Neurology News
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Thursday, May 25, 2017

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BY NOAH GLENN

If you experience migraines, you know how painful and debilitating they can be. But you may not know about the latest research and the newest treatment options. In this podcast, Teshamae Monteith, MD, assistant professor of neurology and chief of the headache division at the University of Miami Miller School of Medicine as well as a Neurology Now editorial board member, explains the difference between a migraine and a headache, theories on the causes of migraine, and current and promising treatment options.​

Did you know, for example, that breath-powered nasal delivery is being used to administer triptans, a common migraine medication? The device, which consists of a nozzle that is placed over the nose and a mouthpiece to blow into, allows patients to use their own breath to disperse a low dose of powdered medication into the nasal passage. This patented technology delivers medication faster and in greater amounts than oral tablets, and may be especially helpful for those who experience nausea and vomiting.

Dr. Monteith also discusses how lifestyle habits such as exercise, deep breathing, and avoiding certain food may help prevent attacks.

Whether your migraines are episodic or chronic, or with or without aura, Dr. Monteith notes, you have more treatment choices than ever before. The bottom line: With good information, you can play a role in managing your migraine.

To listen to the podcast, go to bit.ly/NN-MigrainePodcast.


Tuesday, May 23, 2017

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Image credit: cooldesign

BY SARAH OWENS

Parkinson's disease may start in the gut before it spreads to the brain, according to a study published online on April 26 in Neurology. Researchers found that people who underwent a truncal vagotomy—a procedure in which part of the vagus nerve, which connects the stomach to the brain, is removed—appeared to have a lower risk of developing Parkinson's disease.

Vagus Nerve Factor

In Parkinson's disease, insufficient levels of the chemical dopamine in the brain lead to tremors, movement and balance problems, and other symptoms such as loss of smell, depression, and constipation. But while Parkinson's is considered to be a disease of the brain, researchers have wondered if its origins may extend to other parts of the body.

A theory called the Braak hypothesis suggests that alpha-synuclein, a protein thought to play a role in the disease, spreads to the brain from the stomach via the vagus nerve, which connects the brain with the heart, lungs, and digestive tract and is involved in unconscious body functions like heart rate. Studies on rats and mice have appeared to support this theory, showing that animals who had surgery to remove part of the vagus nerve had a decreased risk of developing Parkinson's disease.

Brain-Gut Hypothesis

To see if the connection held true for humans, too, researchers at universities in Sweden and the United States gathered data from nationwide health registers in Sweden and identified 9,430 people who underwent a vagotomy between 1970 and 2010 and matched them with 377,200 people who did not have a vagotomy. They followed the patients until they were diagnosed with Parkinson's disease, died, left Sweden, or until the end of 2010—whichever happened first.

A total of 4,930 patients developed the disease over the follow-up period. The researchers found no association between Parkinson's and selective vagotomy, in which nerves are removed from the stomach only. But people who underwent a truncal vagotomy—in which nerves are removed from multiple organs, including the stomach, liver, and gall bladder—were somewhat less likely to develop the disorder.​

The risk reduction disappeared 20 years post-surgery, though, which suggests that vagotomy may simply delay, rather than prevent, the disorder. But the researchers believe that what happens in the gut may influence the development of Parkinson's disease, and, in turn, explain why gastrointestinal symptoms such as constipation sometimes show up long before movement symptoms, the study authors say.

Research Advances

There is still much to learn about the origins of the disease, including how alpha-synuclein is transmitted through the vagus nerve, the authors say.

In the meantime, Parkinson's disease research is thriving. In March, the FDA approved a new treatment, safinamide (Xadago), for patients with Parkinson's who take levodopa/carbidopa and experience frustrating "off-times"—periods of uncontrolled movement. Another study published in March found that just a small amount of daily exercise resulted in a big reduction in Parkinson's risk. Browse our entire collection of stories on Parkinson's at bit.ly/NN-Parkinsons


Thursday, May 18, 2017

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BY SARAH OWENS

Efforts to reduce stroke risk may also reduce the risk of dementia among people aged 80 and older, who often have the highest risks for both conditions, according to a study published online on April 28 in the journal Alzheimer's and Dementia.

Similar Risk Factors

Stroke and dementia share many risk factors, including high blood pressure, high cholesterol, obesity, and poor health and exercise habits. In addition, people who have a stroke are about two times as likely to develop dementia as people who don't have one, even if they don't have any other cardiovascular risk factors.

Both conditions are also major public health concerns. Stroke prevention campaigns have resulted in a modest reduction in stroke rates and in the number of people who die from a stroke over the past two decades, but it is still a major preventable cause of death in older adults. And cases of dementia are projected to increase in the near future, as the percentage of older adults in the population increases.

If a campaign to reduce stroke could also reduce dementia, doctors could score a one-two win for public health.

