This is a follow up on my post, what is the state of neurology on the blogosphere. Social media is growing and pulling in professionals at a breath-taking pace. This phenomenon, which many have previously turned there noses up at, is now becoming an indispensable part of our personal and professional lives.
Social networks are important, and in today’s world, overwhelmingly digital. The importance of social networks is stressed in some books such as Linked and Connected. So what are the important social networks relevant to neurologists?
1. LinkedIn
The social network medium most professionals prefer is LinkedIn. It is probably the extreme lone-wolf who could afford not to have a presence on LinkedIn today. There are so many neurologists on LinkedIn, and it is a good medium to establish and broaden professional connections. These connections are almost impossible otherwise. There are quite a few valuable professional Neurology LinkedIn groups such as:
Twitter is a multipurpose and open social medium which gives professionals an invaluable platform to do practically whatever they like. It is however very rapid fire, relying on quick and short messages, limited to 140 characters. These messages, called tweets, may be educative or inspirational, amusing or controversial. Anyone may follow you, but you may also block nuisance followers. You may unfollow anyone you wish, and sometimes this happens at an alarming pace. Many professionals use Twitter to circulate interesting and breaking research work or articles they come across. It is a veritable way of keeping abreast of developments across your patch, but you have to check your twitter feed frequently; unfortunately old tweets tend to fade away. Here is a list of active neurology Twitter accounts.
This is probably the most popular social network platform, perhaps considered less academically rigorous. Many Facebook accounts combine social and professional activities, but you may decide to make parts of your account private. There are some interesting Neurology Groups on Facebook worth following such as
ReseacrhGate is a social medium entirely focussed on research output. It links professionals and researchers to others with similar interests. You could keep track of what your collaborators are doing (or up to), and you may follow the research output in your areas of interest. ResearchGate also has an interactive service where you could ask the experts. Indispensable.
5. Pinterest
Pinterest may appear, at first look, to be less relevant for academic and professional activities. It is however reported, along with Instagram, to be the fastest growing social network. Businesses are reporting its value, and I suspect academics and professionals may soon be. It is a graphic network, as demonstrated by myPinterest page. Posts are called ‘pins‘, and these are place on ‘boards‘. Take a look for example at my Neurology Board on Pinterest.
This is another network focused around pictures. You may want to scoff at Instagram but you would be surprised at how many professionals are posting very interesting and enlightening images. Take a look for example at these posts by neuroradiology. I am very poor both behind and in front of the lens, and this is reflected byMy Instagram page.
This is probably the network your children (and grandchildren?) find most fascinating. But don’t run away yet, there are serious stuff here. You wouldn’t believe, for example, that neuroscience is flourishing on Tumblr. This network allows you to play with unlimited space for photos and text. You may find yourself going there more often than you anticipated, but don’t tell the children you are on it!
I have dipped my toes in the waters, and I am beginning to find my feet. The blogosphere is a huge universe and I wondered who else are ‘out there’ blogging on neurology?
I ‘googled’ neurology blogs and came across sites listing neurology-related blogs. One is titled ’50 fascinating brain science blogs’ and another lists ‘most popular neuroscience blogs’. I plough through the lists looking for blogs that will be helpful to a jobbing neurologist. I soon discover however that most of the blogs listed are not actually neurological. Many where neuroscience and psychology, and a lot were completely irrelevant to neurology.
Caseblog has a section with interesting views on recent neurology issues.
Neurology minutiae is unapologetic for its interest in ‘arcane stuff’ but is nevertheless interesting to peruse.
The Neuro Times has several contributors and talks of trends in the history of neurology and neuroscience
Lancaster General Hospital neurology blog has a variety of professionals contributing to it although the last entry was dated 2013.
Neurology update is very educational and seems to target neurology trainees
Oliver Sachs is interesting but refers to ‘Dr. Sacks’ in the 3rd person! Hmm. I wasn’t convinced there was much there for a jobbing neurologist but nevertheless worth a look in view of the eminence associated with the name
Blogs on the margins of neurology
Neuropathology blogis quite detailed and covers all aspects of neurological pathology
Brain Watch is a neuroscience blog of Wired. Quite good
Brain HQ is a large blog with interests beyond neurology and neuroscience
There are several other neurology or neuroscience themed blogs with fascinating names like ‘mindhacks‘, ‘brain windows‘, ‘brain waves‘, and ‘neurodudes‘ but I didn’t think they were relevant to practice or of sufficient general interest to explore.
