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Saturday, May 14, 2016

Reviving Memory With An Electrical Current

May 14, 2016



Last year, in an operating room at the University of Toronto, a 63-year-old women with Alzheimer's disease experienced something she hadn't for 55 years: a memory of her 8-year-old self playing with her siblings on their family farm in Scotland. 
The woman is a patient of Dr. Andres Lozano, a neurosurgeon who is among a growing number of researchers studying the potential of deep brain stimulation to treat Alzheimer's and other forms of dementia. If the approach pans out, it could provide options for patients with fading cognition and retrieve vanished memories.


Right now, deep brain stimulation is used primarily to treat Parkinson's disease and tremor, for which it's approved by the Food and Drug Administration. DBS involves delivering electrical impulses to specific areas of the brain through implanted electrodes. The technique is also approved for obsessive-compulsive disorder and is being looked at for a number of other brain disorders, including depression, chronic pain and, as in Lozano's work, dementia.

In 2008, Lozano's group published a study in which an obese patient was treated with deep brain stimulation of the hypothalamus. Though no bigger than a pea, the hypothalamus is a crucial bit of brain involved in appetite regulation and other bodily essentials such as temperature control, sleep and circadian rhythms. It seemed like a reasonable target in trying to suppress excessive hunger. To the researcher's surprise, following stimulation the patient reported a sensation of deja vu. He also perceived feeling 20 years younger and recalled a memory of being in a park with friends, including an old girlfriend. With increasing voltages, his memories became more vivid, including remembering their clothes.

Using a 3-dimensional brain mapping technique called standardized low-resolution brain electromagnetic tomography, or sLORETA, Lozano's group uncovered an explanation for the unexpected findings. They found that stimulating the hypothalamus was in turn driving increased brain activity in the hippocampus, a key cog in the brain's memory circuitry. As Alzheimer's progresses, not only does the hypothalamus atrophy, but electrical communication between neurons in the region also gradually becomes impaired.
That our memories — so entwined with our personalities and senses of self — might be so vulnerable to a brown out is, existentially speaking, rather alarming. There's something palpably dehumanizing about reducing our past selves to the exchange of electricity between neurons, and also about retrieving memories by hot-wiring the brain.

Yet the prospect of the latter is undeniably intriguing. Given that Alzheimer's affects 1 in 9 people over the age of 65 and that current therapies are in many patients dismally ineffective, Lozano felt all but obligated to dig further. His group launched a test in six patients and published the results in the Annals of Neurology in 2010.

The study included patients with mild and severe disease who received stimulation in the fornix continuously for 1 year. "The fornix is like the highway leading into the hippocampus," explains Lozano. "It's easier to stimulate than the hippocampus itself and crucial to memory function." As expected those with more severe disease continued to mentally deteriorate, however it appeared that in those with mild disease, cognitive decline slowed with stimulation.
Next, Lozano launched a randomized trial involving 42 patients from the US and Canada, all of whom had electrodes implanted in the fornix on both sides of the brain. In half the patients the stimulation was turned on right away. In the other half the stimulation wasn't turned on for a year, though they didn't know it.

Preliminary results, published in December 2015 in the Journal of Neurosurgery, were mixed but encouraging.
Given that so few people have had electrical stimulation applied to memory circuits, perhaps the most significant finding was that both the surgery itself and DBS of the fornix appear safe. No serious long-term neurological side effects were seen in either patient group, supporting future research in the field.
In terms of efficacy, however, after one year there were no significant differences in cognition between the groups, as measured by two scales commonly used to measure Alzheimer's disease symptoms, the ADAS-Cog and CDR-SB. Alzheimer's tends to progress slowly and reversing or slowing the neurodegeneration associated with condition may take time to become noticeable. Lozano's final results won't be reported until four years out.

