News from the International Congress of Parkinson's Disease and Movement Disorders: Smartphone Monitoring of PD Symptoms Proves Accurate in Clinical Trial

Hurley, Dan   Neurology Today:  6 July 2017 - Volume 17 - Issue 13 - p 35doi: 10.1097/01.NT.0000521718.33696.b8

VANCOUVER—The first clinical trial to employ a smartphone app to continuously measure symptoms associated with Parkinson's disease (PD) has found the technology to be well-accepted by patients during 24 weeks of use and highly correlated with traditional clinical measures, according to a poster presented here on June 6 at the International Congress of Parkinson's Disease and Movement Disorder?s.

Indeed, the smartphone measurements proved sensitive enough to detect upper-limb tremors that were not reported or present during standard physician-administered assessments.

“If you compare healthy control data to the patients rated as having no tremor, the data from the smartphone is clearly picking up a tremor,” said Michael Lindemann, PhD, from Roche's Innovation Center in Basel, Switzerland, on behalf of the research team.

“It's not only consistent with how physicians have measured the disease so far, it actually augments the picture, offering a unique window into patients' day-to-day life in an unobtrusive fashion,” Dr. Lindemann said.

STUDY DESIGN

Incorporated into a phase 1 clinical trial of a drug under development by Roche and Prothena Biosciences, the study involved 44 patients with early-stage PD. The research also included 35 healthy controls recruited in a separate study using an identical approach. Patients were asked to carry out six tests of symptoms every morning, including sustained phonation, gait, balance, dexterity, rest tremor, and postural tremor. In addition, they were asked to carry the smartphone with them throughout the day so that the device's accelerometer and gyroscope could passively monitor their movements. Results were compared to standard clinical measures, including the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) obtained by clinicians.

Adherence to the protocol was surprisingly good throughout the duration of the trial. Patients performed the six active tests on average at least three times per week, although slowly dropping from over 75 percent adherence at the outset of the trial to about 50 percent by the end. Likewise, the patients carried the smartphone with them to permit passive monitoring about six hours per day at the outset of the trial, dropping to about four hours per day by the end. Even so, that was enough to generate a total of 24,104 hours of passive monitoring during the course of the study.

The smartphones' measurements of the patients' performance of the daily tests were generally consistent with the physicians' ratings on the MDS-UPDRS for these symptoms: rest tremor (p=0.04); postural tremor (p=0.010); dexterity (p=0.04); balance (p<0.001); and gait (p<0.001).

“Moreover, active test features for healthy controls were often significantly different from PD patients whose motor symptoms were scored as ‘0’ (that is, absent), suggesting that active test data collected in the two weeks before and after a clinical visit may augment the clinical picture obtained at site visits,” the poster stated.

Using machine learning to detect the patients' walking, standing, sitting and other movements during passive monitoring, the study found significantly lower gait activity (36 percent less) than healthy controls, reflecting less mobility. It also detected 17 percent fewer standing up/sitting down transitions per hour compared to healthy controls, and 38 percent fewer turns per hour while walking than healthy controls.

Commenting on the study, E. Ray Dorsey, MD, MBA, professor of neurology and director of the Center for Health and Technology at the University of Rochester Medical Center in New York, said: “This is the first time a smartphone has been incorporated into a clinical trial in Parkinson's disease. This is actually a big deal. Rather than just conducting assessments twice a year in the clinic, this study shows you can obtain continuous, objective assessments in the real world. It could be especially useful in drug trials, to see if somebody is showing an improvement over the course of a study. That would be powerful information.”

This report was one of several reports from the Neurology Today Conference Reporter coverage of the International Congress of Parkinson's Disease and Movement Disorders. Look for more coverage from the meeting here: http://bit.ly/NTCR-MDS-NT.

In an upcoming issue of Neurology Today, we will provide broader look at the challenges and opportunities of using wearable technologies in neurology clinical trials.

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•. International Congress of Parkinson's Disease and Movement Disorders Abstract 541. Lipsmeier F, Fernandez Garcia I, Wolf D, et al. Successful passive monitoring of early-stage Parkinson's disease patient mobility in Phase I RG7935/PRX002 clinical trial with smartphone sensors http://http://www.mdsabstracts.org/abstract/successful-passive-monitoring-of-early-stage-parkinsons-disease-patient-mobility-in-phase-i-rg7935prx002-clinical-trial-with-smartphone-sensors/.

