December 31, 2007, 7:45 am

When the senses become confused - Synesthesia

Imagine being able to feel sound – really feel it. That is exactly what happened to one young woman after having a stroke. Sandra Blakeslee reports in the New York Times that Sherrilyn Roush suffered from a midbrain stroke, and a year and a half later began feeling tingling on her body in response to sounds.

This odd mixing of the senses, synesthesia, occurs when sensory areas of the brain that do not normally communicate engage in cross-talk. Most synesthetes are born with crossed connections, it manifests itself in different ways, some can “taste” words, others may feel complex shapes in response to taste, or even see colors attached to specific letters or numbers.

In this case, Dr. Ro said, the crossed wiring developed as a consequence of the stroke. Imaging studies reveal that fiber tracts from Dr. Roush’s midbrain that normally go to higher regions involved in touch are disorganized and diminished. Such disruption can lead to enhanced connectivity in remotely connected regions of the brain like hearing and touch.

Dr. Ro and colleagues have tested Dr. Roush for the last seven years, observing how her brain has reorganized. An article describing her case appears in the November issue of Annals of Neurology.

For several months, Dr. Roush found herself bumping into doors. When she drove, her car would veer to the right. But gradually, the weakness on her left side and the neglect of space around her left side diminished. Her only concession was to give up driving a car with a stick shift because of lingering weakness in her leg.

But in laboratory tests a year later, she exhibited a rare phenomenon. If simultaneously touched on both hands, she would feel an increased sense of pressure on her left hand. Her brain was reorganizing in ways that baffled her doctors.

Not long after that, sounds began to produce tingling, hair-raising sensations of touch on her body. Something about that radio announcer’s voice — its pitch or timbre — was unbearably irritating. The sound of a duck quacking or the sharp clanging of a fire alarm sets her teeth on edge. When she rides the subway, the sound of the train hitting the rails makes her left side “feel on the way to tingle.”

But the soft sound of water bubbling is “soothing, almost like a massage on my skin,” Dr. Roush said, adding, “Round sounds produce a very light tickle but without the annoying part of being tickled.”

She always feels touch sensations, positive and negative, on the left side of her body, particularly the outside of her arm, thigh, head and shoulder. They do not reach the bottom of her leg. Sometimes they make her squirm. But most, she said, do not interfere with everyday life.

Click here to read the entire article from the New York Times

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December 24, 2007, 12:18 pm

Deep Brain Stimulation Trials Offer Hope

HealthDay News reported on August 1, 2007 that JFK Johnson Rehabilitation Institute was able to partially rekindle the mind of a man who had suffered from brain damage and had been in a minimally conscious state for six years.

This patient was the first of 12 to try deep brain stimulation in a U.S. Food and Drug Administration-approved trial. In order for this method to be used, the individual must undergo an operation in which electrodes are implanted in the brain and used to stimulate the thalamus on both sides of the brain. The electrodes are placed to facilitate and augment already existing neural networks, exercising the individual’s brain and re-enforcing those pre-existent pathways. The device is then fine-tuned for optimum stimulation followed by no stimulation cycles.

This particular study showed marked improvement within 48 hours. The patient was able to turn his head in response to voices, and with a little more time he was able to name and use objects, when previously he was unable to speak at all.

This patient continues to improve outside of the trial with the stimulator in
place,” Fins said. “But we’re in uncharted territory about what kind of degree
of recovery he might ultimately achieve.”

“It’s very dicey stuff, brain injury, because the next patient we enroll in the study, that brain injury will not be the same because no two are alike,” Giacino said. “We need to continue to replicate the findings and figure out who would benefit from this.”

Dr. Jonathan Friedman, director of the Texas Brain and Spine Institute, agreed. “This could have huge implications but it’s all speculative with just one patient,” he said. “Every head injury is very different. It’s probably naive to think we could stimulate every patient in the same way, although some might benefit even more.”

Click here to read the entire article

Click here to read more about Deep Brain Stimulation
Click here to read about “locked-in” syndrome

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December 20, 2007, 7:40 am

Walking decreases the risk for dementia

According to a recent study published in the Dec 19 issue of the journal of Neurology, walking and other low-level exercises decrease the risk of vascular dementia in older adults. The study, unfortunately, did not find a link between low level activities and decreased onset of Alzheimer’s disease. Specifically, the study found that men and women over the age of 65 who preformed low-level, non-strenuous, activities on a daily basis were 71 to 73 percent less likely to develop symptoms of vascular dementia over a four year period.