Number Crunching

To find out if stroke prevention equals dementia prevention, researchers at the University of Western Ontario in Canada examined the effects of a robust stroke-prevention campaign initiated in 2000 in the province of Ontario. They used a number of nationwide administrative databases at the Institute for Clinical Evaluative Sciences in Canada to calculate the number of strokes and cases of dementia throughout Ontario from 2002 to 2013.

During this period, the number of strokes remained unchanged among those between ages 20 and 49 years. The number decreased by 22.7 percent for those between ages 50 and 64; by 36.9 percent for those between ages 65 and 79; and by 37.9 percent for those aged 80 and older.

The number of cases of dementia increased by 17.3 percent in people between ages 20 and 49 and by 23.5 percent in those between ages 50 and 64 years, which researchers hypothesized may be due to greater awareness of young-onset dementia as well as over diagnosis of dementia in this age group. For those between the ages of 65 and 79, the number of cases of dementia remained unchanged. Most importantly, in those 80 and older, the number of cases decreased by 15.4 percent.

Shared Benefits

The results, the study authors say, show that a public health campaign to reduce stroke among those aged 80 and older may also be effective at reducing dementia. Since people in this age group are especially vulnerable to stroke and dementia and more often have one or more risk factors, the results are very promising, they add.​

Given the effectiveness of Ontario's campaign, they conclude, public health agencies in other areas throughout the world should strive to develop "integrated systems of stroke and dementia prevention."


Thursday, May 11, 2017

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BY SARAH OWENS

Great relationships are good for the soul, and new research suggests they may be good for the brain, too. A study published online on May 3 in the Journal of Alzheimer's Disease found that older adults who reported feeling positively supported by friends and family had a reduced risk of developing dementia over a 10-year period.

Relationship Quantity – and Quality

Positive social relationships are strongly linked to good health. Having close friends and family can boost mood, help ward off depression and anxiety, and even lower the risk of heart problems. Studies also show that having a close network of friends and family can reduce the risk of developing Alzheimer's disease and dementia.

Existing research has mostly examined the link between health and relationship quantity, or the number of friends study participants have. To learn more, researchers at University College London in England decided to measure the effect of relationship quality. Specifically, they wondered, do strong social ties have a long-term effect on dementia risk?

Measuring Social Support

Researchers followed 10,055 people aged 50 years and older who were participating in the long-running English Longitudinal Study of Aging and did not have dementia.

At the beginning of the study period, participants completed a questionnaire about how supported they felt by different people in their social networks, including friends, spouses, parents, children, and other immediate family members. The questions included, "How much do they really understand the way you feel about things?" "How much can you rely on them if you have a serious problem?" "How much can you open up to them if you need to talk about your worries?" and "How much do they criticize you?"

Ten years later, the researchers used doctors' diagnoses taken from health records to identify all cases of dementia—340 participants or 3.4 percent—since the beginning of the study.

Strong Social Support Equals Lower Dementia Risk

People who felt more strongly supported by those in their social networks had a lower risk of developing dementia.

Digging deeper, the researchers found that people who received strong social support from their children had the lowest risk of developing dementia. Conversely, those who received negative feedback from multiple sources—from both spouses and children, or from both family and friends—had the greatest increased risk of dementia.

The findings, the study authors conclude, suggest that supportive social relationships can play a major role in maintaining brain health and in warding off dementia. They also suggest that doctors and other health care professionals should encourage people who are vulnerable to dementia to pursue social activities and strengthen their relationships.

Read our story "Life Lines," from our December 2016/January 2017 issue, to learn how to join a social support group–or how to start one of your own: bit.ly/NN-LifeLines.

For more about how social ties help the brain, read "The Ties that Bind": bit.ly/NN-TiesThatBind.


Friday, May 5, 2017

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BY SARAH OWENS

Two stories published in Neurology Now in 2016 have won top awards from the American Society of Healthcare Publication Editors (ASHPE).

The Gold award for Best Profile was awarded to the October/November 2016 cover story, "Shining a Light" (bit.ly/NN-ShiningALight). Written by Neurology Now Managing Editor Mary Bolster and Gina Roberts-Grey, the story profiles Kimberly Williams-Paisley, wife of country singer Brad Paisley, whose mother was diagnosed with primary progressive aphasia, a form of dementia that affects speech, in 2005.

For years Williams-Paisley and her family struggled to understand what was happening to their mother, who died in November 2016, at age 73. Williams-Paisley wrote a book about the experience called Where the Light Gets In.

The Bronze award for Best Single News/Analysis Article was awarded to "Stem Cell Reality" (bit.ly/NN-StemCellReality), a news article in the December 2016/January 2017. Written by Gina Shaw, the article lays out the facts and myths about stem cell therapies, especially those offered through unregulated clinics in the US and abroad. Shaw profiled several people with neurologic conditions who sought treatment with stem cell therapy, some with devastating consequences. She also provides tips for avoiding scams.

Every year, the Society, which recognizes excellence in the field of healthcare publishing, convenes a jury of editors and publishing professionals who review more than 3,000 submissions before conferring the awards. To learn more and see the full list of winners, go to www.ashpe.org.