Category Archives: Neurology

From the NHS Choices YouTube channel: A psychiatrist explains the motivation behind Munchausen's syndrome, also known as factitious illness, where someone pretends to be ill or causes symptoms in themselves. This can include inflicting wounds or tampering with blood and urine samples. He also explains the importance of getting treatment and describes another form of the condition where a person fabricates an illness in someone in their care (Munchausen's syndrome by proxy):

Comments from Twitter:

Julie Meadows-Keefe @esq140: Fascinatingly & disturbingly real.

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Here are my suggestions for some of the top articles in medicine for July-August 2012:

Where are you on the global fat scale? BBC calculator: http://goo.gl/ZnI6D

Drug cheating at the Olympics: who, what, and why? 7% of elite athletes admitted to doping ~ 1000 people at each Games http://bit.ly/Mcc1bz

Risk of pneumonia decreased with use of angiotensin converting enzyme (ACE) inhibitors - BMJ meta-analysis http://goo.gl/dE9Ks

One Doctor’s Prescription to Avoid Social Media Overload http://goo.gl/bdtPU

Cents and Sensitivity - Teaching Physicians to Think about Costs - NEJM http://goo.gl/aUQE3

How fat is fat? The Lancet compares CTs with visceral fat vs. subcutaneous fat deposits http://goo.gl/iO9sa

Increasing contraceptive use in developing countries has cut the number of maternal deaths by 40% - The Lancet http://goo.gl/hHjIO

Qsymia is the second new drug for obesity approved by the FDA in the last month, after Belviq http://goo.gl/wCqi7

Mass General knocks Johns Hopkins out of the top hospital spot it's held for 21 years, while at the same time Cleveland Clinic is closing in on Mayo Clinic - U.S. News & World Report's 2012 list of the best U.S. hospitals http://goo.gl/URpei

Feedback of DNA based risk assessments does not motivate behaviour change - BMJ http://goo.gl/3HaRy

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive acknowledgement in the next edition of this publication.

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From TED Education series, Jun 26, 2012: Some people take aspirin or ibuprofen to treat everyday aches and pains, but how exactly do the different classes of pain relievers work? Learn about the basic physiology of how humans experience pain, and the mechanics of the medicines we've invented to block or circumvent that discomfort.

Lesson by George Zaidan, animated by Augenblick Studios.

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August 3, 2012

Connie K. Ho for redOrbit.com Your Universe Online

Coffee lovers take note: coffee may have health benefits related to Parkinsons disease. A new study examined the influence coffee has on the disorder. Based on the results, researchers believe that coffee can help control movement, easing the symptoms of Parkinsons. The findings are featured in the online issue of Neurology, a journal of the American Academy of Neurology.

Studies have shown that people who use caffeine are less likely to develop Parkinsons disease, but this is one of the first studies in humans to show that caffeine can help with movement symptoms for people who already have the disease, explained study author Dr. Ronald Postuma, a member of the American Academy of Neurology and a researcher at the Researchers Institute of the McGill University Health Center, in a prepared statement.

In the study, 61 participants who showed symptoms of Parkinsons disease, such as daytime sleepiness, were split into two groups. One group took a placebo and the other group took a pill with 100 milligrams of caffeine twice a day for three weeks then 200 milligrams twice a day for three weeks. The second group consumed the equivalent of caffeine from two to four cups per day.

Following a six-week exam period, the group that was given caffeine supplements showed a five-point average in improvement in Parkinsons severity rating as compared to participants who were given the placebo.

This is a modest improvement, but may be enough to provide benefit to patients. On the other hand, it may not be sufficient to explain the relationship between caffeine non-use and Parkinsons, since studies of the progression of Parkinsons symptoms early in the disease suggest that a five-point reduction would delay diagnosis by only six months, noted Postuma in the statement.

The group that took caffeine also showed an average of three-point improvement in body stiffness and body movement as compared to those who were in the placebo group.

The people who received caffeine supplements experienced an improvement in their motor symptoms (a five-point improvement on the Unified Parkinsons Disease Rating Scale, a rating scale used to measure the severity of the disease) over those who received the placebo, suggested Postuma in the statement. This was due to improvement in speed of movement and a reduction in stiffness.

However, caffeine did not positively improve daytime sleepiness, depression, or quality of life in the participants; its also important to take note that, as the study was done in a short amount of time, the influence of caffeine may decrease over time.

