Can We Solve The Mystery Of Progressive MS?

Primary Progressive MS
Primary Progressive MS

We have more and more powerful drugs to treat relapsing-onset MS. Studies have shown that proper therapy early in the course reduces the risk of long-term disability and probably the chance of “converting” to progressive MS. Yet, despite therapy, some patients appear “destined” to have a progressive course later in the disease. At that point, disease-modifying drugs are less effective. This leads to the controversy of whether MS is an “inside-out” or “outside-in” disease. Most experts favor the outside-in theory, which postulates that neuroinflammation happens first and neurodegeneration follows. Recent studies seem to support this hypothesis. Utilizing a 7-Tesla MRI, inflammatory activity is more prominent in the gray matter of progressive as compared to relapsing MS patients.

A new study presented at the ACTRIMS 2016 Forum reported that infiltrates of B-cells in the meninges may be the main source of inflammatory or cytotoxic molecules released into the cerebrospinal fluid, causing cortical tissue injury in progressive MS. If this is true, measuring levels in the cerebrospinal fluid of these B-cell infiltrates may help in stratifying patients who have early or are at risk for progressive MS, and this in term might lead to using increasingly effective drugs.

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About Our Center:
Fullerton Neurology and Headache Center is a state-of-the-art medical office, strategically located near St Jude Medical Center, providing comprehensive neurological care. It is fitted with larger exam rooms and an infusion suite, furnished with new equipment and furniture and designed to be to easily accessible.

Why Do African-Americans Distrust Medical Research?

African-Americans and Alzheimer's Desease Risk.
African-Americans and Alzheimer’s Desease Risk.

Even though African-Americans have a higher risk of developing Alzheimer’s compared to Caucasians, they join research studies in much smaller numbers.

The Wisconsin Registry for Alzheimer’s Prevention is trying to overcome the distrust. It has an ongoing study, beginning in 2001, and 1500 people have been recruited, and the study will last for 15 to 20 years. By 2008, only 7 African-American participants were in the study. Recently, that number has increased to 122.

To me, the reluctance and mistrust are understandable. Especially shocking and callous was the Tuskegee Study, which lasted decades. It enrolled African-American men diagnosed with syphilis. Initially, there was no effective treatment, but the researchers, after effective medication was found, deliberately withheld it.

Another example is detailed in the book “The Immortal Life of Henrietta Lacks.” She was a 31-year-old African-American mother of 5 who died of cervical cancer in 1951. Before her death, a physician at Johns Hopkins gave a slice of her tumor to another researcher who was trying to find human cells living outside the body. This technique is termed cell culture. The cells indeed grew and are named HeLa cells. They have been used for many years. They are commercialized and have generated millions of dollars in profits. They were used by Jonas Salk to develop the polio vaccine. The Lacks family was unaware that this had occurred until the mid-1970s. They have received no compensation.

See the Sunday, March 27, 2016, Los Angeles Times, article by Crocker Stephenson.

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Epilepsy and Driving

Epilepsy and Driving
Epilepsy and Driving

In California, physicians must, by law, report patients with epilepsy to the DMV. Patients need to be reported only at diagnosis and not if they have subsequent seizures. The reasoning should be obvious. Patients otherwise would never inform their physicians of a seizure. The DMV will usually allow patients to drive after being seizure-free for 3 months, occasionally 6 months, and are more willing to do so if the patient is taking an antiepileptic drug.

A separate issue is what to do when patients have been seizure-free and are tapering their medications. According to a study presented at the 69th Annual Meeting of the American Epilepsy Society, epileptologists were asked what their routine practice was. About half advised no driving at all during the 3 to 6 months after tapering is complete and patients are off therapy. During the first year of withdrawal, patients with epilepsy overall have a seizure risk of 15%. If the patient drove 30 minutes per day, the average seizure rate would be about 0.3% for that year. Further, most of the responding physicians found that recommending that a patient restrict or minimize driving often results in their decision to remain on treatment.

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Can A Woman Be Too Thin Or Too Rich?

Anorexia of aging
Anorexia of aging

So, Can really s woman be too thin or too rich? According to the Duchess of Windsor, certainly not too rich but maybe too thin.

A new study found that weight loss between midlife and late life may be a maker for mild cognitive impairment. These ages are defined as between 40 and 65. The study was from the Mayo Clinic Study of Aging, which included 10,000 people. It found that a weight loss of about 10 pounds per decade led to a 24% increase in risk of mild cognitive impairment. The findings were consistent whether the participants were underweight, normal weight, overweight, or obese at enrollment. Effects seemed greater in men than women.

Findings do not necessarily indicate causality. They are several possible reasons, according to the researchers. One is that the weight loss could result from the “anorexia of aging,” which is presumed to be caused by dysfunctional production of certain hormones. Secondly, symptoms such as depression and apathy, which may predict cognitive impairment, may also contribute to decreased appetite and weight loss. Thirdly, neuropathological changes may cause both weight loss and cognitive impairment. For example, impairment in smell and changes in taste, seen in several disorders, may result in decreased appetite and weight loss.

See JAMA Neurology, February 2016.

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