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Swimming and deep brain stimulation do not mix, researchers warn – STAT

For people with Parkinsons disease, deep brain stimulation can calm the tremors and tame the unwanted movements that come with the progressive neurodegenerative disease. Electrodes implanted in the brain, controlled by a device placed under the skin of the chest and equipped with an on-off switch, can ease troubling symptoms and synchronize complex motions.

A new paper reports a worrying development: Nine proficient swimmers lost their ability to swim after DBS surgery for Parkinsons, even though the implant improved other movements walking, for one that require coordination of the limbs. Why swimming mastery disappeared remains a mystery, but the doctors who described the cases Wednesday in Neurology wanted to sound an alarm right away.

Patients and neurologists should be aware of the potential loss of the ability to swim following subthalamic DBS, Dr. Christian Baumann, study co-author and an associate professor of neurology and a neurologist at University Hospital Zurich, told STAT. We warn all patients to be cautious when going into deep waters.

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One patient, a 69-year-old man who owned a lakeside house, found this out in dramatic fashion. Feeling confident after DBS because of his good motor outcomes, he literally jumped into the lake, where he would have drowned if he had not been rescued by a family member, the researchers wrote.

A 61-year-old woman complained that although she was a competitive swimmer who had regularly raced across Lake Zurich, when her DBS was activated, she could swim only a little over a tenth of a mile, and only with an awkward stroke.

When three other patients switched off their DBS devices, they could immediately swim again. But their other movements and neuropsychological symptoms deteriorated so rapidly that they turned the DBS back on.

Deep brain stimulation, approved to treat Parkinsons in the U.S. in 1997, has become the standard of care for people whose tremors and motor fluctuations are no longer responding to medical treatment. After other Parkinsons drugs stop working, patients typically take levodopa, a precursor to dopamine, to restore levels of the neurotransmitter that their bodies no longer make in sufficient quantities. But levodopas effects fade, too. Doses wear off, patients sometimes freeze while walking, and they have involuntary movements.

Instead of restoring dopamine, DBS sends electrical signals from surgically implanted electrodes directly to neurons thought to be responsible for movement. Why patients could still walk but not swim made the researchers wonder if DBS affects the brain in a different way than levodopa does. Patients with DBS, which they can turn on when needed to control tremors, continue to take levodopa.

I think that imprinted synchronized activity in different brain structures, which have been learnt, may be changed by DBS, i.e. the change of activity in one network piece alters the whole network, which might explain this outcome, Baumann said. But this is hypothetical.

Dr. Michael Okun, medical director of the Parkinsons Foundation and executive director of the Norman Fixel Institute for Neurological Diseases at University of Florida Health, noted the preliminary nature of the case reports as well as changes in how much dopamine the patients were taking after DBS. He was not involved in the study.

All of the patients in their series had dopaminergic reductions in medication greater than 50% post-surgery and it is possible that this factor may have played a large role in the decline in function, he said. Proper prospective testing of the device in the on- and off-medication condition, as well as in the pre- and post-operative testing conditions, will be required to sort out the root causes of this phenomenon. In the meantime, Parkinsons patients with or without DBS should not swim without a buddy.

Other complex motor behaviors, such as skiing, playing golf, or skating, might also be affected, Baumann said. But swimming is the most worrisome not just for people with DBS, Okun warned.

One important piece of advice for all Parkinsons patients is to never swim alone, Okun said. The risk of medication wearing off and freezing has been known to be associated with drowning in Parkinsons disease regardless of whether or not a deep brain stimulator has been implanted.

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Swimming and deep brain stimulation do not mix, researchers warn - STAT

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Implications of the AHA/ASA Updated Definition of Stroke for the 21st Century – WFN News

Note:The views expressed by the authors are their own and do not represent an official statement by the American Heart Association/American Stroke Association.

Stroke was defined by the World Health Organization (WHO) more than 40 years ago as rapidly developing clinical signs of focal (or global) disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin.1This was a working definition created for a study assessing the prevalence and natural history of stroke, and it served its purpose at the time.

The ensuing decades have witnessed major advances in basic science, pathophysiology and neuroimaging that have dramatically improved our understanding of ischemia, infarction and haemorrhage in the central nervous system (CNS). There is little doubt that permanent injury occurs well before the 24-hour threshold, and therefore purely time-based definitions are inaccurate and obsolete. Further, neuroimaging has demonstrated that clinically transient symptoms are often associated with evidence of acute cerebral infarction and that infarction may occur without overt symptoms.

