Posts Tagged neurology

[BLOG POST] Anti-epilepsy medicine use during pregnancy does not harm overall health of children, study finds

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Children whose mothers have taken anti-epilepsy medicine during pregnancy, do not visit the doctor more often than children who have not been exposed to this medicine in utero. This is the result of a new study from Aarhus.

Previous studies have shown that anti-epilepsy medicine may lead to congenital malformations in the foetus and that the use of anti-epilepsy medicine during pregnancy affects the development of the brain among the children. There is still a lack of knowledge in the area about the general health of children who are exposed to anti-epilepsy medicine in foetallife. But this new study is generally reassuring for women who need to take anti-epilepsy medicine during their pregnancy.

Being born to a mother who has taken anti-epilepsy medicine during pregnancy appears not to harm the child’s health. These are the findings of the first Danish study of the correlation between anti-epilepsy medicine and the general health of the child which has been carried out by the Research Unit for General Practice, Aarhus University and Aarhus University Hospital.

The results have just been published in the international scientific journal BMJ Open.

The researchers have looked into whether children who have been exposed to the mother’s anti-epilepsy medicine have contact with their general practitioner (GP) more often than other children – and there are no significant differences.

No reason til worry

“Our results are generally reassuring for women who need to take anti-epilepsy medicine during their pregnancy, including women with epilepsy,” says Anne Mette Lund Würtz, who is one of the researchers behind the project.

The difference in the number of contacts to the general practitioner between exposed and non-exposed children is only three per cent.

“The small difference we found in the number of contacts is primarily due to a difference in the number of telephone contacts and not to actual visits to the GP. At the same time, we cannot rule out that the difference in the number of contacts is caused by a small group of children who have more frequent contact with their GP because of illness,” explains Anne Mette Lund Würtz.

Of the 963,010 children born between 1997 and 2012, who were included in the survey, anti-epilepsy medicine was used in 4,478 of the pregnancies that were studied.

Anti-epilepsy medicine is also used for the treatment of other diseases such as migraine and bipolar disorder. The study shows that there were no differences relating to whether the women who used anti-epilepsy medicine during pregnancy were diagnosed with epilepsy or not.

Background for the results

Type of study: The population study was carried out using the Danish registers for the period 1997-2013.

The analyses takes into account differences in the child’s gender and date of birth, as well as the mother’s age, family situation, income, level of education, as well as any mental illness, use of psychiatric medicine and insulin, and substance abuse.

Source: Anti-epilepsy medicine use during pregnancy does not harm overall health of children, study finds

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[WEB SITE] Brain plasticity after injury: an interview with Dr Swathi Kiran

What is brain plasticity and why is it important following a brain injury?

Brain plasticity is the phenomenon by which the brain can rewire and reorganize itself in response to changing stimulus input. Brain plasticity is at play when one is learning new information (at school) or learning a new language and occurs throughout one’s life.

Brain plasticity is particularly important after a brain injury, as the neurons in the brain are damaged after a brain injury, and depending on the type of brain injury, plasticity may either include repair of damaged brain regions or reorganization/rewiring of different parts of the brain.

MRI brain injury

How much is known about the level of injury the brain can recover from? Over what time period does the brain adapt to an injury?

A lot is known about brain plasticity immediately after an injury. Like any other injury to the body, after an initial negative reaction to the injury, the brain goes through a massive healing process, where the brain tries to repair itself after the injury. Research tells us exactly what kinds of repair processes occur hours, days and weeks after the injury.

What is not well understood is how recovery continues to occur in the long term. So, there is a lot research showing that the brain is plastic, and undergoes recovery even months after the brain damage, but what promotes such recovery and what hinders such recovery is not well understood.

It is well understood that some rehabilitative training promotes brain injury and most of the current research is focused on this topic.

What techniques are used to study brain plasticity?

Human brain plasticity has mostly been studied using non-invasive imaging methods, because these techniques allow us to measure the gray matter (neurons), white matter (axons) at a somewhat coarse level. MRI and fMRI techniques provide snapshots and video of the brain in function, and that allows us to capture changes in the brain that are interpreted as plasticity.

Also, more recently, there are invasive stimulation methods such as transcranial direct current stimulation or transcranial magnetic stimulation which allow providing electric current or magnetic current to different parts of the brain and such stimulation causes certain changes in the brain.

