Stem Cell Therapy in MS

Early studies of use of stem cells in MS required that patients be exposed to high doses of multiple chemotherapy drugs to wipe out their immune systems and then be reinfused with their own stem cells. One in 2 patients died in the first studies, and mortality remained no better than 1 in 10 in later studies.

Current research does not require patients be treated with chemotherapy drugs. Rather, “autologous” stem cells (the patient’s own) are now used. These must be obtained from the bone marrow, not the blood, and then be purified and expanded out of the patient’s body. In one recent study, they are infused intravenously. In another study, they are infused intrathecally (that is, using a spinal tap). These studies have shown good safety, but it is too early to know if there is a sustained clinical benefit.

Patients should be very careful of centers in California and in Mexico that, in my opinion, are scamming vulnerable MS patients. The patient’s own blood is drawn, and following very limited processing, it is reinfused. There is no scientific basis for this method, nor has it ever been shown to help.

Dr. Jack Florin, MD
Neurologist

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Potassium Can Reduce Stroke Risk

A study reported in the journal Stroke involved over 90,000 postmenopausal women for an average of 11 years. Results were that postmenopausal women who eat foods higher in potassium are less likely to have strokes and die from them than women who eat less potassium-rich food. Percentages of reduced risk vary from 12 to 27 depending upon the amount of potassium and associated disorder such as hypertension. Excessively high levels of potassium in the blood have serious risks, especially with kidney disease, and these patients should be carefully monitored.

Dr. Jack Florin, MD
Neurologist

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Can Hyperbaric Oxygen Help Concussions?

A new study, recently published in JAMA Internal Medicine, says that it does not. US servicemen with persistent symptoms of concussion entered the study. There were 3 groups. One underwent hyperbaric oxygen, 40 sessions; the second underwent sham treatment; and the third standard care. The first 2 groups did better than the third. The researchers concluded that hyperbaric oxygen treatment does not work but the ritual of intervention does.

Hyperbaric oxygen is approved by the FDA for decompression illness in scuba divers, carbon monoxide poisoning, and certain soft tissue infections. There are many off-label uses, which are not covered by insurance, at a cost of $200 to $400 each session, and the FDA and medical experts warn consumers about these unproven claims.

Dr. Jack Florin, MD
Neurologist

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Brain Structure and Personality

A study published in 2012 in the Proceedings of the Royal Society identified a number of cortical areas associated with how many friends people had on Facebook. Lonely people have changes in different areas in the brain. In both groups, the changes were in the left half of the brain.

A new study published in 2014 in PLoS Biology used the same hypothesis in monkeys. They studied social status, identifying dominant versus subordinate animals. The dominant animal made choices that benefited both themselves and others as opposed to choices that would only reward the individual. Further, subordinate animals paid attention to social cues provided by animals of any social rank, whereas dominant animals only paid attention to cues provided by other dominant animals. The researchers were also able to identify grey matter regions that were larger in more dominant animals and different structures that were larger in subordinate animals.

Using nonhuman primates, various kinds of therapies can be tested, such as noninvasive brain stimulation or medications.

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Dr. Jack Florin
Neurologist
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Alzheimer’s Disease And Neuroticism

As dementia is expected to increase dramatically with global aging, risk and protective factors are being studied. Extrinsic risk factors include lower educational level, vascular risk factors, and head trauma. Intrinsic factors are mainly family history and genetic disorders. Another intrinsic factor recently studied is personality. One element of personality is termed dispositional traits. They may influence the risk of dementia by affecting behavior, lifestyle, or reactions to stress. Studies show that neuroticism is associated with cognitive decline and dementia. Other risk factors are longstanding distress and psychosocial stressors in midlife.

A new study, published in Neurology, sheds more light on these issues. It involved 153 women with a 38-year followup. There is a neuroticism scale that assesses emotional reactivity, anxiety, psychosomatic concerns, ego-strength, and guilt proneness. The flip side is the extraversion scale, which assesses sociability and positive affect. They found that the combination of low extraversion / high neuroticism had the highest risk of Alzheimer’s, whereas the combination of low neuroticism / high extraversion had a lower risk.

Possible explanations: People with low neuroticism may have a healthier lifestyle and less inflammatory risk profiles; high levels of glucocorticoid (stress) hormones may cause damage to areas of the brain important in learning, cognition, and memory; and low neuroticism has been found to be associated with higher levels of a beneficial compound termed serum brain-derived neurotrophic factor.

Dr. Jack Florin, MD
Neurologist

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A Brave New World

Check out an article in Neurology Today, October 16, 2014, titled, “On the Hunt for Neuroprosthetics to Enhance Memory”. A governmental defense agency has awarded grants of $40 million to UCLA and University of Pennsylvania to develop implantable neuroprosthetic devices, mainly for military personnel who have been diagnosed with traumatic brain injury. Preliminary research has shown that deep brain stimulation can enhance memory in patients with mild Alzheimer’s and can treat severe depression. Also, a study at UCLA involved epilepsy patients who were receiving deep brain stimulation, and their memory was enhanced when the electrodes stimulated a certain area of the brain. Also, transcranial magnetic stimulation improved memory scores by up to 25% in healthy volunteers. The magnets were directed at a structure near the hippocampus, but it is not known how long the improvement in memory with magnetic stimulation lasts.

The new devices will be designed in collaboration with scientists at the Lawrence Livermore Laboratory to build a device 10 times smaller and much more powerful than existing ones. That device will then be implanted in the brain. It will be many years before this would be ready to help injured veterans.

There are obvious ethical concerns, mainly that manipulation of brain networks could be used as a form of mind control. Last year, scientists at MIT were able to stimulate the hippocampus of a mouse and trick it into thinking it was receiving foot shocks when there were none. Careful guidelines are needed, and the authors of the article state, “This is uncharted territory.”

Dr. Jack Florin
Neurologist
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