What is the value of celebrity neurology?

It is always headlines when a celebrity comes out with, or dies of, any disease. The disease often gets a boost, its profile raised high. We saw this with the ‘Jade Goody effect‘ which boosted cervical cancer screening. The same occurred with the ‘Angelina Jolie effect‘ which improved the provision of breast cancer services.

Angelina Jolie
Angelina Jolie

The celebrity effect also works in Neurology, although never as successfully as the examples above. Some single-minded neurology celebrities have tackled their diseases head-on, often by funding research. This is the case with the Michael J. Fox Foundation and Parkinson’s disease (PD).

Michael J Fox
Michael J Fox

The celebrity may support a charity on account of a family member with a condition such as JK Rowling aiding the Multiple Sclerosis Society in Scotland on behalf of her mother who had the disease; unfortunately they eventually fell out.

Most recently we learnt that Robin Williams had Lewy Body disease a variant of Parkinson’s disease, and he probably died from the hallucinations common in this disorder. Will this boost the profile Lewy body diseases? Will it improve research into its risk factors and treatment?

Robin Williams
Robin Williams

Sometimes its a celebrity event that does the trick. The ice bucket challenge raised millions for MND. The celebrity endorsements for the campaign was a boost for those fighting to eliminate the disease. And one of the best clips is of Benedict Cumberbatch-worth a look!

https://www.youtube.com/embed/YOa7ZjxRuKM” target=”_blank”>

But how valuable is a one-off benefit such as this? A lot it seems going by the MND Association feedback-£7m is not to be scoffed at!

On the theme of MND we see the example of a celebrity ‘endorsement’ of a different type. Stephen Hawking, the world-renowned theoretical physicist, has not been particularly bullish in his support of MND but his biopic, The Theory of Everything, has had an interesting effect;

https://www.youtube.com/embed/Salz7uGp72c” target=”_blank”>

A grandfather made a self-diagnosis of MND after watching the film. Talk of celebrity influence!

What of naming nerve cells after celebrities? Yes indeed. Heard of the Jennifer Aniston neuron? Neuroscientists have discovered that individual nerve cells learn to recocgnise specific faces, and Jennifer’s was a face they used in their trials. A lot of good it has done for her, but a clever way for neuroscience to embed their lesson in our minds; a very good use of celebrity.

By Angela George, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=6044960
By Angela George, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=6044960

Which other celebrities with neurological diseases have raised the profile of their condition, or influenced it, in any way at all? The subject for a blog sequel!

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Bee venom acupuncture for PD?

 

Yes you heard it right-potential benefit from bee venom acupuncture in Parkinson’s disease (PD). What next you may say? But breathe easy, its from a study form the Journal of Alternative and Complementary Medicine. The treatment, in addition to conventional PD treatment, shows significant improvements in gait speed, PDQL score, and activities of daily living.

 

 

I am not sure I will be in a hurry to send my patients for this unconventional treatment based on a this open labelled, prospective, uncontrolled study of 11 subjects.

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Head transplant, anyone?

Coming near you soon, a maverick performing human head transplantation. The idea of head transplantation has a long history. Performing it in humans however is a different kettle of fish.The present day advocate is an Italian neurosergeon Sergio Canavero. He has passionately championed the idea and you should listen to him here at a TED talk.

https://www.youtube.com/embed/FmGm_VVklvo” target=”_blank”>

His attempts have however not convinced the American Neurosurgeons who rebuffed his attempts to involve them. Who would be the guinea pig for Dr Canavero! There is already a patient waiting eagerly, and these journalists discuss the layman’s view of the patient’s perspective.

https://www.youtube.com/embed/pJOQx6XNh-Y” target=”_blank”>

 

A pacesetter or a crank? Too early to pass judgment but history shows that the scientific establishment repeatedly resists ground-breaking progress: remember in-vitro fertilization, antibiotics for peptic ulcer etc? I recently reviewed two books on my other blog, thedoctorsbookshelf.com, and both books, The Rise and Fall of Modern Medicine and Bad Medicine, cite several examples of this type of institutional conservatism. Reassuringly not everyone is dismissing him and some are already talking the ethics of head transplantation.

Canevaro on the other hand seems to have done his homework well. Gauging by this paper which reviews the planned protocol he is taking the matter seriously. And this newspaper article suggests a team will be set to go in 2017!

We have to watch this space.

