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Thursday, August 17, 2017

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BY LISA COLLIER COOL

Vincent Van Gogh ranks as one of the most brilliant—and prolific—artists of all time, painting hundreds of masterpieces ablaze with vivid colors, bold brushstrokes, and swirling coronas. He also experienced seizures, hallucinations, and other symptoms throughout his short life that many historians, his own doctors, and Van Gogh himself attributed to a neurologic disease: epilepsy.

Other famous artists, including Willem de Kooning, who developed Alzheimer's disease, created masterful works of enduring genius while living with neurologic conditions. More recently, Chuck Close, an American painter and photographer, has talked about how his various neurologic conditions both enhance and limit his artistic output (bit.ly/NN-ChuckClose).

We asked sculptor Rebecca Kamen how having dyslexia has shaped her work.

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To Rebecca Kamen, the periodic table of elements most students have to memorize in high school is a thing of beauty. So are black holes, fossils, and Einstein's theory of relativity—all of which have served as inspiration for her science-influenced sculptures. What particularly fascinates the 66-year-old artist from McLean, VA, is the intricate wiring of the human brain.

As an artist-in-residence in neuroscience at the National Institutes of Health (NIH), she created one of her best-known sculptures, Butterflies of the Soul, which was inspired by the landmark discoveries about the nervous system of Santiago Ramon y Cajal, the 1906 Nobel Prize winner in Physiology or Medicine. "Studying the thousands of drawings he made of the brain's neurons under the microscope, each of which was a tiny masterpiece—and discussing them with neuroscientists at the NIH—was life-changing," says Kamen.

Purkinje Butterflies

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Entranced by Cajal's pictures of Purkinje cells (neurons in the brain's cerebellar cortex), she created a sculpture of vein-like "butterflies" perched on green mylar "branches," each of which was hand stained in a process similar to one scientists use to prepare slides of cells for viewing under the microscope. Kamen's passion for the brain's neurons is fueled by the fact that she has dyslexia, a neurologic disorder that affects about 10 percent of people worldwide, according to Dyslexia International.

Language Difficulty

"Everyone assumes that dyslexia is a reading problem because it's often diagnosed after a child starts struggling with written materials in school, but it actually starts at a much younger age with difficulty processing spoken language," says Paula Tallal, PhD, adjunct professor at the Salk Institute and the Center for Human Development at the University of California San Diego. "For example, a child with dyslexia may have difficulty processing words with similar sounds, such as 'dad' and 'bad,' which in turn interferes with reading fluency."

When Kamen was growing up in the 1950s in Philadelphia, her disorder went undiagnosed. "Schoolwork, especially reading and math problems, was such a struggle that I couldn't get into college in my state until my parents and the principal wrote letters advocating for me, and even then I was only admitted on probation," she recalls. "One guidance counselor asked my parents why they were wasting their money sending me to college because, in his opinion, I wasn't cut out for it."

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Experiential Learning

Kamen proved him wrong by not only graduating from Penn State University with a degree in art education but also earning two master's degrees. "It wasn't until I became a college professor myself that a friend and fellow teacher figured out that I had dyslexia. She pointed out that instead of getting most of my information from reading, which remains difficult for me, I go out in the world and learn through experience, such as talking to astrophysicists and neuroscientists in their laboratories when I'm working on sculptures, or holding things in my hands and examining how they work."

A retired professor at Northern Virginia Community College, where she taught art for 35 years, Kamen remains devoted to turning neuroscience into art. Recently, she helped patients at the Levine Children's Hospital in Charlotte, NC, where she was an artist in residence, create paintings and voice recordings that she combined into a multimedia sculpture of a tree with its branches rendered to look like the brain's neurons. The project was sponsored by the McColl Center for the Arts. "One young patient I collaborated with, an 18-year-old who spent several months flat on his back in the ICU, found it so inspiring to create art during his recovery that he's now volunteering at the hospital to show other kids the amazing power of the brain to create beauty, even when it's injured."

For more about Rebecca Kamen and her work, go to http://RebeccaKamen.com. To view a video of her art project with patients at the Levine Children's Hospital,visit bit.ly/Kamen-ArtProject. For interviews of artists with other neurologic conditions, go to bit.ly/NN-TheArtOfIllness.


