Bringing the ER to the stroke patient!

mobile stroke

We are trying to do a better job educating our patients about the warning signs of stroke, and that if they think they might be having a stroke they should act FAST and call 911 to get to the ER as soon as possible.

Stroke

However, despite these efforts only 5% of US stroke patients get to the ER in time to receive clot busting therapy to treat their stroke.  Furthermore, the quicker the drug is given, the better the outcome, TIME IS BRAIN!

time is brain

We would like to see patients getting treated within one hour of the onset of their stroke, but because of the time it takes to get to the hospital and get evaluated in the ER this is rarely possible.

A pilot study in Texas is looking at getting stroke therapy administered faster by bringing the ER to the stroke patient.

mobile stroke

The project brings a mobile CT scanner and a stroke neurologist (via telemedicine) to the patient in a specially equipped ambulance.  The investigators hope to see stroke patients getting treated faster and improved outcomes.

Advertisements

Gene therapy trial for Duchenne Muscular Dystrophy

dmd

Duchenne and Becker muscular dystrophy are both caused by mutations in the same dystrophin gene.

How it this possible?

Well, the genetic code which is translated to from proteins “talks” in words made of three letters (base pairs).

dmd dna

A gene mutation that deletes only one or two base pairs, or worse still signals the end of the word (known a “premature stop codon”) will result it a very abnormal dysfunctional gene product, leading to complete deficiency of functioning dystrophin, and the more severe Duchenne Muscular Dystrophy.

dmd muscle bx

Normal muscle bx (a) vs Duchenne muscular dystrophy (b) with complete absence of dystrophin (d)

However a gene mutation (deletion) that removes base pairs in a multiples of three is called an in-frame mutation, and causes a (sometimes only minor) qualitative change in the dystrophin protein, leading to the milder Becker’s muscular dystrophy.

Ataluren (also known as PTC124) is a small molecule designed to overcome premature stop codons.

alturen

Put simply, the idea is that it might convert some Duchenne boys in to a milder form (more like Becker’s) of muscular dystrophy by allowing them to produce some more normal dystrophin.

The drug can only help boys affected with premature stop codons confirmed by DNA testing.

The drug is currently undergoing Phase III trialsClick here for more information.

Sleep Apnea Treatment Improves Golf Performance!

 

A new study suggests treating obstructive sleep apnea with continuous positive airway pressure, or CPAP therapy, improves golf performance in middle-aged men.

 

CPAP
 
Up to six months of CPAP treatment was associated with significant improvements in excessive daytime sleepiness.
5-tips-for-fighting-jet-lag-4

CPAP patients also experienced better quality of life and an 11% drop in their average handicap index.

Among the more skilled golfers with baseline handicaps of 12 or less, the average handicap dropped by 31%.

Patients attributed their enhanced performance to improved concentration, endurance and decision making.

Click here to take an on-line test to see if you might have a sleep disoder.

Click here to find out more about sleep disorders in general.

And find out more about the Comprehensive Sleep Medicine Program at Monmouth Neuroscience Institute.

Petadolex for Migraine Prophylaxis: The Facts

index

Posted by Sonia Jasuja, MSIV Drexel University College of Medicine

As a current student of traditional Western Medicine, I have been trained to turn towards modern pharmacology and away from natural remedies, for the most part.  However, as someone who has suffered from severe skin allergies all my life, I know how desperate patients can get in order to find something that really works! When Western Medicine fails us, where can we turn?

During my clinical Neurology rotation at Monmouth Medical Center, I saw another issue that plagues patients: Migraine.  While there have been great advances in the prevention and treatment of migraine, some patients are still left with debilitating pain. It was during this rotation that I first heard about Petadolex, or Petasites hybridus (aka Butterbur).

