New type of nerve cell in brain. POTSers, take note… and hope

This article discusses the discovery of a new type of neuron in the hypothalamus. 

A new type of nerve cell found in the brain

This specific type of nerve cell handles cardiovascular functions, playing some sort of role in regulating heart rate and blood pressure. The cardiovascular system being the interlocked system  that it is, this presumably also includes force of heart contractions, tension of the vessels, and other autonomically-driven activities.

The autonomic part of the nervous system is supposed to be the ring-master for the automatic functions of life, everything that has an up and a down: blood pressure, heart rate, sleeping/waking, appetite and thirst, and so on. Its dysregulation in CRPS is probably one of the most stubborn problems in treating and managing this disease. Finding a type of nerve that so explicitly  handles one part of that extraordinarily complex set of inter-relating functions is fascinating enough, but the ramifications are tremendous.

Here they discuss it in terms of its relationship to the thyroid, an endocrine organ that’s an important part of those regulatory mechanisms, on the chemical-messenger side. The thyroid drives the creation and balance of these types of nerves; these types of nerves then influence the output of the thyroid. It’s a metabolic two-step, a mutual relationship characteristic of nearly every chemical/physical connection in the human body.

Those who have POTS and other forms of autonomically-driven cardiovascular problems might have a new cause for hope. Being able to separate out that particular set of mechanisms from the rest of the nervous system, at least to some degree, may give them a chance of managing their disease better without throwing the rest of their autonomic functions further off.

Anyone who has been that nauseously dizzy and that weak for that long would be terribly glad of the chance. This is great science, and not just for those with thyroid disorders.

Links:
“A new type of nerve cell found in the brain”
Eurekalert press release on these findings
Wikipedia on CRPS
What is dysautonomia? – with a focus on cardiovascular issues
CRPS, ANS dysfunction, and chronic vertigo

Share

Makes my brain explode — but now it can be repaired

It’s almost impossible to discuss this article without leaping out of the chair and waving my arms around, squealing with the sheer thrill of its deep and wide implications for treatment and understanding:

Precisely Engineering 3-D Brain Tissues

Using a 3-D printer, transparencies, and binder clips, these wunderkinder can create neural tissues that mimic the cellular proportions and relationships of real, living brains.

On this basis, here are some possibilities discussed in the article:

  • Watch how brain tissue responds under different circumstances, leading to new understanding of brain growth, disease progression and structure-dependent brain abnormalities.
  • Repair damaged brain tissue. With historic rates of traumatic brain injury in the most productive age group, this alone is world-changing.
  • With samples from patients, custom brain cultures can be grown, and drugs tested against them, targeting drug treatment that works on the first trial. This saves people who need CNS-affecting drugs countless weeks and months — even years — of untold misery, as different drugs get pushed through their systems in an effort to find one that works.

Harvard Med and MIT at their collective finest.

The great challenge, of course, is getting this OUT of the lab and INTO the populations that need it. I hope it’s not kyboshed by those whose profits depend on the current ineffective, inefficient, expensive, and unspeakably brutal systems of CNS treatment.

Let good medicine prevail.

Share

White matter map and why it matters

This article describes a new, life- and reality-based map of the white matter in the human brain:

First Micro-Structure Atlas of Human Brain Completed

It addresses two crippling gaps in our understanding of the brain:

1. Hitherto, brain models have been derived from microscopic analysis of a handful (so to speak) of cadaver brains.  Since significant physical and chemical changes begin to happen immediately upon death, this puts a hard limit on  how accurate these models can be — and gives us no real clue about the true extent of the inaccuracy, because there were no living models to compare them with.

2. Until now, the science has focused on grey matter. We don’t even really know what white matter does, except convey the messages the grey matter processes. (It’s a bit like not knowing anything about your internet uplink — not ISP contact info, speed, bandwidth, nor hardware — even though your work and connections depend on your internet access. You can still get something done, but if anything goes wrong, where do you start?) One day in the near future, we’re going to be really embarrassed about ignoring white matter for so long.

