treatment of post-traumatic brain injury executive dysfunction that integrates (1) theories of cerebral function and organization, (2) cognitive-behavioral theory of problem solving, and (3) learning theory. The model delineates appropriate targets of and methods for the treatment of executive dysfunction. A practical application of the theoretical model is described in the form of a comprehensive day treatment program, Executive Plus. A test of the model is also discussed, focused on the comparison of Executive Plus and a standard day treatment program along parameters dictated by the model.
03/29/2006
09:38 AM
Self regulation and Goal Theories in Brain Injury Rehabilitation
Journal of Head Trauma Rehabilitation. Characterizing Treatments in TBI Rehabilitation: Issues for Research and Practice. 21(2):142-155, March/April 2006
Goal planning is a central concept in the clinical practice of rehabilitation. Several disciplines within psychology and medicine have elaborated theories related to goal attainment and self-regulation, the process of managing one's own goal-directed behavior. These theories may be highly relevant to brain injury rehabilitation both to help address characteristic deficits in executive function and to teach clients how to manage life tasks outside of formal rehabilitation. In this article, we describe testable, theoretically motivated interventions at 2 levels: the goal level focused on attaining or enhancing performance on individual tasks and the self-regulation level of metacognitive processes involved in planning and managing one's own goal-directed behavior. We also discuss issues in experimental methodology that are important to adapting this area of research to brain injury rehabilitation, including consideration of cognitive status and other individual differences in selecting the participant sample, choice of between-subjects versus within-subjects experimental design, and selection of appropriate outcome measures.
03/29/2006
09:37 AM
Implications of Basic Science Research for Brain Injury Rehabilitation A Focus on Intact Learning Mechanisms
Journal of Head Trauma Rehabilitation. Characterizing Treatments in TBI Rehabilitation: Issues for Research and Practice. 21(2):131-141, March/April 2006
Within a theoretical framework for rehabilitation that distinguishes between automatic and controlled processes, this article reviews basic science research and addresses the following issues: What cognitive abilities remain relatively intact after severe traumatic brain injury, and how can we incorporate intact skills into rehabilitative techniques? The reviewed research indicates that individuals with severe traumatic brain injury (a) generally perform similar to controls on cognitive tasks (or task components) that require automatic and implicit processes as opposed to consciously controlled processes; (b) can learn through implicit learning mechanisms; and (c) can acquire and use automatic processes in complex, cognitive task performance.
03/29/2006
09:36 AM
Constraint based Therapies as a Proposed Model for Cognitive Rehabilitation
Journal of Head Trauma Rehabilitation. Characterizing Treatments in TBI Rehabilitation: Issues for Research and Practice. 21(2):119-130, March/April 2006
This article proposes that constraint-induced therapy represents a theoretical model of rehabilitation emerging from basic research with implications for cognitive remediation attempts. It provides an overview of current work on constraint-induced therapies with a focus on the most widely used of these techniques, constraint-induced movement therapy (CIMT). An example from recent research in the cognitive sciences demonstrates how underlying principles of the CIMT could be used to guide rehabilitative efforts for cognitive dysfunction. Limitations and obstacles of applying such an approach are discussed.
03/29/2006
09:35 AM
Functional Reintegration of Prefrontal Neural Networks for Enhancing Recovery After Brain Injury
Journal of Head Trauma Rehabilitation. Characterizing Treatments in TBI Rehabilitation: Issues for Research and Practice. 21(2):107-118, March/April 2006
Functions of the prefrontal cortex (PFC) are fundamental to learning and rehabilitation after brain injuries, but the PFC is particularly vulnerable to trauma. We propose approaches to cognitive training that are hypothesized to specifically enhance PFC function. We present a theoretical framework that generates hypotheses regarding the effects of training on the functional integration of processes across distributed networks of brain regions. Specific outcome measurements that may be used to test these hypotheses in clinical trials are proposed. This neural network-level approach may guide cognitive rehabilitation and facilitate development of adjunctive biologic treatments to enhance the effects of training.
03/29/2006
09:33 AM
Using Treatment Theories to Refine the Designs of Brain Injury Rehabilitation Treatment Effectiveness Studies
Journal of Head Trauma Rehabilitation. Characterizing Treatments in TBI Rehabilitation: Issues for Research and Practice. 21(2):99-106, March/April 2006
Many rehabilitation treatments are difficult to define, resulting in a lack of clarity about their essential "active ingredients." Treatment theories can narrow the scope of possible active ingredients, by clearly specifying how the treatment is believed to act. Efficacy studies of theory-defined treatments assess their clinical value, but also advance the science underlying the theory. In addition, treatment theories shape inclusion and exclusion criteria by suggesting what types of patients may benefit, and shape outcome measures by suggesting where the treatment impact should be seen. Finally, treatment theories can assist an investigator in the selection of an optimal study design.
03/29/2006
09:30 AM
Presurgical and Intraoperative Mapping of the Motor System in Congenital Truncation of the Precentral Gyrus
American Journal of Neuroradiology 27:493-497, March 2006
A 43-year-old man presented with a grade II astrocytoma in the left postcentral gyrus and superior parietal lobule. Preoperative functional MR imaging and diffusion tensor imaging mapped distal upper-extremity primary motor cortex and white matter, respectively, adjacent to the tumor, within a congenitally truncated precentral gyrus. Because of the congenital anomaly, this region of primary motor cortex was inaccessible to direct visualization or intraoperative electrocortical stimulation. The integration of preoperative and intraoperative mapping data facilitated resection of the tumor while avoiding a postoperative motor deficit.
03/29/2006
09:29 AM
Epidemiologic classification of seizures associated with neurocysticercosis observations from a sample of seizure disorders in neurologic care in India
Acta Neurologica Scandinavica, Volume 113, Number 4, April 2006, pp. 233-240(8)
To determine the etiologic role of neurocysticercosis (NC) in a hospital-based sample of epilepsies divided according to International League Against Epilepsy (ILAE) epidemiological criteria and number of seizures prior to presentation.
