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Tuesday, April 26, 2016

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Courtesy of the Laboratory of Neuro Imaging at UCLA and Martinos Center for Biomedical Imaging at MGH, Consortium of the Human Connectome Project


BY SARAH OWENS

Fifty six high school brain enthusiasts gathered in Washington, DC, last month to compete in the 17th Annual USA Brain Bee, and one--Karina Bao, a junior at Little Rock Central High School in Little Rock, AK—emerged victorious.

Battle of the Brains

Designed to test the knowledge of budding neuroscientists, the competition poses challenges across a range of neuroscience topics, from emotions, memory, and sleep to Alzheimer's disease, Parkinson's disease, autism, and research. Contestants have to complete a neuroanatomy laboratory practical exam with real human brains, make a diagnosis after face-to-face interactions with patient actors, analyze an MRI brain scan, and study brain tissue under a microscope. The competition culminates in a final question-and-answer session.

As champion, Bao secured a summer internship at a neuroscience lab and took home two trophies, one for her and one for her school. She also advances to the 17th World Brain Bee Championship, which will be hosted in July by the Federation of European Neuroscience Societies and held in Copenhagen, Denmark. Bao will compete against about 25 other national champions from Australia, Brazil, Canada, China, Nigeria, Poland, Turkey, the United Arab Emirates, and other countries.

Building "Better Brains"

The USA Brain Bee was established 17 years ago by Norbert Myslinski, PhD, a neuroscientist at the University of Maryland School of Dentistry to promote interest in neuroscience topics among young scholars. "I want to motivate young men and women to learn about the brain, and inspire them to consider careers in basic and clinical neurosciences," says Dr. Myslinski. The Brain Bee "builds better brains to fight brain disorders," he says. The competition has since expanded to 160 chapters in 40 regions on six continents.

For more information about the USA Brain Bee, contact Norbert Myslinski at nmyslinski@umaryland.edu or karobinson@umaryland.edu.

Read our story about last year's winner here.​


Tuesday, April 12, 2016

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BY FRAN KRITZ

Almost half of all Parkinson's patients experience psychosis—seeing, hearing, or smelling things that aren't there, becoming paranoid, or believing things that aren't real—at some point during their illness, usually in advanced stages. The treatment, in many instances, is antipsychotic medication, but a new study, published last month in JAMA Neurology, raises questions about their use.

Disturbing Trend

Researchers, led by Daniel Weintraub, MD, a psychiatrist and professor of neurology and psychiatry at the University of Pennsylvania School of Medicine, looked at records from a large Veterans Affairs database and compared close to 8,000 Parkinson's patients who took antipsychotic drugs at any point between 1999 and 2010 to a control group with the same number of Parkinson's disease patients who did not take antipsychotic drugs.

Each patient in the group who received the medications was compared with a control patient of the same age, gender, race, and years since diagnosis, and dementia diagnosis. The researchers found that those who took antipsychotic drugs were more than twice as likely to die during the six months after starting the drugs as those who were not given antipsychotics.

Black Box Warning

This isn't the first time a concern has been raised about an increased risk of death with antipsychotic drugs. The US Food and Drug Administration (FDA) requires "black box" warnings on antipsychotic drug labels about an increased risk of death when taken by patients with dementia. Dementia is ultimately diagnosed in about 80 percent of Parkinson's patients but a 2011 study by Dr. Weintraub published in JAMA Neurology found that the warnings had not reduced antipsychotic prescriptions for those patients.

Older Drugs Result in More Deaths

The risk of death for patients differed depending on which antipsychotic was prescribed. Older antipsychotics such as haloperidol, were found to have a 50 percent greater chance of death than newer antipsychotics, such as quetiapine, a commonly prescribed drug. The researchers don't know why older drugs cause more deaths, but a follow-up study will look at factors such as diagnoses of other diseases and injuries to see what might be causing the higher rate of deaths.  

Alternatives to Antipsychotics

Physicians should look for other ways to treat psychosis before prescribing medication, advises Dr. Weintraub. He suggests ruling out other medical conditions, reducing dopamine doses, and recommending behavioral therapy methods. "Antipsychotics should be used in these patients only when the psychosis is clinically significant, and patients probably should not be left on these drugs long-term without re-evaluation," he says.

