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What's New in the Brain: Update in Neurology from the American College of Physicians Annual Meeting 2014

written by Linda Yau, M.D., F.A.C.P.
on Friday, 18th April ,2014

Last week I had the privilege of attending the ACP Annual Meeting where 10,000 internists from the United States and the international community meet to attend talks on the state of the latest in the field.  Dr. Martin A. Samuels, the Chairman of Neurology at Harvard Medical School, summarized some the major findings in Neurology research this past year:

1)       Alzheimer’s  Disease:  Three clinical trials were published this year in the New England Journal of Medicine.  All three studies for new medicines did not show improvement for patients who took them for the length of the research trials.  The medicines all targeted amyloid (protein deposits) in the brain. Brains of Alzheimer’s patients show tangles of amyloid, so scientists have targeted trying to decrease amyloid in the brain.  Researchers are hopeful that if patients are diagnosed earlier (even before symptoms of memory loss are apparent) by using amyloid imaging, that these medications may be helpful.

 

2)      Parkinson’s Disease:  Both in Dr. Samuel’s lecture and in Dr. Daniel Kremen’s (neurologist, Thomas Jefferson Medical School) lecture on tremor, a new theory for the cause of Parkinson was summarized.  Drs. Braak and Braak have hypothesized that a prion (infectious agents that exist as folded proteins) that is both inhaled in the nose and swallowed into the gut is responsible for Parkinson’s.  The sequence of spread is from the nasal area to the olfactory bulb of the brain to the stomach and intestines which then spreads to the parts of the brain that are responsible for motor functioning.  This would explain the symptoms that progress from loss of smell and taste to constipation to tremor, rigidity and then dementia.  Many unanswered questions remain such as why do some people get Parkinson’s Disease and not others?  Where does the prion come from and how can one avoid or protect from it?  Hopefully more research will reveal answers.

 

3)      Migraines:  Calcitonin gene related peptide (CGRP) is a neuropeptide (protein in the brain) that dilates blood vessels in the brain.  Part of the pain of migraines is thought to be due to dilation of the blood vessels.  There are many promising new medications that block the CGRP so should be very helpful in stopping migraine headache pain.  They work quickly and do not have as many side effects compared with triptans (examples are Imitrex, Axert, Maxalt, and Relpax) that are currently in use.  The one drawback has been increasing liver function tests in patients in the clinical trials.  Hopefully these medications will be approved by the FDA so that there can be more options for migraine sufferers in the near future.

 

4)      Autism:  The most recent update in the diagnostic manual of psychiatry (DSM V) eliminates the diagnoses of Asperger’s Disorder, Pervasive Development Delay, and Childhood Disintegrative Disorder and lumps them all together under Autism Spectrum Disorder.  Dr. Susan Swedo, leader of the The Neurodevelopmental Work Group, at the National Institute of Mental Health, “recommended the DSM-5 criteria for ASD to be a better reflection of the state of knowledge about autism. The Work Group believes a single umbrella disorder will improve the diagnosis of ASD without limiting the sensitivity of the criteria, or substantially changing the number of children being diagnosed.”

 

 

References:

1)      Alzheimer’s  Disease:  http://www.nia.nih.gov/alzheimers/features/new-clinical-trials-test-alzheimers-drugs

2)      Alzheimer’s  Disease:  http://journals.lww.com/neurotodayonline/Fulltext/2014/03060/Two_Large_Alzheimer_s_Trials_Fail_to_Meet.9.aspx

3)      Parkinson’s Disease:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3776210/

4)      Migraine:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134175/

5)      Migraine:  http://www.bioportfolio.com/resources/pmarticle/255971/New-Agents-For-Acute-Treatment-Of-Migraine-Cgrp-Receptor-Antagonists-Inos-Inhibitors.html

6)      Autism:  http://www.dsm5.org/Documents/Autism%20Spectrum%20Disorder%20Fact%20Sheet.pdf

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