Researchers noted, however, higher levels of exercise on a weekly basis made no difference in the decreased risk of vascular dementia. “… An easy-to-perform moderate activity like walking provided the same benefits as other, more demanding activities of similar intensity,” they said.

The study was the first of its kind to find a longitudinal link between regular low level exercise and decreased levels of vascular dementia. The study used data from the Conselice Study of Brain Aging, a study focusing on the population of Conselice in Italy. The region has similar rates of dementia as the United States and Europe. Below is an excerpt of an article from Medpage Today that reviews the study:

The study was the first to find a longitudinal link between regular exercise and vascular dementia, they said. Their findings bolster those of observational and interventional studies that have consistently found better cognitive performance in more active older adults.

The researchers analyzed data from the Conselice Study of Brain Aging, a population-based study in the Conselice region of Italy examining epidemiology and risk factors for cognitive impairment.

Dementia prevalence in the region was similar to that in the United States and Europe for rural areas with low education levels (37.8 per 1,000 person-years for any dementia and 11.0 for vascular dementia).

At baseline in 1999 and 2000, the study included 749 individuals 65 and older who did not have dementia or sensory-motor deficits that precluded physical activity.

All but 23.2% reported walking and only 21.2% did no stair climbing for exercise or in their daily routine. The most common moderate-intensity activities reported by the cohort were house and yard work, gardening, light carpentry, and bicycling.

More than 99% reported no regular sports or group physical activities and 87.8% reported no vigorous activity, but less than 1% of the cohort was completely sedentary.

Click here to read the entire article from Medpage Today

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December 19, 2007, 9:14 am

Vietnam Head Injury Study Reveals Late Cognitive Decline

Veterans the Vietnam War who received penetrating brain injuries are demonstrating continuing late effects with a faster decline in cognitive  function than vets who returned uninjured. Jordan Grafman, Ph.D., of the National Institute of Neurological Disorders and Stroke, made on online report of his veterans study in Brain, 2007. Grafman was able to differentiate the TBI group with penetrating  injuries from individuals with dementia.He cautioned clinicians to evaluate their patients neurobehavioral status carefully to avoid confusion with the frank signs of dementia. Individuals with higher intelligence as measured on the Armed Forces Qualification Test (AFQT) were found to be "protective in terms of later decline" according to Grafman. Specific areas of brain atrophy in the left parietal and right frontal regions were associated with greater decline. Other indicators were: severity and location of injury, education, intellectual development and genetic endowment.Laterality (left, right or bilateral) was not a factor in AFQT scores . Injuries to the caudate nucleus was found to be as important as AFQT scores in predicting score changes from baseline to the present.

In another study which focused on a swapping of information between the front and back of the brain, conducted by Randy Buckner, Ph.D. of Harvard's Center for Brain Science and reported in the December 6, 2007 issue of Neuron, the reduced communication was associated with degradation of white matter linking elements known as the default network. This network is associated with the functions of remembering and planning.

While these two studies are not related, the reality is that brain injury hastens cognitive decline, particularly the features that are associated with the functional loss of aging. As the injury has caused a disruption of neural tracts, as the person ages the effects of the injury may trigger the loss of more functions.

The issues associated with the aging process for individuals with a brain injury is becoming more important as the number of people living with the long term effects of brain injury increases. Can these studies help us to identify treatment which can slow the cognitive decline or identify strategies to preserve function? The group of young men and women returning from Iraq and Afghanistan will increase the number of brain injury survivors who are likely to experience age related functional changes. We need to learn as much as we can from studies involving older survivors to address the future needs.

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December 14, 2007, 10:16 am

Scientists working to assist a “locked-in” man regain speech.

Can you imagine being trapped in your body, feeling everything, and yet able to do nothing about it? Your nose itches, you need someone to scratch your back, or your feet are cold – how do you communicate this to your care givers, using only the blink of your eye? Yet this is the life that 24-year-old Erik Ramsey is currently living. Erik suffers from what scientists call “locked-in” syndrome. He cannot speak or move, yet he can feel everything. Erik has been “locked-in” since he was 16 years old having suffered a brain stem stroke after a car accident.

