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Infections and cancer: any link to brain tumours?

21 Jan, 15 | by Arun Krishnan, Web Editor

There have been numerous postulated links between the development of cancer following exposure to infectious organisms. In the case of the connection between human papilloma virus and cervical cancer, this association has led to ground-breaking treatments in the form of vaccination. A similar connection has been developed between hepatitis B and liver cancer. While many forms of malignancy carry a poor prognosis, malignant brain tumours are often cited as a particularly aggressive form of cancer and this is borne out in survival rates which are dismal.

A question that has been raised in many previous scientific reports is the putative association between cytomegalovirus infection and the development of glioma, a form of malignant brain tumour. There have been previous studies that have suggested a strong link while others have cast doubt on any association. A recent letter in the New England Journal of Medicine has elicited much controversy regarding the possible benefits of anti-viral drugs for CMV being used as treatments for the most aggressive of brain tumours, glioblastoma. Clearly, this is a contentious area and at some point we need to take an objective unbiased view of the data. To that end, in the current issue of JNNP Dey and colleagues have provided an insightful review of the area and have addressed the arguments for and against a role of CMV in glioma development (2). They have addressed the criteria of Koch’s postulates for causation in developing their argument and have taken a close look at the key studies in this area.

This is a timely and interesting review of a very controversial topic.

  1. N Engl J Med 2013; 369:985-986September 5, 2013DOI: 10.1056/NEJMc1302145
  2. J Neurol Neurosurg Psychiatry 2015;86:191-199 doi:10.1136/jnnp-2014-307727

Fish oil: a treatment for severe epilepsy?

7 Jan, 15 | by Arun Krishnan, Web Editor

Happy New Year to all JNNP readers!

In order to ensure that we start 2015 with an optimistic outlook, I thought that the first post of this year should concern a clinical trial with a positive outcome! Epilepsy is a common and very debilitating condition which leads to significant impairments in quality of life. While a lot of patients with epilepsy can be successfully treated with medication, there remains a significant minority in whom seizures remain resistant to anticonvulsant drugs. There is little consensus on how these patients should be managed. Surgical treatment may be useful if a seizure focus is identified, but in other patients in whom the seizure origin remains elusive, treatment can be problematic.

There has been a vast literature that has focused on the role of dietary strategies in patients with drug resistant epilepsy and most of these studies have focussed on use of the ‘ketogenic diet’. The use of fish oil has also been considered, particularly given studies in animal models that have demonstrated a possible benefit at low doses.

In this issue of JNNP, DeGiorgio and colleagues undertook a randomised placebo-controlled diet of fish oil in 24 patients with drug resistant epilepsy . Their study demonstrated a possible benefit of fish oil at low doses, but no significant benefit at higher doses. This is consistent with studies in animal models which have shown anticonvulsant effects at low doses and proconvulsant effects at higher doses.

As most neurologists would know, drug resistant epilepsy ruins quality of life for sufferers. The present study is encouraging and may provide the impetus for larger randomised studies.

Neurodegeneration in MS: A clue to diability?

12 Dec, 14 | by Steve Vucic, Web Editor

Corticla tarophy has been proposed as an imprtant pathophysiological mechanisms in disability development in progressive forms of multiple sclerosis.  A number of studies utilsing sophistcated MRI tehcniques have yielded such evidence.  In this issue of JNNP and elegant study demonstrated the importance of neurodegeneration at a pathological level, “reflected by a global reduction of neuronal density, the presence of acutely injured axons, and the accumulation of oxidised phospholipids and DNA in neurons, oligodendrocytes and axons“.  As such preventing degenration is the key, although the real question must be how can we revearse the process.  Will antioxidants, antiexcitotoxic agents work??




Forbes Norris Award for editor of JNNP-Professor Matthew Kiernan

12 Dec, 14 | by Steve Vucic, Web Editor

It gives me great pleasure to announce that Matthew Kiernan was awarded the highly prestigious Forbes Norris Award by the International ALS Alliance.
The Forbes Norris Award, first presented in 1994, honours the memory of Dr. Forbes “Ted” Norris (1928 – 1993), a neurologist who dedicated his career to helping people with ALS/MND. The purpose of this prestigious Award is to encourage a combination of two major qualities: management of and advances in understanding ALS/MND, to the benefit of people living with the disease. Some previous recipients have included Professor Nigel Leigh, Stanley Appel, Andrew Eisen, Pamela Shaw and more recently Leonard van den Berg to name a few, all very important names in the filed of ALS.
Once again well done Matthew for a wonderful achievement.

Stress and stroke

28 Nov, 14 | by Arun Krishnan, Web Editor

There are a number of risk factors that we commonly associate with stroke, including hypertension, smoking history, and diabetes. The current issue of JNNP explores the role of stress resilience in the aetiology of stroke . The authors have assessed a large Swedish male population and have provided interesting insights into the role of stress in the development of stroke. They have demonstrated that low stress resilience during adolescence was associated with a subsequent higher stroke risk. They also note that the association was independent of socio-economic status and general physical health. The results are particularly interesting given the emerging associations between early life stress and the development of metabolic conditions, such as diabetes.

