“Fatigue,” noted Dr. Shy of Wayne State University, Detroit, “is a big issue for many patients with inherited neuropathies, and hopefully this will provide a new approach to help treat it.”
J Neurol Neurosurg Psychiatry. 2008;79(7):829-831; 743-744.
Basal Ganglia Stimulation Reduces Tic Severity in Tourette Syndrome
NEW YORK, July 29 (Reuters Health)—Basal ganglia stimulation may offer substantial improvement for some patients with Tourette syndrome, according to a report in the July issue of the Archives of Neurology.
Previous attempts at stimulation of the thalamus and internal part of the globus pallidus have yielded variable effects on tics, the authors explained. Dr. Marie-Laure Welter from Hôpital de la Salpêtrière, Paris, and colleagues evaluated the efficacy of high-frequency stimulation of two associative-limbic relays (the centromedian-parafascicular complex of the thalamus and the ventromedial part of the internal globus pallidus) in three patients with severe, medically refractory Tourette syndrome.
All three patients experienced a marked improvement in tic severity within hours to days after the operation, the authors reported. The best improvement in tic severity was obtained with ventromedial internal globus pallidus stimulation. With stimulation, one patient was able to discontinue dopamine antagonist medication, and another was able to reduce the dosage of such medication by 66%. Stimulation also dramatically reduced self-injurious behaviors in one patient and resolved the moderate generalized anxiety disorder in another patient, the report indicated. Neuropsychological status remained stable in all patients.
The effects of stimulation were sustained or increased during the two-month study period in two patients, the investigators said, but the improvement decreased or disappeared after two months in the third patient.
“This study suggests that high-frequency stimulation of the ventromedial part of the internal globus pallidus can produce a marked reduction in tic severity in patients with Tourette syndrome,” the authors concluded, “which is in the process of being tested in a large patient population.”
Arch Neurol. 2008;65(7):952-957.
Gene Variant Increases Cardiovascular Risk in Women With Migraine
NEW YORK, July 30 (Reuters Health)—In women who have migraine with aura, the presence of the 677TT genotype for the methylenetetrahydrofolate reductase (MTHFR) gene increases the risk of cardiovascular disease, according to a report in the online July 30 issue of Neurology.
This effect was primarily due to a markedly increased risk of stroke in TT genotype carriers, Dr. Tobias Kurth, from Brigham and Women’s Hospital in Boston, and colleagues stated.
Because the biologic pathways linking migraine with aura to ischemic vascular events remain unclear, it would be premature, at this point, to recommend genetic testing for migraine patients, the team stated. Instead, clinicians should continue to counsel their migraine patients about modifiable cardiovascular risk factors.
The new findings are based on a study of 25,001 white US women who were enrolled in the Women’s Health Study and had information on the MTHFR 667C>T polymorphism. At baseline, 3,226 women reported active migraines, including 39.5% with auras. A total of 625 cardiovascular events were logged during an average of 11.9 years of follow-up.
On multivariate analysis, the TT genotype was associated with a slightly reduced risk of migraine with aura. In and of itself, the TT genotype did not raise the risk of cardiovascular disease. However, in the presence of migraine with aura, an additive effect on risk was seen: The relative risk of cardiovascular disease was 2.06 for migraine with aura without the TT genotype and 3.66 for migraine with aura with the TT genotype. The relative risk of ischemic stroke was 4.19 in migraine with aura patients who had the TT genotype. By contrast, no elevated risk of myocardial infarction was noted.
“Our results warrant replication in other large cohorts with information on migraine and aura status according to the International Headache Society criteria,” the authors stated. “In particular, age- and gender-specific effects need to be considered.”
Neurology. 2008 July 30; [Epub ahead of print].