Stress is a Common Seizure Trigger in Epilepsy

https://goo.gl/i2WDy1

Patients with epilepsy face many challenges, but perhaps the most difficult of all is the unpredictability of seizure occurrence. One of the most commonly reported triggers for seizures is stress.

A recent review article in the European journal Seizure, by researchers at University of Cincinnati Epilepsy Center at the UC Gardner Neuroscience Institute, looks at the stress-seizure relationship and how adopting stress reduction techniques may provide benefit as a low risk form of treatment.

The relationship between stress and seizures has been well documented over the last 50 years. It has been noted that stress can not only increase seizure susceptibility and in rare cases a form of reflex epilepsy, but also increase the risk of the development of epilepsy, especially when stressors are severe, prolonged, or experienced early in life.

“Any patient reporting stress as a seizure trigger should be screened for a treatable mood disorder,

The researchers report that while some small prospective trials using general stress reduction methods have shown promise in improving outcomes in people with epilepsy, large-scale, randomized, controlled trials are needed to convince both patients and providers that stress reduction methods should be standard adjunctive treatments for people with epilepsy.


Antipsychotic Medications Linked to Risk of Pneumonia in Alzheimer’s Disease

https://goo.gl/5lKlbZ

Antipsychotic medications are associated with an increased risk of pneumonia in persons with Alzheimer’s disease (AD), according to new research from the University of Eastern Finland. The risk of pneumonia was the highest at the beginning of antipsychotic treatment, remaining elevated also in long-term use. No major differences were observed between the most commonly used antipsychotics.

Pneumonia was listed as one of the leading causes of death in the FDA’s 2005 warning on the use of antipsychotics for the treatment of behavioural and psychological symptoms of dementia. Since then, antipsychotics have been linked to an increased risk of pneumonia in in several studies, but studies among persons with dementia have been scarce. However, almost one third of Finns with Alzheimer’s disease use antipsychotic medication.


Health Reform Update: Administration Can Change Health Care Without Congress

https://goo.gl/LiCAhD

Despite the initial reaction last Friday that Congress was “moving on” from health reform legislation, reports out this week indicate that the House could possibly rekindle negotiations and move forward with an ACA repeal and replace package in the coming weeks. Even with maneuvering in the House, any proposal similar to AHCA would face tough prospects in the Senate where a number of key Republican Senators have expressed concerns and opposition to the bill. The National Council is monitoring congressional action closely and will notify its members if any advocacy is needed.

REFORM THROUGH REGULATION

Even if President Trump is unable to usher repeal and replace through Congress, there are a number of potential reforms that can be made to health care and Medicaid through the regulatory and administrative processes at the Department of Health and Human Services.

Potential reforms to Medicaid via regulations or Centers for Medicare & Medicaid Services (CMS) state waivers include:

  • Imposing work requirements for able-bodied adults;
  • Implementing various cost-sharing measures like premium payments and emergency room copayments;
  • Redefining the Essential Health Benefits, including mental health and substance use treatment; or
  • Revising annual open enrollment period for insurance coverage.


Dementia: Across the Lifespan & Around the Globe

PLOS Medicine Journal has a special issue on dementia. Interesting.......

http://collections.plos.org/dementia

Alzheimer’s Disease International (ADI) estimates there will be over 131.5 million people living with dementia by 2050, as well as a shift in burden from the richest to poorest countries. These trends emphasize the need for a greater understanding of dementia from a global perspective. This PLOS Medicine Special Issue, guest edited by Carol Brayne and Bruce Miller, includes research articles, editorials, and perspectives that highlight the broad range of dementia research.

New Multiple Sclerosis Drug, Backed by 40 Years of Research, Could Halt Disease

https://goo.gl/aVPHwc

A newly approved drug that is the first to reflect the current scientific understanding of multiple sclerosis (MS) – is holding new hope for the hundreds of thousand's Americans living with the disease.

It also highlights the importance of clinician-scientists like UC San Francisco’s Stephen Hauser, MD, who are working to transform research into cures for patients.

The Food and Drug Administration on Tuesday approved ocrelizumab (brand name Ocrevus) to treat both relapsing-remitting MS and primary progressive MS, the first time a therapy has been available for severe forms of the disease.

The drug, the first that targets B cells in the human body, grew out of the work of Hauser, chair of neurology at UCSF, whose team persevered for decades in elucidating the science behind MS, defending findings that contradicted long-standing assumptions and translating the science into a therapy.


Dementia: The right to rehabilitation

https://goo.gl/N7IJJG

Rehabilitation is important for people with dementia as it is for people with physical disabilities, according to a leading dementia expert.

Linda Clare, Professor of Clinical Psychology of Aging and Dementia at the University of Exeter, said people with dementia have a right to cognitive rehabilitation - and it is as relevant for them as physical rehabilitation for people with physical impairments.

Writing in the journal PLOS Medicine, Professor Clare said both share a goal to enable people to participate in everyday life, and in their families and communities, in a way that is meaningful to them.

Professor Clare said: "We tend to think of rehabilitation in terms of people with physical impairment following an injury, but it is equally important in people with cognitive impairment. As a society, we now have a much greater recognition that people with physical disabilities have the right to access services and opportunities, but there it still a long way to go for people with "hidden" disabilities such as dementia, in a landscape where the numbers of people with dementia are expected to rise from 44 mill in 2015 to 117 million by 2050.

