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Archive for Neuroscience/Mental Health

Depression Re-examined: A New Way to Look at an Old Puzzle

Depression affects approximately 10% of Americans. It can be fatal; I found estimates of suicide rates ranging from 2-15% of patients with major depression. When it doesn’t kill, it impairs functioning and can make life almost unbearably miserable. It is a frustrating condition because there is no lab test to diagnose it, no good explanation of its cause, and the treatments are far from ideal.

Jonathan Rottenberg is a psychologist and research scientist who began to study depression after his own recovery from a major depressive illness. He teaches psychology at the University of South Florida, where he is the director of the Mood and Emotion laboratory. He has launched the Come Out of the Dark campaign to start a better, richer national conversation about depression. In a new book The Depths: The Evolutionary Origins of the Depression Epidemic, he reviews insights from recent experiments and asks a number of difficult questions, such as why humans evolved to be subject to incapacitating depressions. He comes up with some startling hypotheses, including the idea that evolution favored depression because of its survival value and that depression is essentially a good thing. He offers his ideas as the basis of a paradigm shift. (more…)

Posted in: Book & movie reviews, Evolution, Neuroscience/Mental Health

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Hacking the Brain – A New Paradigm in Medicine

The word “paradigm” is over misused and overused, diluting its utility. Thomas Kuhn coined the term in The Structure of Scientific Revolutions to refer to an overarching explanatory system in science. Scientists, according to Kuhn, work within a paradigm during periods of “normal science,” punctuated by occasional “paradigm shifts” when the old explanatory model no longer sufficed, and a radically new explanatory system was required. The term has since come into colloquial use to mean any scientific breakthrough, which marketers quickly overused to refer to just about any new product.

I am therefore cautious about using the term, but I think it is appropriate in this case. In medicine I would consider a new paradigm to be an entirely new approach to some forms of illness. Common treatment paradigms include nutrition, physical therapy, surgery, and pharmacology. A new paradigm is emerging in my field of neurology – directly affecting brain function through electromagnetic stimulation.

The brain is a chemical organ, with many receptors for specific neurotransmitters. This has allowed us to use a pharmacological approach in treating brain disorders – using drugs that are agonists (activators) or antagonists (blockers) of various neurotransmitter receptors, or that affect the production or inactivation of the neurotransmitters themselves. There are limits to this approach, however. First, neurotransmitters are not the only factor affecting brain function. The brain is also a biological organ like any other, and so all the normal physiological factors are in play. Further, there is only so much evolved specificity to the neurotransmitters and their receptors.

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Posted in: Neuroscience/Mental Health

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Treating Pain Psychologically

One of the goals of rigorous science is to disentangle various causes so we can establish exactly where the lines of cause and effect are. In medicine this allows us to then optimize the real causes (what aspect of treatments actually work) and eliminate anything unnecessary.

Eliminating the unnecessary is more than just about efficiency – every intervention in medicine has a potential risk, so this is also about risk reduction.

It often seems to me that the goal of “alternative” medicine is to blur the lines of cause and effect, to exploit non-specific effects in order to promote a useless but profitable ritual (acupuncture comes to mind).

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Posted in: Clinical Trials, Neuroscience/Mental Health

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The Limits of Neuroplasticity

I am daily annoyed by overhyped headlines reporting medical and other science news. I think news outlets and the public would be better served if they fired all their headline writers and let the authors and editors craft headlines that actually reflect the story. Of course, often the story is overhyped as well, so this would not be a panacea to annoying science reporting.

Take this headline from The Week (please): “This pill could give your brain the learning powers of a 7-year-old“. The article discusses a recent study (full article here) looking at the effects of a drug, valproic acid, on the ability of young adult male subjects to learn pitch. It might be a good exercise for regular SBM readers to take a look at the full article now and analyze the strengths and weaknesses of the study.

The study found that those subjects taking valproic acid, which is a drug used to treat seizures, migraines, and mood disorders, did slightly better overall in learning to identify the pitch of various tones. The main limitation of the study is that it is very small – 24 participants enrolled, 18 completed. Further, they did not establish a good baseline performance, as the subjects were practicing as they went along. (more…)

Posted in: Neuroscience/Mental Health

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Vitamin E for Alzheimer’s

Recently you may have seen headlines like “Vitamin E slows decline in patients with mild Alzheimer’s” or “There’s still no cure for Alzheimer’s disease, but the latest hope for slowing its progression is already on drugstore shelves.” They were referring to an article in the January 1, 2014 issue of the Journal of the American Medical Association (JAMA) announcing the results of the TEAM-AD VA Cooperative Randomized Trial of vitamin E and memantine (Namenda) for Alzheimer’s disease (AD).

