Category Archives: Neurology

Early use of the multiple sclerosis drug interferon beta-1a might slow and even stop progression of the disease, according to new research from the American Academy of Neurology.

Patients who received interferon soon after their first disease symptoms were less likely to see the disease progress into "clinically definite" multiple sclerosis, which is categorized as having had two separate attacks along with two separate lesions.

Multiple sclerosis is an autoimmune disease that affects the brain and spinal cord. The disease attacks the myelin sheath, a protective covering that surrounds nerve cells.

The disease is degenerative, and symptoms can vary. Patients suffer attacks that can last days, weeks or months. Symptoms affect the muscles, bowel function, vision, numbness, sexual function and personality.

"While we've known it's beneficial to start MS drugs as soon as possible, this is the first trial to show a benefit of early injections of interferon beta-1a treatment at three years," Dr. Mark Freedman of the University of Ottawa in Ontario and a fellow of the American Academy of Neurology said in a statement.

The three-year trial involved 517 people who had experienced their first MS symptoms, which includes tingling, numbness, muscle weakness or balance problems. The participants also showed at least two lesions on their brain that were detected through MRI scans.

One-third of the patients received injections of the drug three times each week, one-third received the injections once a week, and one-third received a placebo. After two years, the patients who received the placebo were then given a three-times-per-week dose of the drug for another year.

Researchers found that those who received the once-a-week dosage or three-times-per-week dosage were less likely to experience a second demyelinating attack three years after the study's start.

Experts said the preliminary study results reinforce the benefits of diagnosing and beginning treatment early for patients with MS.

"Early on, there are few MS lesions, little brain damage, and much better ability of the brain to repair the damage remyelination," said Dr. Anthony Reder, a neurologist and multiple sclerosis expert at the University of Chicago. "The repair process is helped by MS therapies."

Read more:
Early Use of High Drug Dosage Might Slow MS

For example, in their current April/May 2012 issue, I found information about neuropathy and Neuropathy Awareness Week that was relevant to me. One of their feature articles this month, Too Rare for Research? , highlighted the problems that most of us with neuromuscular disease experience in receiving an accurate diagnosis and effective treatment. A companion article provided links useful links regarding rare disease.

The Neurology Now website (see Resources below for web address) offers the ability to search for articles of interest from past issues. A search of their archives found articles on many other neuromuscular diseases, including muscular dystrophy, amyotrophic lateral sclerosis, motor neuron disease, myasthenia gravis, and Freidreichs ataxia. I also found useful articles on other topics of interest to those with neuromuscular disease such as coping with pain, living well with neurological disease, alternative and complementary medicine, and caregiver burnout.

Subscription to Neurology Now can be obtained on their website (see Resources below for address). This magazine offers free print subscriptions to individuals in the U.S. coping with neurological disease, including patients and their families, friends, and caregivers. The Neurology Now website also offers other services, including subscriptions to podcasts and the ability to view the website on internet-enabled mobile devices.

Give Neurology Now a try for reliable, accurate, and easy to understand articles about a variety of neurological disorders including neuromuscular disease. Both the print magazine and the resources available on line provide valuable information from a trustworthy source at no cost to the neuromuscular disease community.

Resources:

Neurology Now website, (2012). Home Page. http://journals.lww.com/neurologynow/pages/default.aspx . Retrieved 4/20/12.

Neurology Now website, (2012). Subscription Services. http://journals.lww.com/neurologynow/Pages/subscriptionservices.aspx . Retrieved 4/20/12.

FTC Disclosure Statement: The magazine reviewed in this article was received by the author as a free subscription. Free subscriptions are available to any individual with a neurological disease residing in the U.S.

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Neurology Now Magazine

Public release date: 15-Apr-2012 [ | E-mail | Share ]

Contact: Rachel Seroka rseroka@aan.com 651-695-2738 American Academy of Neurology

NEW ORLEANS Use of a new drug to detect the beta-amyloid plaques in the brain that are hallmark signs of Alzheimer's disease may help doctors diagnose the disease earlier, according to research that will be presented as part of the Emerging Science program (formerly known as Late-Breaking Science) at the American Academy of Neurology's 64th Annual Meeting in New Orleans April 21 to April 28, 2012.

Currently, Alzheimer's disease can only be definitively confirmed through the detection of amyloid plaques and/or tangles in the brain during autopsy after death or with a brain tissue biopsy. The new method uses the drug florbetaben as a tracer during a PET scan of the brain to visualize amyloid plaques during life.

In order to prove that the florbetaben PET scan detects beta-amyloid in the brain, the global phase III study directly compared brain regions in the PET scan to respective brain regions after death during autopsy.

For the study, more than 200 participants nearing death (including both participants with suspected Alzheimer's disease and those without known dementia) and who were willing to donate their brain underwent MRI and florbetaben PET scan. The amount of plaque found in the 31 participants who reached autopsy was then compared to the results of the scans. A total of 186 brain regions from these donors were analyzed along with 60 brain regions from healthy volunteers. Based on these 246 brain regions the study found florbetaben to detect beta-amyloid with a sensitivity of 77 percent and a specificity of 94 percent.

Comparison of the visual assessment method proposed for florbetaben for clinical practice with the post mortem diagnosis revealed a sensitivity of 100 percent and a specificity of 92 percent. Sensitivity is the percentage of actual positives that are correctly identified as positive, and specificity is the percentage of negatives that are correctly identified.

"These results confirm that florbetaben is able to detect beta-amyloid plaques in the brain during life with great accuracy and is a suitable biomarker," said study author Marwan Sabbagh, MD, director of Banner Sun Health Research Institute in Sun City, Ariz., and a Fellow of the American Academy of Neurology. "This is an easy, non-invasive way to assist an Alzheimer's diagnosis at an early stage. Also exciting is the possibility of using florbetaben as tool in future therapeutic clinical research studies where therapy goals focus on reducing levels of beta-amyloid in the brain."

