The art of spinning catchy neurology headlines

The Neurology Lounge is always on the lookout for catchy neurology article titles to adorn its shelves. My previous blog post in this quest was The art of spinning catchy titles.

Since then, there have been quite a few brilliant article titles that have caught my fancy. We must acknowledge the wordsmiths who craftily and meticulously think up these magical headlines; they put in a lot of thought to conjure up the right words to use. The look into their crystal balls to predict the best way to play around with the meanings. With a bit of lexical alchemy, they miraculously come up with the titles that make us do a double-take, but do so with a smile. Below are 9 such catchy titles.

Parkinson’s disease: Oh my gut! 

By The original uploader was Arnavaz at French WikipediaThis image is an old version created by Medium69.Cette image est une ancienne version créée par Medium69.Please credit this : William Crochot – http://www.cancer.gov, Public Domain, Link

This title reflects the science suggesting that Parkinson’s disease originates from the gut. This editorial restates the proposition that α-synuclein starts accumulating in the intestines before migrating, up the vagus nerve, ‘in a prion-like fashion’, to the brain.

Patent foramen ovale and migraine: closing the debate

Medical Illustrations by Patrick Lynch, generated for multimedia teaching projects by the Yale University School of Medicine, Center for Advanced Instructional Media, 1987-2000.

Patent foramen ovale (PFO) is a hole in the heart which connects the upper two heart chambers, or atria. It normally closes after birth, but in some people it persists to cause some grief to cardiologists and neurologists. Whether a PFO causes migraine or not is a long standing contentious issue in Neurology. The authors of this study found no link between migraine and (PFO). The title is brilliant, but the tone of finality is probably premature; I guess this debate is far from over.

Migraine and inhibitory system – I can’t hold it!

Human brain on white background. _DJ_ on Flikr. https://www.flickr.com/photos/flamephoenix1991/8376271918

And still on migraine is this headline grabber. A bit on the basic science spectrum, I quote from the abstract to give you a flavour: ‘This review focuses on recent structural and functional neuroimaging studies that investigated the role of subcortical and cortical structures in modulating nociceptive input in migraine, which outlined the presence of an imbalance between inhibitory and excitatory modulation of pain processing in the disease‘. I would rather stick with the punchy headline myself.

On the nose: olfactory disturbances in patients with transient epileptic amnesia

Big Nose Strikes Again. Bazusa on Flikr. https://www.flickr.com/photos/bazusa/260401471

This research paper establishes a link between transient epileptic amnesia (TEA) and impairment of the sense of smell. TEA continues to surprise, and there is indeed quite a lot to chew in the paper.

Myelitis in neuromyelitis optica spectrum disorder: the long and the short of it

By JasonRobertYoungMDOwn work, CC BY-SA 4.0, Link

This is a clear play on the defining feature of neuromyelitis optica (NMO), a long segment of inflammation in the spinal cord. This is what neurologists call longitudinally extensive transverse myelitis (LETM). This is an excellent editorial, worthy of the headline. It emphasises the point that NMO really has no defining features, not even the presence of the ‘defining’ antibody, anti-aquaporin 4- just ask anti-MOG NMO about this

AEDs after ICH: preventing the prophylaxis

By BobjgalindoOwn work, GFDL, Link

How do you prevent a harmful preventative practice?. By a paper with a title that is pure genius of course. The authors of this paper highlight the persisting, anti-guideline, practice of using prophylactic antiepileptic drugs (AEDs) in people who have had intracerebral haemorrhage (ICH). The paper rhetorically asks if this has ‘become a habit too difficult to break?’ Not going by this catchy headline!

Paralysis lost: a new cause for a common parasomnia?

Sleepwalking. Gareth on Flikr. https://www.flickr.com/photos/trois-tetes/7240877

Parasomnias are diseases that occur during or related to sleep. This headline is for an editorial on a new parasomnia called anti IgLON5 antibody disorder. This is the subject of my previous blog post titled IgLON5: a new antibody disorder for neurologists. The headline writer here is clearly a fan of John Milton. I however struggled to make the connection between the excellent headline and the subject of the paper. I however presume it relates to the ‘loss of sleep paralysis‘ that accompanies many sleep disorders, including the quintessential parasomnia- REM sleep behaviour disorder (RBD). Excellent title anyway.

Hereditary spastic paraplegia: the pace quickens

By Rawlings, Leo – http://media.iwm.org.uk/iwm/mediaLib//150/media-150073/large.jpgThis is photograph Art.IWM ART LD 6040 from the collections of the Imperial War Museums., Public Domain, Link

With a slightly wicked wit, this headline focuses on the slow walking speed of people with hereditary spastic paraplegia (HSP), contrasting this with the increasing research output on the disease. A bit dated I admit, but the paper refers to work which identified the genetic basis of SPG3, one of the commoner HSPs. A lesson in headline writing from the archives you may say.

Cut your losses: spastin mediates branch-specific axon loss

Synapse. Ben Cadet on Flikr. https://www.flickr.com/photos/47814009@N00/2943548161

The headline is brilliant, but the content goes way over my head. It is an editorial on a basic science paper. For the curious and the nerdy, I quote an extract: ‘during synapse elimination in the developing neuromuscular junction, branch-specific microtubule destabilization results in arrested axonal transport and induces axon branch loss. This process is mediated in part by the neurodegeneration-associated, microtubule-severing protein spastin‘. Enough I hear you say. OK, just stick with the headline.

***

Do you have any catchy titles-please drop a comment.

_________________________________________________________________________

Vagus nerve stimulation: from neurology and beyond!

The vagus nerve is one of 12 pairs of nerves that come off the lower part of the brain called the brainstem. It is the tenth in line and therefore also called the tenth cranial (or X) nerve.