In 2009, the American Heart Association/American Stroke Association (AHA/ASA) published a scientific statement redefining transient ischemic attack (TIA) as, a transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischemia without acute infarction.2This statement formally addressed only one side of the proverbial coin, but clearly implied that objective evidence of infarction should be considered as a defining feature of stroke.

In the spring of 2013, the AHA/ASA published an expert consensus document with a new definition of stroke to reflect these advances.3Authors with expertise in the fields of neurology, neurosurgery, neuroradiology, neuropathology, clinical research methods, epidemiology, biomarkers, policy and global public health were invited from within the AHA/ASA, as well as the American Academy of Neurology, the American Association of Neurological Surgeons and Congress of Neurological Surgeons, U.S. Centers for Disease Control and Prevention, the National Institute of Neurological Disorders and Stroke, the European Stroke Organization (ESO), the World Stroke Organization (WSO) and others to establish a universal definition of stroke.

The major fundamental change compared with older definitions is that the new broader definition of stroke includes any objective evidence of permanent brain, spinal cord or retinal cell death due to a vascular cause based upon pathological or imaging evidence with or without the presence of clinical symptoms. Ultimately, the leaders of the ESO and WSO withdrew from participation and declined to endorse the statement because they disagreed about the inclusion of silent cerebral infarction and silent cerebral haemorrhage within the lexicon of stroke. (See Stroke Definition in the ICD-11 at the WHO.)

The AHA/ASA defined CNS infarction based on pathological, imaging or other objective evidence of infarction. In the absence of this evidence, the persistence of symptoms of at least 24 hours or until death remained a method to define stroke.At present, imaging is not always available and also is not perfect. In much of the developing world and in rural parts of more developed regions, neither [CT or MRI] may be available in the acute setting, if at all, which limits the global applicability of an imaging-based definition of stroke.

Silent lesions have been recognized pathologically as infarctions and haemorrhages since the 1960s but were deemed of uncertain importance. However, they may not be entirely asymptomatic, as patients may have subtle cognitive, gait or other functional impairments in the absence of a typical acute presentation. To some extent, the silence of an infarction or haemorrhage depends on the eye of the beholder. Patients may not be aware of their symptoms due to neglect, denial or simply may attribute them to another cause and not seek a medical opinion. Physicians and other health care providers may vary in their ability to detect mild neurologic abnormalities, or they, too, may ascribe them to an alternative cause.

The AHA/ASA included silent CNS infarctions and haemorrhages within the broadest definition of stroke for multiple reasons.

The new tissue-based definition of CNS infarction depends on either early objective (currently neuroimaging) evidence of infarction or persistence of symptoms for at least 24 hours. If early imaging is not available, then clinicians are left with a diagnostic dilemma in those first 24 hours since the event cannot be clearly classified as stroke.

Ultimately, diagnostic techniques and/or time will help define infarct or haemorrhage based on objective imaging, or TIA in the absence of positive imaging and resolution of symptoms within 24 hours from onset. A major challenge for the future will be the achievement of access to diagnostic and treatment tools in the developing world, where a substantial portion of the global burden of stroke occurs.

The inclusion of silent infarcts and microhemorrhages within the AHA/ASA definition of stroke opens many questions for clinicians. In regions with little or no access to neuroimaging, this change in definition may prove irrelevant for many years to come. However, for those with such access, silent lesions are likely to be detected as a result of the widespread use of MRI for non-cerebrovascular symptoms such as headache or dizziness.

Updating the definition of the disease can have prominent effects on disease surveillance and assessments of public health. In the case of adding a large number of silent infarction cases to the existing number of stroke cases, this will increase the total number of stroke cases while likely decreasing the mortality rate due to the addition of a number of minor/silent cases.4Updating the definition of stroke could result in reclassification of stroke cases for incidence, prevalence, and mortality in national and international statistics, disease classification coding systems and existing health surveys. This is particularly problematic if definitions are applied differently in each region of the globe, and this is a major concern of all stroke organizations. Therefore, the AHA/ASA recommended that symptomatic and silent infarctions and haemorrhages should be counted separately to allow for valid analyses of temporal and geographic trends in stroke. Although the WSO, ESO and WHO will not include the silent lesions within the definition of stroke, they recognize their importance and are going to start counting them within the scope of cerebrovascular disorders in the ICD-11.

