Neurology News

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Wednesday, February 14, 2018

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BY LIZETTE BORRELI

A special exercise program that focuses on balance and eye movements improved balance-related symptoms of multiple sclerosis (MS) such as fatigue, dizziness, and vision problems, according to a study published online in Neurology on January 31.

Poor Balance Is Common for People with MS

Impaired balance, along with fatigue, dizziness, and vision problems, are common symptoms associated with MS and can lead to limited mobility and falls, as well as a reluctance to pursue social activities.

Integrating information from the eyes, ears, and proprioception (a sense of one's self in space) is what allows the body to maintain balance. For many people with MS, the ability to integrate that information is impaired and balance is affected. To date, rehabilitation programs aimed at improving balance and walking ability have focused on strength exercises that do not address the accompanying balance and fatigue problems many people with MS experience.

A Better Balance Program

To find out if a program called Balance and Eye Movement Exercises for Persons with Multiple Sclerosis (BEEMS) that allows patients to process a variety of sensory information while also performing balance and eye movement exercises could help improve balance and reduce dizziness and fatigue, researchers at the University of Colorado School of Medicine in Aurora recruited 88 MS patients to take part in the study. Eligible participants, who ranged in age from 18 to 60, had to be able to walk 100 meters with a cane or other assistive device on one side. They also were assessed for balance, fatigue, and dizziness

Half of the patients were then assigned to BEEMS training while the other half (the control group) were offered the intervention after the end of the 14-week study. The BEEMS group engaged in six weeks of supervised exercises twice a week and received instructions for at-home exercises, which they were expected to perform daily.

Exercises involved maintaining balance on difference surfaces and while walking, both with and without head movements and with the eyes open and closed. During the remaining eight weeks, patients completed one supervised exercise session each week, along with the daily home exercises.

Program Improved Balance

At the six-week mark, improved balance was seen in patients in the exercise program, compared to the control group, as measured on a balance test. People in the BEEMS group saw their test scores improve 10 points compared to three points for those in the control group. After 14 weeks, improvements among MS patients continued to remain significant.

The BEEMS participants also experienced improvements in dizziness and fatigue by doing exercises that focused on controlling eye movement and head movements while standing and walking.

Integrative Exercise Makes a Difference

The study suggests an exercise program that incorporates processing multiple sensory information while doing balance and eye movement exercises should be included in physical interventions for MS patients. The BEEMS program paired with a functional training program could potentially lead to further improvements in gait, which could help patients safely do daily activities.

Still, further research is warranted to determine how long improvements can last beyond the 14-week mark with interventions such as physical therapy exercises that involve eye/head/limb coordination under the supervision of a health care professional.

For more about balance, read our story in Healthy Brain called Balancing Act.


Tuesday, January 16, 2018

​BY SARAH OWENS

In every issue of Neurology Now, we offer a mix of inspiring stories and practical advice for those living with neurologic conditions and their caregivers.  

From tips for navigating the often-daunting costs of caregiving ("Care Costs") and readjusting to life after the death of a loved one ("Begin Again") to stories about people who box to manage symptoms of Parkinson's disease ("Parkinson's on the Ropes") and artists who live with neurologic conditions ("The Art of Illness"), our most-read stories touch on the challenges and triumphs of living with neurologic conditions.

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1. Protect Your Brain for Life: Follow these expert strategies to guard against injury and cognitive decline throughout your life.

http://bit.ly/NN-ProtectYourBrain

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2. Stay Steady on Your Feet: Falls are the number one cause of injury and death among older Americans, especially those with neurologic conditions. Protect yourself with these tips.

http://bit.ly/NN-StaySteady

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3. Care Costs: Caring for someone with a progressive neurologic disease can be financially challenging. This expert advice can help protect you and your loved one.

http://bit.ly/NN-CareCosts

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4. Parkinson's on the Ropes: Exercise programs incorporating boxing skills may help manage symptoms of Parkinson's disease. Find out how you can join a program near you.

http://bit.ly/NN-OnTheRopes

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5. Backup Plans: Sometimes family caregivers die before their patients. Here's how to prepare for the worst-case scenario.

http://bit.ly/NN-BackupPlans

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6. The Art of Illness: Four artists talk about how their neurologic conditions affect their art.

http://bit.ly/NN-ArtofIllness

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7. Begin Again: Reclaiming life after years of caregiving is a gradual, up-and-down process. We asked those who've been there how to ease the transition.

http://bit.ly/NN-BeginAgain

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8. 6 Ways to Help Pay for Adult Day Care Services

http://bit.ly/NN-AdultDayCare

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9. Weight Watch: Some disorders or medications can cause weight loss while others pile on the pounds. Learn how to chart a middle course or adapt to the new you.

http://bit.ly/NN-WeightWatch

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10. Brain Storm: After brain surgery to remove a benign tumor, TV host and journalist Maria Menounos makes her health a priority.

http://bit.ly/NN-MariaMenounos



Wednesday, January 10, 2018

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BY SARAH OWENS

People with early-stage Parkinson's disease had low levels of caffeine and caffeine metabolites in their blood compared to healthy controls, suggesting that caffeine levels may be used to diagnose people with Parkinson's, according to a new study published online on January 3 in Neurology.

The Caffeine-Parkinson's Link

Previous research suggests that caffeine may protect the brain against Parkinson's disease. People who consumed more caffeine daily appeared to have a decreased risk of developing the disease, and vice versa. In addition, preliminary animal studies suggest that caffeine may protect against degeneration in the substantia nigra, an area of the brain implicated in Parkinson's.