"This study will codify what is best medical practice for the treatment of Parkinson's," says Paul Fishman, MD, PHD, a professor of neurology at the University of Maryland School of Medicine. "If doctors use them, they should use them with care."

Fishman says neurologists are hopeful about pimavanserin (Nuplazid), a new antipsychotic medication that was recommended for approval by an FDA advisory committee and could be approved later this spring. "But the cost of pimavanserin will be higher, and it will be a while before we know whether it increases the risk of death in patients," says Dr. Fishman.

For more about psychosis and Parkinson's disease, read Help with Hallucinations in the April/May 2016 issue. For more about treating psychosis, visit our archives.


Saturday, April 2, 2016

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BY SARAH OWENS

Are you caring for a family member or a loved one with dementia? If so, it's important to establish a plan of care early and stick to it, according to a new study in the Journal of the American Geriatric Society. A consistent plan of care reduces the likelihood of unnecessary transitions between facilities, which can increase the risk of health problems, the study finds.

Some transitions, such as those from a hospital to a long-term care facility, may be necessary and warranted, but unnecessary transitions are associated with a greater risk of cognitive deterioration, trauma, and mortality, as well as a lower quality of care, according to the study's authors.

Researchers at the University of British Columbia's Centre for Health Services and Policy Research found that frequent moves pose "a serious challenge to continuity of care and safety, including medication errors, quality deficiencies, preventable hospital readmissions, and mortality."

Study Methods

Researchers analyzed medical, prescription, and hospitalization records for 6,876 patients in British Columbia over a 10-year period following an initial diagnosis of dementia. They found a spike in transitions—defined as a physical move between health care facilities for a stay of at least one night—during the year after diagnosis, with 65 percent of patients experiencing at least one transition that year. Patients continued to transition at least once a year for the remainder of their lives.

Results

Patients who were moved or hospitalized more often tended to die sooner or die of a combination of diseases. Patients who stayed in place, either in their community or at a long-term care facility, tended to live longer. They also tended to receive recommended laboratory testing, counseling, physical examinations, and referrals to specialists.

Plan Ahead

To avoid unnecessary transitions, doctors and families need to intervene early and plan ahead, the study's authors suggest.

  1. Establish a care plan early. Since transitions were found to increase during the first year after a diagnosis, families and caregivers should get involved as soon as possible that first year to help lower the risk of frequent hospitalizations and other moves.
  2. Think long term. Since dementia is a progressive illness, family members need to reassess the care plan regularly. Families can appoint a patient advocate or care manager to coordinate care, say the study's authors.
  3. Secure a reliable primary care physician. Primary care doctors can identify patients who are at a high risk for frequent transitions, such as those who have other diseases or who live in rural areas. In addition, a good primary care physician can ensure proper laboratory testing, provide awareness of community supports, offer referrals to specialists, and deliver counseling to patients and caregivers—all of which can help reduce the number of transitions.I

Photo credit: iStock/IMTMPHOTO


Monday, March 28, 2016

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BY FRAN KRITZ  

Chronic pain is an everyday reality for many people with neurologic conditions such as multiple sclerosis, neuropathy, and fibromyalgia. Now they may have another tool to manage this difficult symptom. A new study in the Journal of Neuroscience shows that mindfulness meditation may reduce perceptions of pain by as much as 24 percent—and that meditation may use a different pathway in the brain than opioids to block pain.

Study Parameters

In a randomized, double-blind study, researchers at Wake Forest Baptist Medical Center in Winston-Salem, NC, divided 78 healthy volunteers with no history of pain into four groups: meditation plus naloxone (a drug that blocks opioid receptors); naloxone but no meditation; meditation with placebo; and placebo with no meditation. Participants were asked to meditate 20 minutes each day over four days. The meditation consisted of sitting up straight with eyes closed, focusing on sensations of breathing, letting go of thoughts without judging, and then bringing attention back to the breath.

Pain Measurement

To simulate pain, the researchers applied heat of 120 degrees Fahrenheit to the backs of the legs of participants who then rated their degree of pain by moving a colored sliding scale to indicate more or less pain. The researchers quantified the scales into percentages.