© 2017 American Academy of Neurology

http://journals.lww.com/neurotodayonline/Fulltext/2017/07060/News_from_the_International_Congress_of.12.aspx

Study predicts future burden of Parkinson’s disease in New Zealand

July 7, 2017

Dr Toni Pitcher

Numbers of people with Parkinson’s disease will double over the next 25 years, according to a new study from the University of Otago, Christchurch’s specialist brain research group.

Today there are at least 9500 people in New Zealand living with Parkinson’s disease. The study predicts the number will double to 17,500 by 2035, and increase to 24,000 by 2068.

The research was done by the Christchurch-based New Zealand Brain Research Institute (NZBRI), which includes clinicians and brain imaging specialists.

Author Dr Toni Pitcher says she and the team wanted to provide robust data on future need by determining numbers of people with Parkinson’s disease will change in the face of an ageing population. They analysed pharmaceutical records relating to the condition to calculate numbers.

Dr Pitcher says as well as being able to predict future need, the study team observed an interesting pattern of disease in older age groups. It was commonly thought the risk of getting Parkinson’s increased as age increased. But the study team found risk increased exponentially until age 75, peaked at age 85, then dropped off sharply after that. Dr Pitcher says this means, according to population data, the rate of increase in the number of people with Parkinson’s will slow down as the proportion of the population reaching the oldest old age range (80+ years) increases.

Professor Tim Anderson, a Christchurch neurologist and part of the NZBRI study research team, says the study is crucial in planning for the future and ensuring appropriate resources are assigned to treat and support those with chronic and progressive neurological disorders of ageing, such as Parkinson’s disease.

The study was funded by the Neurological Foundation of New Zealand.

http://www.otago.ac.nz/news/news/otago655440.html

Why people with brain implants are afraid of automatic doors

• Kristen V Brown  July 5, 2017

When your brain relies on an electromagnetic field, similar fields in the outside world become a threat. 

In 2009, Gary Olhoeft walked into a department store to buy some DVDs. He walked out with his whole body twitching and convulsing.

Olhoeft has a brain implant, tiny bits of microelectronic circuitry that deliver electrical impulses to his motor cortex in order to control the debilitating tremors he suffers as a symptom of Parkinson's disease. It had been working fine. So, what happened when he passed through those double wide doors into consumer electronics paradise? He thinks the theft-prevention system interfered with his implant and turned it off.

We live in a world of many, many signals. The more signals there are, the more opportunity for them to cross — and for people with implanted devices, the effect can be disastrous.

Olhoeft's experience isn't unique. According to the US Food and Drug Administration's MAUDE database of medical device reports, over the past five years there have been at least 374 cases where electromagnetic interference was reportedly a factor in an injury involving medical devices including neural implants, pacemakers and insulin pumps. In those reports, people detailed experiencing problems with their devices when going through airport security, using massagers or simply being near electrical sources such as microwaves, cordless drills or "church sound boards".

While not every one of those reports has been verified, both the FDA and scientists have expressed concerns about scenarios where ambient electromagnetic fields disrupt medical devices that operate in the same frequency spectrum.

"The consequence of EMI [or electromagnetic interference] with medical devices may be only a transient 'blip' on a monitor, or it could be as serious as preventing an alarm from sounding or inappropriate device movement leading to patient injury or death," the FDA wrote in a report all the way back in 2000. "With the increasing use of sensitive electronics in devices, and the proliferation of sources of EM energy, there is heightened concern about EMI in many devices."

A scientific study has been devoted to the impacts of this kind of interference on brain implants, cardiac implants and insulin pumps. The conclusion: As more devices both in our bodies and the built world operate on a frequency, the problem is likely to grow in scope and scale unless we plan carefully.