This map was made as follows:
- using MRI that yields unprecedented resolution, able to provide solid estimates of such details as the width of different neuron fibers (!),
- done on living brains,
- in the skulls of 100 different people — a much more meaningful sample.

This is a great day in neurology. All of us with CNS disorders have a brighter future, with information from this map making its way into the science.

Share

Suicide, including veteran suicide, handled back to front

This article discusses suicide among returning veterans:

Suicide Prevention Expert Outlines New Steps to Tackle Military Suicide

The up-side is, it brings more attention to this national shame: “..while only 1% of Americans serve in the military, the suicide rate of veterans accounts for [20 %] of the overall total in the US.” [Emphasis mine.] They’re overrepresented in suicidal despair, even at this time of epic national meltdown, at a rate of 19:1.

There are some good ideas (badly put) under this deceptive title (new? Hardly), with an unfortunate insularity and gee-whizz ignorance in parts:  “the effects on the mental health of active-duty service members, reservists, and veterans is only just beginning to be felt.”

Only just beginning to be felt? By whom? Reports started streaming out of this population from the start!

The horrific rate of PTSD, brain injury and subsequent/consequent suicide among modern veterans has been in the news nearly since the Iraq war started. And the effects were “felt” by affected veterans and those who love them from the beginning.

That was an astoundingly insensitive choice of words, and when a social scientist is astoundingly insensitive, it automatically makes me question his insight and judgement. After all, social scientists have to pay attention to social cues and have some social awareness in order to do their jobs well.

The suggestions made by this article are,

  • Reduce access to guns and other means of suicide.
  • Watch for sleep disturbances. 
  • Prescribe opioid medications carefully and monitor.
  • Improve primary care treatment for depression.

These instructions are useful and appropriate (though not new at all), but the order puts the primary burden in the wrong place.

The reflex is to consider first how to change the patient’s context and control, and second how to change the provider’s context and control.

But which person — doctor or patient — do the policy makers have more access to?

Which has broader (and more cost-effective) reach per person?

Where does influence and support really come from — especially when the patients themselves are desperate and don’t have the resources to face what they’re dealing with?

Hint: Only one of these two people is licensed, monitored — and paid to show up.

It might be time to focus first on how to change the provider’s context and control — in this case, train primary care physicians in how to evaluate for mental health issues without losing their own minds, and make it easier for them to be more mindful, conscientious and appropriate when prescribing CNS depressants such as opioids.

Policies regarding these things may need to be updated. Despite some alterations and improvements, they still focus on controlling the patient’s access to meds and autonomy, rather than on changing the provider’s involvement and awareness of what’s going on.

This is exactly back-to-front.

This is the best we can do??

At-risk patients — those with PTSD, intrusive pain, or some other confounding factor — need to be seen more often and have mental health screens at each visit. Since many of the well-tested screening tools are short checkbox quizzes, that’s a reasonable addition to care. Some can be filled out in the lobby by the patient.

This serves several purposes: the frequent care provides a disproportionate feeling of support to the patients, reducing despair and helplessness; if the visits feel excessive, it motivates the patients to improve their own resources and self-care, reducing passivity, which improves outcomes; and bad findings on the quizzes provide quantifiable, documented need for mental health care, which can then be provided in a more timely manner and with less argument from payors.

Speaking as someone with significant confounding factors (chronic pain, neuro dysregulation, and acute life stress) I’d be delighted to know my doctor and health care system would do that for me, even though I’m not remotely suicidal myself.

When the behavior of those who are easiest for policies to reach AND most influential in patient care is more appropriate and effective, then it makes more sense to go to the trouble and expense to reach further out into the population’s private lives and try to manage them there.

A more rational and effective approach might be,

    1. Train and retrain all primary care doctors to look for mental health issues. This is something that suicide prevention specialists have been screaming for for years. It’s mentioned last in this article, but should be mentioned first: people who commit suicide were likely to have seen their doctors within a month. Talk about a cry for help falling on deaf ears!

      But most doctors turn into deer in the headlights in the face of mental distress, because they have no real idea about what to do. There need to be better guidelines, a clearer path to mental health follow-up, and failure to meet basic requirements of care needs to create problems for the provider — as they inevitably do for the patient.
       