How has our understanding advanced over recent years?

One of the biggest shifts in our understanding of brain plasticity is that it is a lifelong phenomenon. We used to previously think that the brain is plastic only during childhood and once you reach adulthood, the brain is hardwired, and no new changes can be made to it.

However, we now know that even the adult brain can be modified and reorganized depending on what new information it is learning. This understanding has a profound impact on recovery from brain injury because it means that with repeated training/instruction, even the damaged brain is plastic and can recover.

What role do you see personalized medicine playing in brain therapy in the future?

One reason why rehabilitation after brain injury is so complex is because no two individuals are alike. Each individual’s education and life experiences have shaped their brain (due to plasticity!) in unique ways, so after a brain injury, we cannot expect that recovery in two individuals will be occur the same way.

Personalized medicine allows the ability to tailor treatment for each individual taking into account their strengths and weaknesses and providing exactly the right kind of therapy for that person. Therefore, one size treatment does not fit all, and individualized treatments prescribed to the exact amount of dosage will become a reality.

Senior couple tablet

What is ‘automedicine’ and do you think this could become a reality?

I am not sure we understand what automedicine can and cannot do just yet, so it’s a little early to comment on the reality. Using data to improve our algorithms to precisely deliver the right amount of rehabilitation/therapy will likely be a reality very soon, but it is not clear that it will eliminate the need for doctors or rehabilitation professionals.

What do you think the future holds for people recovering from strokes and brain injuries and what’s Constant Therapy’s vision?

The future for people recovering from strokes and brain injuries is more optimistic than it has ever been for three important reasons. First, as I pointed above, there is tremendous amount of research showing that the brain is plastic throughout life, and this plasticity can be harnessed after brain injury also.

Second, recent advances in technology allow patients to receive therapy at their homes at their convenience, empowering them to take control of their therapy instead of being passive consumers.

Finally, the data that is collected from individuals who continuously receive therapy provides a rich trove of information about how patients can improve after rehabilitation, what works and what does not work.

Constant Therapy’s vision incorporates all these points and its goal to provide effective, efficient and reasonable rehabilitation to patients recovering from strokes and brain injury.

Where can readers find more information?

About Dr Swathi Kiran

DR SWATHI KIRANSwathi Kiran is Professor in the Department of Speech and Hearing Sciences at Boston University and Assistant in Neurology/Neuroscience at Massachusetts General Hospital. Prior to Boston University, she was at University of Texas at Austin. She received her Ph.D from Northwestern University.

Her research interests focus around lexical semantic treatment for individuals with aphasia, bilingual aphasia and neuroimaging of brain plasticity following a stroke.

She has over 70 publications and her work has appeared in high impact journals across a variety of disciplines including cognitive neuroscience, neuroimaging, rehabilitation, speech language pathology and bilingualism.

She is a fellow of the American Speech Language and Hearing Association and serves on various journal editorial boards and grant review panels including at National Institutes of Health.

Her work has been continually funded by the National Institutes of Health/NIDCD and American Speech Language Hearing Foundation awards including the New Investigator grant, the New Century Scholar’s Grant and the Clinical Research grant. She is the co-founder and scientific advisor for Constant Therapy, a software platform for rehabilitation tools after brain injury.

Source: Brain plasticity after injury: an interview with Dr Swathi Kiran

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[WEB SITE] UCLA researchers use noninvasive ultrasound technique to jump-start the brain of coma patient

A 25-year-old man recovering from a coma has made remarkable progress following a treatment at UCLA to jump-start his brain using ultrasound. The technique uses sonic stimulation to excite the neurons in the thalamus, an egg-shaped structure that serves as the brain’s central hub for processing information.

“It’s almost as if we were jump-starting the neurons back into function,” said Martin Monti, the study’s lead author and a UCLA associate professor of psychology and neurosurgery. “Until now, the only way to achieve this was a risky surgical procedure known as deep brain stimulation, in which electrodes are implanted directly inside the thalamus,” he said. “Our approach directly targets the thalamus but is noninvasive.”

Monti said the researchers expected the positive result, but he cautioned that the procedure requires further study on additional patients before they determine whether it could be used consistently to help other people recovering from comas.

