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Stroke

In the News, Research, Stroke

Research suggests art lovers may fare better after a stroke

Research suggests art lovers may fare better after a stroke

Get thee to a gallery: Art lovers may have an edge on happiness among people who are recovering from a stroke.

A study by researchers at the University Tor Vergata School of Nursing in Rome compared quality of life for stroke survivors who had appreciated art, music, and theater before their injury, and those who didn’t. Healthland reports:

Overall, art lovers reported a slew of positive physical and mental health benefits. They had more energy, better general health and improved mobility. They were also happier, less anxious or depressed and had better memory and communication skills.

“Stroke survivors who saw art as an integrated part of their former lifestyle, by expressing appreciation towards music, painting and theater, showed better recovery skills than those who did not,” lead author Dr. Ercole Vellone, assistant professor in nursing science at the University Tor Vergata, said in a statement.

The research, presented during the 12th Annual Spring Meeting on Cardiovascular Nursing, in Copenhagen, Denmark, follows other studies on music’s effect on the brain in stroke recovery.

Previously: Study could lead to new class of stroke drugs, Brain sponge: Stroke treatment may extend time to prevent brain damage, Recovering from a stroke, recovering from war: Two conversations about survival
Photo by vertigonoir

Neuroscience, Research, Stanford News, Stroke

Study could lead to new class of stroke drugs

Study could lead to new class of stroke drugs

Stroke is the third-leading cause of death in the United States and the number-one cause of severe neurological disability, accounting for about $75 billion per year in related costs.

Meanwhile, the closest we’ve got to an approved drug for stroke is actually a clot-buster that, if given very soon after the stroke, can at least dissolve the obstruction that’s cutting off the blood supply to the brain. But it doesn’t address the severe inflammatory damage that occurs after the stroke.

A new study led by Stanford’s Katrin Andreasson, MD, has identified a new target: a receptor found both on nerve cells and on endothelial cells that line the copious capillaries crisscrossing the brain. When stimulated, this receptor both strengthens nerve cells’ ability to survive after a stroke and causes blood vessels to dilate, allowing increased blood flow to both the damaged core area and the at-risk region around it.

I go into more detail in a release on the study. And I also describe how Andreasson’s findings may help explain why a much-heralded class of anti-inflammatory drugs that included the now-withdrawn Vioxx turned out to have some unanticipated cardio- and cerebrovascular side effects.

Emergency Medicine, Neuroscience, Public Health, Research, Stanford News, Stroke

Brain sponge: Stroke treatment may extend time to prevent brain damage

Brain sponge: Stroke treatment may extend time to prevent brain damage

A new study in mice reports that admistering pharmacological doses of a “sponge-like” molecule that occurs naturally in the human body may stave off brain damage from stroke

One of the study’s two senior co-authors, neuroimmunologist Larry Steinman, MD, has published several articles in the past few years on the substance’s anti-inflammatory properties and possible therapeutic benefits in indications ranging from multiple sclerosis (his specialty) to heart attack.

Strokes – there’s a new one every 40 seconds in North America alone – are caused by a sudden drop in the flow of blood to the brain resulting from a clot or, less often, bleeding. Here are the grim statistics:

The largest single cause of severe neurological disability and the third-leading cause of death in the United States, stroke accounts for an estimated $74 billion annually in related costs, including treatment and additional assistance for the three of every four stroke patients whose ability to perform the activities of daily life is impaired. One of every three stroke patients is under the age of 65. In all, there are 5.4 million stroke survivors in the United States and 15 million worldwide.

The only currently approved treatment, tissue plasminogen activator or tPA, is not only costly, but must be given within 4.5 hours of the incident to be effective. That’s already tough, given the initial denial that often prevents those experiencing a stroke from immediately getting help. Further complicating the logistics is the fact that before administering tPA to a patient, doctors have to first run a brain scan to make sure the patient’s stroke was caused by a clot, not by bleeding. (If it’s the latter, tPA, which works by dissolving clots, would make it even worse.)

