Neurosciences

JOURNALISTS: Mayo Clinic is presenting several abstracts at the American Academy of Neurology 2012 Annual Meeting in New Orleans.  Mayo experts are available for comment.  Contact: Brian Kilen 507-284-5005 ...

JOURNALISTS: Mayo Clinic is presenting several abstracts at the American Academy of Neurology 2012 Annual Meeting in New Orleans.  Mayo experts are available for comment.  Contact: Brian Kilen 507-284-5005 ...

ROCHESTER, Minn. — Forced body cooling known as therapeutic hypothermia has reduced in-hospital deaths among sudden cardiac arrest patients nearly 12 percent between 2001 and 2009, according to a Mayo Clinic study being presented at the upcoming American Academy of Neurology 2012 Annual Meeting in New Orleans. The research is among several Mayo abstracts that will be discussed at the conference. The goal of therapeutic cooling is slowing the body's metabolism and preventing brain damage or death. It is believed that mild therapeutic hypothermia suppresses harmful chemical reactions in the brain and preserves cells. Two key studies published in 2002 found therapeutic hypothermia more effective for sudden cardiac arrest patients than traditional therapies. Mayo researchers analyzed a database covering more than 1 million patients and found mortality rates among in-hospital sudden cardiac arrest patients dropped from 69.6 percent in 2001 — the year before the studies appeared — to 57.8 percent in 2009, the most recent data available. "Because we reviewed such a large number of cases, we are confident that the reduction in mortality among in-hospital sudden cardiac arrest patients is significant and sustained," says co-author Alejandro Rabinstein, M.D., a Mayo Clinic neurologist. "We continue to seek answers to the questions: Why did this trend develop, and how can we accelerate it," says co-author Jennifer Fugate, D.O. These measures are important because disease accumulates in the cortex over time, and inflammation in the cortex is a sign the disease has progressed. Other studies being presented at AAN include: Structured resident sign-out during shift changes improves patient care: In the study, junior residents in Mayo Clinic's General Neurology, Stroke and Neurologic Intensive Care Units spent the first half of their rotations using unstructured sign-out approaches and transitioned to a structured system for the second half. The residents reported that the standardized sign-out improved communication substantially, including information on pertinent past medical history, pending lab tests, recommendations on how to handle nursing and pharmacy calls, and up-to-date code status. Residents using standardized sign-out were also more likely to share test results with patients and their families prior to shift changes. This led to a significant increase in overall satisfaction with the sign-out process. "This study is particularly timely now, when residency programs are adjusting to new duty-hour restrictions established in 2010," says lead author Brian Moseley, M.D., a Mayo Clinic neurology resident and Assistant Professor of Neurology. "When you have hand-offs because of the duty restrictions, unless the communication is good, there is a lot of opportunity for error," says Jeffrey Britton, M.D., a Mayo Clinic neurologist and study co-author. "This structured method seems to both prevent the error, but also make the patient and their family feel comfortable that this important communication is happening," says Dr. Britton.

ROCHESTER, Minn. — Mayo Clinic researchers will present findings on stroke and aneurysm treatments and other neurosurgery research at the American Association of Neurological Surgeons annual scientific meeting April 14-18 in Miami. Mayo Clinic neurosurgeons will be available to provide comment for reporters covering the conference. Mayo Clinic studies that will be presented and their embargo dates include: Carotid endarterectomy is a safe, less expensive treatment for stroke A Mayo Clinic study of 1,492 patients found endarerectomaties are a safe, less expensive treatment option for certain patients at risk for stroke. Endarterectomy is used to treat carotid artery disease, a condition in which the carotid arteries narrow or clog, and blood struggles to reach the brain, causing a stroke. "In our study, we found endarterectomy was largely effective," says co-author Fredric Meyer, M.D., a Mayo Clinic neurosurgeon. "Endarterectomy is less expensive than the other treatment for carotid artery disease, so this is important for physicians to recognize." Endarerectomaties cost roughly $200 to $400 less per procedure than carotid angioplasty, the other main treatment to restore proper blood flow to the head. In an endarterectomy, plaque is separated from an artery wall. Angioplasty involves temporarily inserting and inflating a tiny balloon to widen the clogged artery. Different techniques safe and effective for stroke treatment A treatment strategy using different techniques alone or together based on clinical and angiographic features is an effective and safe way to manage intracranial dural arteriovenous fistulas (DAVF), says study co-author Giuseppe Lanzino, M.D., a Mayo Clinic neurosurgeon. Intracranial dural arteriovenous fistulas are abnormal connections between an artery and a vein inside the brain. "The most dangerous complication of a cranial DAVF is brain hemorrhage," says David Daniels, M.D., Ph.D., a Mayo Clinic neurosurgeon and study co-author. Depending on the location, an unruptured fistula can cause neurological problems and blindness. Researchers studied 60 consecutive patients evaluated for intracranial dural arteriovenous fistulas at Mayo Clinic since 2008. Data collected include patient demographics, presenting symptoms and signs, angioarchitecture, treatment recommendations, clinical outcomes, complications and radiological follow-up.

