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ANTI EPILEPSY DRUG PRESERVES BRAIN FUNCTION AFTER STROKE

New research suggests that an already-approved drug could dramatically reduce the debilitating impact of strokes, which affect nearly a million Americans every year.

In the study, one dose of the anti-epilepsy drug, retigabine, preserved brain tissue in a mouse model of stroke and prevented the loss of balance control and motor coordination. Researchers from the School of Medicine at The University of Texas Health Science Center at San Antonio conducted the study, which was published Feb. 3 in The Journal of Neuroscience.

Balance and coordination test

Hours after a stroke, both treated mice and a control group of mice were placed on a balance beam to observe motor coordination. The untreated mice displayed a pronounced loss of coordination with slips and falls. Treated mice had no difficulty with balance, ambulation or turning around on the beam.

"You couldn't even tell they had a stroke," said senior author Mark S. Shapiro, Ph.D., professor of physiology at the UT Health Science Center San Antonio. "They ran across the balance beam like gymnasts."

Histological analysis of the brain tissue of treated mice showed significantly reduced damage to the tissue after the stroke, compared to untreated mice. The protective effects of the medication were observed in treated mice up to five days after the stroke, said Sonya Bierbower, Ph.D., postdoctoral fellow and lead author of the report.

Duration of effect

Future studies will assess how long brain function can be protected after a stroke, and whether injury-related seizures can be prevented. "We are also going to see if we can prevent strokes in high-risk animal models," Dr. Bierbower said.

Retigabine and similar agents open specific proteins called potassium ion channels, whose action stops the electrical activity of nerve cells in the brain. The San Antonio team studied ischemic stroke, in which oxygen and nutrients are suddenly cut off due to a clot in a blood vessel. This is the type of stroke most often seen in humans. "We thought if we could stop the neurons from firing, stopping their electrical activity, we could conserve their resources until the time their blood supply was restored," Dr. Shapiro said. "This proved to be the case."

Cells starved of oxygen and nutrients for six hours are compromised and the process of dying is nearly impossible to reverse. Moreover, when cells die, they release factors that trigger many types of responses including an inflammatory response, leading to more cell death in the areas around the blood clot.

tPA for clots

A drug called tissue plasminogen activator (tPA) treats stroke by dissolving clots to restore blood flow, but this has significant limitations. tPA causes severe thinning of the blood, so it is not an option for patients who have high blood pressure, a history of bleeding or weak blood vessels. tPA is most effective in the first hours after a stroke, but its later use may do more damage than good.

Directly affecting nerve cells

Potassium channel openers such as retigabine work on a completely different system. "They have nothing to do with thinning blood, but preserving cells by putting a brake on their electrical activity," Dr. Shapiro said.

"It's treating the first step in the sequence and stopping the more damaging secondary effects," Dr. Bierbower said. "These agents directly affect the nerve cells themselves."

FDA approved for epilepsy

Because retigabine is approved by the U.S. Food and Drug Administration under the American brand name Ezogabine as an anticonvulsant, physicians may use it off label in stroke patients. FDA approval for specifically this drug as stroke therapy will require a clinical trial to be conducted, and a team of neurologists and neurosurgeons at the Health Science Center is considering it, Dr. Shapiro said.

"As a leading cause of death and disability, stroke poses a major risk to our society," said David F. Jimenez, M.D., FACS, professor and chairman of the Department of Neurosurgery at the Health Science Center. "It is very exciting to see that our collaborative work with our colleagues in physiology could provide a superb way to ameliorate the harmful effects of stroke on our patients."

WORLDS FIRST CHILD BORN AFTER UTERUS TRANSPLANTATION

In a ground-breaking research project at the University of Gothenburg, seven Swedish women have had embryos reintroduced after receiving wombs from living donors. Now the first transplanted woman has delivered a baby -- a healthy and normally developed boy. The world-unique birth was acknowledged in The Lancet on 5 October.

The uterus transplantation research project at the University of Gothenburg started in 1999 and has been evaluated in over 40 scientific articles. The goal of the Gothenburg project is to enable women who were born without a womb or who have lost their wombs in cancer surgery to give birth to their own children.

Live donors

Nine women in the project have received a womb from live donors -- in most cases the recipient's mother but also other family members and close friends. The transplanted uterus was removed in two cases, in one case due to a serious infection and in the other due to blood clots in the transplanted blood vessels.

