Does Acupuncture Work?

In my opinion and according to a review published in Headache Currents, March 2015, acupuncture is all placebo. The classic study was based in the United Kingdom and was performed in 2005 and consisted of a large number of migraine patients. The study was of high quality, randomized, and controlled. The 3 groups were as follows: Those who received real acupuncture, then sham acupuncture, and the third group was patients waiting to be entered into the trial. The sham and real acupuncture group both improved equally. The patients on the waiting list did not. Sham acupuncture involved needling, not acupuncture sites. This study has been replicated many times.

Jack Florin, MD
Neurologist

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Can We Prevent Caregiver Stress?

A study in Neurology, March 31, 2015, refers to other studies that indicate stroke caregivers are also at risk for poor health outcomes (like stroke) and may benefit from primary prevention strategies. Most importantly, restrictions in social and leisure activities are associated with increased risk of depression among the chronically ill and their caregivers. These activities provide caregivers with opportunities to experience positive emotions that are essential to personal resilience. Caregivers who can maintain positive emotions may thus retain more resilience in their caregiving role. A major goal is thus finding ways to help caregivers participate in these activities, promote the caregivers’ wellbeing, and in turn facilitate stroke survivor adjustment.

Jack Florin, MD
Neurologist

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Can We Predict Alzheimer’s?

A new PET Scan, utilizing an isotope that shows deposition of amyloid in the brain, has been approved by the FDA. Unfortunately, it is not covered by Medicare, and patients must pay “cash.” In a recent clinical trial, presented at an Alzheimer’s conference, patients with mild cognitive impairment who tested positive on the scan were 5 times more likely to convert to Alzheimer’s dementia within 3 years than patients who were amyloid-negative. Keep in mind that up to one-third of patients over the age of 65 who have no cognitive symptoms or deficits test positive for amyloid. If, however, the patient tests negative, Alzheimer’s can be ruled out as the cause, and the focus should be on finding other conditions which may be more easily treatable. Early diagnosis is better in that patients and families can be counseled for estate planning, end-of-life issues, advance directives, powers of attorney while the patient is competent to make decisions.

Jack Florin, MD
Neurologist

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What Is Mindfulness?

It is a supposedly transformative discipline with a 2500-year history. It started in the shade of a tree in India, in the fifth century BC, where Siddhartha is said to have reached enlightenment. Until recently, mindfulness was a term confined to Buddhist texts and meditation retreats. Recently, for the increasing burdens of stress, depression, and anxiety, mindfulness has morphed into a healthcare intervention. It is based on the belief that paying more attention to the present moment – your own thoughts and feelings, and to the world around you – can improve your mental wellbeing.

Apps and web courses on mindfulness proliferate. Dr Jon Kabat-Zinn, in 1979, started a medication-based program for stress and chronic pain at the University of Massachusetts Medical School. It was a widely used 8-week intervention with techniques such as mindfulness of breathing and walking meditation. This has led to Mindfulness-Based Cognitive Therapy for depression and Mindfulness-Based Relapse Prevention for addictive behaviors.

Mindfulness is not a single entity but rather several practices leading to a mental state. But does it really work? Many studies have been done, and none are convincing. Scientific knowledge is scant. Its goal is to help people to “decenter” from disruptive inner experiences and to see thinking as thinking rather than something that drives behavior. When the gap between stimulus and reaction is extended, people can become more in control of how and if they do react.

Jack Florin, MD
Neurologist

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Should You Take Statins If You Have Secondary Progressive MS?

No drug has been proven to modify the course of secondary progressive MS despite many studies. Further, it is not clear if there is continued inflammation in the brain in patients with secondary progressive MS. Research is now focusing on neuroprotective agents. Simvastatin (Zocor) was shown in clinical trials years ago to have measurable beneficial effects on MRI in MS patients. Another study showed that it may block the therapeutic effect of beta interferon. Now a new study showed that simvastatin could reduce brain atrophy in secondary progressive MS. No study has shown a consistent beneficial clinical effect. So, don’t take 80 mg of Zocor with the hope that it will improve the course of secondary progressive MS unless you need that dose to treat elevated cholesterol.

There are other potential neuroprotective drugs in the pipeline, including a monoclonal antibody termed anti-LINGO-1 that may promote remyelination. There are several other similar medications. They are all early in development and will not be available for at least 5 years.

Jack Florin, MD
Neurologist

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Over-The-Counter Sleeping Aids Can Increase the Risk of Dementia

This was the conclusion of a study published in the January 26, 2015, edition of JAMA Internal Medicine. Elderly patients with no signs of dementia who were taking allergy and sleep aids such as Benadryl or Nytol, older antidepressants, and bladder medications such as oxybutynin for more than 3 years were found to have an increased risk over the follow-up of about 7 years. Patients using the highest doses showed an increased risk of dementia of 54% compared to no use, and the risk of Alzheimer’s alone was raised by 63%.

There are limitations to this study. These medications may have no significant impact on people under 60. For people who have early but undiagnosed dementia, these drugs probably unmask the symptoms. They do so because they reduce acetylcholine in the brain, and the reduction of that neurotransmitter is an important reason for cognitive symptoms with Alzheimer’s.

The take-away message is to use these drugs sparingly, and older patients may be especially vulnerable.

For more information, see Neurology Today, March 5, 2015.

Jack Florin, MD
Neurologist

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