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Neurology Now:
Department: AAN Patient Advocacy

Postcards from the Cutting Edge

Susman, Ed

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Ed Susman covers health and science issues for United Press International.

San Diego, April 2006 – The American Academy of Neurology (AAN) convened 11,000 neurologists, researchers and other healthcare professionals to discuss the latest advances at its 58th Annual Meeting here. Following are dispatches from the weeklong conference where 1,600 scientific studies were presented.

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PARKINSON'S: New Guidlines for Treatment

The AAN released new guidelines aimed to educate neurologists on the treatment of Parkinson's. Based on a comprehensive review of scientific evidence, the guidelines help doctors diagnose the disease earlier and more accurately and then treat it more effectively.

The guidelines stop short of spelling out “exactly how one treats patients, with what drugs and at what time in the course of the disease — that still remains very much part of the art of medicine,” lead author William J. Weiner, M.D., said in discussing these highlights from the guidelines.

* Screening for depression, psychosis and dementia: Parkinson's patients should be screened for and treated for common psychiatric symptoms that are often left untreated. “Many people just assume that depression, hallucinations and memory loss are inevitable side effects of Parkinson's disease and don't even discuss them with their neurologist,” said Dr. Weiner, director of the Parkinson's Disease and Movement Disorders Center at the University of Maryland. “Effective treatments are available, and treatment can greatly improve quality of life.”

* Non-pharmacologic treatments: Regular exercise and physical therapy can improve movement difficulties. “People often aren't aware that exercise and therapy can help with many of these problems,” Dr. Weiner said. “It's important to keep talking with your neurologist about new problems or symptoms or any changes.” There's evidence that speech therapy may be effective in improving voice volume, but none to support acupuncture, chiropractic or massage to improve movement.

* Neuroprotective therapies: Levodopa remains the main therapy and, contrary to widespread belief, does not appear to accelerate disease progression. But the guidelines caution against over-the-counter remedies.

“There is no neuroprotective [preventive] therapy that has shown any proven value for Parkinson's disease,” Dr. Weiner said. “The guidelines demonstrate that nutritional supplementation, for example, does not work.”

Oksana Suchowersky, M.D., director of the Calgary Movement Disorders Program, reviewed 11 studies that considered neuroprotection therapies. She found no protective evidence for vitamin E, coenzyme-10 or prescription drugs, though levodopa was found to be safe without speeding up disease progression.

The guidelines also indicate that deep brain stimulation may help “improve motor function and reduce motor fluctuations, dyskinesia [involuntary movements] and medication usage.”

To access the guidelines and helpful summaries for patients and caregivers as well as physicians, visit www.aan.com and click on “Practice Guidelines.”

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MIGRAINE: Linking Headaches and Heart

New studies indicate that migraines can be dangerous warning signs for heart attacks. That's especially true for women who experienced migraine with aura, which is most commonly a visual or tingling sensation that comes on right before the migraine attack.

A study of 27,840 women found that women over age 45 who have migraine with aura (including sensations like flashing lights, geometric patterns or distorted vision) assumed a 1.7-fold increased risk of developing coronary heart disease. They also faced twice the risk of having a heart attack.

“People with migraine should not lose perspective, however,” said study author Tobias Kurth, M.D., assistant professor of preventive medicine at Brigham and Women's Hospital/Harvard Medical School. “It is important to keep in mind that the biggest group of migraineurs — those without aura — do not have this increased risk.”

His advice for the 40 percent who have migraine with aura: Do as others do to reduce coronary risk by eating better, exercising, and avoiding smoking and overeating.

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Early Warning Signs

Migraine attacks appear to affect as many as 2.1 million American teenagers — but many of them are not getting treatment with prescription drugs. Paul Winner, O.D., director of the Palm Beach Headache Center, estimated that 1 in 16 adolescents suffers from migraines — 6.3 percent of the total in his study. He said early identification and treatment of teens with migraines might prevent those headaches from evolving into chronic daily headaches.

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Show Me the Donation!

Cuba Gooding Jr. was honored to accept the AAN Foundation's 2006 Public Leadership in Neurology Award. But for a movie star who already owns an Oscar, this award meant more than just another figurine for his mantel. What excited him most about winning it was the accompanying $5,000 honorarium he received from the AAN to donate to the charity of his choice.

figure. Cuba Gooding...
figure. Cuba Gooding...
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“Show me the money!” Gooding shouted at the AAN's awards luncheon, repeating the catchphrase he made famous in his Oscar-winning portrayal of the charmingly arrogant football star in Jerry Maguire.

Upon receiving the $5,000 check, Gooding announced he'd donate it to the cause he got involved with because a close friend's daughter has multiple sclerosis. So he invited Joyce Nelson, president of the National Multiple Sclerosis Society, to join him onstage. The pair then reprised the movie scene in which his character keeps exhorting agent Jerry Maguire (played by Tom Cruise) to shout “Show me the money” ever louder.

“I need to hear you say it louder, Joyce!” Gooding kept saying.

“Show me the money!” she'd shout.

When she finally shouted it loud enough for Gooding to hand over the check, Nelson thanked him not just for the donation but also for the very reason the AAN was honoring him: raising public awareness by lending his name and celebrity to MS causes. “What you do for us,” she said, “money can't buy.”

©2006 American Academy of Neurology

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