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The study was supported by Bayer Healthcare Berlin.

Original post:
New method may help detect marker for Alzheimer's disease earlier

From Mayo Clinic YouTube channel: "Being in the hospital after major surgery is no fun. On top of dealing with pain, patients have uncertainty. They also have to worry about getting all the information they need to support their recovery. That's not always easy in the hospital; things happen quickly and doctors and hospital staff are often really busy. Doctors at Mayo Clinic may have a solution to this issue. They're giving iPads to heart surgery patients to see if a new iPad app can make hospital stays easier and more satisfying."

Our research presented during the 2011 ACAAI meeting showed that 95% patients thought the iPad was helpful for coming to understanding of their condition:

PATIENT PERCEPTION OF A POINT-OF-CARE TABLET COMPUTER (IPAD™) BEING USED FOR PATIENT EDUCATION - P318

A. Nickels*, V. Dimov, V. Press, R.Wolf, Chicago, IL.

Background:

During the fall of 2010, the Internal Medicine/Pediatrics program at University of Chicago introduced Point-of-Care Tablet Computers (iPad™) for clinical use. iPads™ are intended to improve access to EMR, work flow, resident and patient education, and access to electronic clinical tools. The graphic display and ease of interface makes the iPad™ a potentially powerful tool to achieve these goals. This pilot study is designed to gauge the initial patient perception of the iPad™ when used for patient education.

Methods:

8 questions, physician administered, patient survey of Allergy Immunology patients or their parents. Preloaded iPads™ with education materials (“mind map” diagrams, clinical pictures) into the photo software were used to clinically education the patients. Simple percentages and Fisher’s exact non-parametric test were used for statistical analysis. Results: 20 patients surveyed (11 resident/9 attending). For those survey items without 100% agreement, there was no statistically significant difference in responses based on level of training (p?0.45). 100% [0.861, 1] of participants liked the iPad™ being used to help explain their children’s condition, 95% [0.783, 0.997] of participants did not find it distracting. 100% [0.8601, 1] found it helpful. 100% [0.861, 1] would like it to be used again to help explain medical information. 95% [0.784, 0.9974386] thought the iPad™ was helpful for coming to understanding of their condition. Limitations of this study include a convenient sample, physician-administered survey, and observer bias.

Conclusion:

Patient perception was very positive toward the use of a Point-of-Care Tablet Computer (iPad™) in a clinical setting. While limited to only two operators, level of training did not have an effect on patient perception. Confirmation of the results may be required before wider implementation.

Source:  Patient Perception of a Point-of-Care Tablet Computer (iPad) Being Used for Patient Education. A. Nickels, V. Dimov, V. Press, R. Wolf. American College of Allergy, Asthma & Immunology (ACAAI) 2011 Annual Meeting.

http://www.annallergy.org/supplements

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Richard Smith is a former editor of the BMJ and chief executive of the BMJ Publishing Group. He is well-known for provocative editorials. Here is an excerpt from one, published recently in The Scientist:

"Elsevier, the world’s largest publisher of scientific journals, has seen broadly stable revenues (€2,236 million in 2006, €2,370 million in 2010) but growing profits (€683 million in 2006, €847 million in 2010).

Scientific journals remain very profitable. Few industries manage a profit margin of 35.7% (that for Elsevier in 2010), but then few industries are given their raw material—in this case, scientific studies—not only for free, but also in a form that needs minimal processing."

It is nice to see that the current and a former editor of the two most famous British medical journals, The Lancet and BMJ, are now on Twitter:

Why has the Cochrane Collaboration never quite taken off in the US?

— richard horton (@richardhorton1) April 5, 2012

Any symptom in an elderly person should be considered to be a drug side effect until proved otherwise. Jerry Avern

— Richard Smith (@Richard56) April 2, 2012

References:

Reading Into the Future | The Scientist, 2012.

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A postal survey included a random sample of 4,500 Australians aged ? 50 years between in 2009-2010 and the response rate was 37%.

Medications use was very common, 87% of participants took one or more drug (called medicines in Australia) and 43% took five or more in the previous 24 hours.

Complementary medicines were used by 46% of participants.

The most commonly used medications were:

- antihypertensive agents, 43% of participants
- natural marine and animal products including fish oil and glucosamine, 32%
- lipid-lowering agents, 30%

Doctors recommended 79% of all medications and 93% of conventional medications.

Much medicines use was to prevent future disease by influencing risk factors.

In a 2011 study, 4 medication classes were linked to 67% of drug-related hospitalizations:

- warfarin, 33%
- insulins, 14%
- oral antiplatelet agents, 13%
- oral hypoglycemic agents, 11%

High-risk medications were implicated in only 1.2% of hospitalizations.

50% of these hospitalizations were among adults 80 years of age or older. 65% of hospitalizations were due to unintentional overdoses.

Classification of adverse reactions to drugs: "SOAP III" mnemonic (click to enlarge the image):

Adverse drug reactions (ADRs) affect 10–20% of hospitalized patients and 25% of outpatients.

Rule of 10s in ADR:

10% of patients develop ADR
10% of these are due to allergy
10% of these lead to anaphylaxis
10% of these lead to death

References:

A national census of medicines use: a 24-hour snapshot of Australians aged 50 years and older. Tessa K Morgan, Margaret Williamson, Marie Pirotta, Kay Stewart, Stephen P Myers and Joanne Barnes. MJA 2012; 196 (1): 50-53, doi: 10.5694/mja11.10698

4 medication classes linked to 67% of drug-related hospitalizations

Image source: Wikipedia, public domain.

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