“It is possible that we were just very lucky and happened to have stimulated the patient just as he was spontaneously recovering,” Monti said.

A report on the treatment is published in the journal Brain Stimulation. This is the first time the approach has been used to treat severe brain injury.

The technique, called low-intensity focused ultrasound pulsation, was pioneered by Alexander Bystritsky, a UCLA professor of psychiatry and biobehavioral sciences in the Semel Institute for Neuroscience and Human Behavior and a co-author of the study. Bystritsky is also a founder of Brainsonix, a Sherman Oaks, California-based company that provided the device the researchers used in the study.

That device, about the size of a coffee cup saucer, creates a small sphere of acoustic energy that can be aimed at different regions of the brain to excite brain tissue. For the new study, researchers placed it by the side of the man’s head and activated it 10 times for 30 seconds each, in a 10-minute period.

Monti said the device is safe because it emits only a small amount of energy — less than a conventional Doppler ultrasound.

Before the procedure began, the man showed only minimal signs of being conscious and of understanding speech — for example, he could perform small, limited movements when asked. By the day after the treatment, his responses had improved measurably. Three days later, the patient had regained full consciousness and full language comprehension, and he could reliably communicate by nodding his head “yes” or shaking his head “no.” He even made a fist-bump gesture to say goodbye to one of his doctors.

“The changes were remarkable,” Monti said.

The technique targets the thalamus because, in people whose mental function is deeply impaired after a coma, thalamus performance is typically diminished. And medications that are commonly prescribed to people who are coming out of a coma target the thalamus only indirectly.

Under the direction of Paul Vespa, a UCLA professor of neurology and neurosurgery at the David Geffen School of Medicine at UCLA, the researchers plan to test the procedure on several more people beginning this fall at the Ronald Reagan UCLA Medical Center. Those tests will be conducted in partnership with the UCLA Brain Injury Research Center and funded in part by the Dana Foundation and the Tiny Blue Dot Foundation.

If the technology helps other people recovering from coma, Monti said, it could eventually be used to build a portable device — perhaps incorporated into a helmet — as a low-cost way to help “wake up” patients, perhaps even those who are in a vegetative or minimally conscious state. Currently, there is almost no effective treatment for such patients, he said.

Source: University of California – Los Angeles

Source: UCLA researchers use noninvasive ultrasound technique to jump-start the brain of coma patient

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[ARTICLE] Evaluation of upper extremity neurorehabilitation using technology: a European Delphi consensus study within the EU COST Action Network on Robotics for Neurorehabilitation – Full Text

Abstract

Background

The need for cost-effective neurorehabilitation is driving investment into technologies for patient assessment and treatment. Translation of these technologies into clinical practice is limited by a paucity of evidence for cost-effectiveness. Methodological issues, including lack of agreement on assessment methods, limit the value of meta-analyses of trials. In this paper we report the consensus reached on assessment protocols and outcome measures for evaluation of the upper extremity in neurorehabilitation using technology. The outcomes of this research will be part of the development of European guidelines.

Methods

A rigorous, systematic and comprehensive modified Delphi study incorporated questions and statements generation, design and piloting of consensus questionnaire and five consensus experts groups consisting of clinicians, clinical researchers, non-clinical researchers, and engineers, all with working experience of neurological assessments or technologies. For data analysis, two major groups were created: i) clinicians (e.g., practicing therapists and medical doctors) and ii) researchers (clinical and non-clinical researchers (e.g. movement scientists, technology developers and engineers).

Results

Fifteen questions or statements were identified during an initial ideas generation round, following which the questionnaire was designed and piloted. Subsequently, questions and statements went through five consensus rounds over 20 months in four European countries. Two hundred eight participants: 60 clinicians (29 %), 35 clinical researchers (17 %), 77 non-clinical researchers (37 %) and 35 engineers (17 %) contributed. At each round questions and statements were added and others removed. Consensus (≥69 %) was obtained for 22 statements on i) the perceived importance of recommendations; ii) the purpose of measurement; iii) use of a minimum set of measures; iv) minimum number, timing and duration of assessments; v) use of technology-generated assessments and the restriction of clinical assessments to validated outcome measures except in certain circumstances for research.