Thursday, August 3, 2017

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In the August/September 2017 issue, we interview Christopher Jackson and his wife Veronica Vazquez-Jackson about their son CJ, who was diagnosed with severe autism when he was 2 years old. His parents were told he would never speak. Now 12, he's fully verbal, crazy about his younger sister, and full of joy. He still has trouble regulating himself and continues with occupational therapy, but his parents are optimistic about his future. In this online exclusive, we look at the role of genetics in autism spectrum disorder.

BY ROBERT FIRPO-CAPPIELLO

An array of genetic factors has been associated with autism spectrum disorder, as researchers apply recent advances in genetic analysis to zero in on the genes—and the complex interactions of those genes—that may be implicated in autism.

Studies of identical twins, who share 100 percent of their genetic makeup, show that they are more likely to share an ASD diagnosis than fraternal twins or siblings, who share roughly 50 percent of their genetic makeup. This suggests a strong link between genetic factors and ASD, and that a shared environment—in utero and in the home—may play less of a role.

In addition, first-degree relatives—parents, siblings, and children—of people diagnosed with ASD show higher rates of the disorder than the general population. Interestingly, even those who are not diagnosed with the condition often demonstrate higher rates of ASD-like symptoms, such as social and language challenges and repetitive and restrictive behaviors.

Developmental genetic disorders such as Fragile X syndrome, tuberous sclerosis, and Down syndrome increase the likelihood of an ASD diagnosis.

Unlike simple hereditary traits such as fair skin or freckles, the disorder is thought to result from what is called complex genetics, in which a number of autism-susceptible genetic factors combine. This might explain why, for instance, some identical twins do not share a diagnosis, and why neurotypical children of parents with ASD may demonstrate some behaviors associated with autism.


Wednesday, July 5, 2017

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In the August/September 2017 issue of Neurology Now, we feature letters in response to various stories in the June/July 2017 issue. Here, we include other letters we didn't have room to print. Our story on Peg Van Horn, an 87-year-old who has had spasmodic dysphonia for more than 20 years, was particularly resonant.

Many Voices

Thank you for publishing an article about Peg Van Horn in Pictures of You ("Talking Points," June/July 2017, bit.ly/NN-TalkingPoints). I also have spasmodic dysphonia and have been involved with the National Spasmodic Dysphonia Association (NSDA) community since 1989. Our community has thousands of members who live vibrantly like Peg Van Horn. We in the NSDA are always happy when word gets out about this rare neurologic voice disorder. We want everyone with spasmodic dysphonia to know that there is help and hope. You are not alone.

Mary Bifaro

Charlotte, NC

I enjoyed reading the latest issue of Neurology Now and especially the Pictures of You interview with Peg Van Horn. I was diagnosed with adductor spasmodic dysphonia more than 16 years ago and Peg's description of and experience with this rare voice condition is very much what I have experienced. Thank you for shining a light on this condition, and my sincere appreciation to Peg Van Horn for sharing her insights, frustrations, and delightful way of encouraging all living with this disorder. The NSDA is an invaluable organization and resource for patients and their families living with this rare voice disorder.

Charlie Reavis

President

National Spasmodic Dysphonia Association

Alpharetta, GA

I was delighted to read the article about Peg van Horn and her spasmodic dysphonia (SD) in the recent edition of Neurology Now. Thank you for such an excellent and informative article, and for helping spread awareness about SD both in the neurologic community and to the wider public. The article is well written, and shows the positive attitude Peg has after living with the disorder for more than 20 years. Your article ticks all the boxes in terms of reaching and educating the right audience. Thank you for writing about Peg Van Horn and putting a human face to our voice disorder.
David Barton
Past President NSDA

Auckland, NZ

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Thoughts on Diet

I just finished reading the current issue and was particularly interested in comments about the Feingold diet ("Brain Food," June/July 2016, bit.ly/NN-BrainFood). Reading about the diet more than 40 years ago made a major difference in our family's life.

