Category Archives: Neurology

In this White Board Series, Cleveland Clinic cardiothoracic surgeon Eric Roselli, MD, takes us on a tour of the heart that simply illustrates complex problems so everyone can understand. He says, "We can take care of you better if you understand your disease", and I could not agree more. The videos are below:

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From NHS Choices YouTube channel: Patrick, 54, was diagnosed with gout (a form of arthritis) 22 years ago. He describes the symptoms, treatment options and how he learned to live with the condition:

Here is a list of some of the new drugs for an old disease (gout):

Febuxostat is a non-purine-analogue inhibitor of xanthine oxidase that opened a new era in the treatment of gout.

Modified uricases

The use of modified uricases to rapidly reduce serum urate concentrations in patients with otherwise untreatable gout is progressing. Pegloticase, a pegylated uricase, is in development.

JAMA update, 08/2011: New Treatment Offers Hope for Patients With Severe Gout: pegloticase (Krystexxa) costs $2,500 per dose (http://goo.gl/gz9sO).

Drugs in development

Transport of uric acid in the renal proximal tubule and the inflammatory response to monosodium urate crystals (shown above) are targets for potential new treatments.

Several pipeline drugs for gout related to the targets above include:

- selective uricosuric drug RDEA594

- various interleukin-1 inhibitors. Canakinumab (trade name Ilaris) is a human monoclonal antibody targeted at interleukin-1 beta. It was rejected by the FDA panel in June 2011.

References:

Gout therapeutics: new drugs for an old disease. The Lancet, Volume 377, Issue 9760, Pages 165 - 177, 8 January 2011.
Diuretics, beta-blockers, ACEi, non-losartan ARBs associated with increased risk of gout vs. CCB lower risk. BMJ, 2012.
With FDA Approval, a Gout Drug Now Costs $5 Instead of Pennies - WSJ, 2011.
FDA Panel Rejects Gout Drug Canakinumab on Safety Concerns http://goo.gl/lO9uy
The strange story that links gout with the birth of the cocktail drinks. Lancet, 2012.

Comments from Twitter:

francis berenbaum @Larhumato: Gout explained by a patient. Very informative for medical students.

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ScienceDaily (Oct. 17, 2012) Research shows that use of popular antidepressants is linked to an increased risk of some strokes caused by bleeding in the brain, but that the risk is low, according to a multi-study analysis published in the October 17, 2012, online issue of Neurology, the medical journal of the American Academy of Neurology.

For the research, scientists analyzed all of the studies that have looked at antidepressant use and stroke, which included 16 studies with more than 500,000 total participants. They found that people taking selective serotonin reuptake inhibitors (SSRIs), which are the most commonly used antidepressants, were 50 percent more likely to have an intracranial hemorrhage than those not taking the antidepressants and about 40 percent more likely to have an intracerebral hemorrhage.

But study author Daniel G. Hackam, MD, PhD, FRCPC, of Western University in London, Ontario, said the findings should be viewed with caution. "Because these types of strokes are very rare, the actual increased risk for the average person is very low," he said.

An estimated 24.6 of these strokes occur per 100,000 people per year. According to the research, the use of SSRIs would increase the risk by one additional stroke per 10,000 people per year.

"Overall, these results should not deter anyone from taking an SSRI when it is needed," Hackam said. "In general these drugs are safe, and obviously there are risks to having depression go untreated. But doctors might consider other types of antidepressants for people who already have risk factors for these types of strokes, such as those taking blood thinners, people who have had similar strokes already or those with severe alcohol abuse."

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The above story is reprinted from materials provided by American Academy of Neurology (AAN).

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Antidepressants linked to increased risk of stroke, but risk is low, study finds

Public release date: 17-Oct-2012 [ | E-mail | Share ]

Contact: Angela Babb, APR ababb@aan.com 612-928-6102 American Academy of Neurology

MINNEAPOLIS Research shows that use of popular antidepressants is linked to an increased risk of some strokes caused by bleeding in the brain, but that the risk is low, according to a multi-study analysis published in the October 17, 2012, online issue of Neurology, the medical journal of the American Academy of Neurology.

For the research, scientists analyzed all of the studies that have looked at antidepressant use and stroke, which included 16 studies with more than 500,000 total participants. They found that people taking selective serotonin reuptake inhibitors (SSRIs), which are the most commonly used antidepressants, were 50 percent more likely to have an intracranial hemorrhage than those not taking the antidepressants and about 40 percent more likely to have an intracerebral hemorrhage.