More intriguing for now were comparisons of glucose utilization. Glucose is our brains' primary fuel. The degree to which glucose is burned is a commonly used measure of brain activity. Patients with Alzheimer's typically have reduced glucose activity in their brains, as well as, again, shrinking memory circuits. The older patients in Lozano's study who had stimulation turned on exhibited markedly increased glucose use in the brain's memory regions. Not only that, the hippocampus of some study patients who received DBS actually increased in size.
Reversing withering hippocampi by encouraging the growth of new neurons is seen as a holy grail in Alzheimer's research, and Lozano's finding is supported by a recent animal study demonstrating that DBS in rats causes the release of growth factors that induce neuronal growth in the hippocampus.
Lozano acknowledges that retrieving childhood memories, which he says has occurred in about one-third of his patents — requires lofty voltages that he would be uncomfortable sending patients home on. Yet he's encouraged by the early findings that suggest the procedure is safe. "We also know that in patients who receive stimulation there is an increase in glucose utilization in memory areas of the brain," he says, a finding that could mean there's a way to overcome some of the damage from Alzheimer's.

Evidence supporting DBS in dementia is emerging from other research groups as well. A 2012 study published in the New England Journal of Medicine reported that in seven patients receiving DBS to a brain region called the entorhinal cortex, spatial memory improved – meaning they could more easily remember the locations of newly learned landmarks. The entorhinal cortex works in concert with the hippocampus to solidify memories.

A group at the University of Cologne in Germany is instead focusing on delivering DBS to a part of the brain called the nucleus basalis of Meynert, another region in which impaired neuron function is thought to contribute to Alzheimer's. Last year they published a study in Molecular Psychiatry in which four of six patients either remained cognitively stable or improved in response to DBS, as measured by the ADAS-cog. Like in Lozano's study no serious side effects were seen.
Despite the mounting evidence for DBS, not everyone is convinced.
Referring to Lozano's second clinical study, Dr. Nader Pouratian, a neurosurgeon and DBS researcher at UCLA, comments, "The recent deep brain stimulation trial for Alzheimer's disease clearly demonstrates the safety of this approach for trying to treat the progression of disease. Unfortunately, [the findings] suggest that the therapy may not be as robust as initially proposed."
However he acknowledges Lozano's results suggest that DBS to the fornix might be promising for a subgroup of patients, those being older people with less severe disease.

"The most promising areas are likely the fornix or the entorhinal area," he says. "But I believe further studies are necessary to better elucidate the efficacy of this treatment before proceeding to a larger scale randomized trial."
In a 2008 episode of the medical television drama House, the show's main character Dr. Gregory House survives a bus crash that leaves his memory murky. In an attempt to remember the medical history of a fellow collision victim – and inspired by Lozano's initial paper — House voluntarily undergoes deep brain stimulation. Following the procedure the grouchy TV doctor's memory returns. As is customary on the show, he cracks the case.
DBS for treatment of Alzheimer's and other dementias is a field in its infancy. Unlike on TV, in all likelihood it won't be widely used anytime soon to retrieve specific memories. "Even though House did this, we're not doing it yet," cautions Lozano.

Yet the fact that the therapy can in some people rescue recollections – albeit random ones – and possibly induce new neuron growth in memory regions of the brain seems reason enough to pursue it further.
"We're hoping to use electricity to drive activity in areas of the brain involved in memory and cognition," says Lozano. "We want to turn these brain networks back on."


http://nhpr.org/post/reviving-memory-electrical-current

Hepatitis Awareness Month 2016: Hepatitis C Parkinson’s disease link, rheumatoid arthritis, and liver inflammation

By: Bel Marra  Saturday, May 14, 2016 


May is Hepatitis Awareness Month, which mainly focuses on the different types of hepatitis including hepatitis C, but we have compiled a list of our news stories discussing hepatitis alongside other conditions like Parkinson’s disease, rheumatoid arthritis, and liver inflammation.
Hepatitis B and C are lifelong conditions that increase your risk of health complications, including liver cancer. May 19 has specifically been designated as a hepatitis day of testing in the U.S. to remind healthcare providers and the public to get tested, especially if they are at a higher risk.
Below are some articles that examine hepatitis and other related topics like how hepatitis increases the risk of cardiovascular disease, how hepatitis is linked to an increased risk of Parkinson’s disease, and how hepatitis C infection can cause rheumatoid arthritis, to name a few.