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At the time of print, Kasner is with the University of Pennsylvania and Sacco is with the University of Miami.

References

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To Your Good Health: Long-term hiccups have been a plague since youth – Arizona Daily Star

DEAR DR. ROACH: My friend has been struggling with almost never-ending hiccups since she was young. There seems to be no apparent trigger for them. They happen all hours of the day and even wake her up in the middle of the night. She will hiccup until it starts to become very painful for her, and she cannot make them stop. Shes tried every remedy she can find drinking water, holding her breath and slowly letting out, even doing handstands.

She lives in a rural community with no doctor who can figure it out. They also dont seem to take seriously how disruptive and painful it is. They tell her theres nothing they can do. Do you have any suggestions? What kind of specialist treats this problem? N.E.

ANSWER: Persistent hiccups can be a severe problem. The hiccup (singultus, in Latin) is a spasm of the diaphragm, the main muscle of breathing, and an ancient neurological reflex. There are numerous case reports of people having hiccups lasting for decades, despite exhaustive searches for cures. The effect on a persons quality of life can be devastating.

In a person with hiccups lasting more than 48 hours, its appropriate to look for one of the more common causes, but often, a cause is not found. This starts with a careful history and physical examination. A history of medication use is critical, since some medicines Aldomet, an old blood pressure medicine; diazepam (Valium); and dexamethasone, a steroid similar to prednisone are known causes.

Enlarged thyroid (goiter) and enlarged lymph nodes are causes of irritation to the phrenic nerve, which controls the diaphragm. Oddly, irritation in the external ear (such as by a hair) can stimulate the vagus nerve, which can affect the phrenic nerve via a neurological reflex. Gastroesophageal reflux disease may be the most common cause and it sometimes can be seen on exam, even if the person has no symptoms. A stroke is a known cause, but that does not seem likely for your friend.

If no cause is found, a doctor must make his or her best guess at treatment. The most common drugs tried are gabapentin, baclofen, metoclopramide and chlorpromazine, but only the last of these is indicated by the Food and Drug Administration for hiccups. None of these drugs is benign enough to use lightly. Because undiagnosed GERD can be a cause, it may be worth trying a proton pump inhibitor, such as omeprazole.

DEAR DR. ROACH: Im 61 years old and came down with facial shingles 11 months ago on my right side. The pain started in my ear, moved to my eye and then the entire side of my face and scalp. It was a severe case. I still suffer with post-herpetic neuralgia pain and itching. Just last month, I had a mild case (forehead and bridge of nose) on my left side, which I guess is rare but happens. Should I get the shingles vaccine to prevent more incidents in the future? My doctor and neurologist say it wont help, and two other doctors say it will but that I should let my immune system get stronger before getting it. S.R.

ANSWER: Another case of shingles is very unlikely; however, the downside of the vaccine, beyond a sore arm, is small. Vaccination will not help with the post-herpetic neuralgia, which is persistent nerve pain after shingles. Hopefully that will go away; it usually does.

You can get the shingles vaccine as long as the rash is gone.

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To Your Good Health: Long-term hiccups have been a plague since youth - Arizona Daily Star

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Southeastern Multi-Specialty and Urgent Care Whitevilles open house/ribbon cutting set for Friday – The Robesonian

November 09, 2019

In preparation for my recent trip to Ireland, I made sure I had my annual flu shot since I knew I would be in close quarters on the flight overseas. I very rarely get sick but figured I should error on the side of caution. Despite the flu shot, a combination of airplane air, change of climate, and one of my travel mates bringing her crud along for the trip, I ended up with some kind of chest cold.

Since my return I have tried just about everything to ditch this crud, from riding my Harley Davidson Softail really fast in order to blow the germs away, to sweating it out at CrossFit. I am happy to report that nearly two weeks later I can almost sleep through the night without coughing.

Cold season, unlike flu season, is really a 12-month affair. Anytime you get lots of people together in a space airplane, mall, movie theater, etc. chances are some of them have a cold and the germs are just waiting to jump on you.

Colds are the result of a viral infection, and there are several different types. The one that usually causes a cold in grown-ups like us is called the coronavirus and happens most often in early spring and winter. Colds cause sneezing, coughing, stuffy or runny nose and sometimes fever and chills. For the most part, colds will work their way out in three to five days, but some of the effects may linger longer.