The substance tested in the study, alpha-B-crystallin, is produced in healthy tissues as well as in the brain in response to a stroke – but, according to neurosurgeon Gary Steinberg, MD, PhD, the study’s other senior co-author, not in sufficient amounts to fully quench the inflammatory mayhem that follows. Indeed, much of the damage caused by stroke is due not to the initial blockage of blood flow to affected brain areas, but to the ensuing storm of inflammatory activity brought about by a scream of molecular sirens, an ensuing police riot of trigger-happy immune cells squirting brain-cell-breaking oxidants.

Alpha-B-crystalline seems to act like a sponge, soaking up all these crazed inflammatory hotheads, shrinking the ultimate size of the stroke lesion, and apparently reducing the resulting behavioral deficits even when given 12 hours after the stroke. At least in mice. (Stay tuned.)

Photo by Pobre.ch

Mental Health, Podcasts, Stanford News, Stroke

Recovering from a stroke, recovering from war: Two conversations about survival

Recovering from a stroke, recovering from war: Two conversations about survival

Before I head to the beach, I wanted to mention two 1:2:1 podcasts that complement articles in the latest issue of Stanford Medicine magazine.

Jill Bolte Taylor, PhD, is a brain scientist who wrote about her stroke in the New York Times best-seller, My Stroke of Insight. At the beginning of the book, she describes her stroke in remarkable detail. It felt like she was sort of looking at herself inside out: living and feeling the stroke on the one hand and on the other, observing her body and motor skills as they crash. It’s all rather unnerving in its clarity. She describes her neurological breakdown with such granularity that it makes you wonder who was taking the notes.

In our conversation for the Stanford Medicine article, she couldn’t talk about the day of her stroke (she’s muzzled by a movie deal in the works), but she does talk about the eight years it took to recover. You can hear the full conversation in the podcast, and if her story captures your imagination, take a look at her TED talk. It’s the second-most viewed presentation over the program’s past five years, with more than 8 million online viewers.

Another podcast pertains to survivors of extreme psychological and physical trauma. And it makes you ask, can the residue from unspeakable abuse at the hands of a terrorist government ever be diminished? That’s one of the questions posed by a United Nations-backed tribunal trying Khmer Rouge war criminals in Phnom Penh, Cambodia. For the first time and to an unprecedented degree, the trial is including victims’ testimonies as a central component of the proceedings. Thousands of survivors from Pol Pot’s reign of terror live in the Bay Area, and mental health workers here, some of whom are affiliated with Stanford, are helping these survivors with critical mental health issues like PTSD.

I talked with Daryn Reicherter, MD, a psychiatrist at Stanford, who works with Cambodian immigrants in San Jose, Calif. He’s seen survivors of some of the worst human crisis of the 20th century – not only Cambodian immigrants but also asylum seekers from Darfur, Congo, and the Middle East, along with refugees from Vietnam, and Central and South America. Tracie White has written an amazing story for Stanford Medicine asking the question: Can the testimony at the tribunal ever bring a sense of justice and help heal the psychological scars for the victims of the terror campaign? The horror of the physical and psychological abuse thrust upon the nation by their fellow citizens won’t leave your mind very easily.

Previously: Surviving survival: The new Stanford Medicine magazine is out

Bioengineering, Neuroscience, Stroke

Honorary mad scientists build semi-functional brain

In a straight-out-of-sci-fi experiment, University of Florida researchers grew neurons on a computer chip – and the neurons started to think. That is to say, they started to show signs of brain activity. By the time the brain cells had been left to grow for 30 days, researchers measured levels of neural activity approaching those present in a real, live, developing mammal brain. IT’S ALIIIIVE!

Well, sort of alive, anyway. The computer-chip model that researchers designed cannot, by itself, retain information or demonstrate intellectual capacity.  The success of this synthetic brain does, however, suggest the possibility of future treatments for brain trauma or for brain-matter replacement in the wake of disorders like strokes.