But study author Daniel G. Hackam, MD, PhD, FRCPC, of Western University in London, Ontario, said the findings should be viewed with caution. "Because these types of strokes are very rare, the actual increased risk for the average person is very low," he said.

An estimated 24.6 of these strokes occur per 100,000 people per year. According to the research, the use of SSRIs would increase the risk by one additional stroke per 10,000 people per year.

"Overall, these results should not deter anyone from taking an SSRI when it is needed," Hackam said. "In general these drugs are safe, and obviously there are risks to having depression go untreated. But doctors might consider other types of antidepressants for people who already have risk factors for these types of strokes, such as those taking blood thinners, people who have had similar strokes already or those with severe alcohol abuse."

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To learn more about stroke, visit http://www.aan.com/patients.

The American Academy of Neurology, an association of more than 25,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer's disease, stroke, migraine, multiple sclerosis, brain injury, Parkinson's disease and epilepsy.

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Antidepressants linked to increased risk of stroke, but risk is low

Newswise MINNEAPOLIS A new study shows that having a high amount of beta amyloid or plaques in the brain associated with Alzheimers disease may cause steeper memory decline in mentally healthy older people than does having the APOE 4 allele, also associated with the disease. The study is published in the October 16, 2012, print issue of Neurology, the medical journal of the American Academy of Neurology.

Our results show that plaques may be a more important factor in determining which people are at greater risk for cognitive impairment or other memory diseases such as Alzheimers disease, said study author Yen Ying Lim, MPsych, with the University of Melbourne in Victoria, Australia. Unfortunately, testing for the APOE genotype is easier and much less costly than conducting amyloid imaging.

For the study, 141 people with an average age of 76 who were free of any problems in memory and thinking underwent PET brain scans and were tested for the APOE gene. Their memory and thinking was then tracked over the following year and a half, using a set of computer-based cognitive assessments that were based on playing card games and remembering word lists.

The study found that after a year and a half, people who had more brain plaques at the start of the study had up to 20 percent greater decline on the computer based assessments of memory than did those who had fewer brain plaques. The study also found that while carriers of the APOE 4 allele also showed greater decline on the memory assessments than those who did not have the allele, carrying the 4 allele did not change the decline in memory related to the plaques.

Our finding that brain plaque-related memory decline can occur while people still have normal memory and thinking shows that these plaque-related brain changes can be detected and measured while older people are still healthy. This provides an enormous opportunity for understanding the development of early Alzheimers disease and even a sound basis for the assessment of plaque-targeting therapies, said Lim.

The study was supported by the Australian Commonwealth Scientific Industrial and Research Organization, Edith Cowan University, Mental Health Research Institute, Alzheimers Australia, National Aging Research Institute, Austin Health, CogState Ltd., Hollywood Private Hospital, Sir Charles Gardner Hospital, the Australian National Health and Medical Research Council, the Dementia Collaborative Research Centers Program and the Science and Industry Endowment Fund.

To learn more about Alzheimers disease, visit http://www.aan.com/patients.

The American Academy of Neurology, an association of more than 25,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimers disease, stroke, migraine, multiple sclerosis, brain injury, Parkinsons disease and epilepsy.

For more information about the American Academy of Neurology, visit http://www.aan.com or find us on Facebook, Twitter, Google+ and YouTube.

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Plaque Build-Up in Your Brain May Be More Harmful Than Having Alzheimer's Gene

Here are some suggestions from the official AMA newsletter for 5 recommendations to help academic medical centers evolve, with my comments:

1. Build a brand name by holding faculty accountable for cost and quality. Mayo Clinic has mastered that and they offer a "subscription service" allowing local hospitals to gain quick access to Mayo experts - and to advertise that in the local press.

2. Become part of a larger community network. This is part of the "spokes of a wheel" concept to generate referrals to the tertiary center from the peripheral clinics and hospitals.

3. Increase effectiveness by maximizing use of extenders such as telemedicine and simulation technology. Mayo Clinic has a TeleStroke unit. Cleveland Clinic offers an "all-electronic" second opinion for a base price of $600.

4. Become an information hub. MayoClinic.com, the online patient information portal of the Mayo organization, is a good example of that concept.

5. Align research efforts with clinical and business strategies.

Bart Demaerschalk, M.D., neurologist and medical director of Mayo Clinic Telestroke, shows us how the smartphone technology works:

References:

Academic medical centers may face shrinking profits. Amednews staff. Posted April 4, 2012.
Image source: openclipart.org, public domain.

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