If you are wondering about how colds affect our fitness routine, you are in the right place. Lets look at three questions regarding colds and fitness:

Does exercise prevent colds?

Regular exercise appears to have the advantage of being able to jump-start the immune system, and that can help reduce the number of colds you get. With exercise, the number and aggressiveness of certain immune cells, such as the ones called natural killer cells, increase by as much as 50% to 300%. If you exercise regularly, this temporary increase can help make the immune system more efficient at destroying intruders that cause illness such as colds. In one study reported in the American Journal of Medicine, women who walked for a half-hour every day for one year had half the number of colds as women who did not exercise. In this study, researchers associated regular walking with increasing levels of infection-fighting.

Does too much exercise make you catch a cold?

While for most of us over-exercising is not an issue, for some elite athletes it can be. Research indicates that athletes that participate in high-intensity sports marathon running, triathlons, etc. can actually get more colds. When an athlete trains too hard, the very white blood cells that help prevent illness decrease, leaving the body more vulnerable to getting sick. These ultra-athletes need to be aware and make sure they build in recovery days to their workouts to prevent illness.

Can you exercise with a cold?

Because exercise may help to boost immune function, its usually safe to exercise with a cold as long as you listen to your body. Sometimes cold medications, such as decongestants, can increase your heart rate. In addition, your heart rate is increased with exercise. The combination of exercise and decongestants can cause your heart to pump very hard. You may become short of breath and have difficulty breathing.

If you have a fever with a cold, exercise may stress your body even more. Thats why its important to wait a few days to get back to your regular exercise regimen. Working out too hard with a cold could stress your body, causing you to feel worse. This additional stress may hinder your recovery. It is best to back your exercise down a notch until you are 100%. Consult with your health-care provider if you have any questions or concerns about exercising while you are under the weather.

So there you have it. Exercise to prevent colds, keep exercising a little when you are under the weather, and dont work out so hard that your immune system crashes. My advice is to keep the hand sanitizer handy, dont drink behind your family or friends, and stay out of crowds until the sniffling season passes.

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Southeastern Multi-Specialty and Urgent Care Whitevilles open house/ribbon cutting set for Friday - The Robesonian

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MS Drug Execs Tell All; APOE and Delirium; Brains in Space – MedPage Today

Competitors' prices, not drug development costs, dictated initial prices of multiple sclerosis (MS) drugs, former pharma leaders told Oregon Health & Science University researchers. (Neurology)

The investigational Alzheimer's drug aducanumab should be approved now or the FDA will hold back a much-needed treatment for at least 5 years, Biogen's top scientist warned. (Endpoints News)

Cannabis cut headache and migraine severity in half, but its effectiveness seemed to diminish over time. (Journal of Pain)

Carriers of the APOE4 gene who had high levels of C-reactive protein had increased risk of post-operative delirium, but non-carriers did not. (Alzheimer's & Dementia)

Approximately 61,000 deaths related to traumatic brain injury (TBI) occurred in 2017, with suicide as the leading category of TBI-related death. (Morbidity and Mortality Weekly Report)

Some patients recover remarkably well after hemispherectomy because of reorganization in the remaining half of the brain. (Cell Reports)

Long-term exposure to air pollution was tied to lower episodic memory scores. (Brain)

How the brain adapts to long-term spaceflight may reveal information about neurodegeneration on earth. (JAMA Neurology)

The FDA rejected a high-dose naloxone syringe (Zimhi) to reverse opioid overdose due to questions about chemistry, manufacturing, and controls (CMC) testing, not safety or efficacy, Adamis Pharmaceuticals said.

Early effective treatment may protect pediatric MS patients from cognitive decline. (European Journal of Paediatric Neurology)

A sublingual formulation of riluzole (Exservan) for ALS patients won FDA approval, Aquestive Therapeutics announced.

Risdiplam, the investigational, survival motor neuron-2 (SMN2) splicing modifier for spinal muscular atrophy, won FDA priority review, Genentech said.

Certain types of oral antibiotics appeared to be tied to an elevated, delayed risk of Parkinson's disease. (Movement Disorders)

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Terrace man with neurological medical conditions burned in acid attack – Coast Mountain News

A Terrace man is recovering from chemical burns on his face after being attacked with suspected battery acid and police say that the two culprits remain at large.

