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Not All Gait Impairments Are the Same

By: Jordana Bieze Foster Although previous findings have suggested that certain gait impairments in patients with diabetes are specifically linked to neuropathy, researchers from Loma Linda University in California also have found gait abnormalities in patients with type 2 diabetes who did not have neuropathy. In comparing 15 subjects with nonneuropathic diabetes with 16 control subjects, the investigators found significant differences in velocity and stance width, both while walking in a straight line and while making turns. The results, which were published in December in the on-line version of the European Journal of Applied Physiology, suggest that not all of the gait impairments observed in patients with diabetes can be explained by loss of sensation. Previous research from the MedStar Research Institute in 2002 found that tandem stand and one-foot stand measures could distinguish patients with diabetic neuropathy from patients with nonneuropathic diabetes and from nondiabetic controls, but that static balance variables did not differ significantly between the latter 2 groups. In addition, previous research from the Loma Linda group, presented in June at the annual meeting of the American Diabetes Association, found that 4 weeks of treatment with the insulin sensitizer rosiglitazone was associated with significantly improved gait velocity and sway.

Matters of Intelligence

By: Larry Hand Different but equal. That's the general conclusion of a new study on the intelligence of men and women: "The neuroanatomy of general intelligence: sex matters," published in January in the on-line version of NeuroImage. The study shows that men have about 6.5 times the amount of gray matter related to general intelligence as women, and women have almost 10 times the amount of white matter related to intelligence as men. Gray matter represents information processing centers, and white matter represents the networking of the processing centers. But the 2 different neurologic pathways still produce equivalent overall performance on standard measures of cognitive ability, the study shows. According to lead author Richard Haier, MD, PhD, professor of psychology at the University of California, Irvine, these results have the potential to aid research on dementia and other cognitive disorders. Haier and coauthor Rex Jung, PhD, a University of New Mexico neuropsychologist, used voxel-based morphometry to convert MRI pictures into structural brain "maps" that correlated brain tissue volume with IQ.
New FDA Approvals By: Jordana Bieze Foster and Larry Hand Diabetic Peripheral Neuropathy A 338-patient study published in the December 14 issue of Neurology that supports the effectiveness of the anticonvulsant drug pregabalin for the treatment of neuropathic pain dovetailed nicely with the FDA's approval of the drug for the same indication later that month. Investigators from the University of Rochester found that patients with a 1- to 5-year history of painful diabetic neuropathy treated for 5 weeks with pregabalin, marketed by Pfizer as Lyrica, were significantly more likely to experience a 50% reduction in pain than those treated with placebo. Improvements in end point mean pain scores also were significantly greater in patients who received the drug than in those who received placebo. Sleep scores also improved significantly in the treatment group. Pfizer announced on December 31 that pregabalin had received FDA approval for treatment of neuropathic pain associated with diabetic peripheral neuropathy and for the treatment of postherpetic neuralgia. The company is still awaiting approval of the same drug for adjunctive treatment of partial seizures in adults. Bipolar Disorder In December, the FDA approved the use of extended-release carbamazepine capsules for treatment of bipolar disorder. Marketed as Equetro by Shire Pharmaceuticals, the capsules have a 3-bead extended-release system and are available in 100-, 200-, and 300-mg doses. Genetic Test The first of its kind, the AmpliChip Cytochrome P450 Genotyping Test cleared FDA approval in late December. Made by Roche Molecular Systems, it allows physicians to test patients for potential drug interaction complications and optimal use of drugs. The test analyzes a cytochrome-P450-family gene, which plays a role in the metabolization of some drugs, including antidepressants and antipsychotics. The FDA cautions that the test is not a stand-alone tool but is intended for use with clinical evaluation and common methods of determining treatment options. Severe Chronic Pain Ziconotide intrathecal infusion received FDA approval in late December for management of severe chronic pain in patients who are resistant to other therapies and need intrathecal therapy. Developed and marketed as Prialt by Elan Corporation, ziconotide is a nonopioid analgesic N-type calcium channel blocker. According to Elan, it is the synthetic equivalent of a conopeptide found in the marine snail, Conus magus. Sleep Sepracor won FDA approval in mid-December to market eszopiclone, or commercially Lunesta, as a sleep aid and for the treatment of insomnia. It is the first sleep treatment available for long-term use. In January, Sepracor announced a change as to the commercial availability of Lunesta. Because of the FDA's recommendation that the drug be classified as a Schedule IV controlled substance by the Drug Enforcement Administration, additional time was needed to complete the process. The company is now an- ticipating availability by the end of March.
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