03/29/2006
09:28 AM
The Perianeurysmal Environment Influence on Saccular Aneurysm Shape and Rupture
American Journal of Neuroradiology 27:504-512, March 2006
The purpose of this study was to evaluate whether interactions between intracranial cerebral saccular aneurysms and the perianeurysmal environment (PAE), in the form of contact constraints, influence aneurysm shape and risk of rupture.
03/29/2006
09:27 AM
Carotid Plaque Texture Analysis Can Predict the Incidence of Silent Brain Infarcts Among Patients Undergoing Carotid Endarterectomy
European Journal of Vascular and Endovascular Surgery Volume 31, Issue 4 , April 2006, Pages 373-380
Patients were assessed using transcranial Doppler, carotid ultrasound and pre- and postoperative magnetic resonance imaging (MRIs). The clinical status, need for shunt insertion and significant decrease in the blood flow in the middle cerebral artery were recorded. All data were analysed using multivariate regression models.
03/29/2006
09:26 AM
A neuro Behcets case complicated with intracranial hypertension successfully treated by a lumboperitoneal shunt
Joint Bone Spine Volume 73, Issue 2 , March 2006, Pages 200-201
A 21-year-old man had been diagnosed as having thrombosis of the dural sinus secondary to Behçet’s disease. Despite treatment with
acetozolamide, azathioprine and methylprednisolone over the ensuing 6 months, he had little improvement in his symptoms of intracranial hypertension and required frequent lumbar CFS drainage. The patient then underwent lumboperitoneal shunt operation, which resulted in rapid resolution of papilledema and gradual improvement in the visual field. In conclusion, we suggest that in BD patients with dural sinus thrombosis, in whom the intracranial hypertension developed but failed to normalize after treatment with immunosuppressive agents, lumboperitoneal shunting should be considered as an effective therapeutic tool.
03/29/2006
09:25 AM
Advances Toward an Understanding of Brainstem Gliomas
Journal of Clinical Oncology, Vol 24, No 8 (March 10), 2006: pp. 1266-1272
The diagnosis of brainstem glioma was long considered a single entity. However, since the advent of magnetic resonance imaging in the late 1980s, neoplasms within this anatomic region are now recognized to include several tumors of varying behavior and natural history. More recent reports of brainstem tumors include diverse sites such as the cervicomedullary junction, pons, midbrain, or the tectum. Today, these tumors are broadly categorized as either diffuse intrinsic gliomas, most often in the pons, or the nondiffuse brainstem tumors originating at the tectum, focally in the midbrain, dorsal and exophytic to the brainstem, or within the cervicomedullary junction. Although we briefly discuss the nondiffuse tumors, we focus specifically on those diffuse brainstem tumors that regrettably still carry a bleak prognosis.
03/29/2006
09:24 AM
Epilepsy and Obstructive Sleep Apnea
European Neurology 2006;55:74-79
A few publications documented the coexistence of epilepsy and obstructive sleep apnea (OSA). The extent, nature, and clinical relevance of this association remain poorly understood. We retrospectively reviewed the database of our sleep center to identify patients with both sleep apnea and epilepsy.
03/28/2006
07:39 AM
Altered Inhibition in Lateral Amygdala Networks in a Rat Model of Temporal Lobe Epilepsy
J Neurophysiol 95: 2143-2154, 2006. First published December 28, 2005
Clinical and experimental evidence indicates that the amygdala is involved in limbic seizures observed in patients with temporal lobe epilepsy. Here, we used simultaneous field and intracellular recordings from horizontal brain slices obtained from
pilocarpine-treated rats and age-matched nonepileptic controls
(NECs) to shed light on the electrophysiological changes that occur within the lateral nucleus (LA) of the
amygdala. No significant differences in LA neuronal intrinsic properties were observed between
pilocarpine-treated and NEC tissue. However, spontaneous field activity could be recorded in the LA of 21% of
pilocarpine-treated slices but never from NECs. At the intracellular level, this network activity was characterized by robust neuronal firing and was abolished by glutamatergic antagonists. In addition, we could identify in all
pilocarpine-treated LA neurons: 1) large amplitude depolarizing postsynaptic potentials
(PSPs) and 2) a lower incidence of spontaneous hyperpolarizing PSPs as compared with
NECs. Single-shock stimulation of LA networks in the presence of glutamatergic antagonists revealed a biphasic inhibitory PSP
(IPSP) in both NECs and pilocarpine-treated tissue. The reversal potential of the early GABAA receptor–mediated component, but not of the late GABAB receptor–mediated component, was significantly more depolarized in
pilocarpine-treated slices. Furthermore, the peak conductance of both fast and late IPSP components had significantly lower values in
pilocarpine-treated LA cells. Finally, paired-pulse stimulation protocols in the presence of glutamatergic antagonists revealed a less pronounced depression of the second IPSP in
pilocarpine-treated slices compared with NECs. Altogether, these findings suggest that alterations in both pre- and postsynaptic inhibitory mechanisms contribute to synaptic hyperexcitability of LA networks in epileptic rats.
03/28/2006
07:36 AM
Magnetic resonance imaging defines structural brain injury acquired during critical illness
Critical Care 2006, 10(Suppl 1):P460
Patients with non-neurological critical illness commonly develop cerebral dysfunction, which may take the form of delirium, coma, and long-term cognitive impairment. Delirium in the ICU is associated with increased mortality and prolonged mechanical ventilation and hospital stay, and is commonly attributed to metabolic derangements. Tests such as brain computed tomography (CT) and cerebrospinal fluid analysis are frequently nondiagnostic. We hypothesized that brain magnetic resonance imaging (MRI) is a valuable tool in the diagnosis of delirium and coma acquired in the ICU.
