New and Noteworthy Information—December 2015
The risk of epilepsy is increased in children with hospital-diagnosed pertussis infections, compared with the general population, but the absolute risk is low, according to a Danish study published in the November 3 issue of JAMA. Researchers used data from population-based medical registries covering all Danish hospitals to identify all patients with pertussis born between 1978 and 2011 and followed up through 2011. Investigators used the Civil Registration System to identify 10 individuals from the general population for each patient with pertussis, matched on sex and year of birth. They identified 4,700 patients with pertussis, of whom 90 developed epilepsy during the follow-up. The cumulative incidence of epilepsy at age 10 was 1.7% for patients with pertussis and 0.9% for the matched comparison cohort.
Chronic users of antiepileptic drugs have poorer standing balance, compared with nonusers, according to a longitudinal twin and sibling study published in the November issue of Epilepsia. Researchers studied 26 twin and sibling pairs. Siblings were of the same gender, but only one in each pair had exposure to antiepileptic drugs. Clinical and laboratory balance examinations were conducted twice, and at least one year elapsed between examinations. The mean within-pair differences in balance measures were calculated cross-sectionally at baseline and follow-up, and longitudinally. Researchers found no significant mean within-pair difference at baseline in age (mean, 44), weight, and height. Cross-sectional sway measures from posturography and clinical static balance tests showed poorer performance in antiepileptic drug users, compared with nonusers, on several test conditions at baseline and follow-up.
Treatment for symptomatic intracerebral hemorrhage (sICH) after thrombolysis for stroke does not significantly reduce the likelihood of in-hospital mortality or hematoma expansion, according to a retrospective study published online ahead of print October 26 in JAMA Neurology. Of 3,894 patients treated with IV rt-PA within 4.5 hours after onset of ischemic stroke symptoms, 128 had sICH. The median time from initiation of rt-PA to sICH diagnosis was 470 minutes, and the median time from diagnosis to treatment of sICH was 112 minutes. The in-hospital mortality rate was 52.3%, and 26.8% of participants had hematoma expansion. In multivariable models, code status change to comfort measures after sICH diagnosis was the sole factor associated with increased in-hospital mortality. Severe hypofibrinogenemia was associated with hematoma expansion and occurred in 36.3% of patients without hematoma expansion.
Gaucher disease or mutations in the β-glucocerebrosidase gene (GBA) may protect individuals from deficiency in visual color discrimination, according to a study published September 14 in Journal of Parkinson’s Disease. Investigators tested groups of patients on the Farnsworth-Munsell 100 hue test (FMHT) and calculated their mean Total Error Scores (TES). Patients were classified as having Parkinson’s disease only, Gaucher disease only, Parkinson’s disease and Gaucher disease, GBA mutations, GBA mutations and Parkinson’s disease, or as controls. Patients with Parkinson’s disease only had the highest mean TES, and patients with Gaucher disease only had the lowest mean TES. GBA carriers without Parkinson’s disease made more errors than patients with Gaucher disease only, which was approximately the same number of errors as healthy controls.
Brain scans of people in a coma may help predict who will regain consciousness, according to a study published online ahead of print November 11 in Neurology. Researchers compared 27 prospectively recruited comatose patients who had severe brain injury (14 with traumatic injury and 13 with anoxic injury) with 14 age-matched healthy participants. Standardized clinical assessment and functional MRI were performed at an average of four days after withdrawal of sedation. Patients who were comatose showed a significant disruption of functional connectivity of brain areas spontaneously synchronized with posterior cingulate cortex, regardless of etiology of injury. The functional connectivity strength between the posterior cingulate cortex and the medial prefrontal cortex was significantly different between comatose patients who subsequently recovered and those who subsequently scored an unfavorable outcome three months after brain injury.
Raloxifene does not have a significant cognitive effect for women with Alzheimer’s disease, according to a study published online ahead of print November 4 in Neurology. Investigators conducted a randomized, double-blind, placebo-controlled pilot study with a planned treatment period of 12 months. Women with mild to moderate late-onset Alzheimer’s disease were randomized to high-dose (ie, 120 mg) oral raloxifene or identical placebo provided once daily. Forty-two women randomized to raloxifene or placebo were included in intent-to-treat analyses, and 39 women contributed 12-month outcomes. Results on the Alzheimer’s Disease Assessment Scale, cognitive subscale showed no cognitive benefits in the raloxifene-treated group. Raloxifene and placebo groups did not differ significantly on secondary analyses of dementia rating, activities of daily living, behavior, or a global cognition composite score.
