A brain-killing virus, a ‘cocktail’ for self-healing, and a combat sport for a crippling neurological disease
This week, there’s a lot happening in neuro. For starters, researchers of a preclinical study have shown that a certain “sleeping” virus may cause more harm to the brain than previously thought. Across the pond, experts have found that healing spinal fractures may be as easy as taking this two-drug “cocktail.” And, are physicians at higher risk for dementia than the general population? Read on to find out all this and more in this week’s NeuroBrief!
The father of EEG. Nearly 100 years ago—in 1924—Hans Berger, MD, recorded the first human electroencephalogram (EEG). The German psychiatrist published his breakthrough findings 5 years later in 1929, but his research was met with much skepticism and disbelief. Ten years following Dr. Berger’s first successful EEG recording, British electrophysiologists Edgar Douglas Adrian and B.H.C. Matthews confirmed Dr. Berger’s basic observations. With this validation, Dr. Berger’s discovery was finally recognized as an important diagnostic tool in the neurosciences. Although the EEG has been replaced today by CT, it still has a place in the diagnostic work-up of seizures, degenerative brain changes, brain tumors, head injuries, encephalitis, and other neurologic disorders.
In the News
Get moving, now! Could being more active prevent your brain from shrinking? It certainly seems so, according to results from a study to be published in the American Academy of Neurology’s 72nd Annual Meeting proceedings. These researchers found larger brain volumes in older adults who walked, swam, danced, and gardened. Using MRI, they measured the brains of 1,557 participants (mean age: 75 years) with a range of activity levels. None had dementia, but some had mild cognitive impairment and some had the APOE gene (linked to greater Alzheimer disease risk). Sure enough, those who were less active had smaller brain volumes compared with those who were most active (871 vs 883 cubic cm, respectively). This was a difference of 12 cubic cm (1.4%), which equals nearly 4 years of brain aging! Results held even after excluding those with mild cognitive impairment. So, get out there and cut a rug, plant some flowers, swim some laps, or take a few turns around the block. Your brain will thank you!
Boxing and PD? In more “get moving” news, researchers have found that boxing could ease non-motor symptoms—like depression and anxiety—in patients with Parkinson disease (PD). It may also improve quality of life. If this sounds somewhat familiar, it might be because last week’s NeuroBrief reported that playing ping-pong improved symptoms in PD patients. Beginning to see a pattern? We certainly are!
Rock Steady Boxing (RSB) is a nonprofit, non-contact fitness program that was designed specifically for those with PD. Coaches help participants in a tailored boxing routine that lasts for 90 minutes. The routine was designed to increase strength, speed, agility, endurance, hand-eye coordination, footwork, and accuracy. About 871 RSB sites exist through the world, and about 43,500 patients with PD are currently enrolled.
Researchers surveyed 1,709 participants with PD, including 1,499 current or former participants in the program, and 201 non-participants. Among those involved in the RSB program, almost half attended an average of at least two classes per week. Those who were active participants in RSB activities during the course of the study scored better than those who were not on measures of quality of life and willingness to exercise. A full 70% reported improvements in their social lives, 63% in fatigue, 62% in their fear of falling, 60% in mood, and 59% in anxiety. More than enough reason to tell your PD patients to go out there in the ring and go a few rounds!
Brain-killing virus. Most Americans will become infected with at least one type of herpes simplex virus (HSV) at some point in their lives, with the virus becoming dormant after the initial infection. Occasionally, the virus may reactivate, usually causing mild cold sore symptoms. But, some versions of the virus can have more serious adverse health effects upon reactivation—including neuronal destruction. In fact, more and more researchers are showing that HSV reactivation in older age and neurodegeneration are linked, though the mechanism underlying this association remains unclear.
In the latest study on the HSV-brain connection, researchers found that reactivated HSV in the trigeminal nerves can kill sensory neurons. In murine models, they studied HSV reactivation by conducting detailed analysis of the trigeminal ganglia over time and found that HSV reactivation induced apoptosis. But, there is some good news. They also studied the effects of the antiviral drug acyclovir and found that it may prevent HSV reactivation and neuronal apoptosis. More studies are needed, but these findings are promising. In the future, antivirals could play a role in protecting against HSV reactivation and neurodegeneration. Who would’a thunk?
Could your eyes be the windows to…your memories? Apparently so, according to researchers from the Rotman Research Institute. Using a new eye tracking technique, they found that eye movements play a functional role in memory retrieval. In the study, participants moved their eyes when deciding whether they had seen an image before, and researchers found that these eye movement patterns may predict memory mistakes.