03/27/2006
12:44 PM
MILD STROKE PATIENTS BEST TREATED WITH TPA
Neurology Today. 6(6):29,31, March 21, 2006
Laino, Charlene
03/27/2006
12:43 PM
IS NORMAL PRESSURE HYDROCEPHALUS A DIAGNOSIS IN SEARCH OF CRITERIA
Neurology Today. 6(6):21-22, March 21, 2006
Carroll, Linda
03/27/2006
12:42 PM
NEW STUDIES CONFIRM BENEFIT OF STATINS FOR STROKE
Neurology Today. 6(6):5-7, March 21, 2006
Moyer, Paula
03/27/2006
12:41 PM
TNF ALPHA MUTATION LINKED TO RUPTURE IN BRAIN AVMS
Neurology Today. 6(6):1,11, March 21, 2006
Moyer, Paula
03/25/2006
10:18 AM
Prognostic markers of the outcome in severe head injuries
Critical Care 2006, 10(Suppl 1):P467
Neuronal-specific enolase (NSE) is a subunit of the enolase group specific for the central neural system, found in the neurons and the neuroendocrine tissue of the brain. NSE is released as a result of leakage across the injured neuronal membrane; elevations of serum NSE are due to neuronal injury and increased permeability of the blood–brain barrier. Protein S-100 (especially the B subunit) is a calcium binding protein found in high concentrations specifically in neurogliar and Schwann cells. Procalcitonin (PCT) is the precursor of calcitonin and under normal conditions it is not detected in the plasma (0–0.5
ng/ml). PCT is elevated in microbial sepsis and trauma.
03/25/2006
10:17 AM
Depression in neurological disorders an update
Current Opinion in Psychiatry. 19(3):294-298, May 2006
Depressions are a heterogeneous group of conditions that contribute significantly to impairments in quality of life, independent of the severity of neurological illness. Depression may predate neurological signs and symptoms in the evolution of neurodegenerative disorders, and there is some evidence that depressive illness itself may be a risk factor in the aetiology of some dementias. This review aims to summarize the relevant current literature on diagnosis, aetiology and treatment of depression in neurology.
03/25/2006
10:25 AM
Involvement of GABAergic modulation of antinociception induced by morphine microinjected into the ventrolateral orbital cortex
Brain Research Volumes 1073-1074 , 16 February 2006, Pages 281-289
Previous studies have shown that microinjection of morphine into the prefrontal ventrolateral orbital cortex (VLO) produces antinociception. The current study examined whether ?-aminobutyric acid (GABA) containing neurons in the VLO were involved in this antinociception. Under light anesthesia, the GABAA receptor antagonist bicuculline and picrotoxin or agonist muscimol and THIP was microinjected into the VLO in non-morphine-treated (control) and morphine-treated (microinjection into the VLO) rats. Noxious heat-evoked tail flick (TF) latencies (TFLs) were measured in all of these groups of rats every 5 min. Bicuculline or picrotoxin (100, 200, 500 ng in 0.5 µl) depressed the TF reflex in a dose-related fashion. A smaller dose (100 ng) of bicuculline or picrotoxin microinjected into VLO significantly enhanced the VLO morphine-evoked inhibition of the TF reflex. In contrast, administration of muscimol (250 ng) or THIP (1.0 µg) significantly attenuated the morphine-induced antinociception in the VLO morphine-treated rats. These results suggest that the GABAA receptor is involved in the modulation of VLO morphine-induced antinociception, and provide a behavioral support for the hypothesis that morphine may directly inhibit the GABAergic inhibitory interneurons leading to indirect activation of the descending antinociceptive pathway through a disinhibitory effect on the VLO output neurons and depression of the nociceptive inputs at the spinal cord level.
03/25/2006
10:23 AM
Evidence of reuptake inhibition responsible for mecamylamine evoked increases in extracellular serotonin
Brain Research Volumes 1073-1074 , 16 February 2006, Pages 321-324
The present report using microdialysis approach investigates the neurochemical mechanism of mecamylamine in the regulation of extracellular serotonin in the dorsal raphe nucleus of freely behaving rats. These results suggest that mecamylamine may block serotonin reuptake, the effect consistent with its efficacy of antidepressant.
03/25/2006
10:22 AM
Functional magnetic resonance imaging of cholinergic modulation in mild cognitive impairment
Current Opinion in Psychiatry. 19(3):299-306, May 2006
Mild cognitive impairment often represents the earliest clinical phase of Alzheimer's disease and is thought to involve synaptic dysfunction. Functional neuroimaging methods may be sensitive to these early physiologic changes and may be useful in early detection, therapeutic monitoring, and prediction of treatment response and other clinical outcomes. This review will focus on functional magnetic resonance imaging and its use in measuring the effects of cholinergic modulation in mild cognitive impairment.
03/25/2006
10:20 AM
Allopregnanolone a Progesterone Metabolite Is More Effective Than Progesterone in Reducing Cortical Infarct Volume After Transient Middle Cerebral Artery Occlusion
Annals of Emergency Medicine Volume 47, Issue 4 , April 2006, Pages 381-389
We compare the effects of postinjury administration of allopregnanolone, a metabolite of progesterone, to progesterone in an animal model of transient middle cerebral artery occlusion.
03/25/2006
10:17 AM
Resectable Brain Metastases
Journal of Clinical Oncology, Vol 24, No 8 (March 10), 2006: pp. 1289-1294
Brain metastases are the most common brain tumors seen in clinical practice, comprising well over half of all brain tumors. For many years, surgical resection of brain metastases was considered a form of palliative therapy only, but more recently it has been shown to have a more important role in extending survival in appropriately selected patients. Newer surgical techniques have helped to reduce the morbidity associated with tumor resection. Although randomized studies have demonstrated the need for postoperative whole-brain radiotherapy, there remains interest in the use of other surgical adjuncts to delay or eliminate the need for fractionated radiotherapy. The use of various treatment modalities, particularly image-guided surgery and stereotactic radiosurgery, allows clinicians who are focused on the treatment of brain metastases to achieve superior levels of tumor control within the brain. As a result, overall survival is much more dependent on the status of the patient's systemic disease.
