Stroke in Young Adults Becoming More Common

Richard Libman, MD

Stroke may be affecting people at a younger age, according to a recent study published in the journal Neurology. This is not the first study to suggest this unsettling trend and other research has found similar results.

The first question to ask is whether stroke in young people only appears to be more common because of improved diagnosis. Magnetic resonance imaging (MRI) has been more widely used for stroke diagnosis, and MRIs are much more sensitive than computed tomography (CT) scans to detect small strokes. So some of the increase in diagnosis of stroke in young people may be due to improved technology and not a true increase in incidence.

Still, stroke is often diagnosed by the judgment of a physician, not necessarily by the type of scan. So increased use of MRI may not fully explain the trend.

The most widely accepted explanation, although unproven, is the rise in obesity in children. One of the main complications of obesity is diabetes. Obesity itself is a risk factor for stroke, and diabetes is an extremely strong stroke risk factor. The rise in obesity and diabetes among children may set the stage for stroke in young adulthood.

This possibility is quite alarming, and should serve as a wake-up call to healthcare practitioners. We need to address children obesity sooner rather than later. Full Post - to Detail View

Can Chocolate Help Prevent Stroke in Men?

Richard Libman, MD

According to a recent study published in the journal Neurology, eating a moderate amount of chocolate each week may be associated with a lower risk of stroke in men. Study participants who ate the largest amount of chocolate, about one-third of a cup of chocolate chips, had a lower risk of stroke compared to the men who ate no chocolate.

Though it is tempting to recommend more chocolate consumption (at for least men), the usual caveats pertain to this kind of study design. While this is a prospective study, it is still observational and not randomized, so unmeasured differences between the groups of chocolate eaters may have influenced the outcome.

For example, men who are already healthier for various reasons might consider it “safer” to consume larger amounts of chocolate. They may have a lower stroke risk because they are already healthier in ways the study didn't measure, not because they eat more chocolate. So it would be premature to assume a direct relationship between eating chocolate and a lower risk of stroke. 

A randomized trial is the only way to establish whether chocolate is beneficial for stroke prevention. Regardless of there being many willing volunteers for a randomized trial of chocolate versus placebo, it's unlikely that researchers would conduct one.  

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Deep Brain Stimulation Helps Parkinson’s Patients Over Long Term

Michael Schulder, MD

Deep brain stimulation (DBS) appears to help people with Parkinson’s disease over the long term, according to a recent study published in Neurology

In the study, 159 people with Parkinson’s disease were randomly assigned to deep brain stimulation in either the lobus pallidus interna (GPi) region of the brain or the subthalamic nucleus (STN) region of the brain and were followed for three years. Participants reported motor symptoms in a diary for 30 minutes every half hour for two days before each of the six study visits. Medication use was allowed in the study. 

The most consistent improvement was related to the effects on movement, including decreased tremor, stiffness and slowness of movement.  DBS of both areas of the brain improved motor symptoms by 32 percent on average over the course of three years. As such, this randomized study confirms what previous single-center reports have stated in that patients who have DBS surgery for Parkinson’s disease maintain the benefits of this treatment for years. 

However, one provocative finding in this study was that patients with DBS of the STN area of the brain were more likely to have decreased mental function over time compared to those who received DBS of the GPi area of the brain.  While it is unclear if this difference was due to different medication doses or the direct effect of DBS in each brain area, further study to clarify this finding is surely needed.

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Jack Osbourne’s Diagnosis of Multiple Sclerosis at Age 26

Karen Blitz, MD

Recently in the news, 26-year-old Jack Osbourne, son of Ozzy and Sharon, announced that he was diagnosed with multiple sclerosis (MS). While some might think that being diagnosed with MS at 26 is a bit young, the truth is that MS is the most common chronic neurodegenerative disease affecting young people. The peak time a person is diagnosed with MS is between 20 and 30 years of age, affecting women more often than men.
While the cause of MS is unknown, it is believed to be an autoimmune disease. Studies suggest that early treatment at onset can change the course of this disease, allowing for better outcomes later in life. While there is no cure for MS, there are treatments available including injectable medications, a monthly intravenous treatment or a pill that can be taken orally. Within a year, we are hopeful that two more oral medications may be approved.
For more information about the diagnosis and treatment of MS, please go to the Multiple Sclerosis Center at the Cushing Neuroscience Institute.

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Singer Sheryl Crow’s Brain Tumor Diagnosis

Michael Schulder, MD

As reported in the news recently, singer Sheryl Crow has been diagnosed with a benign tumor called a meningioma, a tumor that occurs outside of the brain.  These tumors grow from the lining of the brain, inside the skull known as the dura mater, making them less severe of a problem than tumors that arise within the brain itself.  Moreover, most meningiomas are benign tumors, meaning they almost never spread outside of the head, and patients can be cured by surgery.  In the United States, about 10,000 people a year are diagnosed with a meningioma.

While most meningiomas can be treated with surgery, not all meningiomas can be removed safely.  If the tumor appears attached to critical structures such as the brainstem or optic nerves, in some cases it is much better for the surgeon to remove only as much of the tumor as can be done safely.  As meningiomas usually grow slowly, performing a “subtotal removal” may relieve a patient’s symptoms for many years.  An excellent alternative for many patients is to be treated with a non-invasive method called stereotactic radiosurgery (SRS).  This technique, invented 60 years ago, uses highly focused radiation beams to treat small tumors in one or several treatment sessions.  Nearly 95 percent of the time, patients with meningiomas who receive SRS will have their tumor controlled.

Additionally, not all meningiomas are benign.  A small percentage (1 to 2 percent) of these tumors are malignant; they tend to grow back even after surgery and radiation.  A larger fraction, maybe 30 percent, is deemed “atypical.”  These tumors have some tendency to re-grow despite surgical removal, although not in all cases.  For this reason, we still don’t know for sure if patients with “atypical” meningiomas need radiation therapy after the tumors are removed, although there is an increasing tendency to offer this treatment.

A final consideration is that many if not most meningiomas are diagnosed as “incidental findings” – in other words, they are found on an magnetic resonance imaging (MRI) or computed tomography (CT) scan done for unrelated symptoms.  In such cases, it is often best to do nothing beyond getting follow-up MRI scans, and to reserve surgery only if the tumor clearly enlarges over time.  That is why most people with meningiomas never actually get surgery.  So the bottom line is, if you or your loved one has a meningioma, you have some very favorable options to consider. Full Post - to Detail View