Olhoeft, who had just recently gotten his implant, at first had no idea why his trip to the store had triggered his tremors. "Without the implant, the tremors were so bad that I couldn't walk or talk," he told Gizmodo. "After they installed it, I had no symptoms until I walked into that Best Buy. Then within four seconds I started to shake again."

ater, at his doctor's office, Olhoeft found out that the device had somehow been switched off, right around the time he'd gone to the store. Olhoeft is a retired professor of geophysics in The United States who taught courses on electromagnetism, so with those two details, it wasn't hard for him to figure out what had probably gone wrong. His implant, he says, operated at the same electromagnetic frequency as Best Buy's theft detection system, and the two signals interfered with each other.

"When you get an implant, they warn you about interference with devices like MRI machines. But they don't warn you about Best Buy or Walmart," he said. "I go to a support group for people with deep brain stimulation implants and I gave a talk about interference. I asked how many people had an experience like mine at Best Buy and all 50 people put their hands up."

Like Olhoeft said, it's not that no one had warned him. In its manuals, Medtronic, the maker of the device, clearly advises patients that things such as hairdryers, mobile phones, power tools and yes, in-store security systems may impact devices. The patient manual for Medtronic's deep brain stimulation devices has an entire appendix to potential sources of EMI, and the consequences for not heeding these warnings that it lists are dire: System changes, changes to stimulation, injury or even death.

The trouble is, as medical implants become not only more ubiquitous, but more connected, so does the rest of the world. And device makers have to not only plan for devices that work in today's environment, but hopefully also a decade down the road, when patients still have the same implant but the world of signals around them may be substantially different.

"The internet of things, wireless power transfer, electronics in cars, cellular smart meters, nonlethal crowd control, there's an endless list of new rapidly emerging electromagnetic technologies that have to be tested" for possible interference, Olhoeft said.

"You can think to some degree about changes that may come down the road, but typically those changes you anticipate are only extensions of what you already know," said Frank Fischer, the CEO of NeuroPace, which makes brain implants that target epilepsy.

How, for instance, will a world with autonomous vehicles, with features such as wireless charging and radar sensors, impact patients with brain implants or pacemakers? Or, in the more distant future, what if we're all walking around with implants that make us smarter, and treat our depression? How will this complex world of signals interplay then?

"I don't think you're ever going to be able to foresee the future," said Fischer. "In reality, what you want to do is make sure that when things do go wrong, a device goes into some kind of safe mode and then allows a patient to reset it."

Medtronic, which makes Olhoeft's device, echoed this sentiment in a statement. "While our product testing is extensive, we cannot account for all possible scenarios," the company said. Though "most electrical devices and magnets encountered throughout the course of a patient's typical day" are unlikely to have any impact, there's really no guarantee.

Every day since that one at Best Buy, Olhoeft has navigated the terrain of that ambiguity. He's discovered that the airport security checkpoints, his local hall of justice, and sports arenas all operate near the frequency of his device and could potentially interfere with it. To test such situations, he uses a detector that tells him the frequency of things such as security systems to make sure they're operating on a different frequency than his device. If the frequency is a match, he asks to go around.

When he goes to his university library, he has to ask them to turn off the inventory control system so that he can enter, and at the hospital he steers clear of walking too close to the MRI machine. In his own home, he and his wife took out the dimmer switches on all the lights, which have their own small electrical field. So does the AC unit and the fridge. Since having his implant installed, he's discovered that the world is a minefield of potential interference that in an instant could potentially send his body into debilitating shaking.

It's all precautionary, in hopes that he can avoid those worst-case scenarios listed in his patient manual.

Olhoeft has heard from other patients like him that have had trouble with their implants and interference. One woman who had a DBS implant like his found that when her Prius was in charging mode, it turned her device off. Another man had a DBS, cochlear implant and cardiac pacemaker that all operated near the same frequency and interfered with the operation of the devices.

Olhoeft, whose implant is now six years old, from an era when the iPhone was still a novel technology, wonders how it might restrict his life in the future. He has become something of an advocate for the issue, speaking out about his own experience, sending comments to the FCC and suggesting to the US Department of Justice that implants like his should be recognised as a disability, since it requires him to navigate cautiously around a world built for people without bodies that emit electromagnetic signals.

