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Archive for February, 2015

Spinal cord injury: another step forward.

16 Feb, 15 | by Arun Krishnan, Web Editor

Around the world, spinal cord injury (SCI) is a common and devastating long-term complication of trauma that can result in lifelong disability or even death. There are frequent media reports of treatments that may help patients with SCI walk again and these range from new drugs, to robotic devices to new developments in stem cell research. Despite the hype, the fact remains that there are no treatments that have been proven to definitively alter outcomes in this condition.

One of the major problems with drug trials in SCI is finding a way to measure the response to the drug. Many drugs that are potentially useful may fail in clinical trials because we are not able to accurately determine which patients benefit the most. In other neurological conditions such as multiple sclerosis, the ability to use biomarkers such as MRI has revolutionised our diagnostic and treatment approach, leading to significant gains for patients.

In the current issue of JNNP, Kuhle and colleagues http://jnnp.bmj.com/content/86/3/273.abstract have published a paper which demonstrates that measuring levels of neurofilaments, structural proteins that are present in neurons, may be useful in determining the degree of spinal cord injury. The exciting fact about this paper is that neurofilament levels correlated closely with acute severity of SCI and with the eventual neurological outcomes. The other benefit with this assay was that levels were measured in the blood of patients with SCI, rather than in the cerebrospinal fluid. This makes the assay for more acceptable in the clinical setting. The authors also provide some evidence that neurofilament levels may be responsive to drug treatments and in this case, they have assessed how levels vary according to treatment with minocycline, a medication that has been previously trialled in SCI.

This is a well-designed study. It represents an important step forward in diagnostic methods and treatments for SCI.

Dementia in Parkinson’s disease: what can we do about it?

4 Feb, 15 | by Arun Krishnan, Web Editor

It has been around 200 years since James Parkinson first outlined the clinical features of the condition that would later bear his name. While his descriptions of Parkinson’s Disease (‘shaking palsy’) may have focussed largely around the motor manifestations of this condition, recent insights have provided strong evidence that non-motor manifestations contribute significantly to poor quality of life for patients with this neurodegenerative condition (for an excellent review see the reference below by Jankovic).

Depression, cognitive impairment, sexual dysfunction and constipation are just some of the problems that these patients can develop and it is a source of immense frustration for both patients and clinicians that these problems are so hard to treat. Our current approaches to treating Parkinson’s disease are focussed on medications that really only improve motor outcomes, so what is a neurologist to do when a patient describes the effects of non-motor manifestations on his/her quality of life?

In this issue of JNNP, Wang and colleagues provide a thorough overview of the role of cholinesterase inhibitors as treatments for cognitive impairment in Parkinson’s Disease http://jnnp.bmj.com/content/86/2/135.abstract . These are drugs that have been used in the setting of Alzheimer’s Disease for a number of years. In addition to suggesting that these medications have benefits in Parkinson’s Disease as well as an excellent safety profile, the paper also highlight the fact that the treatments have only been assessed in small clinical trials and that larger studies in this population may be required before they can become an established part of treatment for this condition. Nevertheless, their study provides hope for a major problem which currently remains untreatable.

(1) Jankovic J. Parkinson’s disease: clinical features and diagnosis. J Neurol Neurosurg Psychiatry 2008;79:368-376 doi:10.1136/jnnp.2007.131045

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