Category Archives: Neurology Scans

Wiley launches new open access journal: Brain and Behavior

Wiley & Sons will begin publishing Brain and Behavior, an open access journal, this spring. Brain and Behavior is a peer-reviewed, interdisciplinary journal, providing rapid publication of high-quality research across neurology, neuroscience, psychology and psychiatry. The open access format is intended to offer authors more choice, according to a Wiley press release.

“With the launch of Brain and Behavior, the Editorial Board and I, along with the support of many international societies, will offer the research community a high quality peer-reviewed journal that meets the needs of those authors who wish to publish their work in an open access environment. I am delighted to be working with Wiley to deliver this important new service,” according to editor-in-chief Andrei V. Alexandrov, professor of neurology at the University of Alabama at Birmingham.

The open access journals will be published under the Creative Commons Attribution NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. Authors will be paid a publication fee upon acceptance of their articles.

Wiley publishes more than 500 journals. Its open access titles are being launched in collaboration with international professional and scholarly societies.

The Directory of Open Access Journals currently lists 6,214 journals. 

Botox irons out the wrinkles for some Parkinson's patients

Botox is no longer just for looking beautiful; it’s for feeling beautiful, too.

Botox is the commercial name for a medication containing Clostridium botulinum, a bacteria best known for causing botulism or food poisoning.

Today, Botox, or botulinum toxin, is perhaps best known worldwide as a wrinkle remover for its ability to paralyze muscles that cause wrinkles. But increasingly, botulinum toxin is coming into wider use as a medical treatment for pain - one of its first “off-label” medical uses was as a treatment for chronic migraine - or to aid in managing symptoms in movement disorders such as dystonia, Parkinson’s disease, essential tremor and  hemifacial spasm. 

Guillermo Moguel-Cobos, MD, a neurologist at the Muhammad Ali Parkinson Center in Phoenix, Arizona, said when BTn enters nerve terminals it reduces nerve firings which causes the muscles or limbs to retun to their original position.

Doug Eshelman, who has suffered with Parkinson’s disease — a degenerative disorder of the central nervous system — for five years and is a patient at the center, said he wanted to try it the minute his doctor told him about it, even though it’s not a cure, but helps manage the symptoms of Parkinson’s just as it temporarily irons out facial wrinkles.

He told KABC TV in Los Angeles how Parksinson’s had affected his mobility. “Well, I tripped a lot, because I dragged my right leg, I just subconsciously — you just don’t pick it up, so I dragged it.” Help came from something he never expected, Botox, the 61-year-old patient said. Eshelman, who describes himself as an active person, said he had believed Botox was just for cosmetics.

Eshelman said his doctor “…gave me nine shots in my leg and within a week, that inside muscle relaxed and my leg went back into place and I walked fine.

“Sometimes I cry when I think about it, like right now. My whole life is back.”

As a medical treatment, BT is now FDA-approved for strabismus (lazy eye), blepharospasm (involuntary spasms of the eye lids), hemifacial spasm, cervical dystonia (involuntary contracting of the neck muscles) and migraine, but some physicians, like Moguel-Cobos, find it beneficial for Parkinson’s patients as an add-on to standard treatments. Injections are typically give every three months.

Side effects of the injections can include pain, redness, itching, nausea, sweating and headache, according to the FDA. In 2009, the FDA warned that botulinum toxin can spread to other parts of the body and cause muscle weakness, visual impairment, difficulty with speaking, breathing and swallowing, and loss of bladder control.

Seniors scoring better on intelligence tests

It’s not just children who are scoring higher on intelligence tests compared with decades past. Researchers in Sweden say that today’s 70-year-olds score far better on intelligence tests than did their predecessors, according to research from the University of Gothenburg, published in Neurology.

The researchers used 40 years worth of data that had been collected on seniors’ memory, speed, language, logic and spatial awareness in an effort to identify people at risk of developing dementia.

They compared test results from 800 septuagenarians born in 1930 and tested in 2000 with those born in 1901-02 and tested in 1971.

“The improvement can partly be explained by better pre- and neonatal care, better nutrition, higher quality of education, better treatment of high blood pressure and other vascular diseases, and not least the higher intellectual requirements of today’s society, where access to advanced technology, television and the Internet has become part of everyday life,” says study co-author Simona Sacuiu, resident in psychiatry at Sahlgrenska University Hospital and medical researcher at the Sahlgrenska Academy’s Unit of Neuropsychiatric Epidemiology.

