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Monthly Archives: September 2016

Surgery Effective for Tough-to-Treat Epilepsy

Surgery can significantly improve seizure control and quality of life among people with epilepsy, according to a study stretching over 26 years.

“This study may be the longest follow-up of epilepsy surgery patients in that it spans three decades, during which there were several eras of neuroimaging [brain-scanning] techniques,” said Dr. Cynthia Harden, chief of the division of epilepsy and electroencephalography at the Cushing Neuroscience Institute, part of North Shore-LIJ Health System in Great Neck, N.Y. She was not involved in the study.

The research team, led by Dr. Matthew Smyth with Washington University School of Medicine in St. Louis, argued that the findings could have an impact on the way the disease is treated.

As reported Feb. 7 in the journal Epilepsia, they followed 361 patients who had epilepsy surgery over the course of 26 years to determine how the operation affected their condition.

Although drug therapy remains the primary treatment option for people with epilepsy, the study’s authors found that surgery stopped 48 percent of the patients from having seizures and improved the quality of life of 80 percent of those studied.

“In cases where medical [drug] therapy fails to control seizures, epilepsy surgery is a safe and effective treatment option,” explained Smyth in a journal news release. “Despite the increase in the number of epilepsy surgeries performed, and reports in the medical literature of the success of surgery relative to medication, it remains an underutilized therapy for seizure control.”

Smyth’s team noted that surgical complications and death following epilepsy surgery decreased over the course of the study.

“Our findings demonstrate that the benefits of epilepsy surgery are sustained over long time periods,” Smyth concluded. “Increased use of surgical intervention offers patients with epilepsy the possibility of long-term seizure control and improved quality of life.”

For her part, Harden said the new findings are valuable, but “not surprising.”

“The goal of seizure treatment is stopping the seizures, and epilepsy doctors know that the surgical treatment for epilepsy is often the most effective option,” she said. While the study’s retrospective nature “may introduce some bias … the findings are consistent in that temporal lobectomy across all decades was associated with the best patient outcomes, and this is known to be the most effective epilepsy surgery — that has not changed in the past three decades,” she added.

More Success With Gene Therapy

As a child, Tami Morehouse had vision problems. She struggled to read the blackboard at school, and homework took hours.

Yet, she made it through high school and college, and became a social worker. Although she was never able to drive, she learned to ride a bike.

But in her 30s, with three young children, her vision took a turn for the worse. “I’d be reading a book and the words faded away,” she said.

Morehouse was going blind, the result of Leber congenital amaurosis (LCA), a rare inherited eye disease that causes a progressive loss of vision. “As my kids needed me more and more, I was able to do less and less,” Morehouse said.

That changed in 2009, when she was one of 12 people to undergo an experimental treatment using gene therapy in one eye. Now, scientists report even more progress, having successfully treated the second eye of three patients, including Morehouse. The new results are published Feb. 8 in Science Translational Medicine.

LCA is caused by a faulty gene, RPE65, that fails to produce an enzyme needed by the retina, the tissue in the back of the eye that converts light images into nerve signals that get sent to the brain.

Lack of the enzyme causes toxic byproducts to build up in the retinal cells, gradually killing them.

“It’s inevitable and progressive, and people watch as they are losing more and more of their vision,” said Dr. Jean Bennett, an ophthalmology professor at University of Pennsylvania Perelman School of Medicine and co-leader of the research team that pioneered the treatment. “By the time they’re teenagers or young adults, they are severely impaired.”

The treatment involved injecting a virus genetically engineered to carry a normal version of gene RPE65 into the retinal cells.

About two weeks later, with the eyes now producing the enzyme, the patients — adults and children — saw a marked improvement in their vision.

“They all gained vision in a very meaningful way,” said Bennett, also a scientist at Children’s Hospital of Philadelphia. “Children can read books, ride their bikes to their friends’ houses — things which they never could do before.”

Initially, researchers only injected one eye because of safety concerns, Bennett explained. The fear was that the first injection would prime the immune system to recognize the virus and attack it when it was injected into the second eye. That would cause inflammation in the eye, potentially leading to more vision loss.

But animal studies showed that didn’t happen, and so they decided it was safe to try the second eye in adults.

“It’s amazing,” Morehouse said. “I just feel so different. I used to wake up in the morning, so afraid and so anxious, that I would look over at the alarm clock and see nothing.”

Prior to the treatments, she could see light and dark, but most of the world was hazy and gray. By night time, when her eyes were tired, she could see very little.

Today, her vision is still significantly impaired. She needs help finding her way to a table in a restaurant, for example, and reading isn’t really possible. Yet, she can tell when someone is approaching, and she can make out a smile.

“Seeing my daughter walk across the basketball court. Seeing my son step up to the plate when he’s playing ball — it’s phenomenal,” Morehouse said.