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Coffee May Help Control Symptoms Of Parkinson's Disease

Public release date: 1-Aug-2012 [ | E-mail | Share ]

Contact: Julie Robert julie.robert@muhc.mcgill.ca 514-934-1934 x71381 McGill University Health Centre

Montreal, August 1, 2012 Caffeine, which is widely consumed around the world in coffee, tea and soft drinks, may help control movement in people suffering from Parkinson's. This is the finding of a study conducted at the Research Institute of the McGill University Health Centre (RI MUHC) that was recently published in Neurology, the official journal of the American Academy of Neurology. The study opens the door to new treatment options for Parkinson's disease that affects approximately 100 000 Canadians.

"This is one of the first studies to show the benefits of caffeine on motor impairment in people who have Parkinson's disease," stated Dr. Ronald Postuma, lead author of the study, a researcher in neurosciences at the RI MUHC, and Professor of Medicine in the Department of Neurology and Neurosurgery at McGill University. "Research has already shown that people who drink coffee have a lower risk of developing Parkinson's disease, but until now no study had looked at the immediate clinical implications of this finding."

Caffeineone of the most widely used psychomotor stimulants in the worldit acts on the central nervous system and cardiovascular system by temporarily decreasing tiredness and increasing alertness. According to Dr. Postuma, sleepiness is commonly associated with Parkinson's disease. "We wanted to discover how caffeine could impact sleepiness as well as the motor symptoms of Parkinson's disease, such as slowness of movement, muscle stiffness, shaking and loss of balance."

The researchers followed a group of 61 people with Parkinson's. While the control group received a placebo pill, the other group received a 100 mg dose of caffeine twice a day for three weeks and then 200 mg twice a day for another three weeks.

"The people who received caffeine supplements experienced an improvement in their motor symptoms (a five-point improvement on the Unified Parkinson's Disease Rating Scale, a rating scale used to measure the severity of the disease) over those who received the placebo," said Dr. Postuma. "This was due to improvement in speed of movement and a reduction in stiffness." Caffeine had only borderline effects on sleepiness, and did not affect depression or nighttime sleep quality in the study participants.

Larger-scale studies need to be carried out over a longer period to clarify these caffeine-related improvements. "Caffeine should be explored as a treatment option for Parkinson's disease. It may be useful as a supplement to medication and could therefore help reduce patient dosages," concluded Dr. Postuma.

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Caffeine may ease Parkinson's symptoms

Public release date: 1-Aug-2012 [ | E-mail | Share ]

Contact: Rachel Seroka rseroka@aan.com 612-928-6102 American Academy of Neurology

MINNEAPOLIS While drinking caffeine each day does not appear to help improve sleepiness among people with Parkinson's disease, it may have a benefit in controlling movement, according to new research published in the August 1, 2012, online issue of Neurology, the medical journal of the American Academy of Neurology .

"Studies have shown that people who use caffeine are less likely to develop Parkinson's disease, but this is one of the first studies in humans to show that caffeine can help with movement symptoms for people who already have the disease," said study author Ronald Postuma, MD, MSc, with McGill University in Montreal and the Research Institute of the McGill University Health Center. Postuma is also a member of the American Academy of Neurology.

For the study, 61 people with Parkinson's disease who showed symptoms of daytime sleepiness and some motor symptoms were given either a placebo pill or a pill with 100 milligrams of caffeine two times a day for three weeks, then 200 milligrams twice a day for three weeks, which was the equivalent of between two and four cups of coffee per day.

After six weeks, the half that took the caffeine supplements averaged a five-point improvement in Parkinson's severity ratings compared to those who didn't consume caffeine. "This is a modest improvement, but may be enough to provide benefit to patients. On the other hand, it may not be sufficient to explain the relationship between caffeine non-use and Parkinson's, since studies of the progression of Parkinson's symptoms early in the disease suggest that a five-point reduction would delay diagnosis by only six months," said Postuma.

The caffeine group also averaged a three-point improvement in the speed of movement and amount of stiffness compared to the placebo group. Caffeine did not appear to help improve daytime sleepiness and there were no changes in quality of life, depression or sleep quality in study participants.

"The study is especially interesting since caffeine seems to block a malfunctioning brain signal in Parkinson's disease and is so safe and inexpensive," said Michael Schwarzschild, MD, PhD, of Massachusetts General Hospital in Boston, who wrote an accompanying editorial. "Although the results do not suggest that caffeine should be used as a treatment in Parkinson's disease, they can be taken into consideration when people with Parkinson's are discussing their caffeine use with their neurologist." Schwarzschild is also a member of the American Academy of Neurology.

The study authors noted that the length of the study was short and that the effects of caffeine may lessen over time.

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A cup of joe may help some Parkinson's disease symptoms