What is it? Butterber is an herbal plant that has been used for medicinal purposes, including migraine and headache, allergies, asthma, and many more. Most herbal remedies use the root extract in the form of a pill. It has properties that relieve spasms and decrease inflammation.1

Is it safe? Yes- studies have determined that Petasites is safe to use for the prophylaxis of migraine. The dose that was cited to have moderate efficacy is 150mg daily.2

Side effects are very mild and include burping, stomach upset, diarrhea, fatigue and itching.3

One important thing to keep in mind- make sure to only buy Petasites hybridus that is certified and labeled, “PA free”. “PA” stands for pyrrolizidine alkaloids, which cause adverse effects in the liver, lungs and circulatory system. PA’s can cause cancer.3

You should not take Petasites if you are pregnant or breast-feeding, have liver disease, or if you are allergic to ragweed, marigolds, daisies or other related herbs. 3

Does it work? Probably, but we still need more information! In 2006, Agosti et al. published “Effectiveness of Petasites hybridus preparations in the prophylaxis of migraine: A systematic review”. Of the two studies that were looked at, the systematic review showed that there is only moderate evidence for the effectiveness of Petasites at the dose of 150mg/day for a period of 3-4 months. The review also thoughtfully pointed out that confounding factors still need to be accounted for. These factors would include things like which migraine treatments have been successful or unsuccessful in the past, and any use of addictive or hormonal substances, such as nicotine or estrogens.2

The review article states that the overall effect size of the 150mg extract dose is approximately 15% percent lower migraine frequency rate per month compared to placebo.2

The bottom line.  If you have frequent or debilitating headaches, you should see you doctor for an evaluation.  You may need some diagnostic testing, and there are probably some very effective conventional medications you can try.  However, if you are still having frequent headaches despite that, Petasites might be worth a try.

REFERENCES

1. Brind’Amour, Katie. “Migraine Herbal Home Remedies From Around the World.”Healthlines RSS News. Healtline Editorial Team, 16 Apr. 2013. Web. 16 Nov. 2013.

2. R. Agosti, R.K. Duke, J.E. Chrubasik, S. Chrubasik, Effectiveness of Petasites hybridus preparations in the prophylaxis of migraine: A systematic review, Phytomedicine, Volume 13, Issues 9–10, 24 November 2006, Pages 743-746, ISSN 0944-7113, http://dx.doi.org/10.1016/j.phymed.2006.02.008.

3. “Butterbur Information | Evidenced-Based Supplement Guide.” MedicineNet. MedicineNet.com, n.d. Web. 16 Nov. 2013.

VBP-15 for Duchenne Muscular Dystrophy

Prednisone has been used since the 1970s for delaying the otherwise obligatory progressive motor deterioration seen in  Duchenne Muscular Dystrophy (DMD.

A good deal of data has been acquired over the years.  In fact there are even ongoing studies looking at different dosing regimens.

The drug is typically started between ages 4-6 at a dose of 0.75 mg/Kg.  However, steroid cause may side effects to Duchenne boys, including weight gain and behavioral problems.

How does it work?  We’re not sure, but we think the medication stabilizes muscle membranes and inhibiting cytotoxic T-cells.

Side effects are mediated by binding sites in the cell nucleus which lead to initiation of metabolic pathways :
NM2

The new drug VBP-15 is molecularity very similar to Prednisone, but lacks the 11 beta hydroxy arm, which reduces the metabolic side effects, without affecting the beneficial membrane stabilizing effects:

nm3

VBP-15 has been shown to improve muscle strength and function in an animal model of DMD without the metabolic side effects of Prednisone:

nm4

Clinical trials in humans are expected to begin in 2013-14.

Watch this space for more information.

Brain-to-Brain Interfacing: Next Step… Mind Control

Post written by Anne Verlangieri, MS IV at Drexel University College of Medicine, Class of 2014

Obi

Step aside Obi-Wan Kenobi, this is not the mind control you’re looking for. A recent study conducted by researchers at Harvard University has demonstrated a method for non-invasive, functional linkage of brain activity from human volunteers and Sprague-Dawley rats. The method, dubbed brain-to-brain interface (BBI), utilizes electroencephalographic steady-state-visual-evoked potentials (SSVEP) and transcranial focused ultrasound (FUS). The goal of the process is to allow human volunteers to use visual stimuli to elicit motor responses from the tail’s of rats. To understand how BBI works, we’ll need some background on the SSVEP and FUS segments.

SSVEP

Numerous neurophysiological studies have shown that there is increased neural activity elicited by a visual stimulus with directed attention. In other words, observer attention on a specific visual stimuli is more important that the stimulus itself, in producing measurable spikes in neural activity. SSVEP utilizes EEG based brain-to-computer interfacing (BCI), to take advantage of this idea. In practice, a human volunteer is equipped with an EEG and instructed to gaze on a designated visual stimulus. The EEG reads the pre-synchronized neural activity, linking the volunteer’s brain with an SSVEP computer.