SCOTTSDALE, Ariz. — April 2, 2012.  A new report released today from the Institute of Medicine highlights numerous gaps in the knowledge and management of epilepsy and recommends actions for improving the lives of those with epilepsy and their families and promoting better understanding of the disorder. Effective treatments for epilepsy are available but access to treatment and timely referrals to specialized care are often lacking, the report's expert committee found. Joseph Sirven, M.D., chair of Neurology at Mayo Clinic in Arizona was one of the 16 members of the committee which met for more than a year to create the report. Among the key highlights of the more than 400-page report: Misperceptions about epilepsy persist and a focus on raising public awareness and knowledge is needed, the report adds. Educating community members such as teachers, employers, and others on how to manage seizures could help improve public understanding of epilepsy. Reaching rural and underserved populations, as well as providing state-of-the art care for people with persistent seizures, is particularly crucial. The report's recommendations for expanding access to patient-centered health care include early. Identification and treatment of epilepsy and associated health conditions, implementing measures that assess quality of care, and establishing accreditation criteria and processes for specialized epilepsy centers. Some causes of epilepsy, such as traumatic brain injury, infection, and stroke, are preventable. Prevention efforts should continue for these established risk factors. People with epilepsy need additional education and skills to optimally manage their disorder. Consistent delivery of accurate, clearly communicated health information from sources that include health care professionals and epilepsy organizations can better prepare those with epilepsy and their families to cope with the disorder and its consequences. Living with epilepsy can affect employment, driving ability, and many other aspects of quality of life. The report stresses the importance of improved access to a range of community services, including vocational, educational, transportation, transitional care, and independent living assistance as well as support groups. The report suggests several strategies for stakeholders to improve public knowledge of the disorder, including forming partnerships with the media, establishing advisory councils, and engaging people with epilepsy and their families to serve as advocates and educators within their communities.

ROCHESTER, Minn. — People with symptoms suggesting rapid eye movement sleep behavior disorder, or RBD, have twice the risk of developing mild cognitive impairment (MCI) or Parkinson's disease within four years of diagnosis with the sleep problem, compared with people without the disorder, a Mayo Clinic study has found. The researchers published their findings recently in the Annals of Neurology. VIDEO ALERT: For video of Dr. Boeve talking about the study and for b-roll of study participants with RBD, visit the Mayo Clinic News Blog. One of the hallmarks of rapid eye movement (REM) sleep is a state of paralysis. In contrast, people with rapid eye movement sleep behavior disorder, appear to act out their dreams when they are in REM sleep. Researchers used the Mayo Sleep Questionnaire to diagnose probable RBD in people who were otherwise neurologically normal. Approximately 34 percent of people diagnosed with probable RBD developed MCI or Parkinson's disease within four years of entering the study, a rate 2.2 times greater than those with normal rapid eye movement sleep. "Understanding that certain patients are at greater risk for MCI or Parkinson's disease will allow for early intervention, which is vital in the case of such disorders that destroy brain cells. Although we are still searching for effective treatments, our best chance of success is to identify and treat these disorders early, before cell death," says co-author Brad Boeve, M.D., a Mayo Clinic neurologist. Previous studies of Mayo Clinic patients have shown that an estimated 45 percent of people who suffer from RBD will develop a neurodegenerative syndrome such as mild cognitive impairment or Parkinson's disease within five years of diagnosis.