The study attracted a lot of media attention. Most of the news reports I have seen were accurate and cautious, explaining the nuances of the study rather than suggesting that everyone should run out and buy vitamin E; but I wouldn’t be surprised to learn that a lot of readers ignored the fine print and did just that. It would be interesting to track sales of vitamin E and see if there was a bump following the publicity.

We know of no treatment that will delay, prevent or cure Alzheimer’s disease, or that affects the underlying disease process. It’s a tragic, frustrating disease that takes away the very things that make us who we are: memory and personality. It is affecting more and more people as the numbers of elderly increase. Available prescription medications are only modestly effective in slowing functional decline and delaying the need for institutionalization. They are expensive, they don’t help everyone, and when they do help, they only help for a limited time. It is very exciting to think an inexpensive vitamin could help patients with mild to moderate AD, but we must resist the temptation to read too much into this study. (more…)

Posted in: Clinical Trials, Herbs & Supplements, Neuroscience/Mental Health

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Detecting Consciousness in the Vegetative

People in a vegetative state, usually as a result of brain trauma or anoxia (lack of oxygen) by definition have no signs of conscious awareness or activity. The definition, therefore, is based largely on the absence of evidence for consciousness.

Of course, arguments based upon the absence of evidence are only as compelling as the degree to which evidence has been properly searched for. In recent years technology has advanced to the point that our ability to detect the possible subtle signs of consciousness in those presumed to be vegetative has increased – mainly through functional MRI scans (fMRI) and electroencephalograms (EEGs).

There has been a steady stream of studies demonstrating that a small minority of patients thought to be vegetative actually display some signs of minimal consciousness. The latest such study was recently published in Neuroimage: Clinical by a research team from the University of Cambridge.

But let’s back up a bit first. Even prior to evaluating vegetative patients with fMRI and advanced EEG techniques, several studies showed that a detailed neurological exam specifically designed to detect the most subtle clinical signs of consciousness could find such signs in some patients who were diagnosed as being vegetative by more standard neurological exam. According to one study as many as 41% of patients diagnosed as vegetative were really minimally conscious, meaning they had subtle signs of consciousness, but still cannot wake up, converse, or act purposefully. (more…)

Posted in: Neuroscience/Mental Health

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Lorenzo’s Oil

Augusto Odone is an Italian economist best known for his son, Lorenzo, after which Odone named the oil that he helped develop to treat his son’s neurological disease. Lorenzo’s oil was the subject of a 1992 movie starring Nick Nolte and Susan Sarandon, and of course what most people think they know about the story they learned from the Hollywood version.

This past week Augusto Odone died at the age of 80, prompting another round of media reporting about Lorenzo’s oil.

Probably because of the Hollywood movie, this story more than any other is an iconic example of the disconnect between the simple narratives the media love to tell (and we love to tell ourselves) and the more complex reality.

The basic facts of the story are not in dispute. Lorenzo Odone, son of Augusto and his wife, had a neurological disease known as X-linked adrenoleukodystrophy (X-ALD). This is a devastating genetic disease in males, with two basic forms. Childhood onset tends to progress rapidly and typically death occurs by age 10, although lifespan can be increased if an early bone marrow transplant is given. In adult onset, symptoms may not appear until adulthood, and then tends to progress more slowly, over decades. Some boys with the X-ALD gene do not develop clinical findings. Women are carriers, with partial protection from their second X chromosome. About half of female carriers become symptomatic, with the slower adult form of the disease.

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Posted in: Neuroscience/Mental Health, Science and Medicine

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The End for CCSVI

A new study published in The Lancet provides the most definitive evidence to date that chronic cerebrospinal venous insufficiency (CCSVI), a hypothetical syndrome of narrowed veins draining the brain that some believe is the true cause of multiple sclerosis (MS), is not associated with MS.

In a science-based world, this study would be yet one more nail in the coffin of this failed hypothesis. But that’s not the world we live in.