Results

After four days, the meditation/naloxone group pain ratings were reduced by 24 percent—even when the brain's opioid receptor pathway was blocked by naloxone. That suggests that meditation uses a different pathway in the brain to block pain. In the meditation group that received the placebo instead of naloxone, pain ratings were reduced by 21 percent. By contrast, the non-meditation groups reported increases in pain regardless of whether they received naloxone or placebo.

Why Meditation Matters

Having another effective nondrug therapy for treating chronic pain is especially important on the heels of the recent US Centers for Disease Control and Prevention (CDC) guidelines for opioid prescriptions, says Fadel Zeidan, PhD, an assistant professor of neurobiology and anatomy at Wake Forest University in Winston-Salem, NC, and the lead author of the study on mindful meditation.  

Millions of people in the US are addicted to opioids, some as a result of treatment for chronic pain, says Thomas Frieden, MD, MPH, director of the CDC.  The guidelines recommend that physicians treat chronic pain initially without drugs, or with nonopioid pain relievers such as ibuprofen. When opioids are prescribed, doses should be low and short-term, to help prevent the chance for addiction. "At the very least, we believe that meditation could be used in conjunction with other traditional drug therapies to enhance pain relief without producing the addictive side effects and other consequences that may arise from opiate drugs," says Dr. Zeidan.

Next Steps

Dr. Zeidan acknowledges the limitation of his study—it included a small cohort and lasted only four days—but says, "We can show you that if you meditate you can feel immediate relief. It may not be long lasting, but neither are opioids." Dr. Zeidan says his group will continue to look at meditation and pain control to determine how long people need to meditate for optimal pain relief.

For information on how to practice mindfulness meditation, visit the UCLA Mindful Awareness Research Center at bit.ly/UCLAGuidedMeditation. To read the CDC guidelines, visit bit.ly/OpioidGuidelines.


Friday, March 18, 2016

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Stroke Recovery: More Rehab Isn't Better, Study Says

BY JAMIE TALAN

A new study testing the benefits of a task-oriented rehabilitation program to strengthen hand and arm weakness post-stroke suggests that more hours of an intensive program are not necessarily better than usual occupational therapy. Patients who received intensive upper-body training–30 one-hour sessions over a 10-week period–fared no better than those who received a more standard type of rehabilitation, or the usual therapy with significantly fewer hours.  

Study Parameters

Researchers at the University of Southern California (USC) randomly assigned  361 stroke patients from seven hospitals around the country to receive either one-hour intensive, structured upper-extremity training three times a week; 30 hours of usual occupational therapy; or occupational therapy that was monitored but with no prescribed amount of hours. The rehabilitation services were delivered in an outpatient setting and the patients' upper extremity motor function and recovery were measured over the course of a year

Results

As reported in the Journal of the American Medical Association, there were no differences between the groups in upper extremity motor performance. The group undergoing intensive, task-oriented rehabilitation did not have better arm or hand strength than the groups who had usual occupational therapy or monitored-only standard rehabilitation practice. In other words, a more intensive treatment protocol wasn't better at restoring motor performance. "These findings do not support superiority of this task-oriented rehabilitation program for patients with motor stroke and moderate upper extremity impairment," the study authors wrote.

Unexpected Findings

The study counters recent research that suggested that more hours of task-oriented upper-extremity training are better for stroke patients than standard occupational and physical therapy. The USC researchers acknowledged that changing practices among physical and occupational therapists could have accounted for the similar motor outcome identified in the study. Also, the variability in the hours of rehabilitation patients received in the control arm of the study could have skewed the results, they said.

Less May Be More

Still, the researchers concluded: "The findings from this study provide important new guidance to clinicians who must choose the best treatment for stroke patients. The results suggest that usual community-based therapy, provided during the typical outpatient rehabilitation time window by licensed therapists, improves upper extremity motor function and that more than doubling the dose of therapy does not lead to meaningful differences in motor outcomes."

Read the full story from which this post was adapted in Neurology Today at bit.ly/NT-StrokeRehab.