The seven remaining women have in 2014 tried to become pregnant through a process where their own embryos, produced through IVF, are reintroduced to the transplanted uterus.

First child from a transplanted uterus

The first early pregnancy was confirmed in the spring after a successful first pregnancy attempt in a woman in her mid-30s, a little over a year after her transplantation.

In early September, the woman successfully delivered a baby by caesarean section, making her the first woman in the world to deliver a child from a transplanted uterus. Her uterus was donated by a 61-year-old unrelated woman.

The caesarean section had to be performed earlier than planned: the woman developed preeclampsia in week 32 of her pregnancy and the CTG indicated that the baby was under stress. A caesarean section was performed in accordance with normal clinical routines so as not to risk the health of the mother and child.

Developing normally

According to Professor Mats Brännström, who performed the caesarean section, the perfectly healthy newborn boy is developing normally. The baby weighed 1,775 grams (3 lbs 14.6 oz) at birth, which is normal size considering the gestational age at delivery.

'The baby screamed right away and has not required any other care than normal clinical observation at the neonatal unit. The mother and child are both doing well and have returned home. The new parents are of course very happy and thankful,' says Professor Mats Brännström, who is leading the research project.

'The reason for the woman's preeclampsia is unknown, but it may be due to her immunosuppressive treatment combined with the fact that she is missing one kidney. The age of the donated womb may also be a factor. Also, preeclampsia is generally more common among women who have become pregnant through IVF treatment.'

Mild rejection episodes

The woman has had three mild rejection episodes since the transplant, one of which occurred during the pregnancy. The rejection episodes, which are often seen also in other types of transplants, could be stopped with immunosuppressive treatment.

Followed closely

The research team followed the pregnancy closely, carefully monitoring the growth and development of the foetus with a special focus on the blood supply to the uterus and umbilical cord.

'There were concerns that the blood supply may be compromised since we had reattached the blood vessels to the womb. But we did not notice anything unusual concerning the function of the uterus and the foetus, and the pregnancy followed all normal curves,' says Brännström.

Major step

The successful delivery is considered a major step forward.

'It gives us scientific evidence that the concept of uterus transplantation can be used to treat uterine factor infertility, which up to now has remained the last untreatable form of female infertility. It also shows that transplants with a live donor are possible, including if the donor is past menopause,' says Brännström.

Several research teams around the world have been awaiting the results of the Gothenburg study in order to launch similar observational studies. The pregnancy attempts are ongoing with the other six women in the project.

WOMEN MORE LIKELY TO DEVELOP ANXIETY AND DEPRESSION AFTER HEART ATTACK

Women are more likely to develop anxiety and depression after a heart attack (myocardial infarction; MI) than men, according to research presented at Acute Cardiovascular Care 2014 by Professor Pranas Serpytis from Lithuania.

 Acute Cardiovascular Care is the annual meeting of the Acute Cardiovascular Care Association (ACCA) of the European Society of Cardiology (ESC) and takes place 18-20 October in Geneva, Switzerland.

Professor Serpytis said: "The World Health Organization predicts that by 2020 depression will be the second leading cause of disability and mortality in the world, surpassed only by ischaemic heart disease. Major depression follows MI in approximately 18% of cases and is an important predictor of disability and poor quality of life in the year post-MI."

He continued: "Patients with depression are nearly 6 times more likely to die within 6 months after an MI than those without depression. The increased risk of death in patients with depression persists up to 18 months after the MI. But despite the fact that post-MI depression is common and burdensome, the condition remains under-recognised and undertreated."

The current study investigated the impact of gender and cardiovascular disease risk factors on the risk of developing depression and anxiety after an MI.

The study included 160 patients admitted with a myocardial infarction to the Vilnius University Hospital Santariskiu Clinics in Vilnius, Lithuania. Patients were interviewed at least 1 month after the MI to collect information on demographic (including sex, age, education, marital status) and clinical characteristics (incidence of diabetes mellitus, previous treatment for hypertension, previous MI), other cardiovascular disease risk factors (smoking, physical activity), and history of mental health issues.

Depression and anxiety were both assessed using the Hospital Anxiety and Depression Scale (HADS): no depression and anxiety (0-7 score), possible depression and anxiety (8-10 score), mild to moderate levels of depression and anxiety symptoms (11+ score).