CCSVI background

CCSVI was first proposed in 2009 by Italian vascular surgeon, Dr. Paolo Zamboni – that multiple sclerosis (MS) is caused by chronic blockage of the veins that drain the brain. The current scientific consensus is that MS is a chronic autoimmune disease, and the pathology is caused by primary inflammation. Dr. Zamboni believes that the venous anomalies he has discovered are the primary cause and the inflammation is secondary. (more…)

Posted in: Neuroscience/Mental Health

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Quantum Neurology

As the resident neurologist on SBM, my ears always prick up when I come across a new neurology-based scam, and my colleagues often send such items my way. In addition the word “quantum” has become a standard marketing term of alt. med quackery. So how could I resist taking a bite out of “quantum neurology”?

One might think (if one were a completely naïve rube) that those claiming to practice quantum neurology have, through diligent research, discovered how certain quantum principles apply to nervous system function and disease, leading to new treatment modalities. On the other hand, a more savvy consumer of such health claims (such as regular readers of SBM) would likely suspect that quantum neurology will turn out to be the same-old mix of nonsense and snake oil in a shiny new package.

Let’s have a look.

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Posted in: Chiropractic, Neuroscience/Mental Health

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Sharyl Attkisson and CBS News: An epic fail in reporting on the murder of autistic teen Alex Spourdalakis

An antivaccine reporter strikes again

The damaged done by the antivaccine movement is primarily in how it frightens parents out of vaccinating using classic denialist tactics of spreading fear, uncertainty and doubt (FUD). Indeed, as has been pointed out many times before, antivaccinationists are often proud of their success in discouraging parents from vaccinating, with one leader of the antivaccine movement even going so far as to characterize his antivaccine “community, held together with duct tape and bailing wire,” as being in the “early to middle stages of bringing the U.S. vaccine program to its knees.” Meanwhile, just last week Anne Dachel, “media editor” for the antivaccine crank blog Age of Autism, gloated about basically the same thing, how although overall vaccination rates remain high, vaccine exemption rates are up in many areas of the country and how her movement has provided plenty of information to “scare [parents] out of vaccinating.”

And it is the very same antivaccine propaganda blog, Age of Autism, that is promoting a different, more insidious message, specifically how the brutal murder of an autistic teen nearly three months ago “illumines the autism nightmare.” What do I mean by “insidious message”? It’s the hijacking of the autism advocacy movement, which tries to advocate for more services for autistic children and adults and more awareness and understanding of autism, by the antivaccine message that autistic people are somehow “damaged,” be it by vaccines or unnamed “toxins,” that the “real child” has been “stolen” by autism, and that any manner of biomedical quackery to “recover” autistics is justified by the horror of autism. Although Attkisson, the reporter for the story discussed below, never specifically mentions vaccines, if you know the background of the case, that message is quite obvious and not very far under the surface of her report on the murder of Alex Spourdalakis:

Not surprisingly, this story was reported by Sharyl Attkisson, who is CBS News’ resident antivaccine reporter. I’ve known her to promote antivaccine views in a manner that gave Robert F. Kennedy, Jr. a run for his money as far back as 2007. Since then, she’s smeared Paul Offit as a “pharma shill,” very likely fed information to someone at AoA to help them portray Lisa Randall at Voices for Vaccines as an “industry group,” done a puff piece about antivaccine physician and hero to the antivaccine movement Andrew Wakefield, and misreported the significance of the Hannah Poling case (which was really just the rebranding of autism). Most recently, Attkisson promoted a truly execrable “review article” summarizing the evidence relating vaccines to autism. The review article, by Helen Ratajczak, cited lots of pseudoscience from antivaccine literature in the service of supporting a truly dumb hypothesis, namely that DNA from vaccines could recombine in the brains of children to result in autism. Attkisson was quite smitten with the idea. As you might imagine, I was not. Along the way, Attkisson also indulged in promoting breast cancer misinformation. No wonder she is the perfect reporter to do this story promoting the viewpoint that autism is so horrible and the system provides so little help that we should understand why a mother like Alex’s might become so desperate that she would poison her son and then, when that failed to kill him, try to slash his wrist, and then, when that failed, stab him in the heart with a kitchen knife.
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Posted in: Neuroscience/Mental Health, Science and the Media, Vaccines

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