Examining the "Stroke Belt"

Richard Libman, MD

National patterns of racial and regional differences in stroke incidence are similar to those for stroke mortality; however, the magnitude of these differences in incidence appears smaller, according to a study appearing in a recent issue of the Annals of Neurology. Known as REGARDS (the REasons for Geographic And Racial Differences in Stroke), the national study further elaborates on the geographic variation in the incidence of stroke, stroke risk factors and cognitive impairment, a condition that includes problems with memory, language or other mental functions.

It has been known for some time that the "stroke belt" is a geographical region with a significantly higher incidence of brain attacks. Stroke by itself is a major contributor to cognitive impairment and dementia. Furthermore, such risk factors for stroke as high blood pressure and diabetes are independent risk factors for cognitive impairment. In the REGARDS study, living in the stroke belt was also a risk factor for cognitive impairment.

The important message is that careful analysis of what makes the stroke belt different from other areas of the country can lead to more insight into what is causing the cognitive impairment, and, hopefully, result in effective preventive measures and treatment.

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Prenatal Surgery for Spina Bifida

Kangmin Daniel Lee, MD

For the first time, a significant clinical trial recently published in the New England Journal of Medicine, shows that fetal surgery can help babies with myelomeningocele. 

Myelomeningocele is the most serious form of spina bifida, the most common congenital disorder of the central nervous system. A baby born with myelomeningocele has a spinal column not completely closed, which allows for the protrusion of the spinal cord. 

Surgery to correct this disorder is typically performed after birth, but often cannot prevent progression of neurologic deficits or some of the other associated problems such as hydrocephalus or Chiari malformation. Prenatal surgery for myelomeningocele repair was first introduced in 1997.

In the study out of the University of California, San Francisco, 183 pregnant women were randomized to have prenatal or postnatal surgery performed. Results of the study show that prenatal surgery reduced the need for shunt placement 40 percent vs. 82 percent and resulted in improved mental development and motor function. However, prenatal surgery increased the risk for maternal complications and premature births. Despite this, children who received prenatal surgery were more likely to walk independently at 30 months, even though the lesion levels were on average, more severe.

The results from this study are clearly important and emphasize the possible advantages of prenatal surgery over postnatal surgery. However, not all the children in the study benefited from prenatal surgery and some had poor outcomes. Patient selection had to be done very carefully. Full Post - to Detail View

Breastfeeding Linked to Fewer Seizures in Kids

Cynthia Harden, MD

A recent article from Medline Plus commented on a study published in the Journal of Pediatrics, where researchers from the School of Public Health at the University of Aarhus in Denmark found that those babies who were breastfed may have fewer seizures after they’re a year old. Moreover, the longer they were breastfed, the better. This finding that breast feeding reduces the risk of onset of early childhood epilepsy is intriguing.

In the study, kids who had breastfed for at least three months had about a one in 135 chance of developing epilepsy after they were a year old. If they were breastfed for at least six months , this chance dropped to about one in 150. Babies on breast milk for at least nine months had about a one in 200 chance of getting the seizure disorder later.

However, the data from the study is somewhat limited in that almost every infant in the study was breastfed for at least one month and only 2 percent of the sample was not breast-fed at all. Given that about 25 percent of US mothers do not breastfeed their infants, a bigger sample size of those in the study who were not breastfed would have been informative. However, for researchers in epilepsy such as myself, the data from the study is remarkable and very thought-provoking.

For more information about epilepsy, diagnosis and treatment, please go here

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Gabrielle Giffords Surgery to Restore Skull Is Fairly Routine

Rick Madhok, MD

As reported by the Associated Press, Congresswoman Gabrielle Giffords underwent surgery to restore part of her skull that was removed during her initial operation to allow for brain swelling after she suffered a gun-shot wound to the head this past January.

Restoring the part of the skull that was removed is routine if the patient has a good outcome to replace the defect. While this procedure is still considered brain surgery, there are much fewer risks than with the initial operation. To replace the part of the skull, certain types of plastic or titanium mesh can be used to recreate it. Keep in mind, the purpose of the skull is to provide a protective barrier to the brain; this can be accomplished with bone or a specially designed material.

One of the most significant developments in this area is custom-designed implants. As such, using fine computed tomography (CT) scans, each implant is made to fit and recreate the skull so the overall fit is as if the original bone itself were replaced. Custom implants are a major advance in restoring the normal appearance of the skull and a procedure such as the one Congresswoman Giffords is receiving, is relatively common.

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