No abstract

Interest in alternative medical treatments, including acupuncture, is increasing. Alternative treatments must be subjected to the same objective standards as all medical treatments. A non-blinded pilot study of the safety, tolerability, and efficacy of acupuncture (ACUPX) for the symptoms of (PD) was performed. Twenty PD patients (mean age, 68 years; disease duration, 8.5 years; Hoehn and Yahr [H&Y] stage, 2.2; Unified Parkinson's Disease Rating Scale score [UPDRS], 38.7) each received acupuncture treatments by a licensed acupuncturist. All patients were treated with two acupuncture treatment sessions per week. The first seven patients received 10 treatments and the last 13 patients 16 treatments. Patients were evaluated before and after ACUPX with the Sickness Impact Profile (SIP); UPDRS; H & Y; Schwab and England (S & E); Beck Anxiety Inventory (BAI); Beck Depression Inventory (BDI); quantitative motor tests, including timed evaluations of arm pronation supination movements, finger dexterity, finger movements between two fixed measured points, and the stand-walk-sit test; and a patient questionnaire designed for the study. Following ACUPX, there were no significant changes in the UPDRS, H&Y, S&E, BAI, BDI, quantitative motor tests, total SIP or the two SIP Dimension scores. Analysis of the 12 SIP categories not corrected for multiple comparisons revealed a post-ACUPX improvement in the sleep and rest category only (P = 0.03). On the patient questionnaire, 85% of patients reported subjective improvement of individual symptoms including tremor, walking, handwriting, slowness, pain, sleep, depression, and anxiety. There were no adverse effects. ACUPX therapy is safe and well tolerated in PD patients. A range of PD and behavioral scales failed to show improvement following ACUPX other than sleep benefit, although patients reported other discrete symptomatic improvements. A broad battery of tests in PD patients suggested that ACUPX resulted in improvement of sleep and rest only. This finding needs to be verified using more in-depth and controlled evaluation of ACUPX for PD-related sleep disturbance.

Patients with semantic dementia make numerous phonological errors in their immediate serial recall of words that they understand poorly. Previous studies have argued that these errors result from a reduction in the normal contribution made by semantics to the coherence of items in the phonological system. It is possible, however, that the errors might reflect additional subtle phonological deficits. Six patients with semantic dementia were tested on a variety of phonological processing and short-term memory tasks, in order to explore these possibilities. For the most part, the patients showed normal performance in phonological awareness and discrimination tasks and normal effects of phonological similarity and word length in immediate serial recall. The more severely impaired patients, however, showed some weakness on tests of nonword repetition and recall. Every patient showed better recall of words that were still relatively well understood, compared with words that were more semantically degraded. This difference extended to nonwords that were phonologically similar to the known and degraded words, suggesting that the patients' semantic deficits could account for their impairments in nonword recall. The recall advantage for semantically known over degraded items also extended to a nonverbal delayed picture copying task, suggesting that the patients' immediate serial recall impairments were underpinned by a central semantic deficit, and not by a separable lexical deficit.

The purpose of this study to compare the long-term clinical outcome of early versus delayed rasagiline treatment in early Parkinson's disease (PD). Subjects (N = 404) were randomly assigned to initial treatment with rasagiline (early-start group) or placebo for 6 months followed by rasagiline (delayed-start group) in the TEMPO study. Subjects who chose to participate in an open-label extension (N = 306) continued to receive rasagiline as well as other PD medications as needed. Average (+/-SD) duration in the study was 3.6 +/- 2.1 years; 177 subjects received rasagiline for > or =5.0 years. Over the entire 6.5-year follow-up period, the adjusted mean difference in change from baseline in total UPDRS scores was 2.5 units (SE 1.1; P = 0.021) or 16% (SE 5.7; P = 0.006) in favor of the early-start versus delayed-start rasagiline group. Although the interaction between treatment and time was significant, values for the early-start group were better than the delayed-start group across all time points. Significantly less worsening (percent change) in total UPDRS scores was observed in the early-start group at the time points 0.5, 1.5, 2.0, 3.0, 4.5, 5.0, and 5.5 years (P < 0.05). Compared to delayed start, early initiation of rasagiline provided long-term clinical benefit, even in the face of treatment with other dopaminergic agents. This might reflect enduring benefits due to neuroprotection or effects on compensatory mechanisms in early PD.

Transmission of intracranial pressure (ICP) to the perilymph of the cochlea may occur via the cochlear aqueduct and possibly other routes. Indirect measurement of perilymphatic pressure may be investigated by observing tympanic membrane (TM) displacement during stapedial reflex contraction. In a previous study we investigated the effects of changes in ICP on perilymphatic fluid pressure in three patients who underwent ventriculo/lumbar-peritoneal shunt operations. The TM displacement technique proved extremely sensitive and revealed marked changes in cochlear fluid pressure brought about by changes in ICP (Marchbanks et al., 1987). The study has been extended to 58 patients with hydrocephalus, intracranial tumours and other neurological conditions associated with abnormal ICP. Significant differences in the TM displacement were found between patients with raised and normal ICP. We have shown that changes in ICP can affect the hydrostatic pressure of the cochlea and influence the peripheral auditory system. The finding that ICP can be correlated with TM displacement strengthens the association between an abnormal TM displacement and abnormal cochlear hydrostatic status, irrespective of cochlear aqueduct patency. We suggest that the TM displacement technique provides a useful non-invasive method for the assessment of perilymphatic fluid pressure.