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Archive for March, 2013

When being overweight pays off!

27 Mar, 13 | by Steve Vucic, Web Editor

Factors influencing mortality in ALS are clearly multifactorial.  The ability to determine these factors and subsequently modify them could be of therapeutic significance in ALS.  The large EPIC cohort recently established that a higher body mass index may be neuroprotective, i.e. reduce mortality in ALS, which was evident in both males and females.  This association could be explained by hypermetabolism.  Namely ALS patients  and SOD-1 mice seem to exhibit a hyper-metabolic state.  Perhaps the link to sport may also have a similar etiology?  Is this a chance association only?  What do you think??

 

Gallo V et al. Prediagnostic body fat and risk of death from amyotrophic lateral sclerosis: The EPIC cohort. Neurology. 2013;80:829-838.

Cortical atrophy in ALS related to cognitive dysfunction. Food for thought?

27 Mar, 13 | by Steve Vucic, Web Editor

Cortical atrophy, as assessed by novel volumetric MRI techniques, have revealed inconsistent results in ALS.  Specifically, while cortical thinning, predominantly within the motor/frontal lobe regions, have been reported by some, absence of atrophy has been reported by others.  Mioshi and colleagues elegantly demonstrate a potential explanation for such discordant MRI findings.  Namely, ALS patients with cognitive dysfunction exhibit abnormalities within the motor and somatosensory areas  while pure ALS patients have normal MRI findings.

Could this be of diagnostic or event therapeutic significance in ALS?  Perhaps!!

Mioshi E, Lillo P, Yew B, Hsieh S, Savage S, Hodges JR, Kiernan MC, Hornberger M. Cortical atrophy in ALS is critically associated with neuropsychiatric and cognitive changes. Neurology. 2013 19;80:1117-23.

 

Seizures, strokes, and plane flights

27 Mar, 13 | by Professor Matthew Kiernan, Editor of JNNP

This is your Captain speaking: "Go easy on the drugs and alcohol and enjoy your flight"

This is your Captain speaking: “Go easy on the drugs and alcohol and enjoy your flight”

 

Planes and an ailing brain….

A high ranking politician got off a longhaul plane flight and promptly had a seizure.
Made me wonder what we know about this type of presentation.
Certain types of illness – especially heart attacks and blood clots – have been linked to air travel aka economy class syndrome.
But there’s been less study of conditions affecting the brain and nervous system, such as stroke and seizures.
Madrid Barajas, a big hospital close to Madrid’s main airport, monitored all cases referred to its neurology department from the airport over several years, to see if they could spot patterns that might be linked to flight.

The most common reason to be referred to neurology was seizure, followed by stroke.

The majority of the people who had fits had not experienced a seizure before.
In most cases, the seizure was linked to having taken drugs or consumed alcohol during or before the flight. In three cases, people had fits because they were smuggling cocaine into the country and had swallowed packets of the drug, which had split.
For those people who were previously diagnosed with epilepsy, most said they had either missed a dose of medication, or had disrupted sleep, or had used recreational drugs.
There were a number of strokes, mostly among people who were already at high risk of stroke because of their high blood pressure. Only one stroke was thought to be linked directly to the flight.
What does this mean for the average air traveller?
Well fortunately, flying is unlikely to cause health problems if you are generally healthy.
Alcohol and drugs don’t mix well with air travel and were linked to many of the cases of seizures.
Fortunately there were no captains in the clinical cohort!
For people with epilepsy, the study showed that the disruption associated with travel can cause health problems if you forget to take medicine or if you fallout of your usual sleep routine. People with epilepsy who are planning a long-haul flight might want to get advice from their doctor in advance about how they can plan to avoid problems.
Travel well!
Check out the study published in JNNP:
Alonso-Cánovas A, de Felipe-Mimbrera A, González-Va
lcárcel J,et al
J Neurol Neurosurg Psychiatry
2011;82:981–5.
http://jnnp.bmj.com/content/82/9/981.full

The First Week

6 Mar, 13 | by Professor Matthew Kiernan, Editor of JNNP

Dr Susanna Park from the Institute of Neurology, UK critically considers Stroke and the First Week

The focus of the March issue of JNNP is stroke, highlighting a range of research assessing risk factors, prognosis, treatment and management.

In this timely issue, Kauranen and colleagues1 present a study which emphasises the importance of cognitive function in the early stages after a stroke as a predictor of long term outcomes. In the study, 140 patients who experienced a first ever ischaemic stroke underwent a neurocognitive evaluation within the first week post-stroke. Before their stroke, all of the patients were engaged in full time employment. Six months later, the main predictor for a return to work was the number of cognitive deficits that were present in the first week.

Importantly, each additional cognitive deficit present in the first week doubled the likelihood of a patient being unable to return to employment at follow-up. This study stresses the role of cognition as an important predictor of long term outcomes post-stroke2, with previous studies indicating that cognitive status is also predictive of long-term functional status3 and quality of life4.

In the same issue of JNNP, El Hachioui and colleagues5 identified that the degree of aphasia one year following a stroke could be predicted within the first week by a combination of factors including phonology scores and stroke severity indices. These studies highlight the first week following stroke as a critical window not only for prognosis but also for rehabilitation and recovery.  Not only are early assessments of cognition and language invaluable for predicting long-term prognosis for stroke patients, but early interventions may be able to intervene in this time period to boost functional recovery and rehabilitative outcomes long-term.

 

Recovery post-stroke.  Wallaby great Michael Lynagh and his neurologist Dr Rob Henderson - discuss Noddies miraculous recovery post-stroke

Recovery post-stroke.
Wallaby great Michael Lynagh and his neurologist Dr Rob Henderson – discuss Noddy’s miraculous recovery post-stroke

 

References

1. Kauranen T, Turunen K, Laari S, Mustanoja S, Baumann P, Poutiainen E (2013) The severity of cognitive deficits predicts return to work after a first ever ischaemic stroke. JNNP 84: 316-321.

2. Arauz A. (2013) Return to work after stroke: the role of cognitive deficits. JNNP 84: 240.

3. Wagle J, Farner L, Flekkᴓy K, Bruun Wyller T, Sandvik L, Fure B, Stensrᴓd B, Engedal K (2011). Early post-stroke cognition in stroke rehabilitation patients predicts functional outcome at 13 months.  Dement Geriatr Cogn Disord 31: 379-387.

4. Nys GM, van  Zandvoort MJ, van der Worp HB, de Haan EH, de Kort  PL, Jansen BP, Kappelle LJ. (2006). Early cognitive impairment predicts long-term depressive symptoms and quality of life after stroke. J Neurol Sci 247: 149-56

5. El-Hachioui H, Lingsma HF, van de Sandt-Koenderman MWME, Dippel DWJ, Koudstaal PJ, Visch-Brink EG. (2013) Long-term prognosis of aphasia after stroke.  JNNP 84: 310-315.

Latest from JNNP

Latest from JNNP