The study showed that memory problems were the only predictor of which 70-year-olds were at risk of developing dementia. Among the over 800 dementia-free 70-year-olds in the study, 5 percent later developed dementia. 



Sacuiu, S. “Secular changes in cognitive predictors of dementia and mortality in 70-year-olds.” Neurology (2010). doi: 10.1212/WNL.0b013e3181f0


Neurology at the movies

Through “Neuro Movie Nights” the Montreal Neurological Institute at McGill University has found a unique way of sharing its fascination with the brain with the public.

The Institute pairs popular films with prominent neurologists and neuroscience “hosts” who talk about the science, or lack thereof, in the films.

In November, neurologist and dementia researcher Lesley Fellows, MD, PhD, hosts Away From Her,” the 2006 drama starring Julie Christie that depicts how dementia affects a woman and her husband. Fellows will comment on her work with dementia patients.

Neurologist Liam Duncan will host The Butterfly and the Diving Bell,” the story of Elle editor Jean-Dominique Bauby who is left almost completely paralyzed following a stroke.

Other movies in the series include “Young Frankenstein,” “Battle Rocket,” “Rainman” and “Extraordinary Measures.”

AAN debuts new clinical practice journal

The American Academy of Neurology joins the field of clinical practice journals this month with the launch of Neurology: Clinical Practice

The AAN is distributing two issues of the new medical journal as a supplement to Neurology in Nov. 2010 and Feb. 2011. Both Neurology and the new journal are published by Lippincott Williams & Wilkins.

Presented as a practical resource for neurologists, articles in the first issue provide updates on treatments for specific diseases and bottom line issues like medical liability claims and health care reform.

“If successful, we will launch NCP as a full-time journal in the family of publications under the auspices of the AAN,” according to editor John Corboy, MD, professor of neurology at the University of Colorado-Denver.

Report: New mothers gain brain volume in areas responsible for nurturing behaviors

A small study of women in their mid-30s suggests that there’s more at work than instinct when a woman becomes a mother.

A Yale University study found that areas of the brain — associated with maternal motivation (hypothalamus), reward and emotion processing (substantia nigra and amygdala), sensory integration (parietal lobe), and reasoning and judgment (prefrontal cortex) – grew in volume within days after giving birth.

The 19 volunteers were an average of 33 years in age and had 18 years of education. All were breastfeeding, none had serious postpartum depression, and about half had given birth previously, according to researchers. Brain volumes were measured before and after giving birth using magnetic resonance imaging (MRI).

The study was published in the October Behavioral Neuroscience (pdf). Lead researcher Pilyoung Kim, PhD, now with the National Institute of Mental Health, speculates that increases in estrogen, oxytocin and prolactin hormones make new mothers’ brains susceptible to “reshaping in response to the baby.”  

The motivation to take care of a baby, and the hallmark traits of motherhood, might be less of an instinctive response and more of a result of active brain building, according to neuroscientists Craig Kinsley, PhD, and Elizabeth Meyer, PhD, who commented on the research.


Kim, Pilyoung; Leckman, James F.; Mayes, Linda C.; Feldman, Ruth; Wang, Xin; Swain, James E. “The plasticity of human maternal brain: Longitudinal changes in brain anatomy during the early postpartum period.” Behavioral Neuroscience, Vol 124(5), Oct 2010, 695-700 doi: 10.1037/a0020884

Kinsley, Craig H.; Meyer, Elizabeth A. “The construction of the maternal brain: Theoretical comment on Kim et al.” (2010). Behavioral Neuroscience, Vol 124(5), Oct 2010, 710-714. doi: 10.1037/a0021057

Tips for finding the best hospital for neurology treatment

The most important factor to consider when seeking neurology treatment at a hospital is whether it specializes in the disease for which you seek treatment. You wouldn’t go to a certified stroke center to receive care for multiple sclerosis.