This is not the first synthetic brain to show promise, though it is the most tangibly biological (Stanford researcher Kwabena Boahen, PhD, for example, has developed a computer chip theoretically capable of powering a computer with the intelligence of the human mind). One can only imagine the evil cackling that would ensue if these technologies ever wound up in the wrong hands.

Via SmartPlanet
Photo by Hatchibombotar

Emergency Medicine, Stanford News, Stroke, Videos

Every second matters for stroke survival, recovery

A very lucky stroke survivor tells his story in this month’s Stanford Health Notes and in the video above.

Minutes after slumping over, paralyzed in mid-conversation, Chris McLachlin was taken to the hospital and given life-saving blood clot-busting medicine. A fellow stroke survivor in the room had recognized the signs and called 911.

Strokes, which are the number one cause of adult disability, starve parts of the brain of blood and oxygen. The quicker blood flow can be restored, the less permanent damage occurs. “Time is brain,” according to physicians who treat strokes.

McLachlin’s speedy treatment made all the difference for him. He’s now back working as an assistant coach for Stanford University’s men’s volleyball team. His youngest son, Spencer McLachlin, captains the team.

Cardiovascular Medicine, Health and Fitness, Research, Stroke

Are young adults in denial about how lifestyle choices affect their health?

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Stroke hospitalizations among men and women ages 15 to 44 have increased notably in the past decade. Now findings from a new survey suggest the rise in stroke among young people could be because they are dangerously naive about how lifestyle choices influence disease risk.

In a survey conducted by the American Stroke Association, 1,248 Americans ages 18-44 were asked about their attitudes regarding health, including influences of and beliefs about health behaviors and their risks for stroke. Results showed nine out of 10 respondents between ages 18-24 believed they make healthy choices yet most consumed too much fast food, drank alcoholic or sugar-sweetened beverages and engaged in other behaviors that could increase their risk of stroke, according to a release.

Other findings included:

  • Among 35-44 year olds, only 22 percent said they were not concerned about cardiovascular diseases and conditions, including heart disease/heart attack; high blood pressure; obesity; high cholesterol; diabetes; and stroke. Yet, about half (48 percent) of them are more likely to have health concerns they struggle with today.
  • Most 18-24 year olds said they want to live long and maintain quality health throughout their life. Yet, one-third of those surveyed don’t believe engaging in healthy behaviors now could affect their risk of stroke in the future.
  • All groups said that they’re least worried about stroke as a personal health threat.

Previously: Stroke Awareness Month begins today. What’s your risk?
Photo by Ernesto Andrade

Addiction, Applied Biotechnology, Autism, Behavioral Science, Bioengineering, Genetics, In the News, Microbiology, Neuroscience, Research, Sleep, Stroke, Technology

Nature Methods names optogenetics its “Method of the Year”

Nature Methods has picked optogenetics, a biological-research technology largely pioneered at Stanford, as its designated “method of the year” for 2010. Karl Deisseroth, MD, PhD, who’s also written a commentary appearing in the same issue, was and is the leading force in this new tool’s development.

If there’s anyone who understands the meaning of the admonition, “Get the right tool for the job,” it’s neuroscientists. Trying to make sense of the 100 billion neurons and 250 trillion nerve-cell-to-nerve-cell connections that dot the human brain is a huge headache.

But the payoff is big, too: Understanding exactly which circuits in the brain go awry in autism, schizophrenia, depression and other mental diseases – not to mention Parkinson’s disease and stroke, which are brain disorders, too – is the surefire way to developing treatments and perhaps cures.

Until recently, though, the only tools researchers had available for dissecting the brain’s circuitry were pretty rusty knives.

There’s electrophysiology, in which investigators place an electrode near a nerve cluster of interest, flip on the juice, and observe the change in an experimental animal’s (or in some surgical procedures, a person’s) behavior. That can cause a nerve to fire, but it can’t keep it from firing, which is sometimes what you’d like to do. And it may excite other nerves in the vicinity that the investigator didn’t intend to affect and doesn’t even know have been affected.