In their study, researchers found that participants were very accurate in identifying images they had seen before as old, scoring almost 90%. Participants were more likely to be correct if their eye movements were the same as when they initially saw the image. But, when they were given a new but similar image, they only scored 70%. Here, the more they stuck to their initial eye-movement pattern instead of focusing on what was different in the image, the more likely they were to be wrong. This is the first study to use the analysis of eye movements instead of behavior to show that people are retrieving memories by pattern completion. Eye tracking allows for memory assessment that may be more accurate than just asking people what they remember. And believe it or not, eye tracking could lead to better screening for dementia.
Pugilist dementia is a neurological disorder caused by what?
Pugilist dementia is caused by multiple concussions. Also known as “punch drunk syndrome” or chronic traumatic encephalopathy, the symptoms of pugilist dementia include tremors, poor coordination, declining mental abilities, memory loss, and explosive behavior. Several factors are thought to cause pugilist dementia—including plaques, scarring, neuron loss, neurofibrillary tangles, and damage to the cerebral blood vessels—but its precise etiology is still unknown. True to its name, this disorder frequently occurs in boxers, but it can also develop in other athletes. Floyd Patterson, Sugar Ray Robinson, Joe Frazier, and possibly Muhammad Ali were some notable sports figures affected by pugilist dementia.
All in the genes. Scientists have created a new computational tool—H-MAGMA—to detect the genes associated with psychiatric and neurological diseases. They also linked these genes to specific brain cell types. Interestingly, they found that genes for psychiatric disorders are expressed early in life, while those for neurological disorders are expressed later in life. Their research was made possible thanks to Genome-Wide Association Studies (GWAS), which allow researchers to compare genetic sequences in those with a particular trait—like psychiatric or neurological disorders—with controls.
Using H-MAGMA, the scientists mapped different brain disorders—including Alzheimer disease, Parkinson disease, amyotrophic lateral sclerosis, multiple sclerosis, schizophrenia, autism, depression, and bipolar disorder—by linking non-coding variants to interacting genes. (Non-coding variants interact with gene expression and regulate how genes create proteins.) They found that genes associated with neurodegenerative disorders are highly expressed in glia, while those associated with psychiatric disorders are highly expressed in glutamatergic neurons. These results further demonstrate how these two groups of disorders are divergent. H-MAGMA is now publicly available and may be useful to the study of genetics and neuroscience.
Inequality of the sexes? Do diagnostic evaluations for stroke differ between men and women? Researchers set out to find out by analyzing claims data from Medicare beneficiaries. They included 78,882 participants aged ≥ 65 years who were hospitalized for ischemic stroke. Women, they found, were less likely to undergo intracranial or extracranial vessel imaging, heart-rhythm monitoring, echocardiography, assessment by a neurologist, or evaluation by a vascular neurologist compared with men. Women with acute ischemic stroke were also less likely to be evaluated by a stroke specialist and less likely to undergo standard diagnostic testing compared with men. Maybe it’s time to even things out between the sexes?
Did Jane Fonda know all along? Could treatment for concussions include aerobic exercise? We’ll hopefully find out soon because researchers are hard at work assessing whether a personalized, progressive aerobic exercise program leads to improvements in post-concussion syndrome. Post-concussive syndrome is bad news for about 30% of adults who have recovered from a concussion but continue to have persistent symptoms, which include headaches, dizziness, fatigue, cognitive impairments, low mood, anxiety, and exercise intolerance. Some researchers have shown that aerobic exercise decrease these symptoms in adolescents. Now, researchers at the University of Calgary are midway through a study geared to see whether a 6-week aerobic exercise program, compared with a stretching program, can do the same for adults. The 56 adults in the study have been “prescribed” a 30-minute aerobic exercise or stretching program for 5 days/week. They’ve also been given a target heart rate for these exercises based on their symptom threshold and were asked to log their activity in a daily online diary. We’re eagerly awaiting the results! Results were presented at the annual meeting of the Association of Academic Physiatrists held in early March.
A cocktail for spinal fractures? Could healing a spinal fracture be as easy taking a two-drug “cocktail”? Pour me a double! Across the pond, researchers are busy figuring out how two existing medications— the ß3 adrenergic agonist (ß3AR) isoproterenol and the CXCR4 antagonist AMD3100/Plerixafor (used for bladder control and bone marrow transplants, respectively)—may have the ability to boost the body’s repair mechanisms. In rats, these two drugs in combination seemed to put bone marrow on “red alert” in cases of spinal fracture. The bone marrow then issued mesenchymal stem cells—which can turn into bone—into the blood to repair bone fractures. Using a spinal fusion model, researchers showed that this enhanced bone formation after spinal fractures. Although this drug combo is still in preclinical trials, it could one day come in handy in the treatment of spinal or other fractures, or even aid in healing after spinal and other bone surgeries.