Other factors that affect the quality of care you’ll receive as a neurology patient are the availability of advanced imaging technology for enhanced diagnosis and treatment, the hospital’s emphasis on research, and its history of mortality rates, medical errors and infection rates. Other important factors to consider are proximity of location, the types of insurance it accepts and your personal level of comfort with the physicians and staff at the hospital.

Some popular magazines and health care ranking companies release annual “best of” lists for hospitals, including those offering neurological care. While valuable in some aspects, these types of reports may not be entirely objective. The rankings may be based partly on questionnaires completed by hospital staff. In other cases the rankings are shaped by a hospital’s participation in consulting services provided by the ranking organization. In other words, the highest rankings might go to those hospitals that respond to the questionnaire or purchased “quality improvement” services through the ranking organization.

The most objective sources for choosing a neurology hospital are reports from non-profit and government organizations that have no stake in the outcomes and that compare all hospitals based on mandated outcome reporting. Unfortunately, the government doesn’t provide overall rankings for neurology hospitals. It would be unlikely for a hospital to specialize in all 600 neurological disease.

However, government offices have released hospital outcome reports for certain types of neurological disorders such as stroke.

The Centers for Medicare and Medicaid Services (CMS) and The Joint Commission require all hospitals to report their performance measures by submitting data on processes of care. These data are updated quarterly on CMS’s hospital compare web site,

U.S. News & World Report ranks the top 50 neurology and neurosurgery hospitals. One important drawback to this ranking is that it presents neurology and neurosurgery as one specialty. In reality these are very different specialties whose physicians receive different training and specialize in treating different conditions. A hospital might rank very high in neurology but have lower outcomes in neurosurgery and vice versa which would affect its ranking. Patients needing an expert diagnosis and treatment plan for a neurological disorder such as multiple sclerosis need to see a neurologist, not a neurosurgeon.

HealthGrades, an independent ratings organization, analyzes and assigns star ratings for different medical conditions or procedures. It names its lists of the top 10 percent of hospitals by specialty, such as stroke care centers of excellence.

Finding a hospital based on location and specialty

There may be other comprehensive reports other than those described above but they are not easily found. An alternative is to locate the patient advocacy group and the medical association devoted to your specific disease.

Some groups such as the ALS Association provide a list of clinics by location.

The Alzheimer’s Association offers a “Personal Care Finder” tool that will recommend services in your area based on a questionnaire you can complete on its web site.

The American Academy of Neurology offers a “Find a Neurologist” tool that will identify AAN members by zip code once city, state or province or country fields are entered.

HealthGrades also lists individual neurologists by state, specialty (Alzheimer’s disease, Parkinson’s disease, epilepsy, etc.) and types of insurance accepted. HealthGrades requires a fee for additional information on whether the neurologist has been board certified, where he or she received their medical education and whether they have received any disciplinary action.


Monitoring neurological effects of H1N1 vaccine and other neurology news

AAN collaborating with CDC on H1N1 vaccine safety monitoring

The American Academy of Neurology and Centers for Disease Control and Prevention are asking neurologists to report any possible new cases of Guillain-Barré syndrome (GBS) following 2009 H1N1 flu vaccination using the CDC and U.S. Food and Drug Administration Vaccine Adverse Event Reporting System (VAERS).

The AAN said on its web site that it does not anticipate that the 2009 H1N1 vaccine poses an increased risk of GBS. “However, out of an abundance of caution, and given that GBS may be of greater concern with any pandemic vaccine because of the association of GBS with the 1976 swine flu vaccine, the CDC and AAN are asking neurologists to report any potential new cases of GBS after-vaccination as part of the CDC’s national vaccine safety monitoring campaign.”

“The active participation of neurologists is going to be critical for monitoring for any possible increase in GBS following 2009 H1N1 influenza vaccination,” according to Orly Avitzur, MD, MBA, FAAN, who is leading the AAN effort.

VAERS reports on 2009 H1N1 and seasonal flu vaccine suggest some neurological adverse effects

According to the CDC’s Morbidity and Mortality Weekly Report:

CDC and FDA staff queried the VAERS database to identify all U.S. reports of adverse events after vaccination with H1N1 vaccines and 2009 influenza vaccines. As of November 24, VAERS had received 10 reports of Guillain-Barré syndrome (GBS), and two additional reports of possible GBS were identified by medical officers reviewing other reports to VAERS describing neurologic events.