The researchers found that nearly one quarter of patients in the study were depressed (24.4%) and of those, 28.2% had received treatment with antidepressants (p<0.05). The average HADS score for depression was 6.87 (±4.6) in men and 8.66 (± 3.7) in women (p<0.05). For anxiety the mean score was 7.18 (±4.6) in men and 8.20 (±3.9) in women (p<0.05).

Professor Serpytis said: "We found that women were more likely to develop anxiety and depression after a heart attack than men. More research is needed to discover the possible reasons for this."

The researchers also found an association between anxiety and smoking. In the study, 15.6% patients were current smokers and their mean HADS score for anxiety was 10.16 (±4.9). An additional 77.5% of patients had never smoked and their mean HADS score for anxiety was 7.3 (±4.1), while the 6.9% patients who had quit smoking more than 2 years ago had a mean HADS score for anxiety of 4.55 (±3.7) (p<0.05).

Professor Serpytis said: "Current smokers were more likely to have anxiety after an MI than never smokers or people who had quit smoking more than two years ago. We did not find any association between smoking and depression after an MI."

Physically inactive patients tended to be depressed, with a mean HADS score of 8.96 (+4.1). Overall, 64% of patients with depression said they were not physically active (p<0.05).

Professor Serpytis said: "Women are misrepresented in many clinical studies on MI even though they often have worse outcomes. Our study shows that women are more likely to develop anxiety and depression after MI than men but until now this issue has been largely unnoticed. Clinicians should assess MI patients, particularly women, for anxiety and depression so that timely treatment can be started."

He concluded: "Our study suggests that encouraging patients to quit smoking and increase their physical activity levels should reduce their risks of anxiety and depression after MI. More research is needed on the links between myocardial infarction and mental health problems."

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MOST PATIENTS DONT GET COUNSELING ABOUT SEX AFTER HEART ATTACK

Most patients don't receive counseling about resuming sexual activity after having a heart attack, according to new research in the American Heart Association journal Circulation.

Researchers interviewed 3,501 heart attack patients in 127 hospitals and one month later by telephone in August 2008-January 2012 in the United States and Spain. The patients' median age was 48 years and two-thirds were female.

One month after their heart attacks, only 12 percent of women and 19 percent of men reported they received sexual counseling from their healthcare provider -- though most reported they were sexually active within the year before their heart attack.

"Even with life-threatening illness, people value their sexual function and believe it is appropriate for healthcare providers to raise the issue of resuming sexual activity," said Stacy Tessler Lindau, M.D., M.A.P.P., study lead author, associate professor of obstetrics and gynecology and geriatric medicine and director of the Program in Integrative Sexual Medicine at the University of Chicago Medical Center.

In rare instances when healthcare providers counseled about sexual activity, they often recommended restrictions more conservative than medical guidelines. For example, those patients given restrictions more most often told to limit sex (35 percent), take a more passive role (26 percent), and/or keep their heart rate down (23 percent).

"Healthcare providers should let their patients know that for most it is OK to resume physical activity, including sexual activity, and to return to work," Lindau said. "They can tell their patients to stop the activity and notify them if they experience chest pain, shortness of breath or other concerning symptoms. If the healthcare provider doesn't raise the issues, I encourage patients to ask outright: 'Is it OK for me to resume sexual activity? When? Is there anything I should look out for?'"

In the United States and worldwide, heart disease is the leading cause of death. About 720,000 people have a heart attack in the United States each year and about 20 percent are 18-55 years old.

In 2013, the American Heart Association published a scientific statement about counseling patients with cardiovascular disease about sexual activity. The statement concluded that sexual counseling should be tailored to the individual needs and concerns of cardiovascular patients and their partners/spouses.

"When the topic of sexual function is left out of counseling, patients perceive that it's not relevant to their medical condition, or that they are alone in the problems they have resuming normal sexual activity," Lindau said.

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Looking After Yourself With Neuropathy Vid

Today's post from beatingneuropathy.tv (see link below) talks about some self-help possibilities for neuropathy patients. As always, Dr Hayes, gives some sound advice and in this case, his suggestions can be seen as a basis for your own body maintenance regime. You can of course add other things to the list.

Episode 37 – Neuropathy Self-Care  
Posted by John Hayes Jr Thursday, December 12th, 2013

Dr. Hayes talks about lifestyle changes that can help neuropathy and fibromyalgia, indeed most pain sufferers get–and stay–healthy, while reducing symptoms. Can it really be this simple? Watch, and try these suggestions!


http://beatingneuropathy.tv/2013/12/episode-37-neuropathy-self-care/