Stroke is a global beast. It is a scourge of the young and old. It strikes suddenly, maiming and killing with wanton abandon. So much has been achieved in the attempts to tame the monster, and yet victory still seems a far-off mirage. What are in the pipelines, beyond Aspirin and Statins? What may improve the outlook beyond intravenous clot busters and intensive rehabilitation? What is the likely future of stroke care? Here is a countdown of my top 10 cutting-edge stroke advances.
Uric acid is a villain as anyone with gout will attest. And yet there have been recent reports of the benefit of this chemical in neurological diseases. I have previously posted on the protective effect of uric acid on Parkinson’s disease (PD). In its further attempt to change its status from sinner to saint, uric acid is creeping into the world of stroke. A recent article in the journal Stroke is titled Uric Acid Therapy Improves Clinical Outcome in Women With Acute Ischemic Stroke. It was used in conjunction with conventional clot busting of course. Uric acid appears to reduce the growth of the infarct-the part of the brain that is irreversible damaged after a stroke. Why is it only women who benefit? Testament to the fact that it is not so easy to redeem a sullied image.
Yes, the simple GTN, popular with those who suffer angina.GTN works in angina by dilating (widening) the arteries thereby improving blood flow to the heart. Why can’t the same effect be expected with the narrow or blocked arteries that lead to stroke? Indeed the effect appears to be the same on the brain as it is on the heart as reported in this article in Stroke titled Effect of Hyperacute Administration (Within 6 Hours) of Transdermal Glyceryl Trinitrate, a Nitric Oxide Donor, on Outcome After Stroke.The authors showed that applying GTN through a skin patch within 6 hours of stroke leads to improved outcomes. This intervention lowers the blood pressure, improves functional outcomes, and improves cognition to boot. To good to be true? Perhaps not.
There are many advances aimed at improving limb function after stroke. These include techniques such as constraint-induced movement therapy and mirror therapy. The exciting advance for me however is virtual reality. This came to my attention in an article in Augmented Reality Trends titled Virtual Reality Assists Stroke Patients Regain Limb Movement.It took some sleuthing to track down the scientific paper, published in Journal of Neuroengineering and Rehabilitation. Titled, in typical academic obfuscation,The visual amplification of goal-oriented movements counteracts acquired non-use in hemiparetic stroke patients, it showed the benefit of a virtual reality environment on hand-reaching in 20 stroke patients. The authors conclude that “the amplification of the movement of the paretic limb in a virtual environment promotes the use of the paretic limb in stroke patients”. Long words, small sample size, but big progress.
Could repeatedly inflating and deflating a blood pressure cuff around the arm reduce the brain damage that occurs following stroke? Strange as it may seem, this is the idea behind remote ischaemic conditioning (RIC). A recent paper in Nature Reviews Neurology titled Remote ischaemic conditioning—a new paradigm of self-protection in the brainexplains how this works. It says RIC protects organs by triggering protective chemical pathways in their cells. This is neuroprotection when applies to nervous structures such as the brain. This process has the potential not only to limit the damage caused by stroke, but to also reduce the risk of the stroke recurring. One study that has looked at this process in detail is published in Stroke and is titled Remote ischemic per-conditioning: a novel therapy for acute stroke?
4. PHD oxygen sensor inhibition
When oxygen supply to the brain is restricted, as occurs in stroke, the brain detects this using proteins called PHD (prolyl hydroxylase domain). PHD triggers a change in the metabolism of the brain cells, letting them adapt to the new state of limited oxygen supply. Unfortunately this adaptation leads to the production of toxic oxygen radicals which cause some of the brain damage that results from stroke. A recent study has however shown that mice that are deficient in PHD develop less severe strokes than normal mice. It requires no stretch of the imagination to guess that medications which inhibit PHD may lead to less severe stroke outcomes. And this is what the title of the research paper says: Deletion or Inhibition of the Oxygen Sensor PHD1 Protects against Ischemic Stroke via Reprogramming of Neuronal Metabolism. A simplified version of the paper is published in News-Medical as Oxygen sensor PHD1 identified as potential target for treatment of ischemic stroke.