03/25/2006
10:16 AM
Whole Brain Radiotherapy in the Management of Brain Metastasis
Journal of Clinical Oncology, Vol 24, No 8 (March 10), 2006: pp. 1295-1304
Brain metastases are an important cause of morbidity and mortality, afflicting nearly 170,000 Americans annually. The prognosis for these patients is poor, with median survival times measured in months. In this review article, we present the standard treatment approach of whole-brain radiotherapy and discuss new directions, including the role of chemical modifiers and the management and prevention of neurocognitive deficits.
03/23/2006
03:16 PM
Levetiracetam in patients with generalised epilepsy and myoclonic seizures An open label study
Seizure Volume 15, Issue 3 , April 2006, Pages 214-218
To evaluate the efficacy and tolerability of levetiracetam (LEV) as either ‘de novo’
(monotherapy) or ‘add-on’ therapy in patients with different generalised epilepsies characterised by myoclonic seizures from an observational study.
03/23/2006
03:15 PM
Electrocardiographic changes in patients with acute stroke in the prehospital setting and their prognostic importance
Critical Care 2006, 10(Suppl 1):P457
Electrocardiographic (ECG) changes can be observed in patients with acute stroke without primary heart disease. The aim of the study was to determine whether ischaemic ECG changes and arrythmia are related to prognosis in this population of patients.
03/23/2006
03:14 PM
Neuron specific enolase and protein S 100 B as prognostic parameters for children with head injury
Critical Care 2006, 10(Suppl 1):P464
Neuron-specific enolase (NSE) (glycolytic enzyme in neurons and neuroendocrine cells) and protein S-100 B (calcium2+-binding protein in astroglial and Schwann cells) are established neurobiochemical markers that can be used for evaluating the severity of organic brain damage. The examination of these parameters in serum was used to show the practical relevance in correlation with further examination criteria (Glasgow Coma Scale [GCS], outcome, hospital treatment and ventilation time).
03/22/2006
03:06 PM
Vagal nerve stimulation Relationship between outcome and electroclinical seizure pattern
Seizure Volume 15, Issue 3 , April 2006, Pages 198-207
In recent years, vagal nerve stimulation (VNS) has been proposed as a possible way to improve the control of refractory (partial and generalized) seizures. To date, however, there is no complete understanding of the underlying mechanism for this action nor are there any available guidelines or criteria for the selection of those candidates that might be most suitable for this kind of neuromodulating surgery. This report presents evidence that should be helpful in defining the clinical criteria for using VNS for the treatment of refractory seizures. We report on 17 patients with severe partial refractory epilepsy and polymorphous seizures, who have been operated on previously or who were excluded from epilepsy surgery and for whom, at least, one seizure type has been electrographically recorded. Sixteen of these patients also had falling seizures. Our objective was to identify responders and to correlate the outcome of their seizures with the EEGraphic onset of their seizure. Follow-up ranged from 4 to 9 years.
03/22/2006
03:08 PM
Decompressive hemi craniectomy for refractory intracranial hypertension after traumatic brain injury
Critical Care 2006, 10(Suppl 1):P458 21 March 2006
Sedation, administration of mannitol or hypertonic saline, mild hyperventilation, moderate hypothermia and high-dose barbiturate therapy are all strategies in the treatment of intracranial hypertension in traumatic brain injury (TBI). Intracranial pressure (ICP) >20 mmHg not responding to conservative strategies caries a bad prognosis, mortality exceeding 80%. A final option in refractory intracranial hypertension might be decompressive (hemi)craniectomy.
03/22/2006
03:04 PM
Antiepileptic drug use in nursing home residents A cross-sectional regional study
Seizure Volume 15, Issue 3 , April 2006, Pages 194-197
The use of antiepileptic drugs (AED), their primary indication, comorbid conditions, and concomitant medications were collected from 565 nursing homes (NH) residents of six NH located around the city of Mainz, Germany representing 5.05% of all NH residents in the area. Data were collected from the electronic pharmacy files and by reviewing all available medical records. Average age was 82.2 ± 2.4 years, 85.5% were women. Of 565 NH residents 28 (4.96%) received AED therapy, of which in 17 (63%) AED were prescribed for a seizure-related diagnosis. In 76.5% seizure types were unspecified and a distinction in focal and generalized epilepsy was made in only 23.5% of patients. Three patients never had epileptic seizures and in four residents the reason for AED use was unclear. AEDs most frequently prescribed were carbamazepine (37.1%), valproic acid (25.9%), and phenytoin (14.8%). Five patients received benzodiazepines (18.5%), newer generation AED were used in only four (14.8%) cases. Residents on average took n = 5.6 ± 3.3 other drugs. Opportunities exist for health care professionals to improve the medical management of nursing facility residents receiving AEDs.
03/22/2006
03:02 PM
Synergistic action of brain derived neurotrophic factor and lens injury promotes retinal ganglion cell survival but leads to optic nerve dystrophy in vivo
Brain 2006 129(4):1014-1026
Trauma or disease in the CNS often leads to neuronal death and consequent loss of functional connections. The idea has been put forward that strategies aimed at repairing the injured CNS involve stimulation of both neuronal survival and axon regeneration.
03/22/2006
03:01 PM
Early ventilation and outcome in patients with moderate to severe traumatic brain injury
Critical Care Medicine. 34(4):1202-1208, April 2006
An increase in mortality has been reported with early intubation in severe traumatic brain injury, possibly due to suboptimal ventilation. This analysis explores the impact of early ventilation on outcome in moderate to severe traumatic brain injury.
