Neurology
Stroke Onset Needs to be Treated Like the Emergency Situation It Is
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Technology Can Reverse the Effects of Some Strokes, but Stroke Onset Needs to be Treated Like the Emergency Situation It Is
Thanks to clot-busting drugs, new devices and minimally invasive procedures, patients experiencing the onset of a stroke have improved chances of surviving with fewer – or even no – long-term disabilities. Still, more than two-thirds of survivors will have some type of disability, according to the National Stroke Association. Stroke is the third leading cause of death in America and the number one cause of adult disability.
According to Michael J. Alexander, M.D., director of the Neurovascular Center and director of endovascular neurosurgery at Cedars-Sinai Medical Center, a good outcome depends on several factors, but nothing is more important than responding quickly and receiving care at a center that is equipped to offer the latest interventions.
Earlier this year, Cedars-Sinai became the first medical center in California to use a new clot-retrieval device for patients with acute stroke. The catheter-delivered Penumbra System received Food and Drug Administration approval in late December 2007 and has been available at Cedars-Sinai since mid-January.
Response to immune protein determines pathology of multiple sclerosis
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New research may help reveal why different parts of the brain can come under attack in patients with multiple sclerosis (MS). According to a new study in mice with an MS-like disease, the brain’s response to a protein produced by invading T cells dictates whether it’s the spinal cord or cerebellum that comes under fire. The study—from researchers at the University of Maryland School of Medicine in Baltimore and Washington University in St. Louis—will be published online on October 13th in the Journal of Experimental Medicine.
In most MS patients, the disease primarily affects the spinal cord and the white matter of the brain. But a small percentage of patients develop an atypical form of the disease, which primarily affects the cerebellum—the part of the brain that controls sensory perception and movement. For these patients, the disease tends to progress more rapidly and the prognosis is particularly bleak.
MS ensues when the body’s T cells invade the brain and trigger nerve-damaging inflammation, in part by secreting proteins called cytokines.
Occasional Memory Loss Tied to Lower Brain Volume
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People who occasionally forget an appointment or a friend’s name may have a loss of brain volume, even though they don’t have memory deficits on regular tests of memory or dementia, according to a study published in the October 7, 2008, issue of Neurology®, the medical journal of the American Academy of Neurology.
The study involved 500 people age 50 to 85 with no dementia who lived in the Netherlands. Participants were asked about occasional memory problems such as having trouble thinking of the right word or forgetting things that happened in the last day or two, or thinking problems such as having trouble concentrating or thinking more slowly than they used to.
Participant’s brains were scanned to measure the size of the hippocampus, an area of the brain important for memory and one of the first areas damaged by Alzheimer’s disease.
Neurotransmitter defect may trigger autoimmune disease
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A potentially blinding neurological disorder, often confused with multiple sclerosis (MS), has now become a little less mysterious. A new study by researchers at the Mayo Clinic in Rochester, Minnesota, may have uncovered the cause of Devic’s disease. Their new study, which will appear online on October 6th in the Journal of Experimental Medicine, could result in new treatment options for this devastating disease.
Devic’s disease, also known as neuromyelitis optica (NMO), results in MS-like demyelinating lesions along the optic nerves and spine. Affected individuals often experience rapid visual loss, paralysis, and loss of leg, bladder, and bowel sensation. Some lose their sight permanently. Unlike MS, Devic’s disease can be diagnosed by the presence of a specific self-attacking immune protein—an autoantibody referred to as NMO-IgG—in the blood. Until now, however, clinicians didn’t know how that protein damaged nerves and contributed to disease symptoms.
Nerve Activity Can Predict Life Or Death for Comatose Patients
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Even when patients are unable to respond, physicians can get valuable information from nerves that can assist in determining whether the patient will live or die in nontraumatic comatose patients. Even in a comatose state, electrically induced nerve responses can be interpreted because the nerve responses are not affected by therapeutic muscular paralysis that occurs when sedatives are given at high dosage.
In a recent study, evoked nerve responses were studied to correlate the nerve activity with the liklihood of survival. Researchers studied forty-seven nontraumatic comatose adults. One hundred eighty-eight somatosensory evoked potential (SEP) measurements were taken from comatose patients within 5 days after they became comatose. Eight patients (17%) had bilateral loss of cortical SEPs from the scalp.
Despite long term intensive care unit (ICU) treatment, all eight of these patients died. Nerve activity in the scalp was present in a group of 39 patients. Of those 39, 14 patients (35.8%) survived and 25 patients died (64.1%). The study suggests that bilateral nerve response loss can predict the death of the patient. However, having some nerve response cannot predict whether the patient will live or die.
