P1 latency as a biomarker for central auditory development in children with hearing impairment

We used the latency of the P1 cortical auditory-evoked potential (CAEP) as a biomarker for the development of central auditory pathways in three children who received intervention through hearing aids and/or cochlear implants. Our goal was to examine the clinical feasibility of using the latency of the P1 CAEP as an objective tool to evaluate whether acoustic amplification for hearing-impaired children has provided sufficient stimulation for normal development of central auditory pathways. If clinicians have such a marker, then they can more confidently make a decision about whether to provide a child with a cochlear implant following an appropriate hearing-aid trial. Using the same marker, clinicians will also be able to monitor the maturation of central auditory pathways once electrical stimulation is initiated.     

Small fiber neuropathy is associated with the metabolic syndrome

Background: The etiology of sensory neuropathies is often not found. We tested the hypothesis that the metabolic syndrome (MS) may be associated with painful neuropathy, in the absence of frank diabetes. Methods: Clinical and quantitative neuropathy assessments were performed on 10 neuropathy patients with MS, 20 with MS with type 2 diabetes (10 recent onset and 10 of >5 years in duration), and 10 healthy, age-matched subjects. Intraepidermal nerve fiber density (IENF) and mean dendrite length (MDL) were determined by quantitative immunofluorescence on skin biopsies using antibody to PGP 9.5. Results: In metabolic syndrome, MDL was reduced and correlated negatively with sensory symptoms, signs, HDL-C, and sural nerve amplitude. The strongest inverse metabolic correlate of the metabolic syndrome neuropathy was HDL-C, which also correlated negatively with sensory symptoms, signs, and sural nerve amplitudes. The strongest metabolic correlate of diabetic sensorimotor neuropathy was HbA1c, which was associated with reduced IENF in patients with >5 years in duration of disease as well as reduced peroneal nerve amplitudes. Conclusions: These data indicate that metabolic features, including HDL-C in metabolic syndrome, are associated with small fiber neuropathy and that MDL is an early marker of sensory neuropathy in patients with MS. Reductions in IENF reflect a longer duration of diabetes, with hyperglycemia leading to a sensorimotor neuropathy. These findings support the possibility that there is a sensory neuropathy with reduced intraepidermal nerve fiber length, which cosegregates with features of metabolic syndrome.     

Education and internationally adopted children: working collaboratively with schools

Families who adopt internationally often need assistance in determining which factors they need to consider when making educational decisions for their child, and they frequently seek guidance from their physician. Understanding how the education system functions, how it differs from the medical system, and how children who have been adopted internationally can succeed in school is important for health care providers, because this information helps parents in making proactive decisions for their children. Internationally adopted children have the best chance of maximizing their learning potential when medical and educational professionals work together to assist families as they plan for their child's education.     

The use of high-dose daily cabergoline in an adolescent patient with macroprolactinoma

Prolactinomas are rare in children and adolescents but well studied in adults. Dopamine agonists are the treatment of choice for all ages. Bromocriptine is the only agonist approved for use in pediatric patients by the FDA. Cabergoline, a second-generation ergot derivative with a longer half-life, has been used in resistant prolactinomas and as first-line treatment in adults. The authors describe an adolescent boy with a pituitary macroadenoma with an initial prolactin level of 73,777 ng/mL. After failing to respond to bromocriptine and standard-dose cabergoline, he responded well to very high daily doses of cabergoline (1.5 mg daily), with a current prolactin level of 726 ng/mL and notable reduction in tumor size. Escalating doses of cabergoline should be considered in pediatric patients with dopamine-resistant prolactinomas.     

Quantitative trait loci for novelty/stress-induced locomotor activation in recombinant inbred (RI) and recombinant congenic (RC) strains of mice

The objective of the present study was to map and compare quantitative trait loci (QTLs) for an anxiety-related trait (novelty/stress-induced activation) in the AXB/BXA recombinant inbred (RI) and AcB/BcA recombinant congenic (RC) strains of mice derived from the A/J and C57BL/6J inbred progenitor strains. Activational responses to a novel open field (OF) were measured under identical stressful conditions (no prior handling or exposure to testing procedures) in both the RI and RC strains. Naive male and female mice were weighed, injected with IP saline and locomotor activity was monitored in a computerized OF apparatus for 15 min. Measures obtained from this experimental design included: (1) total activity scores, (2) time course of response (5 min time blocks over the 15 min session). Data for the RI strains were subjected to a QTL analysis using composite interval mapping. Significant loci were identified on chr 5 (D5Mit356, 41 cM), chr 8 (D8Mit305, 37 cM) and chr 14 (D14Mit36, 6 3cM). Single locus association analysis of the AcB/BcA RC strains identified 15 putative regions, 7 of which overlapped regions independently mapped in the RI strains on chr 1 (58.5-63.1cM), chr 4 (21.9-28.6 cM), chr 5 (19-45 & 74-86 cM), chr 6 (0.5-20.4cM), chr 9 (15-38 cM), chr 13 (47cM) and chr 19 (47cM). The loci identified on chr 5 near D5Mit356 (41cM) in both the AXB/BXA RIS and AcB/BcA RCS maps to a region containing the genes for several GABA(A) receptor subunits. Additionally, the present study provides further confirmation of a frequently identified QTL on chromosome 1. The results are discussed in the context of previous QTL studies of anxiety-related traits that have used genetic crosses that include the A or B6 progenitors.     

Safety, tolerability, and efficacy of continuous transdermal dopaminergic stimulation with rotigotine patch in early-stage idiopathic Parkinson disease

Rotigotine is a new dopamine agonist with transdermal patch formulation for the treatment of Parkinson disease. The aim of this study was to investigate safety and efficacy of rotigotine in patients with early-stage Parkinson disease. In this open-label, dose-escalation, safety and efficacy study, 31 patients in the early stages of idiopathic Parkinson disease received rotigotine to a maximum of 18.0 mg/day. Of the 29 patients who completed the 28-day treatment phase, 24 were maintained at the maximum dose level. The drug was well tolerated, and skin reactions were mild. A statistically significant improvement in UPDRS I, II, and III scores was observed from baseline to end of treatment for the 29 subjects who completed the trial. Mean improvement (+/- standard deviation) was -0.41 +/- 0.78 on UPDRS I (P = 0.0078), -2.76 +/- 3.31 on UPDRS II (P = 0.0001), and -4.62 +/- 5.32 on UPDRS III (P < 0.0001). When results were stratified by maximum dose achieved, significant improvements were seen on all 3 subscores for patients achieving the maximum dose. These data suggest that rotigotine is a safe, well-tolerated, and effective treatment for early-stage Parkinson disease.