The authors suggest that their study highlights the importance of measures for stroke prevention incorporating ways of reducing psychosocial stress.

Working ok with CMT?

20 Nov, 14 | by Steve Vucic, Web Editor

The issue of whether excessive work may lead to increased weakness in hereditary neuropathy is a vexing one and critical for patient management.  in this issue of JNNP this notion has been categorcially dismissed.  There was no worsening weakness with overwork in a  large CMT1A cohort.


Read more:

Neurol Neurosurg Psychiatry 2014;85:1354-1358 doi:10.1136/jnnp-2014-307598
  • Neuromuscular
  • Research paper

Is overwork weakness relevant in Charcot–Marie–Tooth disease?

Multiple sclerosis: what is the role of iron?

18 Nov, 14 | by Arun Krishnan, Web Editor

In the last decade or so, we have seen numerous major advances in our understanding of multiple sclerosis (MS). While the condition was traditionally viewed as a disease of the brain white matter, this hypothesis has been turned on its head with the discovery that grey matter involvement occurs in MS. Furthermore, we now know that this can happen quite early in the disease course and that it may underlie physical disability. A lot of MS patients report cognitive changes that occur even in the earliest stages of the disease and it is very possible that these changes may be due to the loss of grey matter.

In the current issue of JNNP, Haider and colleagues present a very interesting study that demonstrates that involvement of the deep grey matter may play an important role in the development of disability in MS . In addition, they also show that these changes were associated with accumulation of iron in the brain. This is a very important finding as iron has been postulated to play a role in the development of brain oxidative injury.

This is a very interesting study which provides important insights into our understanding of the pathology of MS.

ALS: A long pre-clinical period. Does it start at conception?

4 Nov, 14 | by Steve Vucic, Web Editor

ALS is a rapidly progressive neurodegenerative disorder of the motor neurons with median survival of 3-5 years.  The site of disease onset, and the timing of disease onset remain controversial, although

a sudden and catastrophic degeneration of the motor neurons does occur.  In this issue of JNNP a though provoking review by Eisen and colleagues suggests a long term pre clinicla period, perhaps stretching beck to the in utero period.  In an

accompanying letter,  neuronal dysfunction (preceding degeneration) was reported in a zebra fish model.  Interestingly, this dysfunction was slowed down by riluzole.  The question remains as to whether we are too late by the time the patients present.  But then, who should be treated/monitored.  The genetic cases, or all relatives of sporadic cases.  Clearly there are more answers than questions, although headway has been made, and more research is needed.


Genetic testing for peripheral neuropathy: we are entering a new era.

27 Oct, 14 | by Arun Krishnan, Web Editor

There are literally hundreds of different causes for peripheral neuropathy. While in most cases a decent history and a few blood tests can provide a potential cause, which often turns out be metabolic in nature (e.g diabetes, impaired glucose tolerance), in some patients a diagnosis proves elusive despite extensive investigations. This is a major problem as specific treatments depend largely on finding the underlying cause of neuropathy.

Recently it has become clear that there are patients who have neuropathy due to unknown causes who may harbour a genetic mutation that is causing the condition. This obviously has significant implications not just for the patient themselves, but also for other family members. The spectrum of genes associated with the most common form of inherited neuropathy, Charcot-Marie-Tooth disease has expanded significantly in recent years, to the point where now more than 50 genes have been identified with the condition. Genetic testing for a lot of these is difficult and time-consuming, which often means that the exact mutation remains undiscovered.

The development of new techniques in gene testing has changed all of this and there is an interesting paper in this month’s issue of JNNP which outlines this very nicely . Klein and colleagues have reported on the utility of whole exome sequencing (WES) in the investigations of patients who have a neuropathy that is thought to be genetic in origin, but where previous testing procedures have proven to be futile. The authors demonstrate that this novel genetic testing procedure may help provide a genetic diagnosis in these cases. This obviously has critical importance for the patients themselves, who would otherwise have to carry on without a clear diagnosis, and for their families for whom genetic counselling depends so much on obtaining a precise diagnosis.

Betaferon still works: A new ray of hope for the injectables?

26 Oct, 14 | by Steve Vucic, Web Editor

Over the last 5 years, the therapy for RRMS has radically changed.  Oral therapies have come to the fore, leaving the injectables a “not so flavor of the month”.  In this months issue of JNNP the BENEFITS study group reports on utility of betaferon in CIS.  The time to second relapse was significantly longer when treated with betaferons.


Read more at:

Long-term impact of interferon beta-1b in patients with CIS: 8-year follow-up of BENEFIT

Open AccessPatient's Choice

  1. G Edan1,
  2. L Kappos2,
  3. X Montalbán3,
  4. C H Polman4,
  5. M S Freedman5,
  6. H-P Hartung6,
  7. D Miller7,
  8. F Barkhof8,
  9. J Herrmann9,
  10. V Lanius10,
  11. B Stemper10,
  12. C Pohl10,11,
  13. R Sandbrink6,10,
  14. D Pleimes12
  15. for the BENEFIT Study Group

J Neurol Neurosurg Psychiatry 2014;85:1183-1189 doi:10.1136/jnnp-2013-306222

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