Recent studies have reported two growth factors with the potential to improve stroke care. The first is growth differentiation factor 10 (GDF10). An article in MNT titled Discovery could lead to drug to enhance recovery from strokedescribes GDF10as a chemical which “signals brain cells to make new connections following a stroke“. The scientific paper is published in Nature Neurology titled GDF10 is a signal for axonal sprouting and functional recovery after stroke. This opens the door for potential drug treatments which will improve recovery after stroke.
The second growth factor is Neurotrophin 3 (NT3). This is one type of nerve growth factor which has been shown, at least in rats, to improve brain function. It however has to be administered within 24 hours of stroke. The report published in Brain is titled Delayed intramuscular human neurotrophin-3 improves recovery in adult and elderly rats after stroke. The authors showed that NT3, injected intramuscularly, triggers the sprouting of new nerve cells. This goes beyond neuroprotection and opens a very exiting field for stroke researchers.
2. Stem cell therapy
By Human_embryonic_stem_cells.png: (Images: Nissim Benvenisty)derivative work: Vojtech.dostal (Human_embryonic_stem_cells.png) [CC BY 2.5 or CC BY 2.5], via Wikimedia Commons
Stem cell therapy is a very promising field of medicine, with exciting reports coming out almost daily. Most recently is the benefit in multiple sclerosis (MS). Recent reports suggest that Stroke is not lagging too far behind. A recent article in The Guardian describes what appears to be a successful trial of stem cell therapy in 5 peoplewith stroke. A review article in International Journal of Preventative Medicine outlines the different types of approaches to stem cell therapy; these include neural, haematopoetic and mesenchymal stem cells. If you are keen on the technical aspects you may look at the research paper in Stem Cells and Translational Medicine titledIntra-Arterial Immunoselected CD34+ Stem Cells for Acute Ischemic Stroke.
A step which goes beyond neuroprotection, growth factors, and stem cells, is the creation of functioning nerve cells (neurones) from the supporting cells of the brain (glial cells). This technique promises to repair the part of the brain damaged by stroke by simply replacing the dead cells with new nerve cells. I came across this first in an article in The Guardian titled Brain damage could be repaired by creating new nerve cells. Theevidence so far is from studies in mice but the prospects for this are very exciting indeed. For the scientific details, the original research is in Stem Cells Report titled Sox2-Mediated Conversion of NG2 Glia into Induced Neurons in the Injured Adult Cerebral Cortex.
These are all very impressive developments, hinting at a bright future for stroke care. It is hopefully not far off when a devastating stroke will be a totally reversible event.
Neurology is as much a verbal, as it is a visual, specialty. Whilst the history is the bedrock of the neurological diagnosis, some conditions are only diagnosed by observation. Epilepsy and movement disorders are classical examples. Neurologists are therefore trained to observe the subtlenuances that distinguish between many of the diseases they see.
Neurology is however a very broad specialty, and it is unlikely that any neurologist or medical student would have personal experience of the vast number of neurological conditions. For this reason the video is an important contributor to neurological experience and expertise. The video is also a great educational resource for teaching the fairly complex neurological examination, no easy feat.
Where then can we get the best neurological videos? Here is a selection.
YouTube-based video channels
Youtube is the veritable ‘go-to’ site for most videos. Many patients post their own interesting video clips, but there is no guarantee that these clips reflect the diseases attributed to them. YouTube however has a selection of creditable video channels and here are some credible ones.
JAMA Neurology Channel. This is the video channel of the Journal of the American Medical Association. It is an excellent collection of neurological examination videos, very good for basic neurological skills.
University of Denver Neurology Department Channel. Thischannel, with about 650 subscribers, provides a variety of neurology related videos covering basic clinical topics and recent advances. The videos are typically in the form of lectures.
Brain Journal Channel. This is the video site of Brain, a foremost neurology journal. It currently has just over 80 subscribers and has its focus on cutting-edge neuroscience.