Our youngest son taught himself how to read before he was 4 years old. Sometimes he was a pleasant child, sometimes he was extremely fidgety, unable to sit still long enough to practice the piano. Or, if we were in the car, he would constantly poke and jab the person next to him. One night he was unable to sleep and chewed the drywall off the bottom ledge of the window in his bedroom, swung on a small closet door, tearing it off the hinges, and was in and out of his toy box. I had to sit in a rocking chair with him and rock him until he calmed down enough to sleep. There were times when he was totally uncooperative and would throw temper tantrums. Then I heard about Feingold's diet, and discovered through trial and error that he could not tolerate sugar, but honey was fine. He couldn't eat chocolate, but carob was okay. Anything with red or yellow food coloring affected him. He could eat a slice of tomato, but could not tolerate tomato sauce. I ended up changing our family's diet by editing all my recipes and buying groceries to accommodate his needs. When my son left home to attend university, I stopped monitoring his diet. I felt dietary choices were now his to make. I may not have followed the diet to the letter, but Feingold's book helped me start to help my son be the wonderful person he is. 
Marvel Riley
Livingston, TX 77399

Fasting and prayer as treatment for pediatric epilepsy were described in Mark 9:29, probably 2,000 years ago. As for the Feingold Diet, if artificial food colorings don't cross the blood brain barrier, they are unlikely to change behavior.

C B Brill, MD

Philadelphia, PA


Tuesday, June 27, 2017

 

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BY FRAN KRITZ

As people age, an accumulation of health problems—changes in muscle strength, coordination, vision, and hearing—contribute to an increased risk of falls, says Lisa Shulman, MD, FAAN, director of the University of Maryland Parkinson Disease and Movement Disorders Center in Baltimore. Many people also develop damage to their nerves, or neuropathy, which can cause numbness in the feet and can change how you perceive where your feet are in relation to the floor. If your hearing or vision is impaired, it's harder to anticipate obstacles. And if you stumble or are less flexible in your knees and hips, you're more likely to fall, says Dr. Shulman.

Cognitive Contribution

Physical limitations increase the risk of falls, but so do cognitive changes, notes Dr. Shulman. "We don't recognize that walking requires a combination of both mobility (motor function) and attention (cognitive function)," she says. "If you're walking from the parking lot to the store, you're not just walking. You're also avoiding moving cars, looking for the store entrance while you put away your car keys, and reaching for your shopping list. And you may be walking with a friend who is telling you her latest news. So walking is really a complex act of multitasking, where your attention is divided in many ways. Studies show that even doing just two things at once, such as walking while talking, increases the risk of falls."

Walking and Talking

Measuring the brain activity of healthy older adults while they're walking and talking can predict their risk of falling, according to a new study published in the December 7, 2016 issue of Neurology. Conducted by researchers at the Albert Einstein College of Medicine in New York City, the study involved 166 older adults with an average age of 75 who were already enrolled in an ongoing mobility study. The participants were asked to do three tasks: 1) walk at a normal pace, 2) recite alternate letters of the alphabet while standing, and 3) walk at a normal pace while simultaneously reciting alternating letters of the alphabet.

Multitasking Increases Risk

The researchers measured both walking and letter reciting speed and used noninvasive sensors on the participants' foreheads to measure changes in oxygen levels at the front of the brain. After the testing was completed, the researchers contacted participants every two to three months over the next four years to find out whether they had experienced a fall. Seventy-one participants reported a total of 116 falls, and 34 fell more than once. (Most falls were not serious, with only 5 percent of them resulting in fractures.)

Neither the speed at which the subjects walked nor their speed of reciting alphabet letters predicted who would be more likely to fall. Brain activity during those actions was also not a predictor. But when the researchers looked at brain activity measured when subjects were walking while talking, they found that elevated activity signaled an increased risk of falling in the future. Each incremental increase in brain activity was associated with a 32 percent increased risk of falls.

Looking for Clues

"Our findings suggest that changes in brain activity that influence walking may be present long before people exhibit any sign of walking difficulty. Now we need to find the underlying biological mechanisms or diseases that may be altering brain activity and, if possible, correct them to help prevent falls," says Joe Verghese, MBBS, director of the division of cognitive and motor aging at Einstein and director of the Montefiore Einstein Center for the Aging Brain and the lead study author.

Lower Your Risk

Neurologic conditions that affect gait and mobility such as stroke, Parkinson's disease, multiple sclerosis, neuropathy, and Alzheimer's disease increase the risk of falls, says Dr. Shulman. Talk to your doctor about what type of fall prevention program would be best for you, says Pinky Agarwal, MD, FAAN, a neurologist who specializes in movement disorders in Kirkland, WA. While many programs include strength training and balance exercises such as tai chi, others may be tailored specifically to people with conditions like Parkinson's disease or stroke. Many fall prevention programs are free, or covered by insurance or Medicare.