Researchers verified that patients could see more by performing functional MRI scans before and after the second eye treatment. The brain imaging showed much more response to visual stimuli after their second eye was done.

At 47, Morehouse was the oldest patient. The prior study taught researchers that children improved the most, probably because their retinal cells had suffered less damage.

Now that researchers have established the procedure is safe in adults, they’ve started using gene therapy on the second eyes of children with the condition, Bennett said.

Though more research needs to be done and there are “technical” issues to be overcome, “we want to be able to use this approach in developing similar treatments for other more common blinding diseases,” she said.

Omega-3 Fatty Acids Can Protect The Aging Brain

Middle-aged and elderly adults who regularly eat foods rich in omega-3 fatty acids may slow the mental decline that leads to dementia, according to a new study.

Researchers found that people with the highest blood levels of these essential fatty acids — found in fish such as salmon and tuna — were more likely to perform well on tests of mental functioning and to experience less age-related brain shrinkage.

“We feel fatty acid consumption exerts a beneficial effect on brain aging by promoting vascular health,” said study lead author Dr. Zaldy Tan, an associate professor in the Easton Center for Alzheimer’s Disease Research and the division of geriatrics at the University of California, Los Angeles. This might include reducing blood pressure and inflammation, he added.

Previous research linked dementia risk with the amount of omega-3 fatty acids in blood plasma, which reflects how much people had eaten in the past few days. But in the current work, researchers could estimate the amount of omega-3s that participants had consumed in the past several months by looking at how much had built up in their red blood cells.

“This represents their average intake of fatty acids, not just a snapshot,” Tan said.

The study, published in the Feb. 28 issue of the journal Neurology, did not prove that omega-3 fatty acids prevent mental decline, merely that there may be an association between consumption of fatty acids and brain health.

For the study, researchers measured the red blood cell level of fatty acids in 1,575 dementia-free people whose average age was 67. About three months later, participants underwent mental-functioning tests and MRI scans that examined brain size and blood supply in the brain.

The participants were in the Framingham Offspring Study, which is predominately white. Whether the association would apply to other ethnic and racial groups needs to be explored, the authors said.

The researchers found that those with the lowest levels of omega-3s had worse scores on tests of visual memory, attention and abstract thinking than people who ranked in the top 75 percent for fatty acid levels.

Adults in the bottom 25 percent also tended to have smaller brains overall. The decrease in brain volume was enough to make their brains appear two years older than those of people in the top three quarters for fatty acid levels.

Brain scans also showed signs of less blood supply in the brains of people with the lowest omega-3s levels. This suggests they may play a role in promoting general vascular, or blood vessel, health in the brain, similar to how they are thought to help heart health, rather than acting on just one brain area, Tan said.

The researchers took into account various health and lifestyle factors, including age, education and weight, to explore whether other differences among the people with low levels of omega-3s could help explain their more rapid brain aging.

But after controlling for those risk factors, “the difference [in brain aging] is still there so we conclude that omega-3 fatty acids likely explain them,” Tan said.

However, Tan added that it remains possible that factors they did not control for, such as fruit and vegetable consumption, are really responsible for the brain benefits. Another possibility is that the slight mental decline that the people in the older brain group were experiencing caused them to eat less healthy omega-3 rich foods, instead of vice versa.

“This is a strengthening of the argument that people with less [omega-3 fatty acids] have higher risk of dementia,” said Dr. Nikolaos Scarmeas, associate professor of neurology at Columbia University in New York City.

But questions remain over whether fatty acid levels really influence changes in brain size, Scarmeas added. A clinical trial comparing high and low intake of omega-3s in relation to brain imaging would help answer those questions, he said.

In the meantime, fish is “a good prescription for other things and we have a hint it might be helpful for the brain,” Scarmeas said.

That the current study reported a difference in brain health between people with omega-3 fatty acid levels in the bottom 25 percent and top 75 percent suggests that there is a threshold level of consumption to attain brain gains.

A previous study in which participants filled out food surveys found decreased risk of vascular brain problems among those who ate at least three servings of fish a week.

22 Ways to Relax in 5 Minutes or Less

Food and Drink

Sip Green Tea: Instead of turning purple with rage, get green with a cup of herbal tea. Green tea is a source of L-Theanine, a chemical that helps relieve anger. Boil the water, pour it out, and take a soothing sip — there’s probably still a minute to spare.

Nosh on Chocolate: A carton of chocolate ice cream is no stranger to stress relief, but just a square (about 1.4 ounces) of the sweet stuff can also calm your nerves. Dark chocolate regulates levels of the stress hormone cortisol and stabilizes metabolism.

Slurp Some Honey: Replace stress with sweetness and try a spoonful of honey. Besides being a natural skin moisturizer and antibiotic, honey also provides compounds that reduce inflammation in the brain, meaning it fights depression and anxiety.

