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CURRENT SCIENCE REVIEWS By Joe Bruman January 1998 P. 1 of 4 Lim J et al; J Neurosurg 1997;97:955-960: Of 43 PD patients getting pallidotomy with ablation by rf heating, 11 had previous vascular disease, and 3 of those had a delayed stroke in adjacent tissue after 10, 51, and 117 days, respectively. (Doesn't say what kind of "vascular disease"; I should guess that just about any would demand caution in opting for pallidotomy.) Hunter P et al; J Neur N'surg Psych 1997;63:579-583: Resistance of swallowing impairment in PD patients to dopaminergic therapy (levodopa or apomorphine) suggests that PD may affect other centers than the basal ganglia. Becker T et al; J Neur N'surg Psych 1997;63:590-596: Widely variable, depression affects about 40% of PD patients. They studied 30 such patients and 30 matched controls with PD but not depression, by transcranial sonography, and found morphological anomalies in the basal limbic system (mesencephalon), suggesting that PD affects more than the motor centers of the basal ganglia. Olson L; Nat Med 1997;3(12):1329-1335: Review (very technical) of neural regeneration in the central nervous system. Replacement neurons can grow in the peripheral system of most vertebrates, and the central system of some, but not of mammals. There may be an evolutionary reason. Review covers various possible repair strategies, including brief comments on growth factors and fetal tissue grafts in PD. 95 refs. Shimoda-Matsubayashi S et al; Neur 1997;49:1257-1262: There is more than one form of PD. Comparison of patients having chromosome 6-linked autosomal recessive (familial) parkinsonism with controls and those having sporadic PD showed that the familial PD is marked by elevation of Mn superoxide dismutase, an endogenous neurotoxin. Markopoulou K et al; Neur 1997;49:1262-1267: Testing olfactory impairment in family cluster members with and without PD symptoms, they conclude it may be part of the neurodegenerative process and not a pre-existing condition. Tzourio C et al; Neur 1997;49:1267-1272: Trying to explain conflicting studies of smoking and PD, they compared 193 PD cases with 579 matched healthy controls, finding no overall association between smoking and PD. However the inverse correlation markedly weakens with age, suggesting that smoking may be protective in younger cases but not in older ones. Sato Y et al; Neur 1997;49:1273-1278: More frequent hip fracture seems to go with PD. Assuming bone density as a risk indicator, they measured serum levels of calcium and vitamin D metabolite in 71 PD patients, concluding that sunlight-deprived patients may be at greater risk, and that vitamin D supplementation in such patients may reduce that risk. Goetz C et al; Mov Disord 1997;12:1039-1041: Patient diaries are important in clinical trials, but vary in quality. A training videotape of fluctuations shown beforehand to half of a 20-patient cohort improved agreement with professional assessments. CURRENT SCIENCE REVIEWS By Joe Bruman January 1998 P.2 of 4 Turjanski N et al; Mov Disord 1997;12:1035-1038: After a stroke and hematoma, a 36-yr-old woman developed levodopa- responsive parkinsonism but it became stable a year later. PET scan confirmed uptake deficit in the left putamen. Chouinard S et al; Mov Disord 1997;12:973-976: Collected responses from 160 specialists in 24 countries may lead to consensus on diagnostic criteria for essential tremor. Hubble J et al; Mov Disord 1997;12:969-972: Study of a 450-patient database revealed that clinical signs of essential tremor are related (differently) to gender and age. Swinnen S et al; Mov Disord 1997;12:958-968: Tests of standardized coordinated movement of two limbs showed that PD patients did worse than controls, and slowness probably resulted from attempt to compensate for lack of coordination. Soykan J et al; Mov Disord 1997;12:952-957: Although domperidone is a dopamine antagonist, it reduced gastrointestinal symptoms and accelerated gastric emptying without worsening other PD symptoms or interfering with treatment. Ashraf W et al; Mov Disord 1997;12:946-951: Clinical tests and patient diaries confirmed that psyllium produces both subjective and objective relief of constipation related to PD. Smith L et al; Mov Disord 1997;12:935-945: Entacapone enhanced levodopa-induced reversal of motor disability in MPTP marmosets. Dupont E et al; Mov Disord 1997;12:928-934: In controlled study of 97 stabilized PD patients they found that tolcapone may provide additional benefit (reduced LD requirement). Welsh M et al; Mov Disord 1997;12:923-927: Comparison of 27 female PD patients with matched controls showed significant negative difference in sexual experience and