News in brief - June 2/9, 2003

Head injuries and Parkinson's disease connection - Antibiotic effective treatment for TB - Adverse cardiac events connected to smallpox vaccine increase - NIH funds six new autism centers - Most Americans are active - New arthritis drugs not as cost-effective as old standards

Head injuries and Parkinson's disease connection

Individuals who have had a serious head injury are four times more likely to develop Parkinson's disease than are those who have never had such an injury, according to new research. And the likelihood of developing the disease increases with the severity of the injury.

Longer loss of consciousness and brain bruising visible in a CT scan were more likely to be associated with Parkinson's disease than mild head injury with either no loss of consciousness or only a brief loss, said James Bower, MD, Mayo Clinic neurologist. He was the lead author of the study published in the May 20 Neurology.

Caution was urged in interpreting the study's results. "By no means does it mean that if you have a severe head injury that you will definitely develop Parkinson's," said Dr. Bower. However, he also said he was surprised by the strength of the findings and that some of the head injuries had occurred about 20 years before the start of the disease.

The researchers offered three hypotheses for the connection: A head injury kills brain cells and then normal aging causes the loss of more brain cells until a threshold is reached; the blood-brain barrier is breached and certain proteins or poisons in the bloodstream enter the brain, triggering a process that takes 20 years to produce symptoms; or head trauma causes brain cells to make certain proteins that would not normally develop, starting a cascade leading to cell death.

Antibiotic effective treatment for TB

A new antibiotic appears to be effective against deadly strains of tuberculosis that are resistant to nearly all available treatments, according to a report by physicians at New York University School of Medicine.

The antibiotic linezolid reportedly saved the lives of four women and one girl who had been gravely ill with multidrug-resistant tuberculosis and who were hospitalized at Bellevue Hospital in New York City. The patients ranged in age from 10 to 54 and were resistant to at least eight and as many as 14 anti-TB therapies.

"Trying linezolid was a real act of desperation," said Timothy Harkin, MD, assistant professor of medicine and assistant director of Bellevue's Chest Services. "This certainly seems like a promising medication for multidrug-resistant TB and there is a continuing need for new antibiotics for this disease."

Dr. Harkin and William Rom, MD, professor of medicine and environmental medicine at NYU School of Medicine, were expected to present their findings on May 21 in Seattle at an international conference held by the American Thoracic Society.

They also expressed their hope that large clinical trials could be conducted to confirm their findings. Multidrug-resistant TB is pandemic and the prevalence is particularly high among Russian jail populations and in Eastern European countries such as Estonia and Latvia, they said.

Adverse cardiac events connected to smallpox vaccine increase

At least 15 cases of myopercarditis linked to receiving a smallpox shot have been reported to the Centers for Disease Control and Prevention as of May 2, according to a paper about the program to vaccinate civilians published in the May 16 Morbidity and Mortality Weekly Report.

The agency also noted three cases of chest pain, one case of polyneuropathy and one of chest tightness bringing the total number of serious adverse reactions up to 65 since the program began. There have also been 455 nonserious events, such fever, fatigue or headache.

The agency also reported that the number of inadvertent innoculations has been reduced from 28 to 15 because of the receipt of additional data.

The Dept. of Defense has tallied 29 inadvertent infections, 10 incidents of transmission from a recipient to a close contact, 14 cases of myopercarditis and 25 cases of generalized vaccinia as of the end of March.

More than 35,000 medical and public health workers as well as 350,000 military personnel have received the shot.

No deaths have been directly connected to the vaccine.

NIH funds six new autism centers

The National Institutes of Health has awarded more than $9 million to be split between six research centers to expand its autism network and to support research into the biomedical and behavioral aspects of the disorder, according to a May NIH statement.

Two centers were funded last year. The University of North Carolina at Chapel Hill, and Yale University in New Haven, Conn., became the founding members of the NIH's Studies to Advance Autism Research and Treatment Centers Program.

The agency expects to spend $65 million over the next five years on this effort.

"The major network of centers will accelerate advances in our knowledge about autism causes and treatments and help us achieve our mission of reducing the burden associated with autism spectrum disorders," said Thomas Insel, MD, chair of the National Institute of Mental Health.

Most Americans are active

Nearly a fifth of Americans are very active during their leisure and work time, and more than half are moderately active, according to a report issued by the Dept. of Health and Human Services in May.

"Physical Activity Among Adults: United States, 2000" is the first government report to take into account work as well as recreation to determine levels of physical activity. Researchers analyzed data collected by the Centers for Disease Control and Prevention's National Health Interview Survey. More than 32,000 adults were asked about leisure time activity as well as whether walking or lifting was a part of their work.

While a majority do participate in some kind of activity daily, public health officials expressed the greatest concern about the fact that more than a quarter reported having no or very little physical activity. "Physical activity is essential to good health," said HHS Secretary Tommy G. Thompson. "This study helps give us an even fuller picture of our physical activity status. It confirms that we need to pay more attention to getting adequate physical activity and reversing the alarming risk in obesity that we've experienced nationally during the past decade."

New arthritis drugs not as cost-effective as old standards

COX-2 inhibitors, the newer and more expensive generation of arthritis drugs, may not be as cost-effective as the older and cheaper nonsteroidal anti-inflammatories, according to a paper published in the Annals of Internal Medicine last month.

Both classes of drugs are effective against arthritis pain, but COX-2s are prescribed to avoid the gastrointestinal complications long associated with NSAIDs.

Researchers at the University of California, Los Angeles, and the Veterans Affairs Greater Los Angeles Healthcare System analyzed data from previously published studies finding that one "quality-adjusted life-year" gained by using the newer drugs cost more than a quarter of a million dollars.

The study did, however, suggest that the more expensive drugs may be cost-effective for patients with a history of severe stomach problems such as bleeding ulcers. For that group of patients, one additional healthy year cost around $55,000.

"We hope that this study will help guide primary care providers, rheumatologists, pain management physicians, health insurance companies and patients in developing the best treatment plans to meet individual needs for chronic arthritis," said Ian Gralnek, MD, one of the paper's authors and a UCLA assistant professor of medicine.