"We're going to have to consider using the Americans with Disabilities Act for people with implants," he said. "You know, 'Warning, people with implants should not enter here.'"

http://www.theage.com.au/technology/technology-news/why-people-with-brain-implants-are-afraid-of-automatic-doors-20170704-gx4s2s.html

6 of the Best Apps for Chronic Illness Management

JULY 6, 2017   BY WENDY HENDERSON IN SOCIAL CLIPS.

Managing a chronic illness can be difficult. There are many different medications to take (often at different times), appointments to remember, symptoms to keep track of, and lots of information to absorb. Thankfully, living in a digital age means that there are numerous mobile apps that can help you manage your chronic illness.

We’ve put together a list of some of the best mobile apps for managing your chronic illness1:

Medisafe is an app that helps patients manage medications. It helps with dosage and reminds you when you need to take your meds, increasing adherence rates. The information can also be shared with your healthcare team and pharmacy.

Pain Diary works for anyone with a chronic illness. It allows patients to chart and score pain as well as record and track other symptoms of the disease such as fatigue and mood swings. This app also has a feature where patients can connect with others living with the same chronic illness and swap best practices.

ZocDoc is a handy app if you’ve recently been diagnosed with a chronic illness, since one of the first things you’ll need to do is find a doctor to treat you. ZocDoc allows you to search for local specialist doctors who are approved by your insurance company. The app will even tell you when the doctor is available to see you.

My Medical Info is an app that stores all your relevant health history and insurance details. This makes filling out those endless forms a little less challenging, since you won’t have to rely on your memory for all the details. The app will also allow you to program in doctors’ appointments and all the medications you’re taking.

Fooducate helps you keep track of your diet and make healthy choices. Eating well is an integral part of managing any chronic illness and this app will help you to eat the right foods and get you to a healthy body weight. You can program in how many calories you want to consume a day and then add in the food choices you make, the app will work out the nutritional values of everything you eat and tell you how many calories you’ve consumed. It also works in conjunction with many fitness apps to add in details of any physical activities and calories burned.

Sleep Cycle helps you get the best out of your sleep. The app analyzes how much sleep and the quality of sleep you get each night and you can also have the alarm set to wake you when you’re in your lightest sleep, leaving you feeling less groggy and more refreshed each day.

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Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

https://parkinsonsnewstoday.com/2017/07/06/6-best-apps-chronic-illness-management/

Using Exercise to Help Combat Parkinson’s Disease Symptoms

 JULY 6, 2017  BY WENDY HENDERSON IN SOCIAL CLIPS.

https://youtu.be/j-qvUqkoe9o

In this video from Intermountain Healthcare, Parkinson’s disease patient Michael Foerster talks about how his diagnosis has affected his life. He and Dr. Katherine L. Widnell discuss the benefits of exercise for Parkinson’s disease and how it can help slow down the progression of the disease when used alongside medication and other treatments.

Foerster says that when he exercises, he feels much better and suffers fewer symptoms and they’re less severe. Physical therapist, Laura Jones, explains that exercise can help to make patients feel stronger and counter some of the day-to-day effects of the disease. Used alongside medications and other therapies such as deep brain stimulation, exercise can help Parkinson’s disease patients live a full, active and happy life.

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Parkinsons’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

https://parkinsonsnewstoday.com/2017/07/06/using-exercise-combat-parkinsons-disease/

Prana’s Parkinson’s Therapy Candidate Shows Promise in Preclinical Studies .

JULY 6, 2017  BY JOANA FERNANDES, PHD IN NEWS

Treatment with Prana Biotechnology’s investigational drug PBT434 showed potential in preventing neuronal death in a mouse model of Parkinson’s disease, according to a new study.

Results showed that PBT434 blocked the formation of alpha-synuclein aggregates, a hallmark of Parkinson’s, and normalized iron levels in the brain, thereby protecting neurons from damage.

Prana Biotechnology plans to start a Phase 1 clinical trial later this year to investigate the effects of PBT434 in humans with Parkinson’s disease.

The study, “The novel compound PBT434 prevents iron-mediated neurodegeneration and alpha-synuclein toxicity in multiple models of Parkinson’s disease,” was published in the journal Acta Neuropathologica Communications.

Parkinson’s disease is characterized by the loss of a dopaminergic neurons, which produce the neurotransmitter dopamine, in a brain region called the substantia nigra. Death of these neurons affects the normal functioning of another brain region, the basal ganglia, which is responsible for voluntary body movements.