Monday, June 12, 2017

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BY ROBERT FIRPO-CAPPIELLO

 

In the June/July 2017 issue of Neurology Now, we interview Christine Ha, 2012 MasterChef winner who lost her vision due to neuroymelitis optica, a rare autoimmune disease. After relearning to cook, Ha started a blog called theblindcook.com, which caught the attention of the producers of MasterChef, who encouraged her to audition for a spot on the show. Not only did Ha make the cut; she went on to win, becoming the first blind contestant to appear on the show and to nab the title. We asked her for some of her favorite Mediterranean-style recipes to tie in with our feature on diets linked to a lower risk of cognitive decline (bit.ly/NN-Diets).

Bruschetta

This classic meat-free Italian appetizer gets a pleasant kick from red onion and garlic. These slices will satisfy four people as pre-dinner finger food, but portion sizes and ingredient amounts can vary depending on the size of the baguette and personal taste.

Ingredients

4 Roma tomatoes, diced & strained

½ red onion, diced

Fresh basil leaves, thinly sliced

Minced garlic

Extra virgin olive oil to taste

Balsamic vinegar to taste

Salt and pepper to taste

1 whole grain baguette, sliced into ¾-inch slices

1/8 cup grated parmesan cheese

Instructions

  1. In a medium bowl, combine tomatoes, onion, and basil. Add olive oil, balsamic vinegar, salt, and freshly ground black pepper to taste. Toss well and set aside.
  2. Meanwhile, bake baguette slices at approximately 350 degrees for 3 to 5 minutes or until bread is lightly toasted.
  3. Top with tomato onion mixture. Add parmesan cheese on top if desired.

Furikake-crusted Yellowfin Tuna with Wasabi Mayo

This recipe is designed for tuna steaks cut approximately 1-inch thick. If you've got thinner steaks, cook for less time. Furikake is a Japanese seasoning with dried seaweed, bonito flakes, and sesame seeds, available at specialty food stores. Serves four.

Ingredients

4 yellowfin tuna steaks, approximately 6 oz. each

Salt and pepper

Grapeseed oil, or your favorite cooking oil

4 tsp furikake

4 oz. cholesterol-free canola mayonnaise

4 tsp wasabi paste or to taste

A few dashes of yuzu, a Japanese citrus, or fresh lemon juice

Instructions

  1. Pat tuna steaks dry and season both sides lightly with salt and pepper. Sprinkle furikake on top, bottom, and sides of steaks. Set aside.
  2. In a small bowl, whisk together canola mayonnaise, wasabi paste, and yuzu or lemon juice. Adjust flavors to taste. Set aside to let flavors thoroughly combine while you cook the steaks.
  3. Heat a skillet over high heat. Add oil to lightly coat the pan. Sear tuna steaks on both sides until seared on the outside but rare on the inside, approximately 1 minute per side. Turn down the heat a little if the furikake starts to burn.
  4. Serve immediately with wasabi mayo on the side for dipping.

Quick & Easy Shrimp and Tomato Linguine

This simple but super-satisfying recipe is a good way to use up ripened tomatoes. It makes more than enough for four people, and tastes even better as a leftover after a day in the fridge.

Ingredients

4 tbsp. olive oil

3 cloves garlic, minced

½ medium onion, diced (optional)

4 cups tomatoes, diced

1 cup dry white wine

1 portobello mushroom cap, chopped (optional)

Salt and pepper

1 (16 oz.) package of linguine pasta

1 lb. medium shrimp, peeled and deveined

1 tsp. red chili pepper flakes

Instructions

  1. Heat 2 tbsp. olive oil in a large saucepan over medium heat. Stir in garlic and onion and cook until fragrant, about 2 minutes. Add tomatoes, mushroom, and wine. Simmer over low heat for 30 minutes, stirring frequently. Once tomatoes have simmered into a sauce, season with salt and pepper.
  2. While tomato mixture is simmering, cook linguine according to directions for al dente pasta.
  3. Season shrimp with red chili pepper flakes, salt, and pepper. Heat remaining 2 tbsp. olive oil in a large skillet over medium-high heat, and cook shrimp until pink on the outside and no longer translucent in the center, about 5 minutes. Add shrimp to sauce, and serve over linguine with grated Parmesan if desired.

To read our feature about Christine Ha, go to bit.ly/NN-Ha.