Mike Anderson, 51, was walking home after attending the Philanthropy Day event at the Terrace Art Gallery on Sparks Street near Davis Avenue at 8 p.m. on Nov. 15 when he was approached by two men, according to RCMP.

One of them asked Anderson, who is legally blind, for the time. But when Anderson brought his wristwatch up close to his face, the two men sprayed him directly in the face with an acidic substance, which he says he believes might be car battery acid.

I felt my face get wet, and thenI thought they were going to hit me, so I covered myself up. But my eyes were burning, an emotional Anderson told the Terrace Standard on Monday.

Unable to see as the chemical singed his eyes and blistered his face, all he could hear was the uproarious laughter from his attackers. Then he heard a womens voice, asking them to leave.

Soon after, they were gone.

READ MORE: Terrace man recovering from machete attack

I could open one of my eyes, it would sting and kept closing, but I found a puddle so I could wash my face. I tried to use my phone but it was slippery, and it wouldnt unlock, Anderson says. But I was close to home.

In a news release after the incident, RCMP described the two suspects as Indigenous and in their 20s. One had a small beard, the other was wearing a hoodie.

For Anderson, who was diagnosed this year with a complex neurological condition, walking the two blocks from the art gallery to his home is more difficult than for most people.

In August, Anderson suffered two herniated discs in his spine and was flown to Vancouver General Hospital for two weeks for doctors to administer a nerve block, a method of producing anesthesia.

Then a month later in September, he was walking over to a follow-up appointment for his back, he started to feel unwell. Fearing something was wrong, Anderson went to the hospital, where he lost feeling on his left side. He was sent back to VGH right away.

Doctors diagnosed Anderson with conversion disorder, a neurological condition that mimics the symptoms of a stroke. Rather than damage the actual structure of the brain, the disorder impacts a persons ability to do certain things, resulting in conditions including blindness, paralysis and speech problems.

They didnt know why it was happening, he says. Then they eliminated stroke and said it was neurological, but no clots, bleeding or tumours, so thats good news but it will still take time to retrain my brain.

After the attack, the only way Anderson was able to tell how close he was from home was because he could smell the gas coming from a sewer lift station, a concrete sewer basin in the ground, and knew his street was the next one over.

He was able to get home, struggled with the security keypad on his front door, and washed his face in the sink. He called his son on his landline, who then came home and took him to the hospital. Hospital staff could still smell the chemical on his clothes when he was admitted, he says.

It smelled like sulfur, like rotten eggs. RCMP arent sure what it was, but hospital staff think it was maybe car battery acid.

It took six hours to completely flush the substance out of his eyes and lungs, he says. Hospital staff treated the painful blisters on Andersons face with a cream.

Although hes trying to recover, the fear of being attacked while walking around Terrace has stayed with him.

I was scared. I didnt know where they were, and my eyes are bad because of other conditions. I just hoped I hoped I could see again, he says.

Anderson has been to a few eye appointments since the attack, and was told while his eyes are still irritated, no permanent damage was done to his already limited vision.

READ MORE: Terrace ranks in top 10 of magazines Canadas Most Dangerous Places list

After being diagnosed, Andersons family started a GoFundMe page and have since started it back up again after he was attacked. So far, theyve raised $7,010 out of their $8,000 goal to pay for Andersons medical expenses.

The community support to help him and his family has been overwhelming, Anderson says.

Karleen Lemiski contacted the Helping Hands of Terrace about Andersons story, and the organization jumped on board to cover any of his prescription costs, along with a monetary donation. The Terrace Royal Canadian Legion Branch 13 also contacted Anderson to see if they could help with any mobility items, such as a wheelchair, a walker, which can be used to help a person with mobility issues get around, and grab-bars.

The Kimmunity Angels Society was also contacted, and they are looking into whether they can reimburse Andersons September medical flight back from VGH, his new glasses or other medical expenses.

MaXXed Out Cross Trainings Denise Manion has also set up a fundraiser for a heavyweight sled pull competition scheduled for Nov. 28 to Dec. 6 to help the Anderson family.

Police are asking anyone who may have seen anything or know anything about this incident to contact investigators at 250-638-7429.

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Terrace man with neurological medical conditions burned in acid attack - Coast Mountain News

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