 

By Brain_human_normal_inferior_view_with_labels_en.svg: *Brain_human_normal_inferior_view.svg: Patrick J. Lynch, medical illustrator derivative work: Beao derivative work: Dwstultz [CC BY 2.5 (http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons
By Brain_human_normal_inferior_view_with_labels_en.svg: *Brain_human_normal_inferior_view.svg: Patrick J. Lynch, medical illustrator derivative work: Beao derivative work: Dwstultz [CC BY 2.5 (http://creativecommons.org/licenses/by/2.5)%5D, via Wikimedia Commons

It is an interesting nerve for various reasons. Unlike other cranial nerves, it travels way beyond the head and neck. It has a very long course through the neck to the chest and abdomen. Furthermore it regulates a wide variety of organ functions such as heart, respiratory and gut activities. An important branch of the vagus nerve is the recurrent laryngeal nerve which innervates the larynx (voice box). 

Due to a quirk of the embryonic development of the aorta, this nerve gets pulled down into the chest before it makes a U-turn back to the neck. It is therefore easily damaged in operations of the neck or chest, and therefore the bane of surgeons.

 

By Truth-seeker2004 (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
By Truth-seeker2004 (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)%5D, via Wikimedia Commons

Scientists have recognised this characteristic feature of the vagus nerve and have tried to manipulate it for therapeutic reasons. The most well-recognised is the stimulation of the vagus nerve to control epileptic seizures. This vagus nerve stimulation (VNS) requires implanting a stimulator under the skin on the chest, and this is connected to the vagus nerve with wires. Somehow or the other, this stimulation modulates seizures. The Epilepsy Society has detailed information on the technical aspects of VNS, and below is a video showing how VNS works.

The American Academy of Neurology guidelines on VNS, published in the journal Neurology, help Neurologists decide when to use VNS. Below are the main indications for VNS in epilepsy:

  • Refractory partial onset seizures in adults >12 years not suitable for surgery
  • Partial or generalised seizures in children
  • Lennox-Gastaut syndrome (LGS)
  • Mood improvement in adult epilepsy

VNS has other neurological indications  which are coming online and top of these is Cluster headache. And now, just off the press, is a possible role for VNS in migraine.

Headache by openDemocracy on Flikr. https://www.flickr.com/photos/opendemocracy/1482020719
Headache by openDemocracy on Flikr. https://www.flickr.com/photos/opendemocracy/1482020719

 

There are however several non-neurological diseases that may benefit from VNS including arthritis, diabetes, hiccups and heart failure. Science News explores these indications further in an article interestingly titled Viva Vagus: Wandering Nerve Could Lead to Range of TherapiesLike opening a can of worms, VNS may extend it’s tentacles far and wide; imagine for example that there is a study looking at the benefit of VNS in bulimia.

"Bulimiav bvjkfhdnijf" by Merlymeleanrossana - Treball propi. Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Bulimiav_bvjkfhdnijf.jpg#/media/File:Bulimiav_bvjkfhdnijf.jpg
“Bulimiav bvjkfhdnijf” by Merlymeleanrossana – Treball propi. Licensed under CC BY-SA 3.0 via Wikimedia Commons – https://commons.wikimedia.org/wiki/File:Bulimiav_bvjkfhdnijf.jpg#/media/File:Bulimiav_bvjkfhdnijf.jpg

 

Whatever next?

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

neurochecklists-image

 

 

Parkinson’s disease-a few curious things

Quite a few neurological disorders remain mysteries even when we know so much about them. Parkinson’s diseases (PD) is one of them. Dopamine deficiency is the established final common pathway, but why this deficiency presents in different ways is unclear. PD variants such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and Lewy body disease (LDB) have distinct clinical features to confound any common cause. What then causes dopamine deficiency in the first place?

Substantia nigrai in PD. By Werner CJ., Heyny-von Haussen R., Mall G., Wolf S. [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons
Substantia nigrai in PD. By Werner CJ., Heyny-von Haussen R., Mall G., Wolf S. [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)%5D, via Wikimedia Commons

One link researchers are looking at is the possibility of a pathogen travelling up to the brain from the gut via the vagus nerve. This report from the Annals of Neurology suggests this hypothesis; the researchers found a reduced risk of PD in patients who have had the main trunk of the vagus nerve severed (vagotomy). For more details see a full analysis of the study here.

 

PD PET scan image.By Jens Maus (http://jens-maus.de/) - Own work. Licensed under Public Domain via Commons - https://commons.wikimedia.org/wiki/File:PET-image.jpg#/media/File:PET-image.jpg
PD PET scan image.By Jens Maus (http://jens-maus.de/) – Own work. Licensed under Public Domain via Commons – https://commons.wikimedia.org/wiki/File:PET-image.jpg#/media/File:PET-image.jpg

 

Clearly we can’t recommend vagotomy to our at-risk PD patients, and neither can we recommend gout! Yes, studies have suggested that PD patients have a low uric acid level, and this predates the disease onset. Another study takes things further to suggest that uric acid is neuroprotective because of its antioxidant effect. This long list of PubMed abstracts shows the proliferating research into uric acid.

 

Uric acid crystals. By cnicholsonpath (Uric acid) [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons
Uric acid crystals. By cnicholsonpath (Uric acid) [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)%5D, via Wikimedia Commons

And finally, again from the Annals of Neurology, is a paper reporting increased creativity in people with PD on dopamine replacement treatment. The study compares people with PD on treatment to control subjects. It is however not clear if the creativity is a feature of PD, or of its treatment.

Just a few curious things

=========================================================================

neurochecklists-image