And there’s drugs. They tend to ooze all over (at least in terms of the microscopic scale you’re working at). They also can be pretty imprecise as to which circuits they affect as well as with respect to both how and how much they affect those circuits, and in any case they do whatever they do rather slowly compared with the speed an impulse of information moves along a nerve.

And there’s genetic approaches – mutate a particular gene, see what happens. These approaches have the advantages of working in a very specific way and in a highly reproducible manner. But genetic manipulations are tedious, take a ton of time and mouse food, and are usually irreversible. No quick-and-easy on/off switch here.

And then, wham!! Along came optogenetics, which as the name implies is a blend of optics and genetics (but also of several other disciplines from microbiology to animal care). Deisseroth and his colleagues succeeded in bioengineering mice so that long-known photosensitive molecules called opsins, ordinarily found only in various one-celled creatures, would turn up on the surfaces of mice’s nerve cells. And not just any nerve cells, only the nerve cells forming the circuits that researchers want to manipulate.

Once they figured out how to do that, Deisseroth and his team figured out how to deliver laser bursts of light, at just the right frequency, via a long, flexible optical fiber, to just the right place in a mouse’s brain, then at the flick of a switch turn the circuits on, turn them off, or deliver patterns of on/off repetitions to see how the circuits respond to waves of impulses coming in at various frequencies.

Armed with optogenetics, Deisseroth and his collaborators both at Stanford and elsewhere have identified circuits whose defective operation may be behind sleep disorders, schizophrenia, cocaine addiction, and Parkinson’s disease. This experimental technique has now spread to some 800 labs (and climbing) around the world, and holds promise for understanding how not just the brain but the heart, pancreas, and immune system do what they do, and what’s going on when they’re not doing well.

From December 20 to January 3, Scope will be on a limited holiday publishing schedule. During that time, you may also notice a delay in comment moderation. We will return to our regular schedule on January 3.

Cardiovascular Medicine, Stroke, Women's Health

That “9 to 5″ may be hazardous to your health

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As if sleep interruptions weren’t bad enough, now women also have to worry about their jobs taking a toll on their heart health. New findings presented this week at the American Heart Association conference in Chicago show that women with high levels of stress at work face increased risks of heart attacks.

The Women’s Health Study analyzed data from 17,415 healthy women and found a 40 percent increase overall in cardiovascular disease, and an 88 percent increase in risk for heart attacks alone:

“Our study indicates that there are both immediate and long-term clinically documented cardiovascular health effects of job strain in women,” said Michelle A. Albert, M.D., M.P.H., the study’s senior author and associate physician at Brigham and Women’s Hospital, Boston, Mass. “Your job can positively and negatively affect health, making it important to pay attention to the stresses of your job as part of your total health package.”

While it may be difficult to get rid of stress, the researchers suggested ways to manage it through exercising, spending time with friends and family and limiting bringing work home.

As a new mom who recently returned to work, I feel lucky to have both a baby who sleeps through the night and a low-stress job. Now if I could only figure out what to do about my snoring husband.

Photo by Joshua Hoffman

Research, Stanford News, Stroke

A closer look at new stroke-prevention drug

The Los Angeles Times‘ Health Section has a feature today on the drug dabigatran, the first new drug in two decades to be approved to prevent stroke in patients with atrial fibrillation. As I blogged about earlier this month, a recent study showed that the drug was as effective as, but less likely to cause certain side effects than, its alternative, warfarin. And a separate analysis, conducted by researchers here, showed that the drug also appears to be more cost-effective.

“It’s a potential game-changer,” Mintu Turakhia, MD, MAS, a cardiac electrophysiologist with Stanford and the Veterans Affairs Palo Alto Health Care System, says of dabigatran in the piece. Turakhia was senior author on the cost-effectiveness study, which appeared in the Nov. 2 issue of the Annals of Internal Medicine.

Previously: Newly approved drug appears to provide more cost-effective stroke prevention than warfarin

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