After chart review, four of these 12 reports met the criteria for GBS, four did not, and four are under review. VAERS also received 11 reports of anaphylaxis, and an additional eight reports of possible anaphylaxis were identified by medical officers reviewing the VAERS reports for serious allergic events. Of these 19 cases, 13 met the criteria, five had an anaphylaxis diagnosis on medical record review, and one has not been confirmed. Three of the GBS cases and 15 of the anaphylaxis cases were coded as serious adverse events, in accordance with federal regulation.

The remaining 173 nonfatal serious adverse events after vaccination with H1N1 vaccines are under review. They include: 49 neurologic or muscular conditions other than GBS (28%); 27 pneumonia or influenza-like illnesses (16%); 19 other noninfectious conditions, including multiple medical symptoms (11%); 17 respiratory or ear, nose, and throat conditions (10%); 16 allergic conditions other than anaphylaxis (9%); 15 pregnancy complications (9%); 10 other infectious symptoms (6%); eight  gastrointestinal (5%); six cardiovascular (3%); and 6 psychiatric (3%) cases.

Between October 5 and November 20, a total of 46.2 million doses of H1N1 vaccines and 98.9 million doses of seasonal influenza vaccines were distributed to U.S states and territories.

A total of 3,783 reports of adverse events were received through November 24 after receipt of H1N1 vaccine. Of those, 204 were categorized as serious. In addition, 4,672 adverse events reports after receipt of seasonal influenza vaccines were received, of which 283 were classified as serious.

Smaller fingers have a better sense of touch

Women tend to have better tactile acuity than men. Researchers at McMaster University in Hamilton, Ontario, have now ascertained that it’s the size of their fingers and not their sex that determines a woman’s superior sense of touch.

The researchers measured index fingertip size in 100 university students (50 males, 50 females), then tested each volunteer’s tactile acuity by pressing progressively narrower parallel grooves against a stationary fingertip. They found that people with smaller fingers could discern tighter grooves. 

Researchers also counted the sweat pores in a subset of participants and found that pores are packed more densely in smaller fingers. Sensory receptors, called Merkel cells, cluster around the bases of sweat pores. People with smaller fingers had greater sweat pore density, and thus more closely spaced Merkel cells. 

Does extra sensitivity extend to the small size of childrens’ digits?

The authors’ suggested in the abstract that it’s probable. “We suggest that diminutive digits discern delicate details because within such digits Merkel cell density is high, and consequently SA1 receptive fields are closely spaced and small, resulting in excellent spatial resolution. If the influence of finger size on tactile acuity applies throughout development, then we would expect children to outperform young adults on tactile spatial tasks, as observed in one study (Stevens and Choo, 1996; but see Bleyenheuft et al, 2006).”

The study was published in the Dec. 16 issue of The Journal of Neuroscience.

Illustration courtesy of the Society for Neuroscience.

PTSD associated with lower brain volume?

A small study of 97 combat veterans jointly funded by the departments of Veterans Affairs and Defense suggests that those with post-traumatic stress disorder (PTSD) had smaller cerebral cortex volumes than those not suffering from PTSD. This reduced brain volume left them with less ability to cope in a civilian environment, according to research published in the December Archives of General Psychiatry.

Using new advances in magnetic resonance imaging (MRI) technology, researchers, led by Steven H. Woodward, PhD, of the VA’s National Center for PTSD in Palo Alto, California, re-analyzed the cortical volume in a group of previously studied Vietnam and Persian Gulf War veterans.

Those with PTSD had significantly lower total cortical volume (350,744 mm3 versus 368,896 mm3). Cortical thickness as a weighted mean over the whole brain was also significantly lower among veterans with PTSD (2.384 versus 2.428 mm).

Alcohol or psychotropic medication abuse and severe adrenaline and corticosteroid overload have previously been shown to negatively affect brain volume. Currently there are no studies on the effects of mandatory military vaccinations on brain volume.

Researchers with the University of Geneva, Swiss Federal Institute of Technology, National Center for PTSD, VA Boston Healthcare System, Boston University School of Medicine also took part in the study, published in the December Archives of General Psychiatry.

Half of the participants (37 Vietnam and 13 Gulf War veterans) met criteria for current PTSD as a result of experiencing military trauma.