Hepatitis C infection increases risk of cardiovascular disease (CVD), stroke, and liver damage

Hepatitis C infection increases the risk of cardiovascular disease (CVD), stroke, and liver damage. Hepatitis C infection can severely damage the liver, but new findings from Johns Hopkins revealed that it can also mean dangers for the heart as well.
The findings came from a large ongoing study of men who had sex with men, but not all were infected with HIV. The men were followed to observe progression and risk of disease. A subgroup of the men had both HIV and hepatitis C, two conditions that are commonly seen together.
The men with HIV already had an increased risk of heart disease, but the researchers were interested to examine whether hepatitis C could lead to the same risks.
The researchers found that those with hepatitis C were more likely to have abnormal fat and calcium plaques in their arteries – atherosclerosis – which is a risk factor for heart disease.
Principal investigator Eric Seaberg said, “We have strong reason to believe that infection with hepatitis C fuels cardiovascular disease, independent of HIV, and sets the stage for subsequent cardiovascular trouble. We believe our findings are relevant to anyone infected with hepatitis C, regardless of HIV status.”
Although the researchers are unsure how or why hepatitis C infection increases plaque buildups in the arteries, they stress that those patients with hepatitis C should be closely monitored for heart disease risk factors.

Study author Wendy Post said, “People infected with hepatitis C are already followed regularly for signs of liver disease, but our findings suggest clinicians who care for them should also assess their overall cardiac risk profile regularly.” She added that these patients would benefit from annual cardiac testing and evaluation and have their lifestyle habits assessed. They could be putting their hearts at greater risk, for instance, if they are eating poorly and are sedentary.


A new study has found that hepatitis C may increase the risk of Parkinson’s disease. Parkinson’s disease is a neurological degenerative brain disorder and hepatitis C is a virus that negatively impacts the liver.
Study author Chia-Hung Kao said, “Many factors clearly play a role in the development of Parkinson’s disease, including environmental factors. This nationwide study, using the National Health Insurance Research Database of Taiwan, suggests that hepatitis caused specifically by the hepatitis C virus may increase the risk of developing the disease. More research is needed to investigate this link.”
The World Health Organization estimated that 130 to 150 million people worldwide have hepatitis C, which can lead to serious illness and can go undetected as it may not present itself with many symptoms at first.

Hepatitis C virus infection causes rheumatoid arthritis before HCV detection


Hepatitis C virus (HCV) infection has been found to cause rheumatoid arthritis, even before HCV is detected. Hepatitis C can contribute to liver failure, but it is also known to cause rheumatoid arthritis – inflammation of the joints. Due to the link between HCV and rheumatoid conditions, it’s important that newly diagnosed rheumatoid patients also get tested for HCV as rheumatoid conditions can still occur before HCV is even detected.
A rheumatoid disease can be caused by HCV due to a related infection. Rheumatoid diseases cause pain in the joints, muscles, and connective tissues. Joint swelling and blood vessel inflammation can occur as well. A recent study dove deeper into the connection between HCV and rheumatoid arthritis and uncovered what may link the two.

Hepatitis liver inflammation reduced by specific immune cells

Hepatitis liver inflammation may be reduced by specific immune cells. A new study from Belgium researchers reports that a specific immune cell type in the liver can dampen the immune response, reduce inflammation, and protect against liver damage.
Researchers at Vrije Universiteit Brussel, Belgium used mice to explore monocytes’ role – immune cells that help fight off infection – in combating liver inflammation. In the case of the mice, the researchers focused on trypanosome parasites because they often lead to liver inflammation.
There are two types of monocytes: Ly6c positive monocytes and Ly6c negative monocytes.
When the mice were infected with trypanosome parasites, initially more Ly6c positive monocytes travelled to the infected liver, but the Ly6c negative monocytes did follow as well.

The researchers found the Ly6c positive monocytes actually increased inflammation and promoted liver damage, while the Ly6c negative monocytes reduced the inflammation and prevented further liver damage. This goes to show that Ly6c negative monocytes can work as liver protection.
Researchers now say a means for preventing liver inflammation can result from changing Ly6c negative monocytes in the body. A therapy would either increase their number or function to protect the liver.

Depression and stress levels increase the risk of liver disease, hepatitis


Depression, anxiety, and stress levels have been shown to increase the risk of death by liver disease. The findings come from the University of Edinburgh, and it’s the first study to identify a possible link between psychological distress and death resulting from various forms of liver disease.
The researchers are still unsure about the biological link between psychological distress and liver disease. Previous research showed a strong link between mental distress and cardiovascular disease.
Furthermore, risk factors of cardiovascular disease, such as obesity and high blood pressure, are also risk factors for liver disease.

