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Am Fam Physician. 1998;58(4):947-948

Estrogen May Reduce the Severity of Early Parkinson's Disease

(50th Anniversary Annual Meeting of the American Academy of Neurology) Results of a study of postmenopausal women showed that women with early Parkinson's disease may benefit from hormone replacement therapy. The study included postmenopausal women who had been diagnosed with typical Parkinson's disease within five years of the study and who were not taking levodopa. Of the 171 women who met these parameters, 42 had received hormone replacement therapy at some time and 129 had not. The women were evaluated for disease progression at the initial visit and at two-year visits. Length of estrogen use was not evaluated. While the use of estrogen did not stop or reverse the disease process, women who had taken estrogen demonstrated slower disease progression than those who had not taken estrogen. The investigators believe that if hormone replacement therapy is indicated for other medical reasons, patients diagnosed with Parkinson's disease should not avoid estrogen use before taking levodopa. Further studies are needed to examine the effects of hormone replacement therapy in patients receiving levodopa and to adjust for the duration of estrogen use.—rachel j. saunders-pullman, m.d., et al., Beth Israel Medical Center and Columbia-Presbyterian Medical Center, New York, N.Y.

Thalamic Deep Brain Stimulation Is Effective in Parkinson's Disease

(American Academy of Neurology) Thalamic deep brain stimulation safely reduces tremor contralateral to the site of electrical stimulation implants in patients with essential tremor and Parkinson's disease. This was the conclusion of a study that examined 25 patients (11 with essential tremor and 14 with Parkinson's disease) who had implants placed in the thalamus area on one side of the brain. After three months, patients with essential tremor showed significant improvements in contralateral arm tremor, head tremor, drawing tests, pouring tests, subjective tremor scales, patient-rated disability scores and physician-rated disability scores. The patients with Parkinson's disease showed significant improvement in observed contralateral arm tremor, contralateral leg tremor and patient-rated disability scores. Subjective scores of the Universal Parkinson's Disease Rating Scale (UPDRS) did not improve, with the exception of subjective tremor rating, and improvements did not occur in other UPDRS motor subsets. Overall, two device failures required replacement. The investigators believe that thalamic deep brain stimulation is a safe way to reduce symptoms in patients for whom medicines are not effective.—william g. ondo, m.d., et al., Baylor College of Medicine, Houston, Texas.

Drug Shows Promise in Treatment of Generalized Anxiety Disorder

(18th National Conference of the Anxiety Disorders Association of America) Venlafaxine extended-release therapy (Effexor XR) is effective in treating the symptoms of generalized anxiety disorder, according to an eight-week, multicenter study of 405 nondepressed patients with the disorder. The mental disorder is characterized by persistent, excessive anxiety and worry over routine life activities. In the study, extended-release venlafaxine was compared with placebo and with buspirone. Venlafaxine, given once daily as either a 75-mg or 150-mg dose, was superior to placebo in its ability to reduce symptoms, especially feelings of worry, tension and being on edge. Buspirone was not more effective than placebo. Nausea was the most commonly reported adverse effect. The investigators believe that extended-release venlafaxine may be more effective than other commonly used antidepressants because it targets two neurotransmitter systems, serotonin and norepinephrine, rather than just one.—jonathan davidson, m.d., et al., Duke University, Durham, N.C.

Cholesterol-Lowering Drugs Are Underused in Women

(47th Annual Scientific Sessions of the American College of Cardiology) A multicenter study conducted from 1994 to 1997 in the United States and Canada has shown that significantly fewer women than men with coronary artery disease receive cholesterol-lowering medications despite evidence that these medications can reduce the risk of myocardial infarctions and death related to coronary artery disease. The study evaluated the use of cholesterol-lowering medications in 825 men and women, all of whom had coronary artery disease. About one half of the subjects (20 percent of whom were women) had high levels of low-density lipoprotein (LDL) cholesterol. In 1994, 38 percent of the women and 42 percent of the men with elevated LDL levels were receiving cholesterol-lowering medication. By 1997, the proportion of men receiving medication had increased to 54 percent, and the percentage of women had decreased to 35 percent. At the end of the study, 31 percent of the men had lowered their LDL levels to 100 mg per dL (2.5 mmol per L) or lower, but only 12 percent of the women had reached this goal. The investigators emphasize that recent major trials have proved that the use of cholesterol-lowering medication in persons with coronary artery disease reduces the rates of myocardial infarction and death from coronary artery disease and that the goal of all persons with coronary disease should be an LDL level below 100 mg per dL (2.5 mmol per L).—michael miller, m.d., et al., University of Maryland Medical Center, Baltimore.

Short-Term Tuberculosis Prophylaxis Is Effective in Persons with HIV

(5th Conference on Retroviruses and Opportunistic Infections) According to results of a five-year international study involving 1,600 persons with human immunodeficiency virus (HIV) infection, a two-month course of tuberculosis prophylaxis is an effective alternative to the year-long regimen currently prescribed for persons infected with both HIV and tuberculosis bacteria. All of the participants in the study tested positive for tuberculosis. The subjects were randomized to receive either two months of daily rifampin and pyrazinamide therapy or 12 months of daily isoniazid therapy. After 36 months of follow-up, the number of cases of active tuberculosis was the same in each treatment group. Fewer deaths occurred in the patients receiving the two-month regimen of rifampin and pyrazinamide than in the patients receiving isoniazid, but the difference was not statistically significant. Compliance was better in the two-drug arm of the study; 80 percent of persons in this group completed their treatment, compared with less than one half of the patients in the isoniazid group. The investigators believe that use of the two-month regimen could increase compliance rates and reduce the cost of tuberculosis prevention programs in patients with HIV infection. In the past, poor compliance has limited the effectiveness of tuberculosis prevention programs.—fred gordin, m.d., et al., V eterans Affairs Medical Center, Washington, D.C.

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