SUMMARYPurpose: Diffusion tensor imaging (DTI) studies have reported substantial white matter abnormalities in patients with temporal lobe epilepsy (TLE). However, limited data exist regarding the extent of white matter tract abnormalities, cognitive effects of these abnormalities, and relationship to clinical factors. The current study examined these issues in subjects with chronic TLE. Methods: DTI data were obtained in 12 TLE subjects and 10 age-matched healthy controls. Voxel-wise statistical analysis of fractional anisotropy (FA) was carried out using tract-based spatial statistics (TBSS). White matter integrity was correlated with cognitive performance and epilepsy-related clinical parameters.Results: Subjects with TLE, as compared to healthy controls, demonstrated four clusters of reduced FA, in anterior temporal lobe, mesial temporal lobe, and cerebellum ipsilateral, as well as frontoparietal lobe contralateral to the side of seizure onset. Mean FA was positively correlated with delayed memory, in anterior temporal lobe; and immediate memory, in mesial temporal lobe. Lower FA values in the posterior region of corpus callosum were related to earlier age of seizure onset. Conclusion: TLE is associated with widespread disturbances in white matter tracts and these changes have important cognitive and clinical consequences.

A randomized, double-blind, placebo-controlled study was conducted to assess the efficacy of risperidone in the treatment of developmental stuttering in 16 adults. Eight subjects received placebo and eight received risperidone at 0.5 mg once daily at night, increased to a maximum of 2 mg/day. After 6 weeks of treatment, decreases in all measures of stuttering severity were greater in the risperidone group than in the placebo group; the between-treatment difference was significant (p < 0.05) on the most important measure, the percentage of syllables stuttered. In the risperidone group, reductions from baseline in scores for the percentage of syllables stuttered, time stuttering as a percentage of total time speaking, and overall stuttering severity were significant (p < 0.01); changes in scores on the fourth measure of stuttering, duration, were not significant. No significant decreases occurred in the placebo group. Among the eight patients in the risperidone group, five responded best to 0.5 mg/day, with stuttering recurring at higher doses. The remaining three patients responded better with increasing doses of risperidone. Risperidone was generally well tolerated. The results of this small study indicate that risperidone may be effective in the treatment of developmental stuttering. This finding needs to be confirmed in a larger trial.

Stuttering is a speech disorder that affects one-percent of all adults and much has been learned recently of its neurologic correlates. Stuttering has been associated with excessive cerebral activity of the neurotransmitter, dopamine. Pharmacologic research has suggested that older generation dopamine antagonist (i.e. "typical antipsychotic") medications improve stuttering symptoms, but are associated with poorly tolerated adverse effects. The purpose of this study was to compare the efficacy and tolerability of olanzapine, a novel dopamine antagonist (or "atypical antipsychotic"), versus placebo in the treatment of adult developmental stuttering. Twenty-four adults who stutter participated in a twelve-week, randomized, double-blind, placebo-controlled trial conducted at two separate sites. Subjects received either olanzapine (2.5 mg titrated to 5 mg) or matching placebo. Subjects were rated on an objective measure of stuttering severity (SSI-3), a clinician based global impression (CGI), and a subject-rated self-assessment of stuttering (SSS). Subjects were also monitored for potential side-effects. Twenty-three of the twenty-four subjects enrolled in the trial successfully completed the full course of the study. Olanzapine was statistically superior to placebo on the three ratings of stuttering severity, the SSI-3, the CGI and SSS (p < .05). Olanzapine is a promising medication for the treatment of stuttering and further research is warranted.

We performed glare tests on patients following uncomplicated extracapsular cataract extraction and posterior chamber intraocular lens implantation and on noncataractous phakic patients. Three types of lenses were implanted to compare the effect of optic asphericity and ultraviolet filtration on glare. Glare testing was performed using the Miller-Nadler Glare Tester and Baylor Visual Function Tester. The glare scores of the pseudophakic and phakic patients were statistically similar. In the pseudophakic patients, factors associated with decreased glare performance were posterior capsular opacification and increased pupil size; the intraocular lens type did not significantly affect glare scores.