Brain-computer interface advances through electrocorticography

Researchers have demonstrated how electrodes planted directly on the brain could help people with severe neuromuscular disorders such as spinal cord injuries and ALS to communicate and control devices using only their brain waves.

Mayo Clinic neurologist Jerry Shih, MD, and Dean Krusienski, Ph.D., of the University of North Florida, conducted the brain-computer interface study  on two patients with epilepsy who were being monitored for seizure activity using electrocorticography (ECoG). With ECog, electrodes are surgically placed directly on the surface of the brain to record electrical activity produced by the firing of nerve cells.

Shih hypothesized that feedback from electrodes placed directly on the brain would be more precise than data collected from electroencephalography (EEG), in which electrodes are placed on the scalp.

The two patients sat before a monitor hooked to a computer running the researchers’ software, which was designed to interpret electrical signals coming from the electrodes.

Using only their brain waves, and by focusing on only a single letter, the patients were able to “type” alphanumerical characters on the computer monitor.

Shih called the result of the study “tangible progress” in using brain waves to do certain tasks. “Over 2 million people in the United States may benefit from assistive devices controlled by a brain-computer interface,” said Shih.

The findings were presented at the 2009 annual meeting of the American Epilepsy Society. The study was funded by the National Science Foundation

Tinnitus can be eased by listening to modified music

A study of 23 patients with chronic tinnitus found that the loudness of the ringing in the patients’ ears could be reduced through music therapy.

Researchers at the University of Münster, Germany, led by Christo Pantev, PhD, exposed tinnitus sufferers to their preferred music after the music was “notched,” or  modified, to remove certain notes that matched the of the ringing in their ears. 

After 12 months of listening to the modified music, the target group reported significantly reduced tinnitus loudness. Researchers also observed reduced activity in the auditory cortex areas corresponding to the tinnitus frequency.

Maladaptive auditory cortex reorganization may contribute to tinnitus, according to the researchers. Because cortical organization can be modified by behavioral training, the researchers surmised that listening to the notched music may have re-wired parts of the over-active auditory cortex, or deprived certain auditory neurons, making them less active.

The study was published in the Proceedings of the National Academy of Sciences.


Morbidity and Mortality Weekly Report. Dec. 4, 2009 / 58(Early Release);1- 6

Ryan M. Peters, Erik Hackeman, and Daniel Goldreich. Diminutive Digits Discern Delicate Details: Fingertip Size and the Sex Difference in Tactile Spatial Acuity
J. Neurosci. 2009 29: 15756-15761; doi:10.1523/JNEUROSCI.3684-09.2009

Steven H. Woodward, PhD; Marie Schaer, MD; Danny G. Kaloupek, PhD; Lucia Cediel, BA; Stephan Eliez, MD. Smaller Global and Regional Cortical Volume in Combat-Related Posttraumatic Stress Disorder. Arch Gen Psychiatry. 2009;66(12):1373-1382.

Epilepsia (Abst. 3.149), AES 2009, Electrocorticography In A Brain-Computer Interface (Bci) Paradigm, Authors: Jerry Shih and D. Krusienski

Hidehiko Okamoto, Henning Stracke, Wolfgang Stoll, and Christo Pantev. Listening to tailor-made notched music reduces tinnitus loudness and tinnitus-related auditory cortex activity. PNAS 2009: 0911268107v1-200911268

Researcher says brain replica feasible in 10 years and other neurology news

Professor and neuroscientist Henry Markram of the Brain Mind Institute in Switzerland believes scientists could have a brain model that replicates the functions of the human brain in 10 years. Markram’s team has assembled hundreds of thousands of small pieces of data that his lab has collected over the past 15 years.

Through its Blue Brain Project, the institute has built its first cellular-level model of the neocortical column. A parallel supercomputer performs experiments so that the behavior of the tissue can be predicted through simulations. “When we first switched it on it already started to display some interesting emergent properties,” stated Markram. “But this is just the beginning because we know now that it is possible to build it. As we progress we are learning about design secrets of our brains which were unimaginable before. In fact the brain uses some simple rules to solve highly complex problems and extracting each of these rules one by one is very exciting. For example we have been surprised at finding simple design principles that allow billions of neurons to connect to each other. I think we will understand how the brain is designed and works before we have finished building it.”

