Dizziness Update

DIZZINESS
HC-BPPV ( apogeotropic horizontal canal benign paroxysmal positional vertigo ) Tx=Gufoni maneuver
Neurology 2011; E-pub Dec 14

MS Update in Pregnancy

Multiple Sclerosis
Glatiramer acetate = in pregnancy
Continuum 2010;16(5):193-210
Rebif 22 mcg sc qod then 44mcg
(Interferon beta 1-a)
REFLEXION study sc beta I nterferon-1a 44mcg 3X/wk ...early(AAN2012)

Dementia Update Cliffnotes

DEMENTIA
Dementia with Lewy body DLB=Decreased CSF alpha- synuclein
AD=Decreased CSF amyloid-beta 42 (earlier bio-mkr) ⬆total-tau and phospho-tau
Increased soluble amyloid precursor protein beta (sAPP) (Neuro 77;1:7/11)
DLB and AD = 80 % Diagnostic sensitivity
AD with Lewy body pathology 35-40% Diagnostic sensitivity

Brain 2010 Sept 7 2011.......
P300 < 323ms ,>5.0 mV = nml
E. Braverman, Cornell/Harvard

DRUG Treatment of Psychiatric consequences of DementingIllness
1. Impulsive Tx (stealing, sexual) : (Zoloft) sertraline 200mg/d, lamictal, VPA,divalproex,Inderal
2. Agitation /Paranoia : trazodone
3. Delusional : risperidone (ie. delusion of theft)

Mild Cognitive Impairment Treatment
MCI (Neurology 1/10/12 Vanderbilt nicotine patch 15 mg/d...cotinine is the active ingredient (from tobaccoJrnlAD) 2/14/11

CDR ( Clin. Dementia rating scale ) www.wustl.edu Wash U. St. Louis
CDR 3=severe,CDR2=mod, 1=mild,0.5 very mild

PET in diff dementia PLoS One 2011;6(3):e18111

DBS of entorhinal cortex enhances memory in MCI --( NEJM 2012;366:502-510)

✳FTD ( frontotemporal degeneration )
1. Progranulin Blood Test (A@G Pharma) ⬇Progranulin in blood dt Progranulin gene (PGRN) mutation ( Nature 2006)
2.C9ORF72 mutation(Neuron2011;72:245-56;257-68)(Lancet Neurol.3/9/12)

Alzheimer's Disease ⬆plasma Adiponectin (ArchNeurol2012Jan1)

Parkininson's Treatment Breakthrough

Ucla--Synucleinopathies:PD,DLB,MSA
CLR01....a C-shaped complex molecular compound that wrap around the chains of lysine of alpha-Synuclein aggregates removing them. A process-specific mechanism employing transgenic zebra fish model of PD ( A tropical freshwater fish )

Cotinine for Alzheimer's Treatment

A compound derived from tobacco, cotinine, reduced beta-amyloid plaque aggregation in the brain's of mice with the Alzheimer's disease model. The treated mice also performed better on tasks measuring working memory.
Journal of Alzheimer's Disease online Feb 14 2011

Intractable Pain Treatment

Investigators conducted a phase 1 trial of intradermal NP2, a novel gene transfer vector, which was found to be safe and well tolerated for the treatment of intractable pain resulting in pain relief in cancer patients who were unresponsive to morphine or other treatments.
Annals of Neurology online April 2011

Drosophila Model for Alzheimer's Disease

Joshua Shulman,MD,PhD , instructor of neurology at Harvard medical school used the drosophila model for Alzheimer's disease to determine how variants function. The drosophila tauopathy model, which exhibits age-dependent neurodegeneration, decreased lifespan and hyperphophorylated and misfiled tau protein. The model is used to functionally screen candidate genes in AD which may lead to sooner treatment options for afflicted patients.
Arch Neurol 2011; E-Pub Sept 12 2011