NeuroTherapeutics, Evidence-Based Neurology, and Clinical Equipoise With this issue we inaugurate a new section—NeuroTherapeutics—which will be edited by Ira Shoulson, Assistant Editor. The scope and objectives of this new section are outlined in an editorial by Dr Shoulson Article, and the first review, "Parkinson Disease, the Effect of Levodopa, and the ELLDOPA Trial," by FahnArticle, appears in this issue. We invite scholarly and well-focused reviews directed at NeuroTherapeutics. Dr Fahn's review provides a comprehensive, critical assessment of the clinical value and limitations of levodopa therapy in Parkinson disease. His contribution is a masterpiece on this subject and will be an indispensable reference. Critical Illness Neuropathy and Myopathy Gutmann and GutmannArticle provide a review of severe weakness with respiratory failure that develops in patients as a complication of critical illness in the intensive care unit setting. Specific syndromes are defined and contrasted with other, similar disorders, such as myasthenia gravis and the Guillain-Barré syndrome. They place into clear focus our current understanding of critical illness neuropathy and myopathy. Sensory Polyneuropathy Wolfe and colleaguesArticle describe their extensive experience with patients who have chronic sensory-predominant polyneuropathy. This is a relatively homogeneous, stable to slowly progressive polyneuropathy syndrome. Their findings are put into perspective in an editorial by DyckArticle. Emphasis on the treatment of painful sensorimotor polyneuropathy is an invaluable and important contribution in the comments of Dyck. Visually Triggered Headache Cao and colleaguesArticle describe their experience with patients who have migraine by studying occipital cortex activation during visual stimulation using functional magnetic resonance imaging. They find linkage between spreading depression, vasodilation, and the induction of headache. HLA and Multiple Sclerosis Kwon et alArticle describe their experience with HLA class II alleles and haplotypes conferring susceptibility to multiple sclerosis in Israel. A significant association between HLA alleles and multiple sclerosis in this population has been established. Huntington Disease Gene Carriers Kirkwood and colleaguesArticle describe longitudinal changes in cognitive and motor function among clinically presymptomatic individuals carrying the Huntington disease allele. If carefully measured, subtle psychomotor alterations occur prior to the overt onset of signs sufficient to make a clinical diagnosis in individuals who have inherited the Huntington disease allele. Iron Levels in Huntington Disease Bartzokis et alArticle have quantified in vivo brain ferritin iron levels in patients with Huntington disease compared with controls. Iron levels are significantly increased in Huntington disease early on and offer opportunities for potential therapy. Brain Magnetic Resonance Images and Creutzfeldt-Jakob Disease Bahn and ParchiArticle have evaluated 4 patients with Creutzfeldt-Jakob disease (CJD) using diffusion-weighted brain magnetic resonance imaging (MRI). They demonstrated bilateral hyperintensity in the basal ganglia in all 4 patients, including 1 patient with a striking abnormality in the thalamus. Two of these patients also had hyperintensity in the cerebral cortex. Thus, diffusion-weighted MRI provides a highly sensitive and additional new modality to diagnose CJD. They are careful to point out that specificity for CJD needs to be considered in future studies. Aging and Dementing Many questions still remain as to the relationship between age, aging, and dementing disorders. von Strauss and colleaguesArticle have attempted to estimate the occurrence of dementia in the very old, including nonagenarians. Psychosis and Parkinson Disease Aarsland and colleaguesArticle describe their combined experience in Norway and in the United States in patients with Parkinson disease who have hallucinations and delusions. Clearly, more advanced and widespread brain changes increase the risk that patients with Parkinson disease receiving levodopa therapy will develop these manifestations. Treating Seizures With Vigabatrin vs Carbamazepine Zamponi and CardinaliArticle provide good evidence that these 2 anticonvulsants have similar efficacy and should be equally considered in treating children with newly diagnosed partial epilepsy. Seizures and HIV Pascual-Sedano et alArticle point out that new-onset seizures are infrequent in patients with HIV infection, but they do occur. It seems reasonable to evaluate the presence of HIV infection in at-risk patients with new-onset seizures when more common causes are not found. Reflex Sympathetic Dystrophy Wasner and colleaguesArticle define reflex sympathetic dystrophy and then define pathophysiological mechanisms of vascular abnormalities associated with this syndrome. They find a loss of cutaneous, sympathetic vasoconstrictor activity due to autonomic dysfunction in the central nervous system. These findings are put into perspective in an authoritative editorial by SchwartzmanArticle.
Archives of Neurology – American Medical Association
Published: May 1, 1999
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