Professor Clare oversees the GREAT trial, which is assessing the success of cognitive rehabilitation in more than 500 people across eight sites in the UK. It focuses on tailor-made approaches to the specific, individual problems people encounter at different stages of dementia. Examples may include people wanting to use email to stay in contact with family and friends, gain confidence to go outside, or manage daily tasks better. For people in the more advanced stages of dementia, approaches may focus on being able to dress independently or engage in pleasurable activities.


Concern over high US prescribing levels of common drug linked to dementia

https://goo.gl/uEjKI5

A new analysis raises concern over high prescription rates in the USA of a common drug used to treat overactive bladder. The drug, oxybutynin, when taken orally, is consistently linked with cognitive impairment and dementia in the elderly. The analysis shows that oxybutynin, is prescribed in more than a quarter of cases of overactive bladder (27.3%), even though other more suitable drugs are available. This work is presented at the European Association of Urology conference in London, where concerns are also being expressed about the lack of funded alternatives to oxybutynin in Europe.

Overactive bladder (OAB) is extremely common in persons over 65. Initial treatment is normally via behavioural modifications, which can then be followed by first-line medical treatment such as antimuscarinic medications, including oxybutynin. Antimuscarinic drugs are synthetic compounds, originally derived from mushrooms, which block the activity of the muscarinic acetylcholine receptor. They have several uses, including control of OAB. Oxybutynin is the least expensive antimuscarinic used for OAB, and so tends to be the drug of choice for health care plans such as Medicare. However, a body of evidence has shown that oxybutynin is linked to greater cognitive decline in the elderly1.


Five Lessons From The AHCA’s Demise

https://goo.gl/iKomGG

1. Nothing Is Inevitable
Remember how we were all told Affordable Care Act (ACA) repeal would be on the President’s desk on Inauguration Day? After all, Republicans had already voted for it several dozen times, most recently in January 2016 in an attempt to override President Obama’s veto. Now that they had control of the White House, what could stop them?

As I pointed out in my Health Affairs Blog post last December predicting ACA repeal would fail, however, there’s a difference between making a political statement and enacting real policy. The latter is invariably complex and time-consuming, creating vulnerabilities and pitfalls both known and unknown at the outset. While a cornerstone of tried and true policymaking is to leverage the “strategy of inevitability”—more than seven years ago, the ACA campaign itself vigorously deployed just such a strategy—the underlying premise of that strategy is always inherently false.

So the next time someone tells you you’ve got to “get on board” because a certain bill is guaranteed to pass, you’ll know you have other options, and that person probably knows it too.

2. Stakeholders Matter
While, in my prior piece, I did lament the health care community’s dormancy in the aftermath of the November 8 election, I also anticipated that it would eventually wake up to resist broad ACA repeal. And resist we did. Virtually every hospital and hospital group, every physician group, nurses, patient groups representing the young, old, disease-stricken, and disabled, and many others fervently opposed AHCA. They added analysis of AHCA’s impact on them, as Governors did regarding its impact on their states. At the end of the day, this was simply a bad bill. Stakeholders figured it out and acted when it counted.

Republicans in Congress, believing they had a political mandate to move quickly, truly thought they could ignore these objections. But the stakeholder message spread and town halls filled up; protests lined district offices; opposition letters, phone calls, and tweets, poured in. Ultimately, on the day AHCA was originally supposed to get its final House vote, a Quinnipiac University poll came out showing only 17 percent of the public supported the bill, while 56 percent opposed it, a startling gap rarely seen in any bona fide political polling.

By the time Republicans realized they had to start paying attention to stakeholder concerns, it was too late. The bill was already drafted and introduced and, as the White House and House leadership repeatedly threatened, members were going to be forced to vote ‘up’ or ‘down.’ Clearly, for too many by then, ‘down’ was looking like a better choice than ‘up.’

And 3 more good ones.....


Chronic Fatigue Syndrome Indicator Found In Gut Bacteria

https://goo.gl/kqHzoH

Now, for the first time, Cornell researchers report they have identified biological markers of the disease in gut bacteria and inflammatory microbial agents in the blood.

Senior author Maureen Hanson, the Liberty Hyde Bailey Professor in the Department of Molecular Biology and Genetics, said

“Our work demonstrates that the gut bacterial microbiome in ME/CFS patients isn’t normal, perhaps leading to gastrointestinal and inflammatory symptoms in victims of the disease. Furthermore, our detection of a biological abnormality provides further evidence against the ridiculous concept that the disease is psychological in origin.”

In a study published by the journal Microbiome, the team describes how they correctly diagnosed myalgic encephalomyeletis/chronic fatigue syndrome (ME/CFS) in 83 percent of patients through stool samples and blood work, offering a noninvasive diagnosis and a step toward understanding the cause of the disease.

Ruth Ley, associate professor in the Departments of Molecular Biology and Genetics and Microbiology, is a co-author.

“In the future, we could see this technique as a complement to other noninvasive diagnoses, but if we have a better idea of what is going on with these gut microbes and patients, maybe clinicians could consider changing diets, using prebiotics such as dietary fibers or probiotics to help treat the disease,”

said Ludovic Giloteaux, a postdoctoral researcher in both Hanson’s and Ley’s labs and first author of the study.

Researchers have evidence that an overactive immune system plays a role in chronic fatigue. Symptoms include fatigue even after sleep, muscle and joint pain, migraines and gastrointestinal distress.