Neurology News
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Thursday, April 20, 2017

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BY SARAH OWENS

Tremor, stiffness, slowness, and impaired balance—these movement-related symptoms are the hallmarks of Parkinson's disease. But they aren't the only ones. In fact, many symptoms of the disease are less visible and unrelated to movement. They include depression, anxiety, apathy, hallucinations, cognitive changes, constipation, sleeping problems, and sexual dysfunction.

Since many patients are unaware of these symptoms, they often go untreated. A new campaign by the Parkinson's Foundation—#MoreThanMotor—aims to change that by raising awareness of non-motor symptoms and encouraging patients to discuss and treat them.

Thinking Outside Motor

"In Parkinson's disease, many symptoms—loss of smell, acting out dreams, constipation, depression, and more—show up long before the onset of motor dysfunction," says Michael Okun, MD, FAAN, medical director of the Parkinson's Foundation, a merger of the National Parkinson's Foundation and the Parkinson's Disease Foundation.

As a result, he says, doctors and caregivers should be on the lookout for these symptoms, and doctors should consider Parkinson's when trying to diagnose unexplained changes in mood, loss of sex drive, sleep problems, or constipation in their patients.

Challenging Stereotypes

#MoreThanMotor also wants to challenge the traditional view that Parkinson's "is an old person's disease," Dr. Okun says. "It's true that Parkinson's gets more common as you age, but we see the disease in teenagers and in people in their 20s, 30s, and 40s." The disease can be missed in younger patients because the symptoms are often quite different, he says. "A lot of the neuropsychiatric symptoms, such as depression and anxiety, are more common in younger patients." The disease also affects women, even though it is predominant in men, Dr. Okun adds. It's important to look out for, and treat, both motor and non-motor symptoms in all these patients.

Talk to Your Doctor

If you have Parkinson's disease and are experiencing changes in mood, such as depression and anxiety, or other, non-motor symptoms, don't wait. Talk with your doctor about ways to treat them, Dr. Okun says. Many treatments, including medications, psychotherapy, and lifestyle modifications can help.

"If you have depression, anxiety, apathy, sleeping problems, or sexual dysfunction, and you have Parkinson's disease or you think you do, talk to your doctor," Dr. Okun says. "Ask him or her what's new in treatments [for non-motor symptoms]—there have been a lot of clinical trials lately—and what the tried-and-true techniques are that can help."

Help Raise Awareness

The Parkinson's Foundation is organizing a social media "thunderclap" to promote the campaign. On April 25, all users who've signed up to participate in the thunderclap will automatically post the following message on their Facebook, Twitter, and/or Tumblr account:

#Parkinsons is #MoreThanMotor! Join me to raise awareness of the non-motor symptoms of Parkinson's: http://thndr.me/d8hJK

Join Neurology Now in participating in the thunderclap, and help raise awareness of Parkinson's non-motor symptoms, here: bit.ly/NN-PF-Thunderclap.


Wednesday, April 19, 2017

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BY FRAN KRITZ

High doses of chemotherapy drugs followed by an infusion of a patient's own stem cells may result in remission for people with remitting-relapsing multiple sclerosis (MS), according to a study published online in Neurology on February 1, 2017.  

The new results are from a small clinical trial, called HALT-MS, which was sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health (NIH). Earlier results were published in the third year of the clinical trial while this new study looked at five years of data. The clinical trial included patients with relapsing-remitting MS, which is the most common form of the disease and often involves through long periods with no or only mild symptoms and occasional flare-ups or relapses. Over years, though, symptoms can worsen and progress.

Study Basics

Twenty four patients, ages 18 to 60 (17 women and 7 men) who had not responded to other MS medications, were included in the trial, which involved high-dose immunosuppressive therapy and autologous hematopoietic cell transplant (HDIT/HC.) The high-dose chemotherapy weakens the immune system while transfusions of the patient's own blood stem cells can "reset" the immune system and potentially knock out MS.

Promising Results

At the end of the trial, 91 percent of patients had no disease progression, 87 percent did not relapse, and 86 percent had no signs of new lesions (scars that can indicate MS) on their brain or spinal cord. "These extended findings suggest that one-time treatment with HDIT/HCT may be substantially more effective than long-term treatment with the best available medications for people with a certain type of MS," says NIAID director Anthony S. Fauci, MD.

Some Adverse Events

Three deaths were reported among the trial participants, but they were unrelated to the transplants. Two were the result of MS progression and one was due to cardiovascular disease. The most common side effect of the treatment was infection.

More Studies Needed

More trials are needed before this can be considered a treatment for relapsing-remitting MS, say experts. "Although further evaluation of the benefits and risks of HDIT/HCT is needed, these five-year results suggest the promise of this treatment for inducing long-term, sustained remissions in patients with relapsing-remitting MS, who have a poor prognosis," says Richard Nash, MD, a hematologist with the Colorado Blood Cancer Institute and the principal investigator of the HALT-MS study.

