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Monday, October 05, 2015



Women who experience migraines have different levels of molecules called lipids in the blood than women without headache disorder, according to researchers from Johns Hopkins University in Baltimore, Drexel University in Philadelphia, and the University of Toledo in Ohio. This discovery may lead to earlier diagnosis and more targeted treatment, the investigators said.


For the study, published in Neurology, the researchers analyzed blood samples from 52 women between the ages of 18 and 50 who had been diagnosed with episodic migraine (defined as less than 15 “headache days” per month) and 36 women without headache disorders. The women with migraine had an average of 5.6 headache days per month, and nearly half (48 percent) reported migraine with aura (where the migraine is preceded by symptoms like visual hallucinations, temporary blind spots, or prickly sensations on the skin).


Lipid Levels Differ in Women with Migraine

The researchers tested the blood samples for a group of lipids known to help balance energy in the body and regulate inflammation in the brain. They found that levels of lipids called ceramides were significantly lower in women with migraine than women without. The higher the level of ceramides in the blood, the lower the risk of having migraine, the researchers found.


In contrast, higher levels of two other types of lipid molecules called sphingomyelin were linked to a higher risk of migraine.


To strengthen their findings, the researchers then took a blinded test, randomly collecting blood samples from 14 women (eight with migraine and six without) without knowing who had migraine and who did not. They then tested the samples for these lipids. In every case, the researchers were able to determine whether the participant had a migraine diagnosis or not based on her lipid levels.


Proceed with Caution

The study had several limitations that will need to be addressed in future research, said Karl Ekbom, MD, PhD, of the Karolinska Instituet in Stockholm, in a commentary published along with the study. The study enrolled only a small number of women and no men, he noted, and only included those with episodic migraine, not chronic migraine (defined as more than 15 headache days per month for at least three months). An unusually large number of women in the study reported experiencing migraine with aura, he pointed out.


Future studies should look at participants of both genders with both episodic and chronic migraine, as well as other types of headache disorders, such as cluster headache (recurrent, severe headaches on one side of the head, usually around the eye), he said.


But if the findings can be confirmed in future research, they may help doctors diagnose and distinguish migraine from other types of headache disorders, the researchers said—and may also point doctors towards more effective treatments that target these lipid levels.


Learn more about migraine at the Mayo Clinic website. For more articles about migraine, browse our archives.

Tuesday, September 29, 2015




If you need motivation to lose weight, consider these findings from a new study in Neurology: Being overweight or obese is linked to a higher risk of meningioma, a typically benign tumor that forms in the membranes surrounding the brain and spinal cord.


BMI, Physical Activity, and Brain Tumors

Researchers at the University of Regensburg in Germany reviewed all previously published studies on body mass index (BMI), physical activity, and the two most common types of brain tumors in adults: meningioma and glioma, a malignant tumor that forms in the glial tissue in the brain. The researchers identified 12 studies that looked at BMI and six that involved physical activity. In total, the studies involved 2,982 people with meningioma and 3,057 with glioma.


According to their analysis, people who were overweight (defined as having a BMI of 25 to 29.9) were 21 percent more likely to develop meningioma. Those who were obese (a BMI of 30 or higher) were 54 percent more likely. The researchers did not observe a link between higher BMI and glioma.


People with the lowest levels of physical activity also had a 27 percent higher risk of meningioma than people with the highest levels of physical activity, but the definition of “high” and “low” physical activity differed in each study.


Theories to Explain a Link

“This is an important finding since there are few known risk factors for meningioma and the ones we do know about are not things a person can change,” said study author Gundula Behrens, PhD, in a news release.


While the study cannot prove that excess weight causes meningioma, the researchers suggested some theories that might explain the link. For example, people who are overweight tend to produce more estrogen and insulin, hormones that have been associated with the development of meningioma. 