    2. Manage access to obvious methods of suicide, like CNS depressants and firearms. There are many profoundly depressed people who will kill themselves if it’s easy, but fewer who will really put a lot of energy into it, because energy plummets with major depression — along with impulse control. A deadly combination.

      Reducing access involves having primary doctors get more involved with patients who get CNS depressants like opioids and benzodiazepines; implementing and enforcing access laws to firearms and ammunition; and noticing at-risk people with drug and firearm access and giving them the training they need to reduce their own access on an impulsive basis. (Yes,that’s right, engage the patient’s own inner and outer resources, rather than simply impose limits outside their control.)
       

    3. Increase time span between impulse and action, giving second thoughts a chance to kick in. This is important, because the despair is stubborn, but the suicidal impulse comes and goes. Give it a chance to go, so the person has a future and a chance to recover.

      This involves, again, noticing them; engaging them to leverage their own capacity for self-management; and getting logistical support from those around them.
       

    4. Look for early signs, like sleep disturbance, mood swings and eating or weight disturbances. Don’t know why the latter signs aren’t even mentioned here, when they’re easier to notice from the outside. Veterans certainly have them.

      We’ve been pushing for effective education for all primary doctors around both mental health and pain control (which are tightly linked) for decades. It’s not new, it’s just ignored, underfunded, and badly implemented, costing billions in direct and indirect costs.

      Mental health and pain control are tightly linked because:

      • Pain is depressing.
      • Pain is limiting.
      • The helplessness of those limitations is depressing.
      • CNS depressants are, literally, depressing.
      • Depression and helplessness significantly increase pain response in the brain and nerves.
      • And back around we go.

      It’s a vicious cycle, keeping overtaxed minds between frying pan and fire…

      Lasting treatment success is tied to increasing someone’s sense of self-governance and engagement with life (reducing actual helplessness) not limiting their options and patronizing them into submission (increasing actual helplessness.)

      [Limiting options is necessary and useful for inpatient treatment, but is highly problematic in outpatient care — which is where most mental health issues take place.]

      That same engagement and sense of self-governance also reduces the neural system’s susceptibility to pain.

      It breaks the cycle.

      One of these people is not engaged in life. The other is. Which seems better?

      Let’s do all that now — at last — and see how much faster the suicide rates drop than at any prior point in history. For veterans, civilians, everyone.

      It’d be cheap, effective, and useful. It’d serve our veterans and increase productivity. It’d brighten up the lives of everyone affected by it. Is there a downside?

      Links:

      Suicide Prevention Expert Outlines New Steps to Tackle Military Suicide. ScienceDaily (Sep. 10, 2012)
      6,500 US Military Veterans Commit Suicide Every Year, International Business Times (April 2012).
      Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. NEJM (July 2004)
      PubMed search for “PTSD veterans” results.
      PubMed search for “TBI veterans” results. TBI stands for Traumatic Brain Injury.
      Make the Connection, bringing generations of vets together for mutual support and counseling.
      Suicides — United States, 1999–2007 Centers for Disease Control (January 2011).

      Share

      Reading uses split focus in the eyes and fusing in the brain

      This study looks at how the eyes behave when reading:

      http://www.sciencedaily.com/releases/2007/09/070910092543.htm

      It explains an observation I first made about 35 years ago, sitting on the rug and watching my family read.

      The old assumption was that both eyes look at the same letter at the same time. Speaking as a reader, I had sometimes wondered about that, especially when you read in chunks rather than letter by letter. I felt like  my eyes weren’t quite together, and when I looked at my parents or brothers reading, especially when I looked from below, their eyes seemed to focus a whisker or two below the page. If they were absorbed and reading fast, their eyes seemed to focus further below the page, like they were physically climbing into the book eyes-first; if they were less intrigued, their focus was nearly exactly on the page.

      It turns out that, when reading, the eyes focus a letter or two apart, and that polysyllabic portmanteau words can be read half by one eye and half by the other. The slightly split image is joined in the visual cortex of the brain by a process called fusion.