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Does diabetes protect from MND?

Motor neurone disease (MND) is a dreadful condition, one of the most difficult a neurologist comes across. And the impact on the patient and their families is quite profound. News from the MND world is hardly ever cheering, and this is reflected by my recent post which suggests that formaldehyde possibly predisposes to motor neurone disease. Any good news, no matter how far-fetched, is therefore welcome.

Motor neuron on a muscle cell. Matt Brown on Flikr. https://www.flickr.com/photos/londonmatt/5869934793
Motor neuron on a muscle cell. Matt Brown on Flikr. https://www.flickr.com/photos/londonmatt/5869934793

And this is probably as flimsy as they come; a recent paper in JAMA Neurology suggests that type 2 (and not type 1) diabetes mellitus may reduce the risk of MND. This is a small trial in a Danish population. This is clearly not a case of choosing between the devil and the deep blue sea. It may be cheering news for people with diabetes, but more importantly it may be a clue for researchers looking for a cure for MND.

By International Diabetes Foundation - http://commons.wikimedia.org/wiki/File:World_Diabetes_Day_logo.svg, Public Domain, Link
By International Diabetes Foundation – http://commons.wikimedia.org/wiki/File:World_Diabetes_Day_logo.svg, Public Domain, Link

Talking of MND cures, there is some more hopeful news for people with MND. Researchers in Sheffield are working on potential genetic treatment for people with the SOD 1 gene mutation, an important cause of hereditary MND. This SOD1-targeted gene therapy is essentially gene silencing, and this is still in early stages. But it is hope all the same-the future is not all doom and gloom.

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Chronic fatigue syndrome and the brain

Chronic fatigue syndrome gets short shrift from neurologists. Admit it, we dismiss it with a wink and a nod. We put our noses up at its diagnostic criteria, call it ‘low moral fiber’, and move on to ‘proper’ neurological stuff.

But what if there really is something going on in the brains of patients with this label.

Well this paper in Radiology suggests there is. It reports white matter atrophy and increased functional anisotropy (whatever that means) in the right arcuate and right longitudinal fasciculus. The authors go as far as to suggest this may be a biomarker for the disease. OK, but you need more than 15 patients to go that far!

While still on chronic fatigue syndrome, some researchers have found cerebrospinal fluid (CSF) abnormalities in the disorder. The report from Molecular Psychiatry (no, not the JNNP) shows an increase in the cytokine CCL11, amongst other things, suggesting immune activation of the central nervous system-their words. And this presumably underlies the cognitive dysfunction in chronic fatigue syndrome (CFS, not CSF mind you).

Now all this must be getting too close for comfort for some!

Humble miconazole faces down MS

It will be a great day when a simple course of the antifungal Miconazole cures the dreaded Multiple Sclerosis (MS)- that day a few MSologists will be put out of business! A long way yet however. But a paper in Nature earlier this year suggests that Miconazole may promote myelin repair. The paper is titled Drug-based modulation of endogenous stem cells promotes functional remyelination in vivoNot a very catchy title-I prefer the headline in the lay press. It seems that miconazole, combined with the steroid Clobetazol, may modulate oligodendrocyte progenitor cells and encourage remyelination.

It may still come to pass that a simple prescription will be all that is needed for MS- but did I forget to mention the study was in rats?

 

Is gadolinium toxic?

The US Food and Drug Administration (FDA) has set up an investigation into the risk of brain deposits from repeated contrast-enhanced MRI scans. This follows case reports of brain deposits from gadolinium-based contrast agents (GBCA’s). The risk seems to start from 4 exposures.

By W. Oelen - http://woelen.homescience.net/science/index.html, CC BY-SA 3.0, Link
By W. Oelen – http://woelen.homescience.net/science/index.html, CC BY-SA 3.0, Link

Gadolinium is very important in ‘lighting up‘ lesions which would otherwise be missed on plain MRI scans. There is no doubt of the importance of gadolinium to neurologists, but it is also the case that it is requested more often than is absolutely necessary. There is no conclusive evidence yet, but this report should make neurologists, and patients, think twice before proceeding with the next contrast MRI. These MRI’s are often done ‘just to be sure we’re not missing anything’. We are most probably not!

By زرشک - Own work, CC BY-SA 3.0, Link
By زرشکOwn work, CC BY-SA 3.0, Link

Want to explore this further?

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