The link between physical activity and meningioma is a little murkier, Dr. Behrens said. It’s possible that an undiagnosed meningioma “caused people to reduce their physical activity at the time it was measured,” so it’s unclear whether there’s a strong link between the two, she said.


Dr. Behrens also emphasized that these types of tumors are quite rare, noting that five to eight per 100,000 people are diagnosed with a meningioma each year. The five-year survival rate is 63 percent. In rare cases, meningiomas can be cancerous.


Healthy Weight Equals Healthy Brain

The benefits of a healthy diet and physical fitness go well beyond protecting against brain tumors. Maintaining a healthy weight is linked to a lower risk for stroke and other cardiovascular complications, as well as a lower risk for dementia.


To get started with a healthier lifestyle, post these doctor-approved tips on your fridge:


·         Cut back on processed foods, which are loaded with added salt and sugar.

·         Eat more fruits and vegetables.

·         Choose lean protein and whole grains over fatty meats and simple carbohydrates.

·         Turn off the TV and step outside for a brisk walk, a jog, or a bike ride.

·         Aim for at least 30 minutes of exercise four times a week.


For more tips for keeping your brain and body healthy, browse our archives here.


Image: Flickr, Tanvir Alam

Thursday, September 24, 2015




New research reveals two factors that can increase your chances of developing dementia: having low levels of vitamin D, or a diagnosis of atrial fibrillation, the most common form of irregular heartbeat in the elderly.


Low Vitamin D Linked to Cognitive Decline

Researchers at the University of California, Davis and Rutgers University looked at a group of 382 racially and ethnically diverse seniors with an average age of 76 who were enrolled in a long-term Alzheimer’s disease study in Sacramento, CA, between 2002 and 2010. Nearly 50 percent had normal cognition when they enrolled, while 32.7 percent had been diagnosed with mild cognitive impairment and 17.5 percent had dementia. The researchers measured levels of vitamin D in their blood, identifying those who had vitamin D deficiency (less than 12 nanograms per milliliter [ng/mL]) or insufficiency (12 to less than 20 ng/mL), as well as those those who had adequate (20 ng/mL to less than 50 ng/mL) or high (50 ng/mL or more) levels of the vitamin.


Twenty-six percent of participants were deficient in vitamin D and 35 percent had insufficient levels, the researchers found. More African-American and Hispanic participants were deficient or insufficient than Caucasians: 70 percent versus 54 percent. The researchers found that those with low levels of the vitamin had accelerated cognitive decline and worse performance on cognitive tests.


After about five years, “on average, people with low vitamin D declined two to three times as fast as those with adequate vitamin D,” study author Charles DeCarli, MD, director of the Alzheimer’s Disease Center at UC Davis, said in a news release for the study published in JAMA Neurology.


The declines were most pronounced on tests designed to measure episodic memory (the recollection of autobiographical events) and executive function (skills like reasoning, planning, and problem-solving). These two aspects of cognition are strongly affected by Alzheimer’s disease, the researchers said.


Next Step: Test Vitamin D Supplements

The body’s main source of vitamin D is sunlight, Dr. DeCarli and his colleagues explained. That’s why Caucasians, who have lighter skin that is more sensitive to sun exposure, tend to have higher levels of the vitamin. People also get vitamin D from eating dairy products.


If you suspect you may be deficient in vitamin D, talk to your doctor about what you can do to get more—particularly if you have multiple sclerosis (MS). Many people with MS have low vitamin D, and some research suggests that getting enough of it can help reduce symptoms.


Still, there’s no guarantee that boosting vitamin D through supplements, increased sun exposure, or eating more dairy will stave off dementia, Dr. DeCarli warned. “That needs to be researched and we are planning on doing that,” he said.


Atrial Fibrillation Ups Dementia Risk

Another study published in JAMA Neurology by Dutch researchers found that people with atrial fibrillation, or Afib, have a higher risk of dementia than those without the heart condition.