Dr Phil Kennedy, chief scientist at Neural Signals Inc, is working to change Erik’s plight through the development of an electrode that detects the neural signals in the speech motor area of Erik’s brain. December 2004 the electrode was implanted in Erik’s brain and then the scientists (and four independent labs), began working on decoding the signals by having Erik think of specific vowel sounds. They are able to then map these sounds and use a synthesizer to reproduce “speech”. CNN reports:

Dr. Frank Guenther, associate professor of cognitive and neural systems at Boston University, said his lab, one of three others pursuing neural signal translation, had a breakthrough recently: They were able to hear the sounds Erik was trying to say using the decoder they built.

“That was a very exciting moment, where we knew this process of taking neural signals and driving a synthesizer was going to work,” Guenther said.

This is still a work in progress, and the scientists are hoping to begin working with Erik to map consonants soon.

Click here to read the entire article from CNN

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, 8:45 am

Crosstalk failure results in decreased cognition

In the absence of Alzheimer’s, decreased networking between parts of the front of the brain and parts of the back of the brain cause lower performance on cognitive tests. According to a study published in the Dec. 6 issue of Neuron by Randy L. Buckner, PhD, and colleagues, degradation of white matter is responsible for decreased communication between different areas of the brain affecting the default network. The default network is responsible for functions such as remembering and planning. However, the researchers also found that the degradation of white matter affected the dorsal attention network. The dorsal attention network is primarily engaged in cognitive tasks.

The researchers used MRI techniques to, as Dr. Buckner puts it “…catch… the failure of communication in the act.” The study focused on 93 adults, 38 which were younger controls ages 18 to 34 and 55 which were 60 to 93 years old. The researchers measured correlations between the posterior cingulate/retrosplenial cortex and the medial prefrontal cortex to determine levels of functionality. The following is an excerpt of an article from Medpage Today that discusses the study:

The researchers divided the 93 adults into a young group of 38 volunteers ages 18 to 34 and an older group of 55 volunteers ages 60 to 93.

Dr. Buckner and colleagues measured functional correlations between the medial prefrontal cortex and the posterior cingulate/retrosplenial cortex, two parts of the default network that are widely separated and connected by conduits of white matter.

They found “a dramatic reduction in correlation between the two groups” that was significant on an independent samples t test at P<0.001.>

Using PET scans, nine members of the older group were shown to be free of amyloid deposition, a hallmark of Alzheimer’s, the researchers reported.

But they had only slightly better correlation between the two brain areas than did the older group as a whole, and it was still significantly lower than in the younger group (P<0.001).>

Findings were similar for the dorsal attention system, which includes brain regions used for tasks that require directed attention, the researchers said.

Interestingly, not all widely separated brain systems are impaired, the researchers said. In particular, they showed that there was no significant difference between the younger and older volunteers in correlations between elements of the visual system.

The researchers said a consequence of the lack of communication between brain regions is significantly poorer performance (P<0.05)>

Click here to read the entire article from Medpage Today

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December 13, 2007, 10:12 am

Senate Approves Traumatic Brain Injury Act

The U.S. Senate has reauthorized the Traumatic Brain Injury Act which will expand research as well as provide assistance to individuals living with the effects of brain injury. In 2000 the first TBI Act was passed as part of the Children's Health Act. The reauthorized bill will bring about collaboration between the Center for Disease Control, National Institute of Health, Department of Defense and Department of Veterans Affairs . The bill will also establish a Government Accountability Office study to focus on the reintegration of injured veterans into their communities. The bill will now move into the House of Representatives for consideration.

The bill is vital to research and the funding services for people with brain injuries. The recognition of military service related brain injury is of great importance  and will serve to solidify the efforts of the Brain Injury Summit meeting in Washington which was reported on in this blog by Michael Mason following his participation in that meeting in early November. We, in the brain injury community, wait with anticipation for the approval of the act as it represents a significant  recognition by the government of traumatic brain injury and extends assistance to those who experience lifelong disability as a result of TBI.