Several changes in the normal functioning of neurons are associated with the development of this disease, such as an abnormal iron distribution in the brain. Iron promotes the aggregation of alpha-synuclein, which is toxic to neurons and may cause their death.

Using mice with Parkinson’s disease, researchers observed that treatment with PBT434 improved brain levels of iron and prevented the formation of alpha-synuclein clumps. By doing so, it also prevented the toxic effects caused by the aggregated protein, such as oxidative stress, triggering neuronal loss. Oxidants damage other molecules within cells, such as proteins, lipids and DNA.

Indeed, PBT434 protected the neurons of the substantia nigra, the brain region rich in dopamine-producing neurons that is involved in movement coordination. The new compound also improved movement deficits in mice with Parkinson’s disease.

“These findings are important because Parkinson’s disease and the related synucleinopathies cause significant disability and diminish the independence of afflicted individuals,” David Stamler, MD, senior vice president and chief medical officer at Prana, said in a press release.

“An agent which slows disease progression could have a great impact on reducing disease burden and improving quality of life. We are eager to begin clinical testing of PBT434,” Stamler added.

The scientists who designed PBT434 work at the Florey Institute of Neuroscience and Mental Health in Melbourne, Australia.

https://parkinsonsnewstoday.com/2017/07/06/pranas-parkinsons-disease-drug-candidate-pbt434-shows-potential-mouse-models/

Professors lead call for ethical framework for new 'mind control' technologies

July 6, 2017

As interventions for mental illnesses and neurological disorders are becoming increasingly powerful, an interdisciplinary group of researchers from the University of Pennsylvania, American University and Duke University are calling for new safeguards to guide treatments and protect patients.In a perspective article published in the journal Nature Human Behavior, they argue that these interventions should now be thought of as a form of "mind control." As such, neuroscientists, clinicians and bioethicists should begin looking toward the engineering discipline of control theory as a way to better understand the relationship between brain physiology and mental states.

Control theory describes how dynamic, interconnected systems, such as the ones that govern an airplane or nuclear power plant, work together to safely and efficiently deliver a desired outcome. Applied to the brain, it should guide treatments such that patients gain or maintain control over their own mental states as much as possible. 

The Penn authors are John Medaglia, research assistant professor in the School of Arts & Science's Department of Psychology, and Danielle S. Bassett, Eduardo D. Glandt Faculty Fellow and associate professor in the School of Engineering and Applied Science's departments of Bioengineering and of Electrical and Systems Engineering. They collaborated with Perry Zurn, assistant professor in the Department of Philosophy at American University, and Walter Sinnott-Armstrong, Chauncey Stillman Professor in Practical Ethics in the Department of Philosophy and the Kenan Institute for Ethics at Duke University.

"While we don't believe," Bassett said, "that the science-fiction idea of mind control, totally overriding a person's autonomy, will ever be possible, new brain-focused therapies are becoming more specific, targeted and effective at manipulating individuals' mental states. As these techniques and technologies mature, we need systems in place to make sure they are applied such that they maximize beneficial effects and minimize unwanted side effects."

"Most treatments we employ already have overlapping effects," Medaglia said. "Drugs for Parkinson's disease boost motor function but can also make patients more impulsive. As drugs and other interventions get more powerful, we want to guide them so patients maintain as much autonomy as possible. And, in situations where unwanted side effects are unavoidable, patients should be fully informed what those changes in their mental states might mean for them."

As advances in molecular biology and chemical engineering are increasing the precision of pharmaceuticals, even more spatially-targeted technologies are emerging. New noninvasive treatments send electrical currents or magnetic waves through the scalp, altering the ability of neurons in a targeted region to fire. Surgical interventions are even more precise; they include implanted electrodes that are designed to quell seizures before they spread, or stimulate the recall of memories after a traumatic brain injury.

Research into the brain's "wiring"—how neurons are physically connected in networks that span disparate parts of the brain—and how this wiring relates to changing mental states has enabled principles from control theory to be applied to neuroscience. For example, a recent study by Bassett and colleagues shows how changes in brain wiring from childhood through adolescence leads to greater executive function, or the ability to consciously control one's thoughts and attention. 