Video below: Zooming out, highlighting a single neuron

Blue Brain Project, Ecole Polytechnique Federale de Lausanne

Why is Markram confident?

“The brain is of course extremely complex because it has trillions of synapses, billions of neurons, millions of proteins, and thousands of genes. But they are still finite in number. Today’s technology is already highly sophisticated and it allows us to reverse engineer the brain rapidly.”

The main barrier to completing the replica brain is money, according to Markram. “I absolutely believe it is technically and biologically possible. The only uncertainty is financial. It is an extremely expensive project and not all is yet secured.”

Markram envisions a brain model that will help researchers better understand brain diseases caused by faulty processing in brain circuits, neurons or synapses. Other benefits are outlined on the Blue Brain website

Athletes donate brains to research

Three active NFL player have recently joined 150 retired athletes in donating their brains for concussion research via the Center for the Study of Traumatic Encephalopathy (CSTE).

Boston University School of Medicine, in collaboration with the Sports Legacy Institute (SLI), created the CSTE last year to conduct research of chronic traumatic encephalopathy. CTE is a progressive degenerative disease of the brain found in athletes and others with a history of repetitive concussions.

As part of the donor program, the athletes will also submit to annual interviews so researchers can examine the relationship between clinical symptoms and pathology.

Sports related head trauma is implicated in the death of numerous athletes who, following years of repeated concussions, developed CTE. Boxers, wrestlers, and football players are among those known to have died from CTE complications.

Image: CT scan of patient with brain trauma depicting multiple frontal, parietal, and temporal lobe contusions with associated interhemispheric hemorrhage and a left-sided subdural hematoma measuring 1.7 mm in greatest depth./Rehlman, Wikipedia

New ethical and legal challenges surrounding end-of-life counseling and euthanasia explored

The Lancet Neurology features an in-depth feature by Kathlyn Stone exploring some emerging controversies surrounding euthanasia, physician-assisted suicide, palliative care and the debate over so-called “death panels” in its October issue. Discussion of euthanasia and other end-of-life issues are currently dominated by the advanced directives components of the the United State’s leading health reform plans, but it is a broader subject that will continue to resurface globally.

Researchers worry about growing market for voluntary brain screening tests

Commercially available brain scans are growing in popularity among healthy people who want to allay fears about undiagnosed brain cancer and stroke, but the unnecessary scans may do more harm than good, according to Rustam Al-Shahi Salman, a clinician scientist at the University of Edinburgh. “The difficulty with these health check-ups is that in the small number of people who do harbour some undiagnosed brain condition, there is not a clear next step,” stated Salman.

In a study published in the British Medical Journal, researchers analyzed results of nearly 20,000 brain scans from people who undertook the tests for a variety of reasons, such as general health check-ups or volunteering for medical research. None of them had any symptoms suggesting that they had an underlying brain condition.

The researchers found that almost 3 percent of healthy people had an abnormality on a brain MRI scan and warn that even when an incidental abnormality — such as a weakened blood vessel in the brain or a benign tumor — is discovered, there is no clear medical evidence that treatment would do more good than harm.

“We do not have enough medical evidence to know whether we should treat the abnormalities or just leave them be. Until we have that knowledge, we cannot be sure that commercial screening benefits people with incidental findings on their brain scan. Furthermore, there is little evidence that “peace of mind” lasts for the people with normal brain scans.”

Society for Neuroscience wants experts taking the lead on Wikipedia entries

Wikipedia, a free online encyclopedia, is a widely popular source of public information.  After reviewing the neuroscience entries the Society for Neuroscience (SFN) diplomatically called them “under construction and incomplete.”

The SfN is calling upon its members to improve and expand Wikipedia’s neuroscience content through editing and contributions. It will offer a “Writing for an audience of millions: Wikipedia and neuroscience” training session at its upcoming Neuroscience 2009 conference in Chicago, Ill., Oct. 17-21.

The Neuro Revolution

Michael F. Huerta, Ph.D. reviews The Neuro Revolution, a new book exploring the intersection of neuroscience and neurotechnology by Zack Lynch, founder and executive director of the Neurotechnology Industry Organization.

