Wednesday, November 30, 2016

Acupuncture Found to Reduce Episodic Migraine

  A Cochrane database review of 22 trials with 4,985 participants revealed an apparent reduction in headache frequency in patients with episodic migraine. By this review acupuncture reduced headache frequency more than prophylactic drugs (but not at the six month follow up).
Ann Int Med 2016;165(8):JC44
Additional reference : JAMA 2017 Feb20

Caspase-2 a NEW potential Target in the Treatment of Alzheimer's

  Researchers at the University of Minnesota reported that capsase-2 , cuts the full length TAU protein (which accumulates in the brains of patients with AD and is neurotoxic) into fragments. These pieces of protein adversely affect synaptic signaling in dendritic spines directly leading to cognitive impairments in mice. These fragments PRECEDE the formation of aggregated TAU suggesting that the tangles seen are NOT the cause of AD. In fact the memory problems seen in these experimental mice occur BEFORE brain loss suggesting that blocking caspase-2 could be used to treat Alzheimer's disease.
Nat Med 2015:Epub 2016 Oct 10

Saturday, November 19, 2016

Obesity Is BAD for your Health....Duh...AND MS

  Obesity (BMI over 30) and those overweight (BMI 25-30) affects 46% of Americans over the age of 15 compared to 17% globally.
  Obesity is associated with chronic low-grade inflammation, greater brain atrophy and white matter changes, disturbances in the blood-brain barrier, and an increased risk of Alzheimer's disease. In multiple sclerosis, obesity/overweight in childhood and adolescence is a risk factor for pediatric and adult-onset MS. This is true for both sexes but is more pronounced in females. (Lancet Neurol 2014;13(9);913-923)

Treatment Therapies For Fatigue In MS

  Primary fatigue (unique to multiple sclerosis) involves no precipitating activity, is worsened by heat or humidity, and is worse in the early afternoon. 40 % of MS patients report it as their most disabling symptom. This fatigue may be constant in 30 % of affected individuals.
  The cause of primary fatigue is unknown.
  Treatment options include : cooling, aerobic and strength training, energy conservation, mindfulness, relaxation therapy, magnetic therapy, transcranial stimulation, and drugs.
  Drug therapy to treat fatigue include : amantadine, modafinil, armodafinil, gingko biloba, methylphenidate and amphetamines.
  Comorbid conditions must be addressed : depression, anemia, thyroid disease, disrupted sleep, medication side effects, motor disability with increased energy use. (Continuum 2016;22(3):815-836

Fatigue In MS

   Fatigue is an overwhelming sense of tiredness and is often considered the leading symptom in multiple sclerosis.     Significant fatigue in isolation may precede a diagnosis by several years (Mult Scler 2013;19(11):1526-1532)
  Fatigue at the time of a first attack of MS (CIS) independently predicts a diagnosis of MS (J Neurol Neurosurg Psychiaty 2015;86(5):543-546

Friday, November 18, 2016

Pregnant Women That Take Tylenol Induce Psychopathology In Their Children

  Prenatal acetaminophen was found to be associated with increased risks of psychopathology such as conduct problems, hyperactivity problems and emotional symptoms (ADHD). (JAMA Pediatr 2016 Aug 15;[pub])
  Common causes for taking acetaminophen during pregnancy include infection and fever both of which can produce epigenetic and brain changes according to an animal study. (Biol Psychiatry 2016 Aug 12;[e-pub])
  Animal data also reveal that prenatal acetaminophen, even without inflammation, can disrupt neurodevelopment. (Toxicol Sci 2014;138-139)
  These studies suggest there should be increased efforts to vaccinate women against influenza and to encourage them to avoid exposure to flu infected individuals.

Friday, September 16, 2016

Attacks of Migraine : More Than Just A Headache

  The postdrome phase of migraine  ie. the time between headache resolution and feeling completely back to normal, consisting mostly of fatigue and cognitive disability is an underappreciated contributor to migraine symptomatology.
  Disability from migraine is substantial. It is estimated to be the sixth most disabling condition worldwide (Lancet 2015;386:743).
  According to a recent study, even after the headache passes, sufferers are not able to perform optimally at work or in school for at least several hours.
Neurology 2016 Jul 19;87:309