New marker for raised intracranial pressure
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Magnetic resonance imaging (MRI) measurements of the thickness of the optic nerve sheath are a good marker for raised intracranial pressure (ICP). New research published today in BioMed Central’s open access journal Critical Care shows that a retro-bulbar optic nerve sheath diameter (ONSD) above 5.82mm predicts raised ICP in 90% of cases.
The dural sheath surrounding the optic nerve communicates with the subarachnoid space and distends when ICP is elevated. Thomas Geeraerts, from Addenbrooke’s Hospital, Cambridge, led a team who investigated whether MRI can be used to precisely measure the diameter of the optic nerve and its sheath. He said, “Raised ICP is frequent in conditions such as stroke, liver failure and meningitis. It is associated with increased mortality and poor neurological outcomes. As a result, the early detection and treatment of raised ICP is critical, but often challenging. Our MRI-based technique provides a useful, non-invasive solution”.
The early detection of raised ICP can be very difficult when invasive devices are not available. As the authors report, “Clinical signs of raised ICP such as headache, vomiting and drowsiness are not specific and are often difficult to interpret. In sedated patients, clinical signs frequently appear well after the internal damage has been done. Optic nerve sheath distension could be an early, reactive and sensitive sign of raised ICP”.
Treatment for Parkinson’s examined
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The PhD defended by Juan Carlos Gómez-Esteban at the University of the Basque Country analysed the results of the clinical research undertaken at the Movement Disorders Unit at Cruces Hospital since 1998. It involved a study of the most efficacious surgical operations undertaken and pharmaceutical drugs used to treat these disorders as well genetic studies carried out to date.
The field of movement disorders is one of the most complex branches of neurology. The volume of knowledge acquired is so large that it has needed a number of neurologists to sub-specialise in the matter and multidisciplinary units have been created to tackle problems such as the diagnosis of Parkinson’s Disease and of atypical Parkinsonisms, the choice of the most suitable surgical therapies and pharmaceutical drugs or the carrying out of genetic studies. Thus is 1998 the Movement Disorders Unit at Cruces Hospital in Bilbao was created with neurologists, neurosurgeons, neurophysiologists, anaesthetists, neuropsychologists and radiologists. Since its creation, more than 100 surgical operations have been carried out, the majority on patients with Parkinson’s Disease. Currently it is a centre of reference for functional surgery in the Autonomous Community of the Basque Country (CAPV), and even receives patients from other autonomous communities.
Pain appears common among patients with Parkinson’s disease
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Pain appears to be more common in individuals with Parkinson’s disease than in those without, suggesting that pain is associated with the condition, according to a report in the September issue of Archives of Neurology, one of the JAMA/Archives journals.
“Patients with Parkinson’s disease often complain of painful sensations that may involve body parts affected and unaffected by dystonia,” or involuntary muscle contractions, the authors write as background information in the article. This pain may resemble cramping or arthritis, or have features of pain caused by nerve damage. “The high frequency of these pain disorders in the general population makes it hard to establish whether pain is more frequent among people with Parkinson’s disease than among age-matched controls.”
Giovanni Defazio, M.D., Ph.D., of the University of Bari, Italy, and colleagues compared 402 patients with Parkinson’s disease to 317 healthy individuals who were the same age. Participants provided information about their current age, the age at which they developed Parkinson’s disease, scores on disease rating scales and details regarding any pain that was present at the time of the study and lasted for at least three months.
Chronic stress alters our genetic immune response
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Most people would agree that stress increases your risk for illness and this is particularly true for severe long-term stresses, such as caring for a family member with a chronic medical illness. However, we still have a relatively limited understanding of exactly how stress contributes to the risk for illness. In the August 15th issue of Biological Psychiatry, researchers shed new light on one link between stress and illness by describing a mechanism through which stress alters immune function.
In a very promising preliminary study, Miller and colleagues found that the pattern of gene expression differed between caregivers of family members with cancer relative to a matched group of individuals who did not have this type of life stress. They found that among the caregivers, even though they had normal cortisol levels in their blood, the pattern of gene expression in the monocytes, a type of white blood cell involved in the body’s immune response, was altered so that they were relatively less responsive to the anti-inflammatory actions of cortisol, but relatively more responsive to pro-inflammatory actions of a transcription factor called nuclear factor-kappa B, or NF-κB. Gregory Miller, Ph.D., corresponding author, explains more simply that, although “caregivers have similar cortisol levels as controls, their cells seem to be ‘hearing’ less of this signal. In other words, something goes awry in caregivers’ white blood cells so they are not able to ‘receive’ the signal from cortisol that tells them to shut down inflammation.”