The new clinical trial is "an important study" that "contributes to the accumulating knowledge of the possible benefits and risks of…stem cell transplantation in relapsing MS," says Bruce Bebo, PhD, executive vice president of research at the National MS Society. He added that "larger, well-controlled trials are needed to better understand who might benefit from this procedure and how it compares to the benefits of powerful immune-modulating therapies now available." 


Monday, April 17, 2017

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BY SARAH OWENS

After three days of intense competition among 51 budding neuroscientists at the 18th annual National Brain Bee last month in Baltimore, Sojas Wagle, a 15-year-old sophomore from Little Rock, AK, emerged victorious. In August, Sojas will represent the US at the 2017 International Brain Bee in Washington, DC.

Encouraging Young Brain Scientists

Created in 1998 by Norbert Myslinski, PhD, professor of neuroscience at the University of Maryland in Baltimore, the Brain Bee competition is designed to "build better brains to fight brain disorders," Dr. Myslinski says. Contestants test their knowledge of the brain and nervous system, including its structure, function, and conditions that affect it, such as Parkinson's disease, Alzheimer's disease, and epilepsy.

Every year, Brain Bees are held at the chapter, regional/national, and international level with the winners of each Brain Bee advancing to the next level. There are almost 200 chapters across the world, spanning about 50 countries on 6 continents.

Testing Brain Knowledge

During the two-day competition, the students spend time in a neuroanatomy lab where they rotate through acadaver lab containing 25 stations with real human brains and are asked to identify the parts of the brain marked by pins. "Most of these students have never seen a real live human brain, so it's really an impressive thing for them," says Dr. Myslinski, who was awarded the 2016 International Science Educator of the Year.

  • For the diagnostic section, students work with actors who pretend to have a neurologic disorder such as Parkinson's disease, which the high schoolers must diagnose accurately.
  • For the neurohistology test, students look at brain tissue under a microscope and are asked to identify what they're seeing. "For example, they might have to identify a certain cell in the cerebellum, an axon, or a myelin sheath," Dr. Myslinski says.
  • Contestants also must complete a brain imaging analysis, in which they are asked to identify certain things on MRI scans. The final section involves a live Q&A period, during which students must answer questions like "How heavy is the average adult brain?" and "What's the function of the amygdala?" in front of a panel of judges.​

Once students complete all components, the judges assess the scores and announce a winner.

Crowning the Champion

As champion of the National competition, Sojas wins a monetary prize; an eight-week internship in a neuroscience laboratory; and a donation to his brain disease charity of choice, which is the Alzheimer's Association. He's also the second winner in a row from Arkansas following last year's winner, Karina Bao.

Next, he'll proceed to the international competition, which will be held August 3-6 in conjunction with the annual meeting of the American Psychological Association. Good luck, Sojas!


Thursday, April 13, 2017

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BY FRAN KRITZ

Do you frequently ask people to repeat what they've said? Do you find yourself turning up the sound on the TV news? If yes, you may be among the millions of people who have hearing loss—but don't realize it.

Hearing Loss Is Underrecognized

About one in four Americans who say their hearing is good or excellent actually have hearing damage, according to a new survey by the US Centers for Disease Control of Prevention (CDC) published in the February 10, 2017 issue of Morbidity and Mortality Report. And the damage is often the result of loud sounds during everyday activities at home and outdoors such as loud music.

Looking at the results of more than 3,500 hearing tests conducted on participants ages 20 to 69 in the 2012 National Health and Nutrition Examination Survey, researchers found that 20 percent of participants who said they had no job-related noise exposure nevertheless had hearing damage. Hearing tests are recorded as peaks and valleys on a graph, and the graphs of those 20 percent showed a distinct drop in the ability to hear high-pitched sounds.

Too much noise exposure at home or in the community from things such as using leaf blowers or attending loud concerts can damage hearing just as much as working in a very noisy place, according to the CDC.

Surprising Findings

"Older people are more likely to have hearing loss, but this study finds some young adults are already losing hearing, so this is a concern for all age groups," says Dr. Ann Schuchat, MD, acting director of the CDC. Here are some other surprising results.

  • About 53 percent of adults with noise-induced hearing damage reported no job-related exposure to loud sounds
  • Hearing damage appeared as early as age 20
  • Hearing loss increased with age, from about 1 in 5 (19 percent) among young adults ages 20 to 29 to more than 1 in 4 (27 percent) among adults ages 50-59
  • Hearing loss was more common among men

How Hearing Loss Happens

For humans to hear, sound has to be converted in the ear into electrical signals that are proceesed by the brain. Sound vibrates the eardrum and tiny bones in the ear which in turn vibrate "hair cells" in the inner ear which carry sound to the brain. Exposure to loud noises over time can permanently damage the hair cells, causing hearing loss.