function of the PD group. Fitzpatrick R et al; Mov Disord 1997;12:916-922: A standard questionnaire about health-related quality of life identifies problems that are important to outpatients and that seem to be more common among nonclinic attenders. Tixon F et al; Mov Disord 1997;12:910-915: Comparative survey of 20 elderly nondemented PD patients and 2697 healthy controls, counting various measures of dependency, showed that PD is significant factor in dependency of elderly PD patients living at home, and institutionalization of such patients is four times more frequent than among the general population. Federico F et al; Mov Disord 1997;12:903-909: Proton magnetic resonance spectroscopy to measure certain compounds in 12 PD patients, 7 with MSA, 7 with PSP, and 10 healthy controls showed that this noninvasive technique is useful in distinguishing those conditions. CURRENT SCIENCE REVIEWS By Joe Bruman January 1998 P. 3 of 4 Schwarz J et al; Mov Disord 1997;12:898-902: Single-photon-emission computed tomography (SPECT) using the marker [123]iodobenzamide, of 55 non-fluctuating patients having doubtful response to dopaminergic therapy, accurately predicted response to apomorphine, confirming the diagnostic value of IBZM-SPECT. Joyce J et al; Mov Disord 1997;12:885-897: They compared molecular characteristics of midbrain dopamine neurons in cases of Parkinson's disease, Alzheimer's disease, and Alzheimer's with parkinsonism. Although the degree of cell death is different, some other features are similar. Chaudhuri K et al; Mov Disord 1997;12:877-884: Hypotension following a meal sometimes occurs in PD. They fed a standard meal to 20 PD patients (without autonomic failure) and 16 controls, and found the subsequent hypotension, similar to that caused by autonomic failure, to markedly worsen PD symptoms. Gonera E et al; Mov Disord 1997;12:871-876: Retrospective study of 60 PD patients and 58 matched controls indicates that classic (idiopathic) parkinsonism frequently follows a prodromal (undiagnosed) phase of 4 to 6 years. Lozano A et al; Mov Disord 1997;12:865-870: Simultaneous bilateral pallidotomy (of the GPi) on a young boy with severe generalized dystonia but not PD had no immediate benefit, but progressive and marked improvement began 3 days later. Higgins J et al; Mov Disord 1997;12:859-864: Thanks to study of a large family with autosomal-dominant essential tremor and genetic anticipation, they are closing in on the gene. Young M et al; Neur 1997;49:1278-1283: Motor evoked potential (muscle response) to transcranial magnetic stimulation follows a variable "silent" period, which they measured in 12 PD patients before and after receiving stereotactic pallidotomy. Pallidotomy lengthens the silent interval in the contralateral limb but not the ipsilateral, suggesting that it improves the function of cortical motor inhibitory circuits in PD. Barz S et al; Neur 1997;49;1424-1431: To measure the effect of antiparkinson drugs on olfactory impairment in PD, they measured olfactory event-related potential response to stimulus, either of the trigeminal nerve or by presented sample, in 13 PD patients on therapeutic drugs, 18 PD patients not on drug treatment, and 38 matched healthy controls. They found (1) impaired odor identification in PD is independent of drug treatment, (2) OERP latency was prolonged in PD, more in those on drug treatment, (3) trigeminal response was unaffected either by PD or by drug treatment. Jenner P; Arch Neur 1997;54:1508-1509 et al. After years and $millions gambled on drug development, successful firms still must get practicing MDs to prescribe their product. They buy costly ads in this organ of the AMA, ranging from scholarly essays like this one (Athena) to 2-p hard insert (Lederle, generic selegiline) (SmithKline Beecham, Requip) to 4-p hard insert (Upjohn, Mirapex). CURRENT SCIENCE REVIEWS By Joe Bruman January 1998 P. 4 of 4 Login I; Ann Neur 1981;10:398-399: The role of dopamine from the hypothalamus in the pitituitary gland is still obscure. Nearly 2 decades ago, the author observed that the dopamine antagonist domperidone, given as antiemetic to patients taking lisuride for PD, caused hyperprolactinemia (of the pituitary). Further, hypothalamic dopamine is part of the feedback loop that regulates prolactin, and vice versa. But prolactin induced by various other stimuli (implanted pt tumors, haloperidol, estrogen) in animal tests also raised dopamine and dopamine activity in the striatum, a finding of possible interest to PD therapists. The rather supercilious reply to that modest proposal, by a group of higher-ranking establishment members, is about what might be expected today. J. R. Bruman (818) 789-3694 3527 Cody Road Sherman Oaks, CA 91403-5013