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

May is Stroke Awareness Month: Know the Signs!

David Langer, MD

A stroke is an injury to the brain caused by the obstruction of blood flow to a brain artery-usually by a blood clot or a direct bleed into the brain itself. It can be due to weakness in the vessel wall commonly caused by high blood pressure or cerebral aneurysm.

Stroke is the third leading cause of death and the number one cause of disability in the United States. Stroke or "brain attack" can occur in all ages and nearly one quarter of strokes occurs in people under age 65.

The warning signs of stroke include motor weakness, sensory change (i.e. numbness or tingling of the face, arm or leg), speech difficulty or visual disturbance. Pain is present only in patients with the hemorrhagic form of stroke (a bleed in the brain) which represents only 15 percent of all strokes.

For the most part, the treatment of hemorrhagic stroke remains conservative with therapeutic options to reverse brain injury being very limited. Treatment is surgical only when a blood clot in the brain becomes life threatening. Surgery or catheter-based neurointerventional procedures are often used in patients who suffer bleeds from cerebral aneurysms to prevent a second hemorrhage.

Neurointerventional treatments are becoming more common in treating patients with ischemic stroke-strokes caused by vessel blockage. Along with intravenous clot-busting drugs (called tPA), intra-arterial delivery of these same drugs, as well as new technologies such as intravascular suction catheters and sophisticated mechanical devices, are increasingly being used for patients who either fail medical therapy or who present outside the three-hour time window reserved for the administration of intravenous tPA. Full Post - to Detail View

Headaches after Pediatric Traumatic Brain Injury

Noah Rosen, MD

More than half a million children in the United States sustain a traumatic brain injury (TBI) every year. In a recent study published by Pediatrics, researchers analyzed the prevalence of headaches three and 12 months after mild and moderate or severe TBI in children ages 5 to 17. Three months after a mild TBI, 43 percent of children reported headache, compared to 37 percent of children who had a moderate to severe TBI, and 26 percent of children in the control group. The risk of headache was highest in adolescents and in girls. The researchers concluded that the response to and recovery from TBI is different for children, adolescents and adults and that between boys and girls, there is a difference in symptoms and recovery from TBI.
This study is very important for several reasons. First of all, headaches in adolescents and teenagers are often ignored by parents and teachers until it has progressed to the point of disability. This study suggests early awareness and intervention. Secondly, headache disorders during this developmental period can have long term effects because teenagers can miss fundamental information in school that they will have difficulty catching up later. Lastly, undiagnosed post traumatic headache may increase risk for further damage if the teenager continues to play sports without addressing the issue.
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