AAN Channel. This is the video site of the American Academy of Neurology (AAN). This has more than 2,000 subscribers and is fairly regularly updated. It however doesn’t have a lot of clinical material for learning.
Neurology-specific video sites
Clinical Neurology Videos. This site has an extensive library of very interesting educational videos. It covers the wide spectrum of neurology and worth bookmarking.
Utah Medical School Neurology Videos. This large selection of neurology educational videos focuses on the neurological examination. It shows a lot of abnormal cases to augment learning.
The Neuroophthalmology Virtual Education Library (NOVEL). This is a wide collection of educational and experiential neuroophthalmology videos from the Neuroophthalmology Society of North America. It has several sub-collections by different specialists, and it’s a very useful guide to a complex territory.
Neurology Now Video Gallery. This is a small collection of videos typically in the form of discussions and explanations, and not oriented to clinical examination.
General medicine video sites with neurology sections
The Doctor’s Channel This has a large selection of neurology videos sourced from other sites. It covers the wide range of neurology topics. Many videos are not clinical, but nevertheless interesting.
Medical Videos. This is a general medical video site but with a rather strong selection of diverse neurology videos
Veterinary Neurology Videos. This is an interesting archive of animal neurology videos from the University of Minnesota College of Veterinary Medicine.
Brain cancer is a horrible disease even among cancers. Apart from benign tumours such as meningioma, very few brain tumours have happy endings. It is however not all doom and gloom- there are many advances raising hope for the future of brain cancer. Here are 10 hope-raisers.
Nanotechnology is promising a lot for neurology, and I discussed this in my previous post on 10 remarkable breakthroughs that will change neurology. It is heart-warming to learn that nanotechnology is stepping into brain cancer treatment. Their role is in reducing the damage that normal tissues sustain when brain cancer is treated with conventional radiation. Scientists hope to minimise this damage by delivering the radiation treatment through nanomolecules; because of their small size it is presumed this approach should cause less harm. In this article in Neuro-Oncology titled Rhenium-186 liposomes as convection-enhanced nanoparticle brachytherapy for treatment of glioblastoma, the authors report the efficacy of liposomally encapsulated radionuclides in rat models of glioblastoma. It is complicated stuff but Science Daily’s headline says it all: Treating deadly brain tumors by delivering big radiation with tiny tools.
The challenge for every drug cancer treatment is to deliver the drug as close as possible to the tumour cells. This is particularly difficult for brain cancer because of the protective brain blood barrier (BBB). This shield is composed of the walls of the blood vessels, and the triple-layered sheath covering the brain called the dura.
What if the drugs could be sent across this barrier without breaching it? More Dr. Who than neuroscience, but this is what the ultrasonic screwdriver recently achieved to wide acclaim. Using ultrasound, the scientists successfully delivered chemotherapy drugs across the BBB. This press release from Sunnybrook Health Sciences Centre explains it further. The neurosurgeons used an MRI-guided focused low-intensity ultrasound to force drug microbubbles in the bloodstream across the blood-brain barrier. “The waves repeatedly compress and expand the microbubbles, causing them to vibrate and loosen tight junctions of the cells comprising the BBB. Once the barrier was opened, the chemotherapy flowed through and deposited into the targeted regions”. Very exciting SciFi stuff. Here is a simplified version from IFL Science titled Scientists Have Breached The Blood-Brain Barrier For The First Time And Treated A Brain Tumor Using An “Ultrasonic Screwdriver”.
Electromagnetic field therapy is a new area of brain tumour treatment and not conventional in any way. It however promises to improve survival of patients with glioblastoma who have received conventional radiotherapy and chemotherapy. I came across this in MNT under the title Use of type of electromagnetic field therapy improves survival for patients with brain tumor. This treatment is a form of tumor-treating fields (TTFields), “a treatment that selectively disrupts the division of cells by delivering low-intensity, intermediate-frequency alternating electric fields via transducer arrays applied to the shaved scalp”. The evidence for this is a trial reported in the Journal of the American Medical Association (JAMA) titled Alternating electric fields for the treatment of glioblastoma. It is not a panacea but any light at the end of the dreadful tunnel of brain cancer is worth exploring. It is a good sign that the FDA has approved this technology.
