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Cover Article
Neurotrophic Factors, and Foibles, in Stroke Research
Nerve growth factor, brain-derived neurotrophic factor, and basic fibroblast growth factor have had beneficial effects in animal models of stroke, but these neurotrophic factors may be the newest additions to the growing list of therapeutic agents for stroke that have failed in clinical trials. With neuroprotection following stroke as elusive as ever, researchers are beginning to rethink their methods for evaluating new agents for the treatment of stroke.
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Cover Article
When a Headache Isn't Just a Headache
More than one third of headaches seen in general office practices are
attributable to serious underlying neurologic disease, contends Casilda
Balmaceda, MD. She offers key points and caveats in the diagnosis of
potentially serious head pain syndromes—ranging from headaches
associated with subarachnoid hemorrhage, stroke, and vascular problems
to those signifying brain tumor, infections, ophthalmologic emergencies,
and rheumatologic disorders.
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Cover Article
Are Stroke Patients Getting the Message? One Study Finds Growing Delays in Time to Hospital Presentation
The advent of thrombolytic therapy for ischemic stroke has prompted many public education campaigns aimed at informing the public that stroke is a medical emergency with a limited therapeutic window. But are such efforts working? One recent study, performed after a public awareness campaign, found that time from symptom onset to hospital presentation has actually increased compared with data from a similar study performed in 1992 (before the FDA approval of t-PA).
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Cover Article
Can
Cognitive Decline Be Predicted?
Can normal age-related cognitive decline be distinguished from
preclinical dementia? Ronald Petersen, MD, says yes. He and colleagues
at the Mayo Clinic posit that age, an index of learning, delayed
recall, a higher-order delayed recall term, and a global deterioration
measure are all accurate indicators of potential cognitive decline,
as is a patient's subjective perception of his or her own cognitive
ability.
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Cover Article
How
Heavy Is the Burden of Poststroke Spasticity?
About 20% of stroke patients suffer some level of spasticity;
but according to Chris Kozma, PhD, "the impact of spasticity
on poststroke patients’ quality of life has not been thoroughly
investigated." He and colleagues determined that patients
with poststroke spasticity had lower quality of life scores than
did patients with chronic diseases such as hypertension, diabetes,
or congestive heart failure. His estimates may even understate
the problem, he contends, since "the correlation between
standard measures of spasticity and quality of life are generally
low."
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Cover Article
Manipulating
the Brain Barrier—A Realistic Therapeutic Goal?
Researchers are taking a closer look at the blood-brain barrier,
interested in how they might find ways to cross this seemingly
insuperable obstacle to deliver drugs to the brain, or, conversely,
to protect the integrity of the barrier in hopes of preventing
such diseases as multiple sclerosis, AIDS, Alzheimer’s disease,
and Parkinson’s disease.
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Cover Article
Interferon
Beta Therapy and MS Disease Progression—Clinical Trials Support Early Treatment
Results of Phase III clinical trials show a benefit of interferon
beta therapy in patients at high risk of developing MS as well
as in those with clinically definite relapsing-remitting MS. However,
evidence of efficacy in the later stages of the disease is less
clear, prompting some researchers to wonder whether some patients
are "too far down the pathway of secondary progressive MS to benefit"
from treatment.
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Cover Article
Rethinking
Stroke Risks—Lifelong Hypertension and Valvular Disease Emerge As Strong Stroke Predictors
Hypertension is a well-known stroke risk factor, but is current blood
pressure the only measure that counts? New research indicates that past
periods of high blood pressure are also a strong predictor of stroke
in elderly patients, even if current blood pressure is normal. Other
research suggests that valvular heart disease is a stronger predictor
of stroke than has been previously recognized.
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Cover Article
Scanning
for a Better Diagnosis: Advanced Imaging Aids in Rapid Stroke Assessment
Once regarded only as a research tool, diffusion-weighted imaging is
gradually reaching clinical practice. Early evidence indicates that
this advanced MRI technology can be a valuable tool in patient evaluation
by facilitating rapid lesion assessment, which has led to more appropriate
treatment and a better outlook on prognosis.
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Cover Article
Febrile
Seizures Remain a "Hot Topic"—Are They Benign or Not?
Although the prognosis is "by and large…favorable," febrile
seizures have not been completely exonerated as a risk factor for epilepsy.
"Simultaneous advances" on several fronts, including molecular
genetics, "are rapidly causing the subject of febrile seizures
to heat up."
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Cover Article
Yesterday's
Toxin, Today's Treatment—A Host of New Uses?
Over the past decade, botulinum toxin has moved to center stage as a
promising treatment for a growing number of neuromuscular disorders.
Although it is still approved only for strabismus, blepharospasm, and
hemifacial spasm, suggested indications have expanded to include focal
dystonia, focal spasticity, tremor, migraine, myofascial pain, and a
host of other new uses. This report from a recent major international
conference covers the latest data supporting the current explosion in
potential clinical applications.
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Cover Article
Is It Time to Revisit the
"Myths" of Neurosurgery?
The assumptions underlying some of neurosurgery's traditional practices warrant
a closer look, contended researchers at the 49th Congress of Neurological Surgeons.
In a critical analysis, the researchers identified 10 practices and premises that
have failed to pass the tests of rigorous evaluation. From glucocorticoids for
brain injury to viewing the brain as the exclusive surgical domain of the neurosurgeon,
these concepts "may be regarded as neurosurgical myths," they argued.
"Only by questioning the scientific foundations of our daily practice can
we confidently believe in their merit."
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