Bite Into a Mango: Take a tropical vacation without leaving the desk chair. Use a five-minute break to peel, slice, and bite into a juicy mango, which packs a compound called linalool that helps lower stress levels. Don’t fret about the juice dripping down your chin — the stress relief is worth the mess.

Chew Gum: Minty, fruity, or bubble-gum flavor, a stick of gum is a surprisingly quick and easy way to beat stress. Just a few minutes of chewing can actually reduce anxietyand lower cortisol levels.

Munch a Crunchy Snack: Sometimes there’s nothing more satisfying than munching away on a candy bar when we’re stressed — one study found stressed adults craved crunchy and salty snacks more than usual. But that salty crunch doesn’t have to be so sugary — a handful of trail mix or a bag of celery sticks work just as well.

Inner Peace

Lay Your Head On a Cushion or Pillow: There are days when all we really need is a nice, long nap. But it’s not always possible to start snoring in the middle of the office. If you’ve got a pillow, you’re already on the road to relaxation. Try this visualization technique: Lay your head down for a few minutes and imagine the pillow is a sponge sucking up all your worries.

Meditate: No need to go on a retreat to the mountains — five minutes of peace is all it takes to reap the benefits of meditation. There’s evidence that just two quick bouts of silent meditation per day can relieve stress and depression. So find a comfortable spot in a quiet place, concentrate on your breath, and feel those anxieties start to disappear.

Remember to Breathe: Is there any simpler way to relax? Slow, deep breaths can help lower blood pressure and heart rate. For the fancy noses out there, try pranayama breathing, a yogic method that involves breathing through one nostril at a time to relieve anxiety. The technique’s supposed to work the same way as acupuncture, balancing the mind and body (and possibly eliminating the need for a tissue).

Try Progressive Relaxation: Anxious? Just squeeze, release, and repeat. Progressive relaxation involves tensing the muscles in one body part at a time to achieve a state of calm. The method (also used by actors) is a great way to help fall asleep.

Count Backward: Nope, it’s not an IQ test, but it is a way to relax. When worries arerunning rampant, try slowly counting to 10 and then back again to calm down. It’s harder to freak about an upcoming date or job interview when you’re busy remembering what number comes before seven. (Hey, kindergarten was a long time ago.)

Use Creative Visualization: The doorbell rings. It’s Ryan Gosling, and he wants to know if you’ll marry him. “Yes!” you shout and then — sorry, time’s up. These little daydreams, also known as “creative visualization,” involve thinking of something that makes us feel happy. It’s an instant mood boost on hectic days when we’re feeling tense.

Close Your Eyes: James Taylor said it: You can close your eyes, it’s all right. Take a quick break from a busy office or a chaotic household by just lowering your eyelids. It’s an easy way to regain calm and focus.

Total Body Relaxation

Give Yourself a Hand Massage: When there’s no professional masseuse in sight, try DIYing a hand massage for instant relaxation that calms a pounding heart.  Massagescan be especially helpful for people who spend a lot of time typing on a keyboard. Hands in general can carry a lot of tension. Apply some luxurious lotion and start kneading the base of the muscle under the thumb to relieve stress in the shoulders, neck, and scalp.

Try Acupressure: Pressure to meet a deadline can be stressful, but acupressure can help release all that tension. Acupressure’s a kind of touch therapy that works by balancing the circulation of fluids and energies in the body. Use the thumb and forefinger to massage the soft area between the thumb and index finger of the other hand. Dab on some lavender oil for extra relaxation.

Rub Your Feet Over a Golf Ball: Leave the clubs at home and just bring the ball. You can get an impromptu relaxing foot massage by rubbing your feet back and forth over a golf ball.

Squeeze a Stress Ball: On days when you want to strangle a coworker, your BFF, or the driver in the next lane, squeeze a stress ball instead. It’s an easy, portable, and non-violent way to relieve tension.

Drip Cold Water On Your Wrists: Pass on the perfume and go with water. When stress hits, head for the bathroom and drop some cold water on your wrists and behind your earlobes. There are major arteries right underneath the skin, so cooling these areas can help calm the whole body.

Brush Your Hair: Really, it looks like a rat’s nest. Even if you’ve already done your 100 strokes for the day, repetitive motions like running a brush through your hair can cause the body to relax.

New Environment

Be Alone: Not everyone needs a cabin the woods, but five minutes of alone time can help you collect your thoughts and clear your head.

Create a Zen Zone: Hiding in a bathroom stall might not sound calming, but do make (or find) a space that’s completely free of stress where you can go to relax. Set up a comfortable chair or light some incense and disappear there for a few minutes until the tension dissipates.

Find the Sun: Here comes the sun — and some stress relief. If it’s a sunny day, head outside for an easy way to lift your spirits. Bright light can be an effective treatment for people who suffer from depression, and can even cheer up otherwise healthy folks.