News Briefs from AAN Annual Meeting April 12-19

Media representatives are invited to attend the American Academy of Neurologyís 49th Annual Meeting April 12-19, 1997, at the John B. Hynes Veterans Memorial Convention Center in Boston, Mass. More than 6,000 neurologists and neuroscientists are expected to attend. Below are summaries of news releases on studies that will be presented during the meeting. PLEASE NOTE INDIVIDUAL EMBARGO DATES AND TIMES FOR EACH RELEASE. For full releases, for more information about the meeting in Boston or to request the Abstracts-on-Disk, contact Sarah Parsons or Rona Stewart at 612-623-8115 or by e-mail [email protected].

EMBARGOED FOR RELEASE UNTIL 7:30 AM, WEDNESDAY, APRIL 16, 1997 Thrombolytic Therapy Brings Brain-Dead Patient Back to Life The use of intra-arterial thrombolysis resulted in the dramatic recovery of a clinically brain-dead patient more than nine hours after stroke symptoms appeared. The case, which will be presented during the American Academy of Neurologyís 49th Annual Meeting April 12-19 in Boston, MA, shows that stroke patients may benefit from thrombolytic therapy even in cases with prolonged brain stem dysfunction. ìI was not optimistic about this case,î said neurologist Wayne Clark, MD, director of the Oregon Stroke Center in Portland. ìThere were no signs of brain activity. No cases had been reported of trying this therapy with a case this severe.î

An angiogram showed the 41-year-old patient had complete blockage in the basilar artery, a critical area of the brain stem. The clot was dissolved by injecting the enzyme urokinase directly into the artery. Within 24 hours, the patient made a dramatic recovery, becoming conscious, able to follow instructions and able to move his hands and feet. In three months, he was walking and living independently at home. Clark said this therapy should be considered for stroke patients who donít meet the three-hour time window for administering a clot-busting drug intravenously. He said the treatment is most effective for those whose strokes affect the back of the brain. The therapy should be considered for young stroke victims especially, Clark said. Another criteria is whether the computerized tomography (CT) scan shows little evidence of stroke damage. ìIn this case, the patientís CT scan didnít look bad, even though he had no brain activity,î he said. ìThe damage was not yet final. At the Oregon Stroke Center, if the CT scan is negative, we are trying treatment ñ up to 24 hours after the stroke symptoms appeared. We know that not all cases will react this way, but we believe some cases may benefit from this therapy and the time window for treatment may be much longer than we thought.î Clark said physicians should be aware of the location of the nearest center that is equipped to offer this therapy. And the public should be aware of the signs and symptoms of stroke and recognize that it is an emergency that calls for immediate treatment, he said. The most common stroke symptoms are numbness, weakness or paralysis of face, arm, leg (particularly on one side of the body), sudden decreased or blurred vision, difficulty speaking or understanding words, dizziness, loss of balance or coordination and sudden and intense headache.

EMBARGOED FOR RELEASE UNTIL 10:45 AM, THURSDAY, APRIL 17, 1997 Sleep Disorder in Parkinsonís Disease Patients Can Lead to Nocturnal Injury Many Parkinsonís disease patients develop sleep disorders that can lead to nocturnal injury, according to a study presented during the American Academy of Neurologyís 49th Annual Meeting April 12-19, in Boston, MA.

A study of 61 Parkinson disease patient/caregiver pairs showed that 15 percent had REM Sleep Behavior Disorder. In one third of these patients there was nocturnal injury either to the patient or to the caregiver. In REM Sleep Behavior Disorder normal paralysis that occurs in dream sleep does not occur. This results in patients ìacting outî their dreams that are often violent. This behavior can cause injury to both patients and their spouses. Sleep disorders are frequent in Parkinsonís disease patients. Many times they go unrecognized until the patientís spouse or caregiver complains of abnormal movements or violent behavior during sleep. ìThis disorder has a tremendous impact on the caregiver, especially when a patient is acting out a dream and may be reaching over and hitting kicking or choking their caregiver,î said study author Cynthia Comella, MD, associate professor of neurology at Rush Presbyterian St. Lukes Medical Center in Chicago, IL. ìThis makes it difficult to continue a relationship, and there is no need for this because it is a treatable disorder. This disorder is very responsive to low doses of a medication called Clonazepam. This treatment usually results in dramatic improvement and can prevent further injury and stress to the spouse.î Other recommendations for better management of the disorder include: accurately diagnosing the reason these behaviors are occurring during sleep; keeping the patient safe by installing safety rails on the patientís bed; the spouse moving to another room to sleep; or locking the door to the room where the patient is sleeping.