SCOTTSDALE, Ariz. — A recent Mayo Clinic study on yips, a condition that has baffled golfers and scientists for decades, will be a featured presentation ...

ROCHESTER, Minn. — Mayo Clinic and partners from the University of Pennsylvania School of Veterinary Medicine, the University of Minnesota College of Veterinary Medicine and College of Pharmacy, the Perelman School of Medicine at the University of Pennsylvania, and NeuroVista Corporation have been awarded a $7.5 million grant (U01) from the National Institute of Neurological Disorders and Stroke, a division of the National Institutes of Health (NIH). The research involves studying new ways to predict and control epileptic seizures in dogs and people. VIDEO ALERT: Journalists: video of a canine seizure is available at the Mayo Clinic News Blog. Epilepsy affects approximately 1 percent of the human population, with an estimated 50 million people worldwide currently suffering from the disorder. The hallmark of epilepsy is the seizure — a sudden and often violent event that strikes patients without warning. The goal of the research is to use information gleaned from real-time electroencephalograms (EEG) to consistently detect impending seizures, and develop methods of preventing these seizures through use of fast-acting drug therapies. The grant awards $1.5 million a year for up to five years. The principal investigators of the studies are Greg Worrell, M.D., Ph.D., Mayo Clinic; Ned Patterson, D.V.M., Ph.D., University of Minnesota College of Veterinary Medicine; Jim Cloyd, Pharm.D., University of Minnesota College of Pharmacy; Charles Vite, D.V.M., Ph.D., University of Pennsylvania School of Veterinary Medicine; Brian Litt, M.D., Perelman School of Medicine at the University of Pennsylvania; and Kent Leyde, chief technology officer of NeuroVista Corporation of Seattle, Washington. NeuroVista, a Seattle based company developing novel technologies for the management and treatment of epilepsy, has developed an implantable device system that continuously collects and analyzes EEG data to detect impending seizures. The system uses an external patient-carried device with a very simple interface—three colored lights—to indicate the risk of an impending seizure to the patient. The system is currently undergoing study in clinical trials in human patients being conducted in Australia. The NIH-funded research will involve applying the NeuroVista technology to dogs with naturally occurring epilepsy, and extending the technology by using it to guide the administration of fast-acting drugs to prevent seizures. It is hoped that this work will translate to a similar solution for human patients.

JACKSONVILLE, Fla. — Researchers have identified a gene that causes adult-onset primary cervical dystonia, an often-painful condition in which patients' necks twist involuntarily. The discovery by a team from the Jacksonville, Fla., campus of Mayo Clinic and the University of Tennessee Health Sciences Center sheds light on a movement disorder that physicians previously could seldom explain. Their research appears in the Annals of Neurology. In 1990, a man with a crooked neck came to see Ryan Uitti, M.D., a neurologist then at Mayo Clinic in Rochester, Minn. Dr. Uitti knew about adult-onset primary cervical dystonia, which results in involuntary twisting of the neck to the left or right, backward or forward. Most people who have it suffer from muscle pain and abnormalities in head position. Some don't think it is all that unusual and may not seek medical help, Dr. Uitti says. "They think they slept wrong at some point, or, because the twisting might straighten out with another maneuver, such as walking backwards, they might actually be accused of being a little crazy," Dr. Uitti says. Dr. Uitti had been taught that there is usually no explanation for the disorder, when it shows up in adulthood. But working with a team of neurologists who have found the genetic causes of other rare conditions, Dr. Uitti began to investigate.