While insights from network science and control theory may support new treatments for conditions like obsessive compulsive disorder and traumatic brain injury, the researchers argue that clinicians and bioethicists must be involved in the earliest stages of their development. As the positive effects of treatments become more profound, so do their potential side effects.

"New methods of controlling mental states will provide greater precision in treatments," Sinnott-Armstrong said, "and we thus need to think hard about the ensuing ethical issues regarding autonomy, privacy, equality and enhancement."

"Pairing network neuroscience and control theory promises to provide greater precision in clinical care," Zurn said. "As this work develops from an ethically-informed perspective, it will prompt better mental health-care policies and a stronger cultural appreciation of the body-mind continuum."

The authors see their article itself as emblematic of the trajectory this work must take: neuroscientists, bioethicists, philosophers and physicians coming together to prepare for the opportunities and challenges these new technologies will introduce.

More information: John D. Medaglia et al. Mind control as a guide for the mind, Nature Human Behaviour (2017). DOI: 10.1038/s41562-017-0119 

Journal reference: Nature Human Behaviour

Provided by: University of Pennsylvania 

https://medicalxpress.com/news/2017-07-professors-ethical-framework-mind-technologies.html

How much does dementia risk increase after traumatic brain injury?

July 5, 2017

The WHO has predicted that TBI will become a leading cause of death and long-term illness during the next ten years. Already one per cent of the population in the United States suffers from a long-term disability caused by TBI. Credit: R Raj (University of Helsinki)

Having a moderate or severe traumatic brain injury (TBI) in middle-age is associated with an increased risk for future dementia, according to a retrospective of study of more than 40,000 TBI patients published in PLOS Medicine by Rahul Raj of the University of Helsinki, Finland, and colleagues.A TBI usually results from a blow or jolt to the head and, in more severe cases, can lead to torn tissues, bleeding and other physical damage to the brain. In the new study, researchers identified everyone in Finland between the ages of 18 and 65 who was hospitalized with a mild or a moderate-to-severe TBI between 1986 and 2014. They then used the Finnish Care Register for Health Care to track hospitalization, after the TBI, with dementia, Parkinson's disease, and amyotrophic lateral sclerosis (ALS) for all 40,639 patients.

3.5% of patients who had a moderate-to-severe TBI went on to receive a diagnosis of dementia, compared to 1.6% for those who only had a mild TBI. After adjusting for confounding factors, people with a moderate-to-severe TBI were 90% more likely than those with mild TBI to be diagnosed with dementia (hazard ratio [HR] 1.9; 95% confidence interval [CI] 1.6±2.2). The risk appeared to be most increased among those whose injury occurred in middle age (HR 2.7 [CI 1.8-4.2] for age 41-50, and 2.0 [CI 1.6-2.4] for age 51-60). There was no increase in the risk of Parkinson's disease or ALS with TBI. The study was limited by a significant number of deaths in the group of patients with moderate-to-severe TBI, potential misdiagnoses of TBIs, and the fact that the database only included patients who were hospitalized, for TBIs and subsequently with dementia or other neurodegenerative conditions, so may have missed those treated in an outpatient setting.

"Our results imply that in working-aged persons, moderate-to-severe TBI seems to increase the risk for developing neurodegenerative disease later in life," the authors say. "The effect of covariates, such as comorbidities, life-style factors and the effect of genetics, should be accounted for in future etiological studies, as well as to improve diagnostics and prevention of dementia after TBI."

The risk of a memory disorder was significantly higher among patients with medium or severe brain injuries than among patients with mild brain injuries (control group). The risk of developing a memory disorder was 2.5 times higher among the 41-50 age group, and 2.0 times higher among the 18-40 and 51-60 groups. The relative risk was slightly lower (1.5 times higher) among the 61-65 group, as the age-related risk for a memory disorder is already higher. Credit: R Raj and J Kaprio / University of Helsinki

More information: Raj R, Kaprio J, Korja M, Mikkonen ED, Jousilahti P, Siironen J (2017) Risk of hospitalization with neurodegenerative disease after moderate-to-severe traumatic brain injury in the working-age population: A retrospective cohort study using the Finnish national health registries. PLoS Med 14(7): e1002316. doi.org/10.1371/journal.pmed.1002316 
Journal reference: PLoS Medicine

Provided by: Public Library of Science

https://medicalxpress.com/news/2017-07-traumatic-brain-injury-dementia-working-age.html

Medical tourism in spotlight as experts call for tighter regulation

July 5, 2017

Countries should unite to tackle unscrupulous advertising of unproven therapies involving stem cells, experts say.