03/22/2006
03:00 PM
Impaired Naming of Unique Landmarks Is Associated With Left Temporal Polar Damage
Neuropsychology. 2006 Jan Vol 20(1) 1-10
Previous studies have shown that the left temporal polar (TP) region is important for the retrieval of proper names for persons. It has been proposed that the key specialization of left TP is for proper nouns (rather than names for persons, per se), which predicts that left TP should support other categories whose members are denoted by proper names (e.g., landmarks). A lesion study tested the hypothesis that impaired naming of famous unique landmarks would be associated with damage to left TP. A Landmark Recognition and Naming Test was administered to participants with lesions to left TP, right TP, or regions outside TP. The results provided strong support for the hypothesis: Landmark naming was significantly inferior in the left group, supporting the hypothesis. The findings converge with previous lesion and functional imaging data to support the idea that the left TP region is important for the retrieval of names for unique entities. This fits the proposal that left TP contains convergence regions that operate as intermediaries between conceptual knowledge retrieval and lexical retrieval for classes of unique stimuli (H. Damasio, D. Tranel, T. J. Grabowski, R. Adolphs, & A. R. Damasio, 2004). (PsycINFO Database Record (c) 2006 APA, all rights reserved)
03/22/2006
02:59 PM
WILL THE DEMISE OF THE NIH HUMAN BRAIN PROJECT HURT THE GROWTH OF NEUROINFORMATICS
Neurology Today. 6(5):34-35, March 7, 2006
03/22/2006
02:57 PM
CHILDREN WITH SICKLE CELL DISEASE RISK STROKE IF TRANSFUSIONS CEASE
Neurology Today. 6(3):6,11-12, February 7, 2006
03/21/2006
08:12 AM
Isoflurane exerts neuroprotective actions at or near the time of severe traumatic brain injury
Brain Research Volume 1076, Issue 1 , 3 March 2006, Pages 216-224
Isoflurane improves outcome vs. fentanyl anesthesia, in experimental traumatic brain injury (TBI). We assessed the temporal profile of isoflurane neuroprotection and tested whether isoflurane confers benefit at the time of TBI. Adult, male rats were randomized to isoflurane (1%) or fentanyl (10 mcg/kg iv bolus then 50 mcg/kg/h) for 30 min pre-TBI. Anesthesia was discontinued, rats recovered to tail pinch, and TBI was delivered by controlled cortical impact. Immediately post-TBI, rats were randomized to 1 h of isoflurane, fentanyl, or no additional anesthesia, creating 6 anesthetic groups (isoflurane:isoflurane, isoflurane:fentanyl, isoflurane:none, fentanyl:isoflurane, fentanyl:fentanyl, fentanyl:none). Beam balance, beam walking, and Morris water maze (MWM) performances were assessed over post-trauma d1-20. Contusion volume and hippocampal survival were assessed on d21. Rats receiving isoflurane pre- and post-TBI exhibited better beam walking and MWM performances than rats treated with fentanyl pre- and any treatment post-TBI. All rats pretreated with isoflurane had better CA3 neuronal survival than rats receiving fentanyl pre- and post-TBI. In rats pretreated with fentanyl, post-traumatic isoflurane failed to affect function but improved CA3 neuronal survival vs. rats given fentanyl pre- and post-TBI. Post-traumatic isoflurane did not alter histopathological outcomes in rats pretreated with isoflurane. Rats receiving fentanyl pre- and post-TBI had the worst CA1 neuronal survival of all groups. Our data support isoflurane neuroprotection, even when used at the lowest feasible level before TBI (i.e., when discontinued with recovery to tail pinch immediately before injury). Investigators using isoflurane must consider its beneficial effects in the design and interpretation of experimental TBI research.
03/21/2006
08:26 AM
Prospective study of hippocampal volume and function in human subjects treated with corticosteroids
European Psychiatry Volume 21, Issue 2 , March 2006, Pages 123-128
Decreased hippocampal volume reported in neuropsychiatric and endocrine disorders is considered a result of putative neuronal damage mediated by corticosteroids. This is the first prospective study of hippocampal volume and function in patients treated with corticosteroids.
03/21/2006
08:25 AM
Temporal lobe epilepsy after experimental prolonged febrile seizures prospective analysis
Brain 2006 129(4):911-922
Experimental prolonged febrile seizures (FS) lead to structural and molecular changes that promote hippocampal hyperexcitability and reduce seizure threshold to further convulsants. However, whether these seizures provoke later-onset epilepsy, as has been suspected in humans, has remained unclear. Previously, intermittent EEGs with behavioural observations for motor seizures failed to demonstrate spontaneous seizures in adult rats subjected to experimental prolonged FS during infancy.
03/21/2006
08:23 AM
The use of levetiracetam in refractory status epilepticus
Seizure Volume 15, Issue 3 , April 2006, Pages 137-141
Six patients with status epilepticus (SE) of various etiologies refractory to at least two antiepileptic drugs
(AEDs) had complete cessation of their seizures following administration of oral levetiracetam (LEV). Seizure types included convulsive, focal, and nonconvulsive status
epilepticus. Effective doses of levetiracetam ranged from 500 to 3000 mg/day, achieving seizure control within 12–96 h. No significant adverse events were noted. Adjunctive levetiracetam should be considered for patients with status epilepticus unresponsive to initial therapy.
03/21/2006
08:22 AM
Oxcarbazepine reduces seizure frequency in a high proportion of patients with both newly diagnosed and refractory partial seizures in clinical practice
Seizure Volume 15, Issue 3 , April 2006, Pages 150-155
The antiepileptic efficacy and tolerability of oxcarbazepine, used both as monotherapy and adjunctive therapy, were observed for 1 year in 202 adult patients, aged 17–83 years, with newly diagnosed or refractory partial epilepsy in clinical practice in Italy. At first observation, the seizure free rate was 72.2% in newly diagnosed patients given
monotherapy, 40% in patients in whom oxcarbazepine replaced another monotherapy and 10.3% in patients given oxcarbazepine as adjunctive therapy. At least 50% reduction in seizure frequency was achieved in 90.7, 72 and 57%, respectively. Efficacy increased with the duration of treatment (p < 0.0001). In the 160 completers the seizure free rate was 61.3% with monotherapy and 28% with adjunctive therapy. 16.3% of patients reported adverse effects, mainly sedation and sleepiness; 5% discontinued oxcarbazepine because of adverse events. OXC is an effective and well-tolerated antiepileptic agent for the long-term treatment of partial epilepsy in adults.