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December 12, 2007, 9:24 am

An Inherited Bias for PTSD

The adult children of individuals with PTSD show a reduction in cortisol production similar to that of their parents. It was also noted that many of the individuals in this group of adult children of PTSD parents also suffered from Mood Disorders. An article in the Archives of General Psychiatry, 2007, September, 64:1040 by R. Yehuda, M.D. described a study to assess low cortisol levels as a vulnerability factor in adult children of parents with PTSD. The study noted changes in the activity level of the hypothalamic-pituitary-adrenal (HPA) axis of the adult children cohort and further identified the possibility that these individuals are more likely to develop PTSD if exposed to a traumatic event.

Individuals with a low probability of developing PTSD have been studied by M. Friedman and reported in Neuropsychiatry Review, January 2006. Dr. Friedman noted that resilient individuals were capable of mobilizing a substance identified as "Neuropeptide Y". These individuals had a lower likelihood of developing PTSD even though they were exposed to the same wartime experiences as individuals who developed PTSD. Individuals without this mobilizing ability were seen as less resilient and more likely to develop long term effects of exposure to trauma. Dr. Friedman, like Dr. Yehuda observed changes within specific regions of the brain. The changes in both studies were lasting and, in the Yehuda study were found to effect the children of individuals with PTSD.

Clearly, the human brain reacts to long term stress exposure through establishing changes which will effect the individual and, as we now have learned, will create a bias for their children to be predisposed to certain psychological problems. Currently the Department of Defense is increasing their assessment of returning troops to determine if they have PTSD, Mild Brain Injury and other problems related to combat acquired physical and psychological injuries. We need to mindful that the effects of the injury may expand beyond the person. Charles Figley, Ph.D. refers to the process of contagion and secondary victimization in PTSD.

Mike Mason, a journalist who wrote "Dead Men Walking"  in a recent issue of Discover magazine, interviewed military medical personnel as well as injured soldiers at Balad Hospital . He  has presented their story at several brain injury conferences and recently at the Professional Seminar Series here at Brookhaven Hospital. The interviews conducted by Mr. Mason with the trauma physicians, nurses and the patients are remarkably similar in the context of being able to hear in the voices of these individuals the impact of their exposure to enormous trauma at primary and secondary levels. We will wait for the future to determine which of those people will develop PTSD or another disorder or which will escape the lasting psychological problems. I hope that we don't make these people or potentially, their children and family, wait to receive the help they may need.

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December 11, 2007, 9:31 am

Even lower impact football helmet hits can cause concussion

A recent study conducted by Kevin M. Guskiewicz, Ph.D. and colleagues at the University of North Carolina, implies that high-impact blows will not necessarily produce concussions, nor will keeping impacts at moderate levels necessarily avoid them. The team recorded 104,714 total impacts: 1,858 of which were over 80 g, and 13 concussions. Of the impacts that exceeded the current theoretical injury threshold of 70 to 75g, less than 0.35% resulted in concussion. Furthermore, seven of the 13 concussions involved impacts of greater than 100 g while the remaining 3 concussions were the result of impacts less than 80g.

In short, according to the researchers, “football concussions can occur from almost any type of head impact, irrespective of magnitude or location, at any level of play, including practice”.

Click here to read the entire article from Medpage Today

The issue of concussions relating to sports continues, for more information:
Click here to read Dr. Gainer’s blog on sports concussion and redux
Click here to read Michael Mason’s blog on a WWE Wrestler TBI advocate
Click here to read Dr. Gainer’s exploration on sports, concussion and depression
Click here to read Michael Mason’s post on Coaches Toolkit for Concussions

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December 7, 2007, 7:46 am

Preliminary study on new seizure medication shows some promising results.

The study, using lacosamide, was conducted over a 12 week period, and consisted of 405 adults with epilepsy who had an average of four seizures a month, with no seizure free period longer than 21 days or more than 8 weeks before the study began.

According to Ed Susman, “Lacosamide, an investigational anti-epilepsy drug, appears to control seizures when used as adjunctive therapy in patients with refractory disease”. Patients using this drug have seen a 36% to 37% reduction in seizures, depending on dosage. According to Dr. Chung, many of the participants have been seizure free for 3 to 18 months while using lacosamide, which has enabled many to regain their drivers licenses.

One draw back that the patients in the study experienced was dizziness, which occurred frequently during the upward titration phase. However, according to Dr Chung the dizziness seemed to subside after the patient achieved the maintenance phase, and then only 10% continued to suffer.

Click here to read the entire article from Medpage Today

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