Checking Caffeine Levels

To investigate the association between how caffeine is metabolized in the body and Parkinson's symptoms, researchers in the department of neurology, the Research Institute for Diseases of Old Age, and the Laboratory of Proteomics and Biomolecular Science at Juntendo University School of Medicine in Tokyo, Japan enrolled 108 patients with early-stage Parkinson's and 31 age-matched healthy controls.

After collecting blood serum samples from all participants, researchers used a lab technique to analyze levels of caffeine and 11 caffeine metabolites, chemicals left behind when caffeine is used for energy by the body. They also asked the participants to report how many cups of caffeinated beverages they consumed per day.

Finally, the researchers compared the results on the blood serum analyses with the participants' disease status (Parkinson's or healthy) and the severity of their Parkinson's symptoms, as measured by two scales that rate stage and severity of the disease.

A Potential Diagnostic Tool

The researchers found that caffeine levels in the blood samples, and levels of 9 of the 11 caffeine metabolites measured, were elevated in patients with Parkinson's disease compared to the healthy controls. The associations remained significant regardless of the participants' total daily caffeine intake, the severity of their symptoms, their sex, and whether or not they carried genes that predisposed them to Parkinson's.

The authors concluded that their findings "indicate a neuroprotective effect of caffeine" and suggest that caffeine levels, as measured through blood serum tests, may be a reliable way to help diagnose Parkinson's disease.


Tuesday, January 2, 2018

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BY SARAH OWENS

Women who used topiramate (Topamax), a drug commonly prescribed for epilepsy, early in pregnancy had an increased risk of having children with oral clefts, especially if they took a high dose, according to a study published online on December 27 in Neurology.

Risks for New Mothers

Topiramate is an effective drug for controlling seizures. It is also prescribed to treat migraines and bipolar disorder. Previous research has shown that taking topiramate early in pregnancy may increase the risk of oral clefts—an opening or split in the roof of the mouth and lip—in children.

Digging through the Data

To find out more about the link between topiramate and oral clefts in children, researchers at Brigham and Women's Hospital, Harvard Medical School, and Massachusetts General Hospital in Boston, MA assessed data from the Medicaid Analytic eXtract (MAX) database, which contains information on patients who receive health insurance under the United States government's Medicaid program. They identified a total of 1,360,101 women between 12 and 55 years old who had had a live-born infant and were enrolled in Medicaid from three months before conception through one month after delivery between 2000 and 2010.

They used Medicaid records to identify women who filled at least one topiramate prescription during the first trimester (the first 90 days) of pregnancy. They divided the women into topiramate users and non-users. Then they used inpatient and outpatient codes contained in hospital medical records to identify oral clefts in infants born to these mothers.

Finally, the researchers compared the incidence of oral clefts between women who had taken topiramate during pregnancy and those who had not.

Significant Link

They found a significant association between topiramate use early in pregnancy and the risk of oral clefts. Among a total of 2,425 infants born to women who took topiramate, the risk of oral clefts at birth was 4.1 per 1,000, compared to 1.1 per 1,000 among infants born to women who did not take topiramate. Among non-topiramate users, the researchers found that those who used lamotrigine, an alternative to topiramate for controlling seizures, had the same lower risk of oral clefts as those who did not use any anticonvulsants, suggesting the risk of oral clefts is unique to topiramate.

Dose Effect

When the researchers looked at women who took topiramate for different conditions, they found that the risk of oral clefts was especially high for those who took it to treat epilepsy. The risk was still present, but less high, for women who took the drug for other conditions, such as bipolar disorder. The risk was also higher with higher doses: Women who took more than 100 mg a day were three times more likely to have children with oral clefts than those who took less than a 100 mg dose.​

These two findings may be related, the researchers noted, since women with epilepsy are likely to be prescribed higher doses than women with other conditions.


Wednesday, December 27, 2017

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BY SARAH OWENS

Pregnant women taking antiepileptic drugs (AEDs) who supplemented their diets with folic acid had a reduced risk of having a child with autistic traits, according to a study published online on December 26 in JAMA Neurology.

Folic Acid's Importance

Folic acid supplements are generally recommended to all pregnant women to reduce the risk of birth complications, such as spina bifida, as well as neurodevelopmental complications.

Supplementation may be especially important for pregnant women who take AEDs, which treat epilepsy and seizures, since anti-seizure drugs are known to interfere with folate absorption and metabolism.

Additionally, research has shown that children born to mothers who took AEDs during pregnancy have an increased risk of developing autistic traits, including repetitive behaviors and impaired social skills and communication.

Studying Mothers with Epilepsy

To find out if folic supplementation would decrease the risk of having a child with autistic traits for women taking AEDs during pregnancy, researchers at several universities in Norway assessed data on participants in the Norwegian Mother and Child Cohort study, a long-running study of the health of pregnant women and their children in Norway. Participants had an ultrasonographic examination between June 1999 and December 2008 and provided information on their use of AEDs and folic acid supplementation during pregnancy as well as follow-up information on the health of their children.

A total of 104,946 children between the ages of 18 and 36 months who were born between March 2016 and June 2017, were included. As part of the study, the mothers answered questions about their children's health using a test that measures autistic traits. The mothers were asked questions such as, "Does your child enjoy being bounced on your knee?" and "Does your child take interest in other children?"

The researchers then compared the mothers' information on AED use and folic acid supplementation with their answers on the test to look for associations.

A Clear Connection

The researchers discovered that women who took AEDs during pregnancy and also took folic acid supplements were significantly less likely to have a child with autistic traits than pregnant women who took AEDs but did not supplement with folic acid. In particular, they found that higher folic acid levels between weeks 17 and 19 of pregnancy were associated with a reduced risk of autistic traits.

The findings, the study authors conclude, suggest that all women of childbearing age who take AEDs should take folic acid supplementation to reduce the risk of autistic traits in their children.