FUS

Transcanial focused ultrasound has been used clinically as a non-invasive therapy for certain brain disorders, (ex. Deep brain stimulation in Parkinson’s Disease) as well as thermal ablation of brain tumors. This technology allows for region-specific brain stimulation, and when set at low acoustic energy, has been shown to excite or suppress rabbit motor/visual cortices; effectively creating a computer-to-brain interface (CBI).

How BBI works

study
(Figure 1. The schematics of the implemented brain-to-brain interface (BBI). The implementation consists of steady-state visual evoked potential (SSVEP)-based brain-to-computer interface (BCI: on the left column) and focused ultrasound (FUS)-based computer-to-brain interface (CBI) segments (on the right column). [doi:10.1371/journal.pone.0060410.g001]

The set-up shown in figure 1, demonstrates how SSVEP and FUS are utilized to link the human volunteer and with the rat’s brain. The volunteer is instructed to look at a specific visual target, creating an increase in EEG bandwidth corresponding to that specific visual stimulation frequency. A SSVEP detector reads the increase in EEG bandwidth and triggers the activation’s of the FUS, which stimulates specific motor area’s of the rats brain, resulting in a twitch in the rat’s tail. Here’s the experiment in action:

What can we do with this technology?

Certainly, the possible applications of BBI are far reaching. The studies authors proposed that this technology could one day be used for indirect sensory/somatomotor communication allowing an increased degree of understanding during verbal communications between speaker and listener.
Other’s have suggested “Hive mind” like problem solving, via a linked think-tank. And of course there is the potential for further human-to-animal interaction; pet owners would jump at the chance to know just what Fido is thinking.
Another recent study used this technology for one student to control another student playing a video game at a remote location.
Regardless of the application, it will be important to look at the legal, ethical, and privacy concerns involving technology that has the potential to transmit thought from one individual to another. The study is free to download and read here.

New Brain Tumor Study at Monmouth Medical Center

ZocchiCenter

The David S. Zocchi Brain Tumor Center at Monmouth Medical Center is a research site for the ACT IV study – an international clinical trial evaluating the effects of adding an investigational vaccine to standard treatment in patients with glioblastoma, the most commonly diagnosed cancerous brain tumor.

Approximately one-third of patients with glioblastoma express a particular genetic mutation – the Epidermal Growth Factor Receptor protein variant III (EGFRvIII) – which is linked to increased tumor cell growth.  Rindopepimut  is an experimental cancer vaccine that may act to promote anti-cancer effects in patients who have tumors that express this EGFRvIII protein.

Sumul N. Raval, M.D., is the medical director of the Brain Tumor Center and primary investigator for the study at Monmouth Medical Center. “The ACT IV study, evaluates the survival rate, time to disease progression, and quality of life among patients with this genetic mutation (EGFRvIII) when the investigational vaccine rindopepimut is added to standard chemotherapy treatment ” said Dr. Raval.

The study is open to adults with newly diagnosed EGFRvIII-positive glioblastoma. Potential participants will undergo a screening phase, during which tumor tissue is tested for EGFRvIII. Other tests, including brain MRIs, physicals, blood tests, among others, will also be performed to determine eligibility.

Once a patient is accepted into the study, he or she will undergo one of two treatment regimens – both of which include injections of the standard course of chemotherapy treatment, temozolomide. One regimen will add injections of rindopepimut – the vaccine under evaluation – combined with a low dose of GM-CSF to “activate” the immune system. The other regimen will add injections of Keyhole Limpet Hemocyanin – the control injection. Study participants have an equal chance of receiving either treatment regimen, and neither the patient nor the doctor will know which treatment the patient is receiving.

During treatment, patients will be closely monitored and will be asked to visit the clinic site several times per month for standard medical tests, including blood tests and periodic brain imaging. Participants will be contacted every month to evaluate their health and to see what additional treatments are being used to treat their glioblastoma.

Participation in the ACT IV study is voluntary and may last up to five years or longer. Patients should discuss the study and other possible treatment options with their doctor, family and friends before deciding to participate. Taking part in the study may or may not improve the condition of a patient’s glioblastoma. There may be risks associated with study participation, and patients should discuss these risks with the study doctor.

To learn more about the clinical trial, visit www.GlioblastomaStudy.com. For more information on the David S. Zocchi Brain Tumor Center at Monmouth Medical Center, call 1-877-577-9800.