Damage from noise exposure is usually gradual so people often ignore things such as muffled sounds until the loss become more obvious, according to the National Institute of Deafness and Other Communication Disorders (NIDCS), a branch of the National Institutes of Health (NIH), which helped fund the CDC study. At that point, especially for older people, damage could be severe enough to affect their ability to hear conversation or traffic noises.

Hearing loss may also contribute to depression if people choose to stay home rather than engage in activities because they can't hear what's going on. Hearing loss has also been linked to an increased risk of dementia, worsening heart disease, and higher blood pressure. Ongoing studies are trying to explain the link.

Discuss Hearing Loss with your Doctor

The CDC urges people to report hearing loss to their doctor who can help arrange a test to determine if hearing aids are needed. Not sure about your hearing? If the answer to these three questions is yes, it's time to schedule an appointment with your doctor.

1. Do you find it difficult to follow a conversation if there is background noise?

2. Can you usually hear and understand what someone says in a normal tone of voice when you can't see that person's face?

3. Do you feel frustrated with your hearing when talking to family or friends?​

3 Ways to Protect Your Ears

1. Avoid noisy places whenever possible.

2. Use earplugs, protective ear muffs, or noise-canceling headphones if you know you'll be exposed to loud noises such as music at a wedding.

3. Keep the volume down when watching television, listening to music or the radio, or using earbuds or headphones.


Tuesday, April 11, 2017

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BY FRAN KRITZ

For people 65 and older, a daytime nap just after lunch and for at least an hour may be just the thing to preserve memory and cognition. That's according to a new study published online in the December 20, 2016 issue of the Journal of the American Geriatrics Society.

Previous studies found cognitive declines in some people 65 and older, as well as an increase in afternoon napping among some older people. Researchers at the Center for Sleep and Circadian Neurobiology at the University of Pennsylvania's Perelman School of Medicine and School of Nursing wondered if there was a relationship between the two, says Junxin Li, RN, PhD, the lead author of the study and a postdoctoral research fellow at the center.

Dr. Li says earlier studies showed that 22 to 69 percent of older adults take daytime naps, a much higher rate than younger people, and that in China a post-lunch nap is considered part of a healthy lifestyle.

Study Parameters

Dr. Li and colleagues conducted telephone interviews with nearly 3,000 Chinese men and women age 65 and older enrolled in the ongoing China Health and Retirement Longitudinal Study, a multiyear study looking at health factors among 18,000 people in China and their spouses, ages 45 and older. The researchers conducted cognitive assessments, including measuring attention span and short-term memory, by asking participants to recite back a list of words.

Participants were also asked about medical conditions, whether they napped after lunch, and if yes, how long the naps lasted and how many hours they slept each night. Additional questions included where the participants lived, their health habits, and their social activities.

Nap Categories

Study participants were categorized as non-nappers (0 minutes), short nappers (less than 30 minutes), moderate nappers (30–90 minutes), and extended nappers (more than 90 minutes). Among the participants, nearly 60 percent said they napped between 30 and 90 minutes each day, with an average of 63 minutes.

Nap-Cognition Link

After accounting for differences in age, education, and general health, researchers found a correlation between naps and performances on cognitive assessments. Participants who took an hour nap after lunch did better on the cognitive tests compared to the people who did not nap or who took either shorter or longer naps. Significantly, people who took no naps, short naps, or longer naps had decreases in their mental ability that were four-to-six times greater than those who took one-hour naps. Those decreases in ability were about the same as would be expected for someone about five years older than each participants' actual age, according to the researchers.

Dr. Li calls the results "intriguing" but acknowledges that the results show an association between napping and cognitive ability rather than a causal effect. The team plans more studies to see if a causal relationship exists.

Dr. Li says that because their study was done among people age 65 and older, their findings are applicable only to people in that age range, though previous studies have shown that napping benefits cognition in other age groups. And while the new study did not examine the connection between napping and insomnia, Dr. Li says that "generally speaking, daytime naps are not recommended in patients with insomnia."

The study found that those who napped longer also slept longer, but those participants may have been "genetic long sleepers" (they both nap and sleep longer), says Dr. Li. "For some long sleepers, the quality of sleep may be poor and therefore they nap in the afternoon to compensate."

The Art of Napping

Based on the study, Dr. Li says the optimum nap should occur no later than 4 pm and for no more than 60 to 90 minutes. Otherwise, it will interfere with nighttime sleep, which has its own brain benefits. "Older adults should schedule an afternoon nap," he says, "rather than falling asleep while watching TV or continuous dozing, which can be interrupted."