03/21/2006
08:21 AM
An audit of electroencephalography requests Use and misuse
Seizure Volume 15, Issue 3 , April 2006, Pages 184-189
To investigate whether electroencephalogram (EEG) requests at St George's Hospital (SGH) are being made according to clinical guideline recommendations.
03/21/2006
08:20 AM
Are there potential problems with generic substitution of antiepileptic drugs
Seizure Volume 15, Issue 3 , April 2006, Pages 165-176
In response to increasing cost pressures, healthcare systems are encouraging the use of generic medicines. This review explores potential problems with generic substitution of antiepileptic drugs (AEDs).
03/21/2006
08:19 AM
Antiepileptic drugs and liver disease
Seizure Volume 15, Issue 3 , April 2006, Pages 156-164
Antiepileptic drugs (AEDs) are no longer restricted to the treatment of epilepsy. These are widely used in a broad spectrum of psychiatric and neurological disorders. Liver plays a major role in the metabolism of a majority of these drugs. Hepatotoxicity is rare, but a real concern when initiating therapy. Likewise, liver disease can adversely affect the biotransformation of some of these drugs.
03/21/2006
08:17 AM
Effect of lamotrigine on sexual function in patients with epilepsy
Seizure Volume 15, Issue 3 , April 2006, Pages 142-149
This open study included 141 patients treated with lamotrigine for a period of 8 months: 79 patients initiated treatment with lamotrigine monotherapy, and 62 were switched to lamotrigine because of lack of efficacy or adverse events to a previous antiepileptic drug (AED). Patients were assessed at baseline and after 4 and 8 months of treatment. In the baseline and final visits the Changes in Sexual Functioning Questionnaire (CSFQ) was applied. Analysis was performed in an intent-to-treat population.
03/21/2006
08:15 AM
Elevated Antitrypsin Is a Risk Factor for Arterial Ischemic Stroke in Childhood
Acta Haematologica 2006;115:186-191
1-antitrypsin (1-AT) is a physiological inhibitor of activated protein C (APC) and therefore decreased APC activity. APC itself causes an anticoagulant effect by inactivating factors Va and VIIIa. The present case-control study was performed to evaluate the role of the elevated 1-AT concentration in pediatric patients with ischemic stroke (IS).
03/21/2006
08:14 AM
The implications of cerebral ischemia and metabolic dysfunction for treatment strategies in neurointensive care
Current Opinion in Critical Care. 12(2):119-123, April 2006
This review outlines recent observations made in a clinical setting that document the extent and degree of cerebral ischemia and metabolic dysfunction after acute brain injury. The intent is to guide clinicians in considering how best to monitor and treat brain metabolism in the intensive care unit.
03/21/2006
08:13 AM
The use of levetiracetam in refractory status epilepticus
Seizure Volume 15, Issue 3 , April 2006, Pages 137-141
Six patients with status epilepticus (SE) of various etiologies refractory to at least two antiepileptic drugs
(AEDs) had complete cessation of their seizures following administration of oral levetiracetam (LEV). Seizure types included convulsive, focal, and nonconvulsive status
epilepticus. Effective doses of levetiracetam ranged from 500 to 3000 mg/day, achieving seizure control within 12–96 h. No significant adverse events were noted. Adjunctive levetiracetam should be considered for patients with status epilepticus unresponsive to initial therapy.
03/18/2006
09:41 AM
Cerebrovascular reactivity and vasospasm after subarachnoid hemorrhage A pilot study
NEUROLOGY 2006;66:727-729
The authors performed serial transcranial Doppler (TCD) and carbon dioxide reactivity (CO2R) testing in 20 aneurysmal subarachnoid hemorrhage patients to determine whether impaired cerebrovascular reactivity was associated with symptomatic vasospasm. Symptomatic vasospasm occurred in 9 of 14 patients with abnormal CO2R and in none of 6 patients with preserved reactivity (p = 0.011). Abnormal CO2R preceded the onset of vasospasm in 7 of 9 patients. Abnormal standard TCD testing was not associated with vasospasm.
03/18/2006
09:51 AM
Modern antiepileptic drugs guidelines and beyond
Current Opinion in Neurology. 19(2):175-180, April 2006
Ten antiepileptic drugs have been licensed since 1990. Their usage will be briefly reviewed focusing on new data and inclusion in guidelines. The hypotheses exploring the underlying basis of pharmacoresistance will be presented.
03/18/2006
09:49 AM
Viruses and the brain from inflammation to dementia
Clinical Science (2006) 110, (393–407)
Many viruses cause encephalitis, but understanding the mechanisms by which viral infection leads to encephalopathy or dementia remain elusive. In many cases, inflammation generated by the host's attempt to combat the infection is itself implicated as a primary factor in causing neuronal dysfunction or degeneration. In this review, we outline the current state of knowledge regarding the pathophysiology of CNS (central nervous system) injury in viral infection.
03/18/2006
09:48 AM
Topiramate in essential tremor
NEUROLOGY 2006;66:672-677
Essential tremor is most prevalent and most disabling in older patients. Additional therapies are required for patients with an inadequate response or intolerable side effects. In small trials, topiramate appeared to be beneficial in essential tremor.
03/18/2006
09:46 AM
Figuring out drawing induced epilepsy
NEUROLOGY 2006;66:723-726
Rare reflex epilepsies are a clinical curiosity but may also give insight into neurocognitive processes. The authors present a patient whose seizures were precipitated by drawing but not by writing. This dissociation complements previous reports on selective impairment of writing. EEG revealed a focus in the right frontal lobe with parietal spread. This is in accord with current cognitive and neural network models of drawing.