Neuro Scans

Women, pregnancy and epilepsy


About 500,000 U.S. women of childbearing age have epilepsy and many of them take medications to control seizures. An analysis of several studies found that one of the more effective drugs at preventing seizures, valproate, increases the risk of birth defects, including lower cognitive scores, in children exposed to the drugs in vitro or through breastfeeding, and should therefore be avoided by women with epilepsy during pregnancy.


New practice guidelines introduced at the meeting also recommended women with epilepsy planning to become pregnant should avoid taking more than one epilepsy drug at a time, work with their doctor to wean themselves off a drug to avoid increased seizures, increase their folic acid intake, and avoid smoking.




Pictured L to R: Mary Katherine Albritton, Cynthia Harden, MD, and Gary Gronseth, MD, at an April 27 press briefing at the Washington State Convention Center. Harden and Gronseth co-sponsored new practice guidelines pertaining to pregnancy and women with epilepsy. Albritton, parent of two young children, gave the patient’s perspective. Photos: Kathlyn Stone


Multiple Sclerosis, mitoxandrone and leukemia risks


Researchers in Italy found that patients with multiple sclerosis who are treated with a cumulative dose of 82 mg/m2 of mitoxandrone (Novantrone) are at a 2.7 higher risk of developing acute leukemia, according to a report presented at the meeting.


The risk seems to increase with higher cumulative doses, and after observing that 21 out of 2,854 MS patients (7.4  patients per 1,000) developed leukemia after treatment with mitoxandrone, the researchers recommend careful monitoring of any patient treated with the drug for six years after the last treatment.


“It is vital that all MS patients treated with mitoxantrone undergo prolonged and careful haematological follow-up to check for acute leukemia,” said lead author Vittorio Martinelli, MD, University Vita-Salute, Milan, Italy.


Mitoxantrone was approved by the FDA in 2000 as a therapy to reduce relapses in patients with progressive multiple sclerosis. 


Therapy for relapsing-remitting MS looks promising in trials


Cladribine, a drug being developed to reduce the frequency of relapses in patients with relapsing-remitting multiple sclerosis, showed a more than 30 percent reduction in the risk of disability progression compared with placebo in 1,326 patients followed over the two-year study period, according to a study presented at the AAN meeting. The drug also demonstrated a reduction of at least 70 percent in the mean number of active brain lesions as measured by magnetic resonance imaging (MRI). 

“The remarkable thing about this drug is you only have to take it 10 days a year,” said lead investigator Gavin Giovannoni, PhD, Institute of Cell and Molecular Science, Barts, United Kingdom, and The London School of Medicine and Dentistry in London.

The trial has been extended for two more years to gather more data on safety and efficacy over a longer term of use. Experts will be particularly interested in observing whether any association exists between cladribine and cancer risk.  


Want to know more about the research launched at the AAN meeting?


Ed Susman, medical writer and publisher of Medical Front Page, and Andrew Wilner, MD, neurologist, author and Medscape blogger (requires registration), were two of the dozens of correspondents reporting, blogging and twittering live from the meeting. My reports are at Doctor’s Guide and Consultant Live: Consultations in Primary Care.


Brains for Sale




If you’re a “Grey’s Anatomy” fan you already know that Dr. Meredith Grey and Dr. Derek Shepherd are tying the knot during the May 7 episode. 


The couple’s online wedding registry lists the AAN Foundation as one of their favorite charities and they’re encouraging fans to make donations to the AAN Foundation in lieu of gifts. The foundation sold virtual brains for $5 at the annual meeting which can also be purchased online at the foundation’s Brain Matters web site.


Donations to the “Buy A Brain” campaign go toward funding research for treatments and cures for Parkinson’s disease, Alzheimer’s disease, multiple sclerosis, brain tumors, traumatic brain injury and other neurological disease.


Neuro Scans

Stem cell ban lifted but researchers must remain vigilant to protect scientific integrity


Earlier this month, President Obama through executive order lifted the ban on federal funding for embryonic stem cell research.


