March Neurology Briefs [part 1]

Following are briefs from studies and guidelines published in the March issue of Neurology, the scientific journal of the American Academy of Neurology (AAN). The AAN is an association of more than 14,500 neurologists and neuroscience professionals dedicated to improving patient care through education and research. For full releases and articles or more information, contact Sarah Parsons or Rona Stewart at 612-623-8115 or by e-mail .

Out of the Clear Blue Sky: Rugby Spectator Struck by Lightning Out of a clear blue sky, a healthy 51-year-old mountain biker was hit by a direct bolt of lightning after stopping to watch a rugby match in Vail, CO, according to a case study published in the March issue of Neurology.

Neurologists and meteorologists together believe to have deciphered for the first time the origins of a lightning ìbolt from the blue.î This refers to lightning striking the ground a considerable distance from the parent thunderstorm in what appears to be fair weather. ìWith the availability of new technology, we were able to search meteorological data to find the lightning flash most likely responsible for striking this patient,î said study author Michael Cherington, MD, chair of the Lightning Data Center at St. Anthony Hospital in Denver, CO.

ìThe tragedy occurred on a day when there were no clouds visible to those in the vicinity,î said Cherington. ìPrior to the event the victim had no warning signs such as thunder and had no reason to take steps to lower his risk of being struck. We were able to determine that the lightning bolt responsible for the patientís injury originated in a thunderstorm that was 10 miles away and obscured by the mountains.î The victim was struck directly in the head and suffered from encephalopathy, an alteration of the brain structure. The strike burned a hole in the right side of his bicycle helmet and caused a burn on his head. The victim also had signs indicating an organic lesion in the brain or spinal cord and burns on the right side of his chest and right thigh. The chin strap of the victimís helmet was found melted to his chin. Four months after the lightning strike, the patient was able to walk and keep his balance. However, he required supervision because he was unaware of safety and had poor judgment. The patient also experienced mood swings and demonstrated delusional thinking. Following his stay in the hospital, the victim was placed in a care facility where he received help with daily living activities and was in a program to help with his behavior. A direct lightning strike such as the one suffered by the victim is the most dangerous. Other dangers from lightning are side flashes from a nearby tree or currents that flow in the ground. Awareness of lightning safety measures can reduce the chances of becoming struck by lightning and under a more typical situation, when the person is aware of a nearby thunderstorm, it is necessary to take precautions. These include: 1) Seeking shelter inside a safe building and away from the outside doors and windows. Avoiding contact with anything that is connected to the electrical or plumbing systems. 2) Getting inside a metallic enclosure such as a car, bus, or van. 3) Avoiding standing near isolated tall objects such as lamp poles or trees. Seeking shelter in a grove of trees and staying closer to the small ones rather than the tall ones.

Treatment Shows Small Benefit for Some Inclusion-Body Myositis Patients Treatment with intravenous immunoglobulin (IVIg) led to small but functionally important benefits for some patients with inclusion-body myositis, according to a study published in the March issue of Neurology. Inclusion-body myositis is the most common acquired inflammatory muscle disease occurring in those over 50. The disease results in slowly progressive muscle weakness and atrophy, and most patients develop difficulty swallowing. Neurologists and patients have awaited this study, as there is no treatment for the disease. The double-blind study involved 19 patients with the disease. Half of the patients received intravenous immunoglobulin and half received placebo once a month for three months. After a washout period of at least a month, patients were switched to the other therapy for another three months.

The study found no significant difference in overall muscle strength between the IVIg group and the placebo group. However, small improvements in some muscle groups were noted, particularly in some muscles of the lower extremities and in muscles controlling swallowing. But other muscles worsened during the same period. ìThe treatment was functionally important for a small number of patients,î said neurologist Marinos Dalakas, MD, study author and chief of the neuromuscular diseases section at the National Institute of Neurological Disorders and Stroke at the National Institutes of Health in Bethesda, MD. ìSix patients had improvement in some muscle groups that improved the quality of the lives.î Dalakas said itís unclear whether the moderate benefits noted in a few patients and the mild benefit to certain muscle groups noted in most patients justifies the use of intravenous immunoglobulin, which is prohibitively expensive. ìPatients and their physicians need to weigh the benefit, cost and practicality of administering this drug, knowing that it may help a small number of patients for a period of time, and that the gains are not major but could be functionally significant in patientsí daily activities,î Dalakas said.