Excessive Drooling ? New Treatment Approved by FDA

  Xeomin (incobotulinumtoxinA) for the treatment of chronic sialorrhea in adults (ages 20-80) such as that seen in Parkinson's disease. Also those adults with cerebral palsy, MSA, PSP.
  100 units is injected into 4 sites in submandibular glands bilaterally.
  NB! Exclusionary criteria: patients on coumadin, + history of Myesthenia Gravis, Lambert-Eaton syndrome, ongoing substance abuse, cognitive impairment < 23/30 on Mini Mental Status exam.
  I use atropine opthalmic drops under the tongue with great success in select patients in my practice.
ClinicalTrials.gov ID : NCTO1653132

Minor Stroke ? Opt NO for t-PA

  Patients with mild ischemic stroke did not benefit from treatment with the clot busting agent alteplase at 90 days compared to aspirin (325 mg) alone according to the PRISMS Trial phase IIb.
JAMA. 2018 Jul 10;320(20):156-166

Maybe Bad News or Male Truckers

  According to a study presented at the 70th AAN annual meeting, people with consistently high occupational exposure to diesel exhaust may have a higher risk of ALS.
  Men with any diesel exhaust at jobs held for at least 10 years were 20% more likely to develop ALS than men with no exposure.
  For men with a 50% likelihood of diesel exhaust exposure due to their occupation, the link was stronger ie. 45% more likely to develop ALS.
  NO association was observed with women with such exposure.
AAN 70th Annual Meeting 2018

Fact: It's Harder to get a Good Night's Sleep When we're Older

  According to an animal study, disruption in sleep patterns and it's consequent threat to their well-being occurs in mammals because advancing age impairs the ability of the circadian clock to reset itself when exposed to light.
  Further, age results in a dramatic reduction in sensitivity to light in the suoprachiasmatic nucleus (SCN), the part of the brain that controls circadian rhythms.
  In one SCN pathway studied in mice, a glutamate receptor (NMDA) which is used to transmit light information became less effective in resetting the circadian clock and exhibited a markedly decreased presence as a part of the aging process.
Neurobiol Aging. 2018 Feb 20

Women's Fertility Not Affected by Epilepsy

  According to researchers who examined data from the Women with Epilepsy: Pregnancy Outcomes Study and compared fertility rates between women with and without epilepsy, women's fertility was not adversely affected by epilepsy.
  In women without a history of infertility, the likelihoodof conceiving and having a live birth was no different between women with epilepsy and those without.
JAMA Neuro. 2018 Apr 30

Insulin Resistant Diabetic ? Make the Bedroom DARKER !

  According to research presented at the APSS annual meeting in Baltimore in June a single night of light exposure during sleep may acutely affect insulin resistance.
  Even healthy adults who slept with an overhead light on had significantly greater insulin resistance the next morning.
  These results are given added significance given the increasingly widespread use of artificial light exposure, especially at night.
  Recall my previous comments about the adverse effects of a dysmetabolic states, such as diabetes are associated with an increased risk of dementing illness and Parkinson's later in life, not to mention end organ disease: brain, nerve, eyes, kidneys, etc.
ASPSS 32nd annual meeting 2018 

Promising New Test for Parkinson's Disease ?

  According to a preliminary study presented at the 70th American Academy of Neurology annual meeting certain proteins in tears may be useful biomarkers.
  Researchers at USC found the levels of total alpha-synuclein to be decreased in patients with Parkinson's disease compared to healthy controls.
  But levels of oligomeric alpha-synuclein were increased in those with Parkinson's disease compared to controls.
  It has been a longstanding challenge to differentiate patient's with Parkinsonism related to another illness from those with Parkinson's disease early on. This may help neurologist's make a diagnosis sooner as we anxiously await a cure.
AAN Annual Meeting Los Angeles 2018

Headache: A Significant Health Problem

  Head pain accounts for 3.0% of all emergency department visits and was the 5th leading cause for such.
  Headache is the 12th most common diagnosis among emergency docs (1.8% of all visits).
  In 2014, there were 4 million ER visits for headache.
  Women of childbearing age made up more than half of the ER visits for headache.
  Interestingly, native Hawaiians and other Pacific Islanders have the highest prevalence of migraine.
Headache. 2018 March 12

Worsened Parkinson's Disease with Low B 12

   Folks with early untreated Parkinson's disease with low vitamin B12 (less than 157 pmol/L) were found to have greater worsening of mobility and cognitive decline over time.
  Further, elevated homocysteine predicted greater cognitive decline.
Mov Disord. 2018 Mar 6

Ambien and Alzheimer's Linked

  Cumulative doses of Zolpidem (Ambien), a common sleep drug, are associated with a greater risk for developing Alzheimer's in elderly patients (65 and older) according to a retrospective study.
J Am Geriatr Soc, doi:10.111/jgs.15018