The researchers looked at 6,514 dementia-free people aged 55 or older who were enrolled in a long-running study of chronic diseases in Rotterdam, the Netherlands, between 1989 and 2010. Nearly 5 percent, or 318 people, had atrial fibrillation at enrollment. By the end of the 20-year follow-up period, 994 participants, or 15.3 percent, had developed dementia, including nearly 80 percent with a diagnosis of Alzheimer’s disease. The researchers calculated that people with Afib were 33 percent more likely to develop dementia than those without it.


Younger People Have a Higher Risk

The researchers then conducted a second analysis including the 6,196 individuals who did not have atrial fibrillation at the start of the study. They identified 723 people who developed Afib after enrollment and 932 who developed dementia, including 741 with Alzheimer’s disease.


In this group, people with Afib had a 23 percent higher likelihood of developing dementia than those without it. And younger participants had the greatest risk: 81 percent for those with Afib under age 67, compared to 12 percent for those over age 67. And younger participants who had had the condition for longer had an even higher risk—230 percent for those who had been diagnosd with Afib more than 12 years earlier.


“Since dementia develops gradually over many years, [Afib] probably needs to occur at a younger age to contribute to the onset of dementia,” the researchers wrote.


Results Are Independent of Stroke History

Atrial fibrillation is known to increase the risk of stroke, which in turn increases the risk for dementia. But the researchers factored that into their analysis and found that having Afib increased dementia risk even when the participants hadn’t experienced a stroke.


Does Treatment Reduce Risk?

The researchers weren’t able to determine whether treating Afib with the appropriate anticoagulant medications can reduce the risk of developing dementia. Future research should investigate this, they said.


In the meantime, treating the heart condition has other proven benefits. Most importantly, if you have Afib and your doctor suspects you’re at risk of stroke, taking the right medication can lower your risk.


Look for an article in the next issue of Neurology Now that discusses stroke risk among people with Afib and offers tips on how to decide what treatment is right for you. And browse our archives to learn about other ways to reduce your risk for dementia.

Wednesday, September 23, 2015




A new study published in JAMA Neurology about multiple sclerosis (MS) and smoking provides yet another incentive to quit: Smokers who continue to puff after being diagnosed with MS may progress more rapidly to the secondary-progressive stage of the disease than those who stop.


A second study suggests that lower levels of melatonin, a sleep-regulating hormone, contribute to seasonal symptom flare-ups or relapses.


How Smoking Affects MS Progression

Researchers from the Karolinska Institute in Sweden looked at a group of 728 people with MS who smoked at the time of their diagnosis and 1,012 people with MS who had never smoked from a Swedish database of MS patients. Among the smokers, 332 continued to smoke after diagnosis. Another 118 quit within the next year. (The remaining patients smoked on and off during the study period or quit more than one year after diagnosis). Of those who smoked at the beginning of the study, 216 developed secondary-progressive MS between November 2008 and December 2011, when the data were collected.


People who continued to smoke after diagnosis converted to secondary-progressive MS (SPMS) on average 8 years earlier than people who quit—at age 48 compared with age 56. The researchers found that each additional year of smoking sped up a person’s time to diagnosis of SPMS by 4.7 percent. (People generally develop SPMS about 20 years after diagnosis, they noted.)


Researchers Urge Smokers to Quit

Given the numerous health risks associated with smoking—like heart disease, lung cancer, and emphysema, among many others—people with MS should be proactive about trying to quit, the researchers said. A good place to start is, which offers resources for smokers trying to kick the habit.


“Health care services for patients with MS should be organized to support such a lifestyle change,” they wrote.


Low Sleep Hormone Levels May Trigger MS Relapses

Another group of researchers, from the Ann Romney Center for Neurologic Diseases at Brigham and Women’s Hospital in the US and the Raúl Carrea Institute for Neurological Research in Argentina, sought to understand why people with MS report more relapses during spring and summer than during fall and winter.


