A randomized clinical trial of high-dosage coenzyme Q10 in early Parkinson disease: no evidence of benefit.

Importance: Coenzyme Q10 (CoQ10), an antioxidant that supports mitochondrial function, has been shown in preclinical Parkinson disease (PD) models to reduce the loss of dopamine neurons, and was safe and well tolerated in early-phase human studies. A previous phase II study suggested possible clinical benefit.

Objective: To examine whether CoQ10 could slow disease progression in early PD.

Rheumatoid meningitis presenting with stroke-like episodes.

Neurologic symptoms in patients with rheumatoid arthritis (RA) are most often caused by osseous compression, affecting the cervical spine or peripheral neurologic structures. CNS involvement in RA is infrequent, consisting of CNS vasculitis or meningitis with or without meningeal nodules.(1) When meningeal infiltration is seen, symptoms of presentation can include focal neurologic deficits, seizure, cranial nerve dysfunction, or altered consciousness.

Contextual considerations in summative competency examinations: relevance to the long case.

Long-case patient-based examinations previously formed the basis of summative competency testing in physician certification examinations. These exams were found to be unreliable and have fallen from favor. During the authors' deliberation of the long case in the neurology certification examinations of the Royal College of Physicians and Surgeons of Canada, they considered the examination context and concluded that the appropriate psychometric analysis of the exams is highly contingent on the context.

Action myoclonus-renal failure syndrome: characterization of a unique cerebro-renal disorder.

Action myoclonus-renal failure syndrome (AMRF) is a distinctive form of progressive myoclonus epilepsy associated with renal dysfunction. The syndrome was not recognized prior to the advent of dialysis and renal transplantation because of its rapidly fatal course if renal failure is untreated. The first and only description of AMRF was in four French Canadian patients in three families (Andermann et al.

Myoclonus.

Myoclonus refers to brief muscle jerks caused by neuronal discharges. Etiologies are numerous, ranging from physiological jerks to myoclonus secondary to severe neurodegenerative conditions. The source of myoclonus may be in the cerebral cortex, the brain stem or the spinal cord and multiple generators may be involved in a single patient.

Excessive daytime sleepiness and sudden-onset sleep in Parkinson disease: a survey by the Canadian Movement Disorders Group.

Context: Somnolence is a recognized adverse effect of dopamine agonists. Two new dopamine agonists, pramipexole and ropinirole, have been reported to cause sudden-onset sleep spells in patients with Parkinson disease (PD) while they were driving. The frequency of these spells and whether driving should be restricted has yet to be established.