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Archive for January, 2015

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 http://jnnp.bmj.com/content/86/2/191.abstract (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 http://jnnp.bmj.com/content/86/1/65.abstract . 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.

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