As they reported in the journal Cell, levels of melatonin, a hormone that helps regulate the body’s sleep-wake cycle and is thought to be involved in immune system function, may be responsible.


The researchers found that in a group of 139 people with MS, relapses decreased by 32 percent during fall and winter. When they looked at a variety of factors that might contribute to these seasonal relapses, including levels of vitamin D and upper respiratory tract infections, they zeroed in on melatonin as the most likely culprit.


Boosting Melatonin Improves MS Symptoms in Mice

To test their hypothesis, the researchers gave mice with symptoms of MS daily injections of melatonin. Boosting melatonin levels improved the animals’ physical symptoms, the researchers saw.


When they looked at cells in the brains and spinal cords of the mice, as well as human cell cultures in a dish, they observed that boosting melatonin helped maintain a healthy balance of two different types of T cells, or immune cells. The hormone appeared to reduce levels of harmful Th17 cells, which attack and damage healthy brain and spinal cord tissue, while increasing levels of regulatory T cells, which keep Th17 cells from wreaking havoc on the nervous system.


Melatonin Supplements Aren’t the Answer—Yet

There’s no proof that taking melatonin supplements will improve symptoms of MS in humans, however. The researchers need to investigate the molecular link between melatonin and disease progression in more detail and identify safe and effective drugs that can be tested in human trials.


“Until a clinical trial is conducted and an appropriate drug and dosage is established, it is not recommended to use melatonin for the treatment of multiple sclerosis,” said study author Francisco J. Quintana, PhD, a researcher at the Ann Romney Center for Neurologic Diseases, in a news release.


To learn about doctor-approved methods for treating MS, browse our archives here.


Images: Flickr, Fried Dough (left), Dawn Ellner (right).

Tuesday, September 22, 2015




If you live with low back pain, you may not be surprised by a new study in Neurology that suggests that pain relief is more important than improved mobility. Physical suffering, researchers found in a survey, disrupts people’s quality of life more than limited movement.


This finding may change the way clinical trials of painkillers are conducted, as well as how doctors treat people with chronic pain, the researchers say.


“While physicians have leaned toward the need to increase mobility, this study shows that patients have a clear preference for pain relief,” said study author John Markman, MD, director of the Translational Pain Research Program at the University of Rochester, in a news release.


Relieve My Pain, Survey Says

Dr. Markman and his colleagues surveyed 269 people with lumbar spinal stenosis, a type of chronic low back pain, who visited the Neuromedicine Pain Management Center at the University of Rochester between 2008 and 2014. Asked whether they would prefer a treatment that allows them to walk farther or one that allows them to walk with less pain, 79 percent of the 221 people who responded said they would prefer to walk with less pain.


People who reported higher levels of pain were more likely to choose walking with less pain over walking farther. But pain-related physical impairment (measured by self-reports, as well as a treadmill test administered by the researchers) had no impact on the responses.


“Even the patients who could not stand long enough to pick up a letter from their mailbox or wash the dishes after dinner chose pain relief” over mobility, Dr. Markman said.


Effective pain relief is likely to influence mobility, the researchers acknowledged. So a treatment that reduces a person’s pain might also enable them to walk farther. But since pain is only one of many factors that can affect function—others may include fatigue, motivation, other medical problems, or the availability of a caregiver—there’s no guarantee that an effective painkiller will also significantly improve mobility.


Redefining “Effective” Pain Relief

Researchers shouldn’t underestimate the importance of pain relief when designing clinical drug trials for people with chronic low back pain, even in the absence of improved mobility, Dr. Markman and his colleagues wrote. And medications that improve pain but don’t improve physical functioning shouldn’t necessarily be dismissed by pain specialists as “ineffective.”


To learn about doctor-approved ways to treat chronic pain, including alternatives to opioid painkillers, read “Rethink Chronic Pain” from the August/September 2015 issue of Neurology Now. For more articles about chronic pain, browse our archives here.


Image by Anthony Wing Kosner.