An international group of leading experts has called for tighter regulation of so-called stem cell tourism. This involves patients travelling to other countries, where medical regulations are less strict, for treatment with potentially unsafe therapies.

Hundreds of medical centres around the world are offering therapies that involve transplantation of so-called stem cells—which they claim have the ability to repair damaged tissues. Clinics are marketing the treatment for a range of conditions, including multiple sclerosis and Parkinson's disease.

Often these therapies are advertised directly to patients with the promise of a cure. But experts say there is often no evidence to show that the treatments will help anyone, or will not cause harm.

Researchers say the practice risks undermining the development of rigorously tested, validated therapies and puts lives at risk.

Writing in the journal Science Translational Medicine, the group has called for coordinated global action to tackle the problem.

They say tighter regulations on advertising stem cell therapies are needed, so that unsupported claims about potential clinical benefits do not go unchallenged.

Global regulatory authorities should agree international standards for the manufacture and testing of cell and tissue-based therapies, they add.

The group—which includes experts from the University of Edinburgh—also calls for the World Health Organization to help guide responsible clinical use of cells and tissues, as it does for medicines and medicinal devices.

Their appeal follows the deaths of two children at a clinic in Germany in 2010, which exploited a legal loophole to offer untested treatments. The clinic has since been closed.

Dr Sarah Chan, a Chancellor's Fellow at the University of Edinburgh, said: "Many patients feel that potential cures are being held back by red tape and lengthy approval processes. Although this can be frustrating, these procedures are there to protect patients from undergoing needless treatments that could put their lives at risk.

"Stem cell therapies hold a lot of promise but we need rigorous clinical trials and regulatory processes to determine whether a proposed treatment is safe, effective and better than existing treatments."

Some types of stem cell transplantation - mainly blood and skin stem cells—have been approved to treat certain types of cancer and to grow skin grafts for patients with severe burns. These treatments have been rigorously tested in clinical trials.

More information: D. Sipp at Riken Center for Developmental Biology in Kobe, Japan el al., "Marketing of unproven stem cell-based interventions: A call to action," Science Translational Medicine (2017). stm.sciencemag.org/lookup/doi/ … scitranslmed.aag0426

Journal reference: Science Translational Medicine 

Provided by: University of Edinburgh

https://medicalxpress.com/news/2017-07-medical-tourism-spotlight-experts-tighter.html

Using light to reset the body clock can treat brain disorders

By Linda Geddes   July 5, 2017

Hospitals are usually badly lit, but many are starting to use light therapy to treat depression, alleviate Parkinson’s disease, and improve stroke recovery

Bright prospects for light therapy

Angela Wyant/Getty

BILLIONS of dollars have been spent in search of treatments for psychiatric conditions and brain disorders, when a cheap and effective drug may have been right under our noses: light. Now hospitals are turning to light to treat depression, strokes and Parkinson’s disease, using it to hit the reset button on our internal clocks.

From green light soothing the pain of migraine, to blue light reducing organ damage during surgery, recent small studies have uncovered some intriguing effects of this therapy. But apart from easing seasonal affective disorder, we’ve been slow to embrace light as a serious contender for treating neurological conditions.

We’ve known for 15 years that a special kind of receptor in our eyes transmits information directly to the body’s master clock, as well as other brain areas that control mood and alertness. These cells are particularly responsive to bluish light, including sunlight.

These receptors enable light to act as a powerful reset switch, keeping the clock in our brain synced to the outside world. But this clock can fall out of sync or weaken as part of ageing or a range of disorders – a problem doctors are now starting to treat with light.

