Analgesia, Another Neurologic Benefit of Video Gaming.

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I still remember the dread of taking my son to the dentist for his first filling, my mind full of flashbacks to the torment of my own childhood dental visits.

Imagine my surprise, when I was called back to pick him up only to find him sitting smiling in the dentist’s chair.

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“Oh, he played video games the whole time” was the explanation I got for his calmness.

Well, now there is medical research that confirms what my son’s pediatric dentist knew >10 years ago, that playing video games can be more analgesic that taking pain medications.

Controlled experiments have consistently shown subjects who are distracted in a virtual reality world, such as a three-dimensional skiing adventure computer game, report less pain than their counterparts using drug-based pain therapy.

Burn doctors in Seattle have use a specially designed virtual reality video game, SnowWorld, where patients concentrate on throwing snowballs at penguins and mastodons to the music of Paul Simon, instead of focusing on the painful wound care happening at the same time.

Click here to watch a video news clip about how this project was used to help a young war veteran’s endure burn treatments.

The Children’s National Medical Center in Washington, D.C., has a new pain care program that utilizes specially designed video games with motion to help distract the kids from their pain and target their bodies the same way a physical therapy session would. Doctors and physical therapists can monitor how the kids are doing and adjust their treatment program accordingly in real-time.

What’s next?
surgery video games

Find out more here.

A new kind of stem cell treatment for Parkinson’s Disease?

ParkinsonsResearch

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First, what is Parkinson’s Disease?

Parkinson’s disease (PD) is a degenerative disorder of the central nervous system, characterized by the death of dopamine-generating cells in the substantia nigra, leading to neurologic symptoms including tremor, rigidity, slowness of movement and difficulty with walking.  Traditionally a clinical diagnosis, uncertain cases can now be more readily confirmed using a DaTscan.

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Early PD, showing L>R rest tremor, awkward movement of the L hand, rest tremor walking, and increased tone in the L arm:

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More advanced PD, showing stooped posture, rest tremor, slow hesitant gait and difficulty turning, and poor postural reflexes (risk of falls).

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How is it usually treated?

Modern treatments are effective at managing the early motor symptoms of the disease, by:

1. Taking extra dopamine, in the form of the precursor drug L-Dopa,

2. Taking MAO-B or COMT inhibitors, which inhibit the breakdown of dopamine, or

3.  Taking synthetic dopamine agonist drugs, which bypass dopamine, and bind directly to the dopamine receptors.

Patient with moderately severe PD, fist untreated (left panel), then after taking L-Dopa medication (right panel).

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Then what happens?

Unfortunately, as the disease progresses, patients develop motor complications characterized by involuntary movements called dyskinesias and fluctuations in the response to medication.  As this occurs, PD patients a can change from phases with good response to medication and few symptoms (“on” state, center panel in video below), to phases with no response to medication and significant motor symptoms (“off” state, left panel in video below), then to dyskinesias (right panel in video below).  It becomes harder and harder to keep the patient “on” (middle panel) with medical treatment.

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What about surgery for PD?

Deep brain stimulation (DBS) surgery to implant a medical device called a brain pacemaker in to the subthalamanic nucleus or globus pallidus can still be an option for PD patients with significant motor fluctuations, as long as they do not have dementia.

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So, we still need more treatment options! What about stem cells?

Current therapies do improve motor symptoms, but they become less effective with time, and do not address the non-motor features of the disease, including dementia, speech and swallowing difficulties, and the gait/balance problems.

In the hope of finding a better treatment, investigators have been trying to replace dopamine deficiency in the brains of PD patients by introducing embryonic stem cell transplants since the 1980s. Some patients improved, but results were very variable, with many patients showing no benefit, and others developing uncontrolled dyskinesias.

One of the problems is that these foreign transplanted cells are attacked by the PD patient’s immune system. There is also a concern that the implanted embryonic stem cells may undergo a transformation in the PD patient’s brain and grow into cancerous tumors.

However, there’s a brand new study about to start at the Scripps Research Institute in La Jolla California: 8 PD patients have undergone removal of small patches of their own skin, which have been turned into a new kind of stem cell that acts like embryonic stem cells, called induced pluripotent stem cells (IPS), and can then be injected back in to the brain.  The main advantage of IPS cells over embryonic stem cells is that they are less prone to rejection by the patients’ immune systems, because the transplanted cells come from the individuals themselves.

Ultimately, the hope is that implanted the stem cells will replace the degenerated cells in the patients’ brains, and start producing dopamine in a more physiologic way, treating all of the effects of PD without the side effects of oral medications.

Only time will tell if this IPS treatment is effective, or if we need some other stem cell strategy to treat PD.  We do know that a lot of PD patients and their families and friends are waiting with baited breath.

Find out more about the IPS for PD study here.

Find out more about stem cell therapy for PD from the Michael J. Fox Foundation.

Expensive Drugs Could Bankrupt Medicare!

Conceptual photo  illustrating expensive drugs and medicines

The United States spent about $98 billion on pharmaceuticals in 2006. This is despite 10% less drug use than other countries.  The problem is that our drugs, on the whole, cost about 50% more than other countries, 77% more for brand name medications.

Take the Lilly drug Cymbalta, for example – the average cost for a 1-month supply in the USA is $176, compared to $113 in Canada and $47 in France:

Think that’s expensive?  Sanofi will soon launch Lemtrada (alemtuzumab), an M.S. treatment that costs $60,000 per year. It will compete against Gilenya from Novartis, which is already on the market at $40,000 per year.

Why?  Some say that it’s because we’re wealthier and need to subsidize for the rest of the world. But even if we paid more based on our relative wealth, it would come to about a 30% premium, not the 77% we do pay. Some say that it’s because we in the US subsidize the massive research and development for drugs. But the entire bill for R&D for the pharmaceutical industry was less than $50 billion in 2006, far less than the “extra” we paid for drugs.  Some say it’s because we are subsidizing massive marketing in the US, which might be upwards of $40 billion in 2006. Again, far less than the “extra” amount.

Critics of pharmaceutical companies point out that only a small portion of the drug companies’ expenditures are used for research and development, with the majority of their money being spent in the areas of marketing and administration. The pharmaceutical industry has thousands of Washington lobbyists to protect their interests, and actually spent $855 million, more than any other industry, on lobbying activities from 1998 to 2006.

Prescription drug prices have become a real political issue in the United States.

Many third party payers can negotiate lower prices to control their low costs, but this causes pharmaceutical companies to raise their retail prices to offset costs.

Using a mail order pharmacy for a 3-month drug supply can save as much as a 29% in out-of-pocket costs and 18% in total prescription costs.

To save even more money, 10 million U.S. citizens bring in medications across land borders from Canada and Mexico each year.  Other patients shop on-line at lower cost overseas pharmacies, and an additional 2 million packages of medications arrive annually by international mail from Thailand, India, South Africa every year.