      Fusion combines the slightly different images from each eye in the primary visual cortex, right at the rear of the brain. It serves several purposes: gives us the complexity of 3-dimensional vision; lets us interpret faint images more accurately; and, in reading, it apparently lets us move faster.

      Focusing a letter or two, or even half a word, apart, would partly explain why my family’s eyes seemed to be focusing slightly below the page. When they get around to studying avid readers reading avidly, I think they’ll find that the eyes can diverge quite a bit more than a letter or three.

      Share

      Blood sugar and mood

      “ScienceDaily (2012-01-10) — Patients simultaneously treated for both Type 2 diabetes and depression improve medication compliance and significantly improve blood sugar and depression levels compared to patients receiving usual care, according to a new study.”

      http://www.sciencedaily.com/releases/2012/01/120110093559.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain+%28ScienceDaily%3A+Mind+%26+Brain+News%29

      In plain English, this means that people with non-insulin-dependent diabetes need to be treated both for diabetes and depression; when that happens, twice as many get stable.

      This falls under the Department of the Blitheringly Obvious, because — as anyone who has hypoglycemia, or has dealt with diabetics knows — depression is the first sign of low blood sugar; low or unstable blood sugar leads to poor decision-making, notably poor food choices; poor food choices lead to unstable blood sugar, and round and round we go.

      To break the cycle, both must be addressed. Otherwise, the cycle continues feeding on itself… er, unfeeding on itself. Or something.

      As anyone with common sense who has dealt with the mentally ill knows, the first intervention is a proper meal. It’s simply amazing how things improve with a little real food inside.

      Unstable blood sugar worsens pain, impairs memory, and limits cognitive function. Low blood sugar specifically creates an unhappy state.

      A hungry brain is not a happy brain!

      Treating type II diabetes without treating depression, or treating depression without treating underlying type II diabetes, is not a recipe for success. The fact that as many as one third of these diabetic patients even get better, is pretty remarkable. Treat both, and over 60% of these people go back to cheerful, stable, productive lives — not needing sickleave, additional benefits, or other direct and indirect expenses.

      Sounds like a good cost/benefit profile to me!

      Share

      Gender & personality — the US isn’t everybody!

      This ScienceDaily article reports on a study which states that the personality differences between men and women are simply enormous and have been substantially underreported for years:

      http://www.sciencedaily.com/releases/2012/01/120104174812.htm

      However, if you read the actual methodology used in the study, you’ll see that the entire population studied was from only one country, the US:

      http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029265

      “Personality measures were obtained from a large US sample (N = 10,261)”

      This is culturally arrogant at best, but it’s now intellectually indefensible. It has recently been demonstrated that one of the most profound gender differences in the brain (math ability) is purely a cultural artifact, when you look at international populations:

      http://www.sciencedaily.com/releases/2011/12/111212153123.htm

      Therefore, what the original study says — that there are enormous personality differences between the genders — is deceptive. All it means is that, in the U.S., huge gender-based personality differences are tolerated, or even encouraged and trained.

      As an international traveler all my life, I could have told you that for free!

      In the math study, one researcher said, “People have looked at international data sets for many years. What has changed is that many more non-Western countries are now participating in these studies, enabling much better cross-cultural analysis.”

      In short, there is no excuse for such sloppy social science as the “gender-based personality differences” researchers have perpetrated.

      Believe it or not, the U.S. is not a good template for studying the entire human population. It’s only a good template for studying the U.S.

      Since these scientists are working from Italy and Britain — both countries with famously self-satisfied national identities — you’d think that would be more apparent to them.

      It’s disturbing to see such cultural subjugation in science. One expects a degree of cultural infatuation in other realms (like cinema and music, which depend on cultural blending for their development), but not in science. Science requires a bit more intellectual integrity, if not clearer thinking.

      Share

      Glia: all that and a bag of chips — but what kind?

      A fascinating study which further clarifies the role of those fascinating, complex, busy busy cells, the glia:

      http://www.sciencedaily.com/releases/2011/12/111229131354.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain+%28ScienceDaily%3A+Mind+%26+Brain+News%29

      ScienceDaily (2011-12-29) — New research indicates that glia cells are “the brain’s supervisors.” By regulating the synapses, they control the transfer of information between neurons, affecting how the brain processes information. This new finding could be critical for technologies based on brain networks, as well as provide a new avenue for research into disorders such as Alzheimer’s disease and epilepsy.

