This issue of CONTINUUM, devoted to the subject of neuroendocrinology, is one of the two issues each year that are not part of our rotating 3-year curriculum cycle of core topics. In fact, this is the first time in the history of CONTINUUM that the topic has been featured. We are indebted to Dr Andrew Herzog, who not only agreed to serve as faculty chair for this issue, but also suggested the idea to us on behalf of the Neuroendocrinology Section of the American Academy of Neurology.
My task in introducing this issue is minimal, for Dr Joseph Martin, one of the pioneers in this important field, has done so eloquently in his invited foreword. The issue begins with a discussion of a primary endocrinologic subject, pituitary disorders, by Drs Andrea Utz and Anne Klibanski. Another chapter, by Drs Eric Frenette and Christian Guilleminault, reviews the critically important influences of neurohormones on sleep.
The other chapters focus on the specific effects of a variety of hormones on specific neurologic disorders. Throughout these reviews, the important role of sex hormones is particularly highlighted. Dr Herzog himself addresses the subject of epilepsy. This is a two-way street in which hormones not only influence the neurologic condition, but epilepsy itself affects reproductive hormones. Perhaps migraine is one of the conditions in which hormonal influences are most widely appreciated. Dr Stephen Silberstein addresses this subject extensively, but covers other endocrinologic influences as well, in his chapter on headache. Although early enthusiasm about the possible benefits of hormonal therapy in Alzheimer disease has been severely dampened, Dr Victor Henderson reviews this subject and other neuroendocrinologic issues in dementia. Dr Cathy Sila tackles a similar task regarding stroke. In the area of movement disorders, a number of interesting phenomena have neuroendocrinologic implications, including the circumstance of anticipation in Huntington disease; differences in the clinical manifestations, as well as the frequency, of Tourette syndrome between males and females; and the occurrence of chorea with pregnancy or the use of oral contraceptives. Drs Irene Malaty, Cecilia Lansang, and Michael Okun discuss these and many other issues. The female preponderance in multiple sclerosis (MS) is well-known, and many are aware of the lower frequency of relapses during pregnancy. In fact, the latter phenomenon has spurred an ongoing trial of estriol for the treatment of relapsing-remitting MS. Recently, intense attention has been focused on the role of vitamin D in MS. These are but a few of the issues reviewed by Dr Peter Riskind in his chapter on this disease.
The patient management problem, constructed by Dr Mark Friedman, will challenge your skills with a fascinating case. In the Ethical Perspectives in Neurology section of this issue, Dr Joseph Kass grapples with the thorny implications of treatment of a pregnant woman with migraine and the responsibilities of the physician to the fetus as well as to the patient. In her section on Practice Issues in Neurology, Dr Page Pennell extends the analysis of neuroendocrinologic influences in epilepsy with her case-based discussion.
Finally, don't neglect the multiple-choice questions crafted by Drs Eduardo Benarroch and Steven Lewis. Emphasizing clinical vignettes they will help you solidify your knowledge of the subject and, when submitted to the AAN, will earn you up to 10 AMA PRA Category 1 CreditsTM.
Neuroendocrinologic factors are not always immediately considered by practicing neurologists. We are grateful to Dr Herzog and his very capable faculty for raising their visibility on our neurologic radar screens.
- Aaron E. Miller, MD