03/18/2006
09:45 AM
Epilepsy surgery in patients with malformations of cortical development
Current Opinion in Neurology. 19(2):169-174, April 2006
Patients with malformations of cortical development often suffer from intractable focal epilepsy. This review considers recent progress in the selection and seizure outcome of patients undergoing resective epilepsy surgery for this condition.
03/18/2006
09:44 AM
Brain stimulation for epilepsy can scheduled or responsive neurostimulation stop seizures
Current Opinion in Neurology. 19(2):164-168, April 2006
Scheduled and responsive direct brain stimulation may be an effective and safe therapy for medically intractable epilepsy.
03/18/2006
09:43 AM
Seizure anticipation from algorithms to clinical practice
Current Opinion in Neurology. 19(2):187-193, April 2006
Our understanding of the mechanisms that lead to the occurrence of epileptic seizures is rather incomplete. If it were possible to identify preictal precursors from the EEG of epilepsy patients, therapeutic possibilities could improve dramatically. Studies on seizure prediction have advanced from preliminary descriptions of preictal phenomena via proof of principle studies and controlled studies to studies on continuous multi-day recordings.
03/18/2006
09:53 AM
Alterations in cortisol negative feedback inhibition as examined using the ACTH response to cortisol administration in PTSD
Psychoneuroendocrinology Volume 31, Issue 4 , May 2006, Pages 447-451
Studies using the dexamethasone suppression test (DST) have demonstrated an enhanced negative feedback inhibition at the pituitary in PTSD, but have not provided information about central feedback effects, since dexamethasone (DEX) does not penetrate the brain well. The authors therefore examined the change in ACTH and cortisol before and after cortisol administration, which acts at central feedback sites in addition to peripheral targets.
03/18/2006
09:42 AM
Recurrent stroke and cardiac risks after first ischemic stroke
NEUROLOGY 2006;66:641-646
Few population-based studies with long-term follow-up have compared risk of recurrent stroke and cardiac events after first ischemic stroke. The relative risk of these two outcomes may inform treatment decisions.
03/18/2006
09:40 AM
Thrombolytic therapy of acute ischemic stroke during pregnancy
NEUROLOGY 2006;66:768-770
The authors report eight pregnant women with acute ischemic stroke treated with thrombolysis (rt-PA [recombinant human tissue plasminogen activator] or urokinase). Seven women recovered. Two extracranial and two asymptomatic intracranial hemorrhages complicated treatment; one woman died of arterial dissection complicating angiography. Three patients had therapeutic abortions, two fetuses were miscarried, and two babies were delivered healthy. Although pregnant women may be treated safely with thrombolytics, risks and benefits to mother and fetus must be carefully weighed.
03/18/2006
09:32 AM
Increasing the specificity of diagnostic criteria for schwannomatosis
NEUROLOGY 2006;66:730-732
Diagnostic criteria for schwannomatosis have been proposed in a recent consensus statement. These criteria permit schwannomatosis to be distinguished from neurofibromatosis type 2 (NF2) in most patients, but there is some clinical overlap between the two diseases. In this study, the authors use data from the population-based United Kingdom NF2 Registry to recommend modifications that increase the specificity of the schwannomatosis diagnostic criteria.
03/18/2006
09:30 AM
Different degrees of right to left shunting predict migraine and stroke Data from 420 patients
NEUROLOGY 2006;66:765-767
The authors analyzed the extent of right-to-left shunting in patients with migraine, patients with cryptogenic stroke, and controls. Patients with both migraine and stroke had larger shunts than did patients with migraine without stroke (p = 0.038), patients with no migraine with stroke (p = 0.007), and control patients (p < 0.0001). Patients with migraine have overall larger shunts than nonmigraineurs, particularly if they have had a stroke. Right-to-left shunting may be causally related to migraine and to the increased stroke risk of migraine.
03/18/2006
09:30 AM
Haptoglobin and the development of cerebral artery vasospasm after subarachnoid hemorrhage
NEUROLOGY 2006;66:634-640
Vasospasm is a prolonged constriction of a cerebral artery that is induced by hemoglobin after subarachnoid hemorrhage
(SAH). The subarachnoid blood clot also contains the protein
haptoglobin, which acts to neutralize hemoglobin. Because the haptoglobin gene is dimorphic, a person can expresses only one of three types of haptoglobin (1–1, 1–2, or 2–2) depending on the subunit genes he or she inherits. Each of these three haptoglobin types has different antihemoglobin activities; therefore, haptoglobin may influence the development of vasospasm differently in various patients with
SAH.
03/17/2006
10:33 AM
The treatment of anomia using errorless learning
Neuropsychological Rehabilitation Volume 16, Number 2 / April 2006 129 - 154
In the contemporary literature, errorless learning is thought to have benefits over more traditional trial-and-error methods. The most prominent investigations of errorless learning are those designed for rehabilitation of severe memory impairments, including numerous demonstrations of effective amelioration of word-finding difficulties.
03/17/2006
10:31 AM
The use of memorised verbal scripts in the rehabilitation of action disorganisation syndrome
Neuropsychological Rehabilitation Volume 16, Number 2 / April 2006 155 - 177
We report data on the rehabilitation of action disorganisation syndrome (ADS). Although prior attempts to rehabilitate everyday actions in our patient, FK, had proved unsuccessful, we report positive results from using a verbalisation strategy. FK was taught a poem based on the steps involved in making a cup of tea. Following training, the everyday action was performed more successfully than prior to training, with the order of the actions in particular being improved when the poem was applied. In addition, there was evidence of error monitoring being carried out contingent on the verbalisation strategy. Across training sessions FK also became more likely to apply the poem and to perform the actions without prompting. However, there was relatively weak training effects across sessions, and the beneficial effects did not transfer to new tasks or to the same task with a different key object. The utility of the approach for severe cases of ADS is discussed.