The ban put in place by President Bush in 2001 limited research funding to approximately two dozen existing embryonic stem cells lines. The ban was viewed as politically motivated by many researchers and the public which overwhelmingly favored increased research that might lead to cures for diabetes, Alzheimer’s, Parkinson’s, spinal cord injuries, and other neurological disorders. Some researchers insist America has lost almost a decade of research time that could have resulted in medical advancements. A possible silver lining to the ban is that many researchers developed new partnerships with colleagues in foreign institutions in order to continue their research.


With the lifting of the ban, hundreds of lines developed since 2001 will be eligible for federal funding. Obama science advisor Harold Varmus, president of Memorial Sloan-Kettering Cancer Center in New York and former head of the National Institutes of Health, recently co-authored an editorial in Science on Obama’s stem cell research and scientific integrity policies (registration required). In the editorial Varmus encourages scientists to stay involved in policy discussions because preserving scientific integrity in a highly politicized environment will require vigilance. 


When lifting the ban, Obama also pledged through a memorandum to appoint only credentialed experts to federal positions that involve evaluating scientific information. 


Wakefulness drug modafinil may be addictive 


Modafinil (Provigil), approved by the FDA for the treatment of narcolepsy, has also come into wider use as a cognitive performance enhancer as it was generally believed to be a safer alternative to amphetamines. A recent study by NIH and collaborating institutions published in JAMA, however, found that the drug blocked dopamine transporters and increased dopamine in the brain. These changes in the brain’s pleasure center could lead to dependence and abuse, say researchers.


Using positron emission tomography (PET), researchers measured the effects of 200 mg and 400 mg, common therapeutic dosages given in pill form, on extracellular dopamine and on dopamine transporters in 10 healthy male brains.


The study is preliminary, given such a small sample, but the findings warrant further study, especially since modafinil has been approved for use by the U.S. military beginning in 2003.


Approved initially for certain Air Force personnel, returning Army and National Guard soldiers have said the drug is readily available to those in combat situations, and clinicians have concerns that returning soldiers may have developed a dependency on the drug. The drug is also increasing in popularity among college students and others who say the drug improves performance, enhances mood and allows better concentration.



JAMA. 2009;301(11):1148-1154.


Closer to a consensus on when brain death occurs?


The medical community, particularly neurologists, have been grappling with the definition of brain death and striving to reach a consensus on when brain death occurs for decades. JAMA first published a landmark article that quantitatively defined the clinical and laboratory criteria used to measure the presence of brain death in 1968. But different protocols at different institutions left openings for disagreements and legal entanglements.


The work took on new urgency in 2005 when the Terry Schiavo case became a national political wedge issue. Not limited to medical experts and ethicists, the case galvanized religious activists, conservative politicians, and celebrities who grandstanded before an eager media. 


Adding to the high drama, President Bush made a midnight flight from his ranch in Crawford, Texas, to Washington, DC, to sign a law passed by an emotionally charged Congress that forced doctors to re-insert the feeding tube that had kept Schiavo alive in a vegetative state for 15 years. After all Congressional and legal maneuvers were exhausted, Florida judge George Greer ruled that Schiavo could be removed from life support as her legal guardian had requested for seven years. Schiavo died from dehydration on March 30, 2005.


After intense study, an ad hoc committee of experts from Harvard Medical School has just issued a new definition on when brain death occurs: Consciousness, Coma, and Brain Death—2009, A Definition of Irreversible Coma: Report of the Ad Hoc Committee of the Harvard Medical  School to Examine the Definition of Brain Death. Will it be the final word?




Left: CAT scan of normal brain. Right: Terri Schiavo’s 2002 CAT scan provided by Ronald E. Cranford, MD, then assistant chief of neurology at the Hennepin County Medical Center, Minneapolis. (The image is fair use, since the doctor released his image to the public.)


Wrapping it up with a bow tie workshop


The American Academy of Neurology, known for hosting an intense dawn to dusk (and beyond) annual meeting, is gearing up for its 61st in Seattle, April 25-May 2.


While the conference attendees work hard, they also know how to have competitive fun at the wildly popular NeuroBowl quiz show and Neuro Idol talent show. The organization does, on occasion, poke a little fun at itself.


This year the AAN is hosting a “bow-tying” booth at the meeting in honor of the bowtie which, along with pale blue blazers, is ubiquitous among neurologists.


I’ll be attending the meeting and filing stories for some free lance clients and doing some news blogging from the meeting here on Flesh & Stone.



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