Monday, August 15, 2016

Experimental Trials for Alzheimer's

   Experimental trials worth mentioning include but are not exclusively : 
1. Infusion therapies to recruit the immune system : solanezumab, aducanumab.
2. To prevent destruction of brain connections : saracatinib which  turns off Fyn, a brain protein which when over-activated triggers destruction of connections between brain cells ( ie. synapses). 
3. Beta-amyloid production blockers such as beta- and gamma- secretase inhibitors. 
4. Tau aggregation inhibitors and tau vaccines to prevent tau from forming the tangles seen in Alzheimer's. 
5. Reduce chronic, low-level inflammation eg. pioglitazone (Actos). 
6. Insulin nasal spray to alter insulin changes in Alzheimer brains. 
7. Modulating known risk factors eg. hypertension, diabetes, stroke, high cholesterol and heart disease. 
8. Estrogen-based hormone therapy to protect women with a higher risk of Alzheimer's.

Monday, June 20, 2016

Best Treatment for Critical Lumbar Spinal Stenosis

  Most patients who underwent spinal fusion after laminectomy decompression scored no better than those who underwent decompression procedures alone in scales that measured difficulty in walking, pain, and impact on quality of life.
NEJM 2016;374:1413-1422
NEJM 2016;374:1424-1434

Lyrica Associated with Major Birth Defects

  From Researchers in Lausanne Switzerland, women that took Lyrica (pregabalin) for a variety of conditions (pain related) during their first trimester of pregnancy had infants with a much higher rate of major birth defects than matched control subjects not taking Lyrica.
Neurology Today
19 May 2016 Vol. 16 - Issue 10:pp1,12-15

Tuesday, April 5, 2016

Accelerated Brain Atrophy with Atrial Fibrillation

  According to data presented at the 2015 European Society of Cardiology Congress, atrial fibrillation in the elderly general population were found to independently have accelerated loss of brain volume and cognitive function.
  The mechanism is unknown but may be multifactorial including altered autonomic regulation of cerebral blood flow, micro emboli to the brain and atrial fibrillation- induced  diminished cerebral blood flow.

Risk of Stroke Increases With IncreasedJob Stress

In a meta-analytic study out of China, people with high stress jobs had a 22% higher risk of stroke than those with low-stress jobs. Women with high-stress jobs had a 33% higher risk of stroke than women with low-stress jobs.Those with high-stress jobs were 58% more likely to have an ischemic stroke than those with low-stress jobs. People with passive (janitors,miners, other manual laborers) and active (doctors,teachers,engineers)did NOT have an increased risk of stroke.
  High stress jobs were found in the service industry (waitresses,nurses aides).
Neurology.2015 Oct 14

IBS, Migraine and Tension Headaches Linked ?

   Irritable bowel syndrome, (the most common GI disorder internationally with 45 million sufferers in the US alone) , tension headaches and migraine may share common genetic mutations.
  Researchers from Istanbul University in Turkey when looking at the serotonin transporter gene and serotonin receptor gene 2A found that IBS, migraine and tension headache groups had at least one gene that differed from healthy participants.

Monday, March 21, 2016

Immunologic Profile in MS Patients Altered with High Dose Vitamin D

   Those with low Vitamin D levels have been shown to have have an increased risk of developing multiple sclerosis in previous studies as well as an increased number of brain lesions on MRI. NEJM JW Neurol Dec 2015, JAMA Neurol 2015;72:1458
  A newer study revealed reduced percentages of IL17+CD4+T cells and effects memory cells CD4+ in patients that received 10,400 IU of vitamin D3 daily.
Neurology 2015 Dec 30

Sunday, March 13, 2016

Potential Treatment for Traumatic Brain Injury and PTSD

  Methylphenidate improved attention, post concussion symptoms and PTSD symptoms. Galantamine improved episodic memory. Both drugs improved depression in TBI and PTSD patients.
Neuropsychopharmacology 2015 Sept 11

Increased Risk of MS in Children In Pregnant Women with Low Vitamin D3

  The children born to women with low vitamin D3 levels were found to be at double the risk of developing multiple sclerosis.
JAMA Neurol. March 7,2016

Modest Seafood intake Decreased Alzheimer's Risk

  Even a single seafood serving a week had a neuroprotective benefit against the development of neurofibrillary tangles and amyloid deposits in people that carry the apolipoprotein e4 risk gene for Alzheimer's. The same is NOT true for those that do not carry the APOE e4 gene. 
  Interestingly, that same population studied also were found to have increased mercury in their brains WITHOUT an adverse effect pathologically.
JAMA 2016;315(5):465-466