03/17/2006
10:30 AM
Transfer of training effects in stroke patients with apraxia An exploratory study
Neuropsychological Rehabilitation Volume 16, Number 2 / April 2006 213 - 229
The goal of the present study was to examine the transfer of the effects of cognitive strategy training for stroke patients with apraxia from trained to non-trained tasks. In strategy training, the occurrence of transfer is expected as the training programme is aimed, not at relearning specific tasks, but at teaching patients new ways to handle the problems resulting from the impairment. Exploratory analyses were conducted on data previously collected in a randomised controlled trial on the efficacy of the strategy training. A total of 113 left hemisphere stroke patients were randomly assigned to a strategy training group and a group receiving occupational therapy as usual. Assessment of apraxia, motor functioning and activities of daily living (ADL) took place at baseline, after an eight-week treatment period, and five months after baseline. The primary outcome measure consisted of standardised ADL observations of trained and non-trained tasks. The analyses showed that in both treatment groups, the scores on the ADL observations for non-trained tasks improved significantly after eight weeks of training as compared with the baseline score. Change scores of non-trained activities were larger in the strategy training group as compared with the usual treatment group.
03/17/2006
10:27 AM
Flooding treatment of phobia to having her feet touched by physiotherapists in a young woman with Downs syndrome and a traumatic brain injury
Neuropsychological Rehabilitation Volume 16, Number 2 / April 2006 230 - 236
This case study describes the treatment of a 32-year-old woman with Down's syndrome and a recent head injury, for phobia to treatment of her feet by physiotherapists. The phobia had the potential to severely limit rehabilitation progress in terms of the client regaining the ability to stand, assist with transfers (including to and from a car), and walk. A single session, in vivo, flooding intervention was used. The treatment resulted in a substantial change in tolerance of physiotherapists' touching of feet to the extent rehabilitation was able to proceed within the bounds of expectation had a phobia not been evident. Benefits were maintained at multiple follow-ups. The results of the case study extend the evidence for the utility of such behavioural interventions to people with complex disability and unusual phobias in neurological rehabilitation systems.
03/17/2006
10:25 AM
Hemodynamic and electrophysiological relationship involved in human face processing Evidence from a combined fMRI ERP study
Brain and Cognition Volume 60, Issue 2 , March 2006, Pages 176-186
Functional magnetic resonance imaging (fMRI) and event-related potential (ERP) experiments were conducted in the same group of subjects and with an identical task paradigm to investigate a possible relationship between hemodynamic and electrophysiological responses within the brain. The subjects were instructed to judge whether visually presented stimuli were faces or houses and then press the corresponding button. Functional MRI identified face- and house-related regions in the lateral and medial part of the fusiform gyrus, respectively, while ERP showed significantly greater N170 negativity for face than for house stimuli in the temporo-occipital electrodes. Correlation analysis between the BOLD signal in the fusiform gyrus and ERP parameters demonstrated a close relationship between the signal and both latency and amplitude of N170 across the subjects. These correlations may indicate that the variation in cognitive demand and hemodynamic responses during the face/house discrimination task is coupled with the variation of N170 peak latency/amplitude across the subjects. Thus, integrative analysis of spatial and temporal information obtained from the two experimental modalities may help in studying neural correlates involved in a particular cognitive task.
03/17/2006
10:24 AM
Cognitive functioning after medial frontal lobe damage including the anterior cingulate cortex A preliminary investigation
Brain and Cognition Volume 60, Issue 2 , March 2006, Pages 166-175
Two patients with medial frontal lobe damage involving the anterior cingulate cortex (ACC) performed a range of cognitive tasks, including tests of executive function and anterior attention. Both patients lesions extended beyond the ACC, therefore caution needs to be exerted in ascribing observed deficits to the ACC alone. Patient performance was compared with age and education matched healthy controls. Both patients showed intact intellectual, memory, and language abilities. No clear-cut abnormalities were noted in visuoperceptual functions. Speed of information processing was mildly reduced only in Patient 2 (bilateral ACC lesion). The patients demonstrated weak or impaired performance only on selective executive function tests. Performance on anterior attention tasks was satisfactory. We tentatively suggest that our findings are inconsistent with anterior attention theories of ACC function based on neuroimaging findings. We propose that the data may imply that the ACC does not have a central role in cognition. We speculate that our findings may be compatible with the view that the ACC integrates cognitive processing with autonomic functioning to guide behaviour.
03/17/2006
10:21 AM
Pattern of Vascular Dementia in India Study of Clinical Features Imaging and Vascular Mechanisms From a Hospital Dementia Registry
Journal of Stroke and Cerebrovascular Diseases Volume 15, Issue 2 , March-April 2006, Pages 49-56
Vascular dementia (VaD) is heterogeneous in its clinical, imaging, and etiological characteristics. Although VaD is common in India, its pattern is not completely known. In a hospital-based cohort, we aimed to characterize VaD by its subtypes and study patterns of risk factors and clinical, and neuropsychological profiles. Vascular mechanisms, known to have racial and genetic variations were identified. NINDS-AIREN criteria were used to diagnose VaD. Patients were subtyped into subcortical, cortical, cortical-subcortical, and strategic infarct dementia. Vascular mechanisms were detected by vascular imaging, cardiac evaluation, and laboratory tests. In the 42 consecutive patients with VaD, subcortical dementia was the most common type (52.4%), followed by cortical-subcortical (26.2%), strategic infarcts in (14.3%), and cortical dementia (7.1%). Stroke (81%), hypertension (71.4%), and diabetes (35.7%) were important risk factors. Small artery disease was the underlying vascular mechanism in 42.9%; intracranial large artery disease, in 16.7%; extracranial disease, in 2.3%; cardioembolism, in 2.3%; multiple mechanisms, in 19%; and unknown, in 16.7%. Subtypes were similar in risk factor profile and neuropsychological features but differed in clinical characteristics and vascular mechanisms. Gait disorder (59.1% vs. 0%) and urinary symptoms (77.3% vs. 16.7%) were more common in subcortical dementia than in strategic infarct dementia (P < .05). Small artery disease was most common in subcortical dementia (72.7%). Intracranial large artery disease was associated |
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