ROCHESTER, Minn. — Mitochondria — subunits inside cells that produce energy — have long been thought to play a role in Alzheimer's disease. Now Mayo Clinic researchers using genetic mouse models have discovered that mitochondria in the brain are dysfunctional early in the disease. The findings appear in the journal PLoS ONE. The group looked at mitochondria in three mouse models, each using a different gene shown to cause familial, or early-onset, Alzheimer's disease. The specific mitochondria changes corresponded with the mutation type and included altered mitochondrial movement, structure, and energy dynamics. The changes happened in the brain even before the mice showed any symptoms such as memory loss. The group also found that the mitochondrial changes contributed to the later loss of mitochondrial function and the onset and progression of Alzheimer's disease. "One of the most significant findings of this study is our discovery of the impact of mitochondrial dysfunction in Alzheimer's disease," says Eugenia Trushina, Ph.D., Mayo Clinic pharmacologist and senior investigator on the study. "We are asking: Can we connect the degree of mitochondrial dysfunction with the progression of symptoms in Alzheimer's disease?" Enlisting the expertise of Mayo researcher Petras Dzeja, Ph.D., the team applied a relatively new method called metabolomics, which measures the chemical fingerprints of metabolic pathways in the cell — sugars, lipids, nucleotides, amino acids and fatty acids, for example. It assesses what is happening in the body at a given time and at a fine level of detail, giving scientists insight into the cellular processes that underlie a disease. In this case, the metabolomic profiles showed changes in metabolites related to mitochondrial function and energy metabolism, further confirming that altered mitochondrial energetics is at the root of the disease process.

ROCHESTER, Minn. — In a reversal of two decades of medical reports, a Mayo Clinic study finds the frequency of nerve damage called diabetic polyneuropathy is similar in prediabetic patients and healthy people. Physicians should seek explanations other than prediabetes for patients who have painful small fiber polyneuropathy, the researchers say. The study was published in the March issue of Diabetes Care. Diabetic polyneuropathies, or DPN, are commonly associated with diabetes and chemical derangements related to high blood sugar. The neuropathies can injure nerve fibers throughout the body, but usually affect the feet and legs. The nerve damage can create sensory, motor and bodily function problems. DPN can be painful and life-threatening. "It is highly unlikely that impaired glucose or associated metabolic derangements cause polyneuropathy, at least not to the high frequency previously reported," says lead author Peter J. Dyck, M.D., a Mayo Clinic neurologist. The five-year study, "Impaired Glycemia and Diabetic Polyneuropathy: The OC IG Survey," tested nearly 550 people representative of a community of older patients of Northern European extraction. Of these, 150 individuals were healthy subjects, 174 had prediabetes indicators, and 208 had newly developed type 2 diabetes. The study concluded that typical or atypical (a painful small-fiber variety) DPN was not more prevalent in prediabetics than in healthy people.

SCOTTSDALE, Ariz. — A new study from Mayo Clinic supports the idea that "what's good for your heart is good for your brain." The study, released today, suggests that eating too much may double the risk for memory loss in people age 70 and older. This research will be presented at the American Academy of Neurology's 64th Annual Meeting in New Orleans April 21 to April 28. VIDEO ALERT: Click here for a video of Dr. Geda explaining the study. "We observed a dose-response pattern which simply means; the higher the amount of calories consumed each day, the higher the risk of mild cognitive impairment," said study author Yonas E. Geda, M.D., MSc, a neurologist and psychiatrist with Mayo Clinic in Arizona. He noted that 2,143 calories per day may double the risk of memory loss. While the relationship between cardiovascular problems and overeating are well known, the study further documents the similarities of cardiovascular risks and neurological risks such as mild cognitive impairment, Dr. Geda says. MCI is the stage between normal memory loss that comes with aging and early Alzheimer's disease. The study involved 1,233 people in Olmsted County, Minn., ages 70 to 89 and free of dementia. Of those, 163 had MCI. Participants reported the amount of calories they ate or drank in a food questionnaire and were divided into three equal groups based on their daily caloric consumption. One-third consumed 600 to 1,526 calories per day, one-third 1,526 to 2,143 calories and one-third 2,143 to 6,000 calories per day. The odds of having MCI more than doubled for people in the highest calorie-consuming group compared with people in the lowest calorie-consuming group. The results were the same after adjusting for history of stroke, diabetes, amount of education and other factors that can affect risk of memory loss. There was no significant difference in risk for the middle group.