Conclusions

Consensus was reached by a large international multidisciplinary expert panel on measures and protocols for assessment of the upper limb in research and clinical practice. Our results will inform the development of best practice for upper extremity assessment using technologies, and the formulation of evidence-based guidelines for the evaluation of upper extremity neurorehabilitation.

Continue —> Evaluation of upper extremity neurorehabilitation using technology: a European Delphi consensus study within the EU COST Action Network on Robotics for Neurorehabilitation | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 1 Flowchart of the design and piloting of the questionnaire

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[WEB SITE] Study shows continuous electrical stimulation suppresses seizures in patients with epilepsy.

When surgery and medication don’t help people with epilepsy, electrical stimulation of the brain has been a treatment of last resort. Unfortunately, typical approaches, such as vagal nerve stimulation or responsive nerve stimulation, rarely stop seizures altogether. But a new Mayo Clinic study in JAMA Neurology shows that seizures were suppressed in patients treated with continuous electrical stimulation.

Epilepsy is a central nervous system disorder in which nerve cell activity in the brain becomes disrupted. In the study, 13 patients with drug-resistant epilepsy were deemed unsuitable for resective surgery, which removes a portion of the brain — usually about the size of a golf ball — that was causing seizures. When patients are evaluated for surgery, a grid of electrical contacts is placed on the brain to record seizures and interictal epileptiform discharges (IEDs). IEDs are electrical discharges that occur intermittently during normal brain function, and have been used as markers to locate portions of brain affected by epilepsy.

In the study, the grid of electrical contacts was used for stimulation at levels the patient would not notice. If the stimulation provided clinical benefit to the patient, this temporary grid was replaced with more permanent contacts that could offer continuous stimulation.

Ten of the 13 patients, 77 percent, reported improvement for both epilepsy severity and life satisfaction. The majority of patients experienced more than 50 percent reduction in seizures, and 44 percent were free of disabling seizures. The reduction in IED rate occurred within minutes of initiating stimulation.

“This study suggests that subthreshold cortical stimulation is both effective clinically and reduces interictal epileptiform discharges,” says lead author Brian Lundstrom, M.D., Ph.D., a neurology epilepsy fellow at Mayo Clinic. “We think this approach not only provides an effective treatment for those with focal epilepsy but will allow us to develop ways of assessing seizure likelihood for all epilepsy patients. It would be of enormous clinical benefit if we could personalize treatment regimens for individual patients without waiting for seizures to happen.”

During seizures, abnormal electrical activity in the brain sometimes results in loss of consciousness. For people with epilepsy, seizures severely limit their ability to perform tasks where even a momentary loss of consciousness could prove disastrous — driving a car, swimming or holding an infant, for example. Approximately 50 million people worldwide have epilepsy, according to the World Health Organization.

Seizures sometimes have been compared to electrical storms in the brain. Seizure signs and symptoms may include:

•Temporary confusion
•A staring spell
•Uncontrollable jerking movements of the arms and legs
•Loss of consciousness or awareness

Treatment with medications or surgery can control seizures for about two-thirds of people with epilepsy. However, when drug-resistant focal epilepsy occurs in an area of the brain that controls speech, language, vision, sensation or movement, resective surgery is not an option.

“For people who have epilepsy that can’t be treated with surgery or medication, effective neurostimulation could be a wonderful treatment option,” Dr. Lundstrom says.

The risks of subthreshold cortical stimulation are relatively minimal and include typical infection and bleeding risks as well as the possibility that the stimulation would not be subthreshold and would be noticed by the patient, Dr. Lundstrom says. The authors note that further investigation is needed to quantify treatment effect and examine the effect mechanism. The authors plan to examine the efficacy of this approach in a prospective clinical trial.

This study represents ongoing efforts to restore normal function to epileptic brain tissue by using neurostimulation. Other efforts are aimed at understanding the physiologic changes that chronic stimulation produces in brain tissue.

Source: Study shows continuous electrical stimulation suppresses seizures in patients with epilepsy

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Neurology Image Library | Internet Stroke Center

Neurology Image Library

View CT, MRI, and Angiogram case studies by diagnosis

This library illustrates a variety of stroke related diagnoses through deidentified case studies. Use keyword searches to narrow down to specific cases of interest and select a diagnosis to view images.