Another technique that is under investigation for treatment of brain cancer is pulsed electric field (PEF). This was the focus of a recent paper in Scientific Reports titled Targeted cellular ablation based on the morphology of malignant cells. PEFpreferentially targets and destroys malignant cells relatively sparing normal cells. The mechanism, if you are curious to know, is called high frequency irreversible electroporation (HFIRE). Or, in plain English, electric disruption of cells. This has reportedly been effective in dogs, and the challenge is to translate the benefits to humans.
Touted as the drug that makes cancer cells explode, Vacquinols are experimental agents which have shown remarkable efficacy in rat models of glioblastoma. The research reported in the journal Cell is titled Vulnerability of glioblastoma cells to catastrophic vacuolization and death induced by a small molecule. The article is quite ‘scientific’ as reflected by the tortuous title, but the whole idea is that vacquinols target some cellular processes and cause the cell membranes of glioblastoma cells to rupture . There is some way to go but imagine this advance translating into clinical practice!
Temozolomide is a conventional treatment for glioblastoma but unfortunately some patients become resistant to this useful drug. Scientist have observed that glioblastoma cells achieve temozolomide-resistance via a protein called connexin 43 (Cx43). Working on this knowledge, they have developed a Cx43 inhibitor called aCT1. I came across this agent in a piece in EurekaAlert titled Scientists find way to make resistant brain cancer cells sensitive to treatment. The scientific paper, published in Cancer Research, is titled Connexin 43 inhibition sensitizes chemoresistant glioblastoma cells to temozolomide. A lucid title for a scientific paper for a change!
4. Propentofylline
“Glioblastoma (1)” by No machine-readable author provided. KGH assumed (based on copyright claims). – No machine-readable source provided. Own work assumed (based on copyright claims).. Licensed under CC BY-SA 3.0 via Commons.
I came across propentofylline in the blog brainmysteries.com under the title Drug that could limit spread of deadly brain tumours. Propentofylline seems to enhance the effects oftemozolomide and radiotherapy, the conventional treatments of brain cancer. In this way propentofylline may slow the spread of the brain tumour cells. It seems to work by inhibiting TROY, the protein that enables glioblastomas to spread to healthy brain cells. For the small print you may read the paper published in Journal of Neuro-oncology titled Propentofylline inhibits glioblastoma cell invasion and survival by targeting the TROY signaling pathway.
Two recent papers have reported on cellular proteins which brain tumours depend on. These are therefore potential targets for future therapeutic interventions. The first is hypoxia inducible factor-1 (HIF-1) whichcancer cells produce when their oxygen supply is threatened. HIF-1 enables the cancer cells to produce new blood vessels (angiogenesis) thereby maintaining their supply of nourishing oxygen. This process is under investigation by researchers at Emory University.
The second property is related to proteins called sterol regulatory element-binding proteins (SREBPs). SREBP’s control the metabolism of glucose and fat in all cells, and researchers at Ohio State University are looking at ways to inhibit these proteins. This would potentially impair the ability of cancer cells to build their cell walls (membranes). Yes, only in mice again but still, hope. Here is a review of SREBP’s and cancer.
The news that Jimmy Carter has melanoma, and this had spread or metastasised to his brain, came as a shock to many of his admirers. It was therefore a relief when they learnt later that Carter’s cancer has all but cleared away. Very unusual to say the least, especially with a cancer as dreadful as melanoma. This remarkable achievement is attributable to an immunotherapy drug called Pembrolizumab, one of several types of drugs called humanised monoclonal antibodies.
Pembrolizumab has demonstrated effectiveness in melanoma and there are now NICE Guidelines for Pembrolizumab in melanoma. But how good is it in primary brain cancers?A trial is currently in progress to assess the efficacy of Pembromizumab in glioblastoma, the most dreaded of brain cancers. There are several other immune therapies that may be effective in brain metastases, and these are reviewed in an article in Current Treatment Options in Neurology titled Targeted therapies in brain metastases.
Brain tumours rage on, but the science is hopefully catching up. Victory beckons over this dreaded disease.
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