News

Organized and early acute stroke treatment has been shown to improve functional deficits, reduce the need for institutionalization after stroke, and reduce patient mortality. Today, stroke research has evolved to incorporate an integrated, multidisciplinary treatment approach. Data from a study done in 2005 in Ontario, Canada, demonstrate the utility of providing rapid and integrated acute stroke treatment in a real-world setting. The study evaluated functional outcomes associated with rehabilitation services that are part of a flagship stroke treatment program initiated by the Ontario government. The hope for the future is that this approach to patient management will reduce associated health care costs, which are anticipated to increase dramatically in the coming decades.

Sudden infant death syndrome (SIDS) is the leading cause of postneonatal death in the United States.1 This unfortunate disorder is characterized by the sudden, unexpected death of an of infant between ages 1 and 12 months whose cause of death remains a mystery in the aftermath of a thorough postmortem examination that includes an autopsy, an investigation of the death scene, and a careful review of the infant's medical history. New research, published in the November 2006 issue of The Journal of the American Medical Association,2 that made recent headlines confirmed earlier research by the same investigative team3,4 showing that serotonergic brain stem abnormalities may be the at the root of SIDS.

In recent months, it's been the rare week that doesn't come with a report about the dangers of antidepressants. These drugs do have their drawbacks, but the dangers they pose are not their main problem. Their biggest shortcoming is that they don't work very well; fewer than half of the patients treated with them get complete relief, and that relief takes an unacceptably long time 2 o 3 weeks t kick in.

Letters to the Editor

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.

A panel of Proteonomic Biomarkers found withinCerebrospinal fluid (csf) may be the key to early differentiationOf alzheimer disease (AD) from other dementias.

The connection between Parkinson disease (PD) and melanoma is becoming increasingly apparent, leading some researchers to call for increased melanoma screening in the PD population. In addition, researchers are disproving previous theories that levodopa may be implicated in the link between melanoma and PD.

Patients with PD may be at more than twice the risk for the development of malignant melanoma than the general population, according to research by John M. Bertoni, MD, PhD, professor and chair of the Department of Neurology at Creighton University, Omaha, and colleagues.1 He presented the results of this research at the American Neurological Association's 131st Annual Meeting this past October in Chicago.

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.

Freud

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

Cerebral Palsy: A Multisystem Review