Researchers examined responses from over 165,000 people who answered questionnaires capturing psychological distress. These participants were then tracked over the course of 10 years with a strong focus on the cause of any deaths.
Those who scored high on symptoms of psychological stress were more likely to die from liver disease, compared to those with lower scores.
Research lead Dr. Tom Russ said, “This study provides further evidence for the important links between mind and body, and of the damaging effects psychological distress can have on physical wellbeing. While we are not able to confirm direct cause and effect, this study does provide evidence that requires further consideration in future studies

http://www.belmarrahealth.com/hepatitis-awareness-month-2016-hepatitis-c-parkinsons-disease-link-rheumatoid-arthritis-and-liver-inflammation/

Prince, Heroin and Parkinson’s Disease


MAY 13, 2016 BY DAVID 

The rock legend taught me some things about coping with my disease.

Prince

___
What is the first question you ask when you learn that somebody you care about has died suddenly? When it is someone famous, we all wonder what happened.
It is sad that the speculation surrounding Prince’s death could be true, that he suffered from opioid abuse.  Still, it’s too early.
The saddest thing for me is that there will no longer be new music from a living Prince. I know many fans look forward to the revealing of a vast treasure chest of recordings by Prince that have never been heard by the public before, but this hardly makes up for the loss of a living legend.
Prince was more than a rock legend. He taught me how to deal with my mental illness and Parkinson’s disease.

Heroin and our Heros?

I am sad that as a society we still don’t know how to think about opioid abuse. There is still so much judgment around opioid deaths.
I am sad that as a society we still don’t know how to think about opioid abuse. There is still so much judgment around opioid deaths.
If Prince died from an opiate overdose, would that make him a criminal or morally apprehensible?
At one point, he changed his name to a symbol. I wonder if that was easier for him than the judgment he may have endured, going from rock god to junkie.
Prince was known for his monster practice sessions, day after day, with little sleep. He reportedly played through physical pain like a twenty-year-old, ignoring his physical and mental needs.
There are many musicians who want to know more about how Prince did it. If it turns out that his secret included opioid pain medication abuse, his death should be a cautionary tale.

I was blindsided

I work as a Social Worker and I have always played by the rules. I managed my anxiety by monitoring my thoughts for negative thinking and by running.

Then I faced a bout of crushing depression. That was difficult enough until I received another diagnosis: Parkinson’s. I learned that my depression was a kind of early warning sign of Parkinson Disease.
Then I faced a bout of crushing depression. That was difficult enough until I received another diagnosis: Parkinson’s. I learned that my depression was a kind of early warning sign of Parkinson Disease.
I was very sad to be diagnosed with Parkinson Disease because progressive neurologic conditions tend to not be good news. Thinking about how this disease may affect my life worries me a great deal.
The best defense against progressive adversity is treatment, and treatment costs money. I knew that I needed to continue to work to give myself the best shot at a quality of life. I was doing well, I had energy, I felt challenged, I slept well, I had good relationships with my coworkers, and I continued to meet my work expectations.
I wondered how long I could keep it up.
As time went on it took more and more energy to focus on my work. I worked with my psychiatrist, I Googled the literature, I changed up medications and doses. I coped with the side effects. I searched for the prescription cocktail, with tolerable side effects, that would keep me in the game.
I don’t know how long the medication mix and match of went on.  At some point, I decided that I didn’t want to find out. I dropped out. I stopped being a social worker at a clinic devoted to helping people with opioid abuse disorders in the middle of a heroin epidemic.

What I have learned from Prince about coping with disease

I can only imagine what it felt like to be Prince. I think no less of his musical performances if it turns out that he abused opioid pain medication. In a way, his uniquely shaped guitar may have symbolized his devil-soul-swapped-fiddle-of-gold that Charlie Daniels sings about.