Most hospitals have small windows and 24-hour lighting, both of which might exacerbate health problems. To tackle this, several hospitals in Europe and the US are installing dynamic “solid state” lighting, which changes like daylight over the course of a day. Such lights can, for example, shine bright whitish-blue in the morning, grow warmer and dimmer throughout the day, and turn orange or switch off at night.

But it hasn’t been clear if such lights make a difference to health. Now Anders West at Glostrup Hospital in Copenhagen and his team have shown it helps people recover from strokes.

Up to a third of people are depressed in the weeks following a stroke, while up to three-quarters experience fatigue and poor sleep. “These symptoms can have an adverse effect on cognitive function, recovery and survival,” says West.

“I think we’re going to see a complete revolution in lighting and architecture in a very short space of time”

He presented data at the Society for Light Therapy and Biological Rhythms conference in Berlin in June, which showed that people recovering from strokes score lower for depression and fatigue, and show more robust circadian rhythms when exposed to solid state lighting. “The effect was comparable to giving patients antidepressants,” says West.

Hospital lighting also seems to have a dramatic effect on severe depression, which often involves a disrupted circadian clock with delayed sleep periods. At the Berlin conference, Klaus Martiny of the Psychiatric Centre in Copenhagen presented research showing that people being treated for severe depression were discharged almost twice as quickly if their rooms faced south-west in comparison with those whose rooms had a north-west aspect. Depending on the time of year, the intensity of daylight in the south-west rooms was 17 to 20 times brighter.

“These are very depressed patients who tend to stay in their rooms and isolate themselves, so they’re more exposed to differences in light intensity,” says Martiny. The 67 people in the study had been randomly assigned rooms, and those who stayed in the brighter rooms were discharged after 29 days on average, compared with nearly 59 days for those in darker rooms.

“We don’t know the precise mechanism, but I think it’s to do with exposure to the morning light, which advances and stabilises their sleep-wake cycles,” says Martiny. His team’s findings are now informing the design of a new psychiatric centre, due to open in Copenhagen in 2022.

Using light to alter circadian rhythms could also help Parkinson’s disease. “One of the main challenges for people with Parkinson’s disease is that they keep waking up in the night, and a lot of them also have problems staying awake in the daytime,” says Aleksandar Videnovic at Massachusetts General Hospital in Boston.

In previous work, his team found that the rhythmic expression of certain genes was flattened in Parkinson’s disease, suggesting a sluggish circadian clock. So Videnovic decided to try treating people with the condition using a light box that emits bright white light twice a day, for two weeks. The idea wasn’t to shift the timing of the clock, but to strengthen it.

The study, published earlier this year, found that those exposed to the bright light slept better at night and were less sleepy and more active in the day, compared with people given a dim red light box as a control (JAMA Neurology, doi.org/b88s). The team also saw improvements in some of the movement symptoms of early Parkinson’s disease.

“We’re at such an interesting time,” says George Brainard at Thomas Jefferson University in Philadelphia. “On the one hand, solid state lighting has emerged that is exquisitely tunable, and can do numerous things,” he says. “At the same time, there’s a matured understanding that light truly affects health.”

Brought together, this provides a very exciting opportunity, says Brainard. “I think we’re going to see a complete revolution in lighting and architecture in a very short space of time.”

Morning dose of sunshine

If light can be a drug, should healthy people be wary of how they use it?

Much has been said in recent years about the harmful effects of blue-enriched light at night from smartphones and other screens, but we are still untangling the effects.

A study published this month found that exposure to bright blue-enriched light for 3 hours during the morning lessens the impact of evening blue-light exposure on sleep and circadian rhythms (Neuropsychobiology, doi.org/b88v). Compared with people exposed to a warmer, dimmer light in the morning, these people also had faster reaction times in both the morning and evening, suggesting they were more alert.

“Light from iPads or whatever will have detrimental effects if people are spending their daytime in darkness, but if they have been in bright light during the day, it [matters less],” says Dieter Kunz of the Charité-Universitätsmedizin hospital in Berlin

https://www.newscientist.com/article/mg23531335-300-using-light-to-reset-the-body-clock-can-treat-brain-disorders/?utm_campaign=RSS%7CNSNS&utm_source=NSNS&utm_medium=RSS&utm_content=news&campaign_id=RSS%7CNSNS-news

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