Domo arigato, Mr. Roboto. Remote stroke interventions may, one day, become a thing—thanks to robotic technology. And it couldn’t come sooner, what with social distancing protocols. Imagine the benefits of treating stroke immediately and remotely with robotics! Researchers recently discovered that the use of robotics by surgeons during diagnostic cerebral angiograms and transradial carotid artery stenting was safe and effective. At the Sidney Kimmel Medical College at Thomas Jefferson University, they tested the use of a next-generation robotic-assisted surgical platform in 10 patients undergoing either diagnostic cerebral angiogram or carotid artery stenting. All procedures were successful, and no complications occurred. The benefits of this are numerous. The robots would allow surgeons to intervene in patients who’ve suffered a stroke, for example, when time is of the essence. Since surgery can be performed remotely, patients would not need to travel, wait for treatment, or be exposed to a deadly airborne virus. Researchers also say that the future use of robots in neuro-endovascular procedures also allow for more precise control over the microcatheter and the microwire. Robotics would also cut down on the radiation surgeons are exposed to because they can operate the robot from a separate room. Robots are currently only FDA-approved for use in certain general surgery and interventional cardiology procedures.
New in Patient Management
Young hypertensives. Hypertension in young adulthood may be associated with middle-aged cognitive declines. Researchersfrom Northwestern University-Tel Aviv University found that people who have relatively high blood pressure during young adulthood had significant declines in both cognitive function and gait when in midlife—about 56 years of age. They followed 191 young adults, who were an average of 24 years old at the start of the study, from the Coronary Artery Risk Development in Young Adults study for over 30 years. Gait assessment and cognitive function testing were done, and researchers used MRIs to evaluate the level of white matter intensity in the brain. They found that higher cumulative blood pressure was associated with slower walking speed, smaller step length, and higher gait variability. Higher cumulative blood pressure was also linked to lower cognitive performance in executive, memory, and global domains. Take note that even in the young, blood pressure elevations may have an impact on future cognitive function and mobility. The results give new weight to the importance of blood pressure control, even in youth.
Statins do it again! Statin therapy may protect against neurological events—especially stroke—after implantation of continuous-flow left ventricular assist systems (CF-LVAS). Is there no end to the benefits of statins? We hope not, especially as far as neuroprotection.
In a retrospective observational study among 200 adults who were implanted with durable CF-LVAS, researchers found lower rates of neurological events in those prescribed statins compared with those who were not (0.11 vs 0.22 events per patient-year, respectively; P = 0.019). Of note, the number of ischemic strokes was 62% lower in those taking statins (P = 0.048), among patients without the CF-LVAS (the HeartMate 3 pump). The rates of hemorrhagic stroke, however, did not differ between the groups. These findings suggest that patients taking statins before CV-LVAS may continue to use them after CF-LVAS to reduce the incidence of ischemic stroke.
Strange bedfellows. Could there be an association between Helicobacter pylori infection and Guillain-Barré syndrome (GBS)? There certainly seems to be, according to a recent study. Researchers extracted data from six case-control studies and estimated the prevalence of H. pylori antibodies according to CSF or serum. They found a strong relationship between GBS and the presence of H. pylori antibodies as there were significantly more antibodies in those with GBS vs controls, particularly in CSF. The researchers concluded that H. pylori infection may have a role in the pathophysiology of GBS. Something to consider in your patients who may be H. pylori-positive!
Are MDs at higher risk for dementia? Thankfully not, according to a large study. Physicians often work under excessive cognitive demands, and although they tend to have healthier lifestyles and lower mortality compared with the general population, they do have an increased incidence of mental disorders. That’s why researchers wanted to investigate the link between being a medical doctor and the risk of incident dementia. They included 3,460 participants aged ≥ 70 years who were enrolled in the Mayo Clinic Study of Aging. Although the physicians in the study (n = 104) were older than others enrolled and mostly male (93.3%), researchers found no significantly different risk for incident dementia in physicians without dementia at baseline (HR: 1.12; 95% CI: 0.69-1.82; P = 0.64) vs the general population. One less thing to worry about!
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Upcoming Medical Meetings
Please note that in the interests of containing the current COVID-19 pandemic, the following meetings have been cancelled. Please contact these organizations for details and specifics on refunds and rescheduling:
American Neuropsychiatric Association (ANPA) 31st Annual Meeting, in Philadelphia, PA, March 18-21, 2020.
The 2020 Lennox-Lombroso Pediatric Epilepsy Conference, in Boston, MA, March 20-21, 2020.
World of Neurosurgery: American Association of Neurological Surgeons (AANS) 2020 Annual Scientific Meeting, in Boston, MA, April 25-29, 2020.
American Academy of Neurology 71st Annual Meeting (AAN 2020), in Toronto, ON, Canada, April 25-May 1, 2020.
The following conference will be held as scheduled:
The 24th Annual Children’s Neuroscience Symposium, in Phoenix, AZ, March 20-21, 2020, has not yet been cancelled. Please check website for up-to-the-minute information.