One of the greatest obstacles to admitting to an opioid abuse problem is realizing that you have one, but that is the first step. When you no longer fight your disease, you have more energy to get the help that you need.
One of the greatest obstacles to admitting to an opioid abuse problem is realizing that you have one, but that is the first step. When you no longer fight your disease, you have more energy to get the help that you need.

I am finding that there are other powerful hedges against adversity besides money. Writing is one of them. Being challenged is good medicine in the fight against Parkinsons Disease.
Writing helps with the psychological aspects of the disease. I have guilt about retreating from the front lines of working with individuals suffering from opioid abuse in the midst of a heroin epidemic. I hope that there is still some good I can do writing about it.

I don’t claim to know everything about disease, about drug abuse, or about recovery. What I have learned is that getting the help you need is the important thing. Please, please, never stop fighting.

Purple Rain



About David Shaw
David S. Shaw is a clinical social worker who has specialized in the treatment of men with substance abuse disorders and maintains an interest in Men’s issues in general. He has particular interest in issues related to male sexuality, Pro-feminism, countering rape culture and the socialization of boys. He lives in the Catskill Mountain region of New York State.

http://goodmenproject.com/guy-talk/prince-heroin-and-parkinsons-disease-snsw/

Friday, May 13, 2016

NeuroDerm starts patient enrollment in long-term safety study of ND0612 for treatment of Parkinson’s disease

May 13, 2016



NeuroDerm Ltd., a clinical stage pharmaceutical company developing drugs for central nervous system (CNS) disorders, today announced the start of patient enrollment in a long-term safety study (trial 012) of the company’s continuously administered subcutaneous levodopa/carbidopa (LD/CD) formulation used in both ND0612H and ND0612L.

The one-year international, open label study will investigate the long-term safety of low and high dose regimens of ND0612. The study is expected to enroll approximately 100 patients, including patients who have previously completed the company’s phase 2 and 3 studies as well as new patients. At least 50 patients will be treated with the highest dose regimen. ND0612, continuously administered through a belt pump, is designed to maintain steady LD/CD levels to improve motor fluctuations that cannot be adequately controlled with oral therapy and, in the case of advanced patients, provide an alternative to treatments requiring surgical intervention.

“This trial is intended to produce long-term evidence of the safety profile of ND0612 as a viable new treatment option for patients with Parkinson’s disease, and a non-surgical alternative for advanced patients who suffer motor complications, who can no longer be controlled with current best standard of care oral therapies,” said Sheila Oren, MD, MBA, Vice President of Clinical and Regulatory Affairs of NeuroDerm. “Previous shorter-term studies with ND0612 have shown clinical benefits that were similar to those obtained with invasive surgical procedures while exhibiting a good safety profile, in contrast to the potentially serious and sometimes life-threatening side effects associated with invasive surgical therapies such as deep brain stimulation and LD/CD intestinal gel.”

“This long-term safety trial marks another important milestone for NeuroDerm and the clinical development of ND0612. Upon the completion of this trial anticipated in 2017, as well as the other parallel trials outlined in our clinical development plan, we intend to submit a New Drug Application (NDA) to the U.S. Food and Drug Administration (FDA) and a Marketing Authorization Application (MAA) to the European Medicines Agency (EMA). We believe that ND0612 has the potential to become a simple therapy alternative that will offer significant new benefits for both moderate and advanced Parkinson’s disease patients who suffer motor complications that cannot be adequately controlled with current therapy,” said Oded Lieberman, PhD, MBA, CEO of NeuroDerm.

ND0612H and ND0612L
ND0612H and ND0612L are designed to significantly reduce motor complications in Parkinson's disease patients through continuous, subcutaneous delivery of LD/CD solution. Previously completed Phase II trials demonstrated that ND0612L maintained steady, therapeutic levodopa plasma concentrations that were associated with major changes in several clinical parameters including "off time" reductions when added to optimized oral standard of care. ND0612H, intended for severe Parkinson's disease patients, was shown to reach even higher levodopa steady plasma levels, indicating that it may provide an effective therapy alternative to current treatments requiring surgery such as deep brain stimulation and LD/CD Intestinal Gel.
Source:

http://www.news-medical.net/news/20160513/NeuroDerm-starts-patient-enrollment-in-long-term-safety-study-of-ND0612-for-treatment-of-Parkinsone28099s-disease.aspx?