Thus, the current findings might help to explain why the caregivers would seem to be in a chronic pro-inflammatory state, a condition of immunologic activation. This activated state could contribute to the risk for a number of medical illnesses, such as depression, heart disease, and diabetes. Dr. Miller remarks that part of the importance of these findings is “because people have traditionally thought that higher cortisol is the reason that stress contributes to disease, but this work shows that, at least in caregivers, it’s actually the opposite - there’s too little cortisol signal being heard by the cells, rather than too much.”
Healthy lifestyle cuts stroke risk: study
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A person’s odds of suffering a stroke might be significantly reduced by maintaining an overall healthy lifestyle, which includes not smoking, exercising daily, consuming a healthy diet, drinking alcohol in moderation and maintaining a healthy weight, according to a study released today.
In the study, people with these five healthy lifestyle habits had about an 80 percent lower risk of ischemic stroke compared to people with none of the healthy habits. An ischemic stroke occurs when a blood vessel supplying blood to the brain becomes blocked; it is the most common type of stroke.
This study shows that a “low-risk” lifestyle recommended to lower the risk of multiple chronic diseases, such as diabetes, cancer and heart disease, may also help ward off stroke, the study team notes in Circulation: Journal of the American Heart Association.
Hypnosis shown to reduce symptoms of dementia
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A scientist at the University of Liverpool has found that hypnosis can slow down the impacts of dementia and improve quality of life for those living with the condition.
Forensic psychologist, Dr Simon Duff, investigated the effects of hypnosis on people living with dementia and compared the treatment to mainstream health-care methods. He also looked at how hypnosis compared to a type of group therapy in which participants were encouraged to discuss news and current affairs.
They found that people living with dementia who had received hypnosis therapy showed an improvement in concentration, memory and socialisation compared to the other two treatment groups. Relaxation, motivation and daily living activities also improved with the use of hypnosis.
New study of gene evolution could lead to better understanding of neurodegenerative disease
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Genetic evolution is strongly shaped by genes’ efforts to prevent or tolerate errors in the production of proteins, scientists at The University of Texas at Austin and Harvard University have found.
Their study also suggests that the cost of errors in protein production may lie in the malformed proteins themselves, rather than in the loss of functional proteins. Misfolded proteins can build up in long-lived cells, like neurons, and cause neurodegenerative diseases.
The work, by Claus Wilke at The University of Texas at Austin and D. Allan Drummond at Harvard, is described in the July 25 issue of the journal Cell.
Measuring the stress of forested areas
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Plants undergo stress because of lack of water, due to the heat or the cold or to excess of light. A research team from the University of the Basque Country have analysed the substances that are triggered in plants to protect themselves, with the goal of choosing the species that is best suited to the environment during reforestation under adverse environmental conditions.
Droughts, extreme temperatures, contamination, and so on – all are harmful to plants. On occasions, the damage is caused by humans. For example, as a consequence of cutting down trees, plants used to shady conditions may be exposed to an excess of light. However, in most cases it is nature itself that causes the stress. In spring, plants have sufficient average humidity and temperatures, i.e. what scientists deem ‘optimum conditions’. But in winter they have to withstand considerable cold and in summer, on the other hand, high temperatures and droughts: adverse environmental factors that generate stress situations. Thus, in winter and in summer, the light which under normal conditions would be a source of energy becomes excessive, given that the metabolism of the plants under these conditions is not able to assimilate it. This process is known as photo-oxidative stress.
Study Links Herpes with Widespread Neuropathic Pain
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Reactivation of genital herpes is linked in some cases with the emergence of widespread neuropathic pain, according to a Finnish study reported in The Journal of Pain.
In the clinic at the University of Helsinki, 17 patients were examined who presented widespread chronic pain with no visible lesions in brain magnetic imaging. Because the majority had herpes simplex virus (HSV) infections, the researchers studied a possible association between herpes and neuropathic pain.
They hypothesized that in HSV-positive patients, the active virus may alter pain processing at different levels of the central nervous system (CNS).
10,000 People in World-first Cerebral Palsy Study
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Researchers from the University of Adelaide, Australia, have launched the largest study of its kind in the world in a bid to better understand the possible genetic causes of cerebral palsy.
The study – requiring cheek swabs of mothers and their children – aims to gather genetic samples from 10,000 people right across Australia.
One of the world’s most serious complications during pregnancy and birth, cerebral palsy is a disability that affects one in every 500 children worldwide, and the consequences are life long.