Goto —> Neurology Image Library

Source: Neurology Image Library | Internet Stroke Center

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[WEB SITE] New technology discovered for brain repair: Chemical transformation of human glial cells into neurons

For the first time, researchers have used a cocktail of small molecules to transform human brain cells, called astroglial cells, into functioning neurons for brain repair. The new technology opens the door to the future development of drugs that patients could take as pills to regenerate neurons and to restore brain functions lost after traumatic injuries, stroke, or diseases such as Alzheimer’s. Previous research, such as conventional stem cell therapy, requires brain surgery and therefore is much more invasive and prone to immune-system rejection and other problems. The research, led by Gong Chen, Professor of Biology and the Verne M. Willaman Chair in Life Sciences at Penn State University, will be published online in the journal Cell Stem Cell on Oct. 15th, 2015.

“We have discovered a cocktail of small molecules that can reprogram human brain astroglial cells into neuron-like cells after eight-to-ten days of chemical treatment,” Chen said. The neurons the researchers reprogrammed survived for more than five months in cell culture, where they formed functional synaptic networks. The scientists also injected the reprogrammed human neurons into the brains of living mice, where they integrated into the neural circuits and survived there for at least one month.

Astroglial cells before treatment with small-molecule cocktails in the lab of Gong Chen at Penn State University Credit: Gong Chen lab, Penn State University

Astroglial cells before treatment with small-molecule cocktails in the lab of Gong Chen at Penn State UniversityCredit: Gong Chen lab, Penn State University”The small molecules are not only easy to synthesize and package into drug pills, but also much more convenient for use by patients than other methods now being developed,” Chen said. Before the promise of the new technology results in pills at a pharmacy, the new research effort must first succeed through much development and testing in the laboratory and then through a series of clinical trials.

Continue —> New technology discovered for brain repair: Chemical transformation of human glial cells into neurons – Medical News Today

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[ARTICLE] Neuroplasticity in action post-stroke: Challenges for physiotherapists

Knowledge regarding neuroplasticity post-stroke is increasingly expanding. In spite of this, only a few physiotherapy interventions have been able to demonstrate effectiveness in achieving recovery of lost sensorimotor control.

The aims of this review article are to highlight and discuss challenges for physiotherapists working with patients post-stroke, to question some current assessment methods and treatment approaches, and to pose critical questions indicating a possible new direction for physiotherapists in stroke rehabilitation.

Differentiation between recovery and compensation post-stroke is increasingly being emphasized. Implementation of this goal in the clinic is insufficient, with a lack of assessment tools with potential to discriminate between the concepts. Large-scale reviews are performed without considering whether functional gains are achieved through “more effective” compensatory strategies or through recovery. Cortical plasticity in neurorehabilitation research and voluntary control in contemporary treatment methods are in focus.

Challenges for physiotherapists in stroke rehabilitation consist of rethinking, including looking upon the body under the influence of gravity, focusing on implicit factors that impact movement control and developing new assessment tools. The introduction of a new assessment and treatment concept aiming at expanding the boundaries of center of mass movements towards the paretic side is proposed. In conclusion, we need to assume our responsibilities and step forward as the experts in movement science that we have the potential to be.

via Neuroplasticity in action post-stroke: Challenges for physiotherapists, European Journal of Physiotherapy, Informa Healthcare.

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[JOURNAL] Current Issue Neurology Today – March 19, 2015 – Volume 15 – Issue 6

Current Issue : Neurology Today.

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[FREE DOWNLOAD] Neurology and Clinical Neuroscience on the App Store on iTunes

The new neurology journal covering cutting edge research in neurology and clinical neuroscience is now available on your iPad and iPhone. Fresh from the newsstand, Neurology and Clinical Neuroscience, brings you a stimulating mixture of original articles, reviews, case reports, pictures in neurology, mutations in neurology, commentaries and more. Enjoy an entirely new browsing and reading experience, and keep up to date with the most important developments in neurology research:

  • – Stay current with the latest articles through Early View.
  • – Be notified when a new issue is available.
  • – Download articles and issues for offline perusal.
  • – Save your favourite articles for quick and easy access.
  • – Share articles with colleagues or students.

more –> Neurology and Clinical Neuroscience on the App Store on iTunes.

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