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Moffat et al. examined the association between Alzheimer disease (AD) risk and endogenous total and free testosterone before diagnosis in 574 men from the Baltimore Longitudinal Study of Aging. Increased free testosterone index (FTI) but not total testosterone was associated with decreased risk of AD after covariate adjustment (26% reduction per 10 nmol/nmol increase in FTI).
see page 188
Low androgenization in elderly subjects with AD
Paoletti et al. found that androgen bioavailability was lower in 96 lean elderly subjects with AD than in 104 age-matched lean control subjects. Thus endocrine pattern may impair cognitive function and may be dependent on increased sex hormone binding globulin levels.
see page 301
The accompanying editorial by Henderson and Hogervorst points out that testosterone reduces formation of ß-amyloid and hyperphosphorylation of tau protein in animal models of AD and may enhance specific cognitive skills in men. For hypogonadal men who are otherwise healthy, they note the possibility that interventions to increase free testosterone could reduce their risk of developing AD. However, whether testosterone might actually reduce AD incidence for hypogonadal men can best be answered in the context of randomized clinical trials. One strategy would be to target men who were both hypogonadal and at increased genetic risk for AD. Over 800,000 middle-age and elderly American men already use testosterone supplements, and preliminary clinical trials have begun to assess whether testosterone therapy can improve dementia symptoms in hypogonadal men with AD.
see page 170
Unilateral pallidotomy vs bilateral subthalamic nucleus stimulation in PD
Esselink et al. demonstrated in a randomized single-blind, multicenter trial of 34 patients with Parkinson disease (PD) that bilateral STN stimulation is more effective than unilateral pallidotomy in reducing symptoms in advanced PD.
see page 201
A twin study of essential tremor
Lorenz et al. studied essential tremor (ET) in 109 elderly Danish twins and found concordance rates for monozygotic twins of 77% to 93% compared to 25% to 59% for dizygotic twins. This evidence for heritability suggests the need for further linkage studies in families with ET.
see page 208
Central sensitization for itch
Normally painful stimuli can elicit itch in chronic itch patients. This phenomenon corresponds to pain induced by pruritic stimuli in chronic pain patients. Ikoma et al. provide evidence for a new type of central sensitization to C-fiber input beyond A-fiber mediated allodynia and punctate hyperalgesia.
see page 212
Reproductive health and testicular function in men with epilepsy
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Bauer et al. studied testicular function in 200 men with epilepsy treated with one antiepileptic drug or untreated vs 105 healthy men. Epilepsy, and in particular, temporal lobe epilepsy was associated with reduced free testosterone and total testosterone. Testosterone was further reduced in men on carbamazepine.
see page 243
Isojärvi et al. evaluated reproductive function and testicular volume in men with epilepsy. Sperm abnormalities were found in men taking carbamazepine, oxcarbazepine, or valproate. The results also suggested that valproate may be associated with reduced testicular volume by ultrasonography in men with generalized epilepsy.
see page 247
The accompanying editorial by John R. Gates notes that these two articles provide important new information concerning the effects of epilepsy and medication on male gonadal function, altering both hormone levels as well as sperm morphology. The Bauer et al. study is particularly important because it includes epilepsy patients not on medication.
see page 174
Pure sleep epilepsies and seizures while awake
Patients who have had seizures only during sleep may nonetheless be concerned about the occurrence of a seizure while awake. In this prospective study of 161 patients by D’Alessandro et al., the estimated risk was 13% during 6 years of follow-up. It was 6.5% for patients with low sleep seizure frequency and good compliance with therapy.
see page 254
Hereditary spastic paraplegia with thin corpus callosum
Casali et al. show that hereditary spastic paraplegia with thin corpus callosum (HSP-TCC), which has been considered rare outside Japan, is frequent in Italy. The phenotype is fairly homogeneous, and includes impaired cognition. There are at least two loci for HSP-TCC, one of which is on chromosome 15q13-15.
see page 262
Successful treatment of infantile spasms with zonisamide
Lotze et al. studied the effectiveness of zonisamide in 23 patients with symptomatic infantile spasms. Six patients (26%) had complete control: spasm cessation and clearing of hypsarrhythmia.
see page 296
Language regression during topiramate therapy
Gross-Tsur and Shalev report three children with epilepsy whose language regressed during topiramate therapy. Recovery followed reduction or cessation of topiramate.
see page 299
Fat intake and cognitive function
Kalmijn et al. found that marine omega-3 polyunsaturated fatty acids and fatty fish intakes were related to a decreased risk of impaired cognitive function and speed among 1,613 middle-aged subjects, whereas higher dietary cholesterol intake was associated with an increased risk of impaired memory and flexibility.
see page 275
The impact of pregnancy on the metabolism of lamotrigine
Pennell et al. studied pregnant women on lamotrigine monotherapy. Lamotrigine clearance (daily dose/serum concentration) progressively increased throughout pregnancy, peaking at >330% of baseline at 32 weeks gestation.
see page 292
MRI suggests high altitude cerebral edema is vasogenic
Wong et al. report a patient with high altitude cerebral edema in which diffusion-weighted imaging suggested a vasogenic mechanism.
see page 335
The prevalence of migraine in neurologists
Neurologist Oliver Sacks, in correspondence, notes in response to the earlier paper by Evans et al. (Neurology 2003;61:1271–1272) that his own classical migraines were one of the reasons he was attracted to neurology and why he chose migraine as the topic of his first book.
see page 342
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