      This study indicates that glia regulate the speed of synaptic transmission, slowing or speeding up synaptic events according to what is needed. This means, for instance, that epileptic seizures, which are synaptic storms, relate to glial misbehavior.

      The next question is, how? Why? What causes the glia to modulate a given transmission?

      I’m looking forward to further studies on this.

      Share

      Assumptions & memory: elders are sharper than we think

      I’m intrigued by how much more capable the elderly are than we’ve been led to believe. Since only the luckiest and most sensible of us will even survive to be old, that makes a certain amount of sense.

      CRPS, which typically attacks people in their “most productive” years (implicit assumption alert!), has shown us that many medications useful in CRPS, which have been given to the elderly like candy for decades (calcium channel blockers, antidepressants, benzodiazepines) have a serious effect on memory and cognition — which was documented only because we don’t expect 38-year-olds to suddenly lose their ability to track simple tasks.

      But the elderly get no slack. If your whip-sharp grandad suddenly can’t remember your kid’s Little League scores, who’s willing to relate it to the meds he just started for his heart?

      And who cares enough about grandpa’s brain to go to bat for him, and insist that the doc find another way to handle things? Hint: what you eat & what you do, do matter. Visits with nutritional consultants and PTs can be prescribed.

      Back to this study:
      http://www.sciencedaily.com/releases/2011/11/111104102129.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain+%28ScienceDaily%3A+Mind+%26+Brain+News%29

      These wonderfully sensible scientists framed an exact goal: they “set out to investigate how implicitly held negative stereotypes about aging could influence memory performance in older adults.”

      They specified “implicit” stereotypes, in other words, ones we’re not aware that we’re responding to. (The kind that patients and doctors hold about each other all the time.)

      When the tests were run with the stereotypes laid in, the older people did worse on the memory tests. When the stereotypes were made irrelevant to the outcome, the elders did as well as the youngsters. On the same type of test.

      Which should tell you just how pernicious and evil those assumptions we make about old people are. When grandma’s memory starts playing up, ask her if she has started any medicine recently. Find out what it was for and how else that can be addressed. Ask if it’s the smallest possible dose that’s prescribed.

      Give up the idea that pills solve problems freely, and recognize that each one imposes a tax on the body and brain.

      If grandpa doesn’t mind losing his mind but won’t give up his risotto and vichyssoise, maybe the pills are fine, but if he simply assumes the doctor is offering the best deal without showing him alternatives, maybe it’s time to talk about alternatives.

      Because doctors default to doing what’s easy and predictable — just like the rest of us! That’s not always what’s best for a mentally or physically active person. They seem to deal with a lot of lazy idiots, and if you or your elders are neither, it takes a lot of effort to bust them out of their groove and get them to think things through.

      Try taking it seriously, because nobody should be forced to lose their mind before they lose their pulse.

      Share

      Vascular growth and brain protection

      “A nourishing protein that promotes the growth of neurons and blood vessels appears to stop the progression of a genetic disease that causes degeneration of the cerebellum, according to new preclinical research. The disease, spinocerebellar ataxia type 1, typically strikes people in the 30s and 40s and eventually causes death.”

      The key protein is called Vascular Endothelial Growth Factor, VEGF. It is known to stimulate the growth of healthy blood-vessel linings. We know for a fact that healthy blood vessels are important to maintaining healthy brains! Without them, we get strokes, not to mention this type of ataxia.

      The funding-hungry researcher’s first thought is, “How do we turn this into a drug?”

      The smart clinician’s first thought is, “How do we improve vasculation, oxygenation and circulation in safe, endogenous, sustainable ways from youth onwards?”

      Don’t need FDA approval for that. Just takes fresh food, fresh air, clean water, and safe activity.

      Clinicians, if you’re puzzled about how to get all that for your patients, call your legislators (use the link on the right to find them) and share your concerns. Those letters after your name are worth more than you might think.

      Share