Blog — Page 20 — Lucia Zamorano, MD, PLC

De Novo Sources of SI Joint Pain

Frank Phillips, MD Midwest OrthopedIcs at Rush Chic-ago, FL

De novo sources of SI joint dysfunction include inflammation, postpartum pain, or a new onset of chronic low back pain with or without trauma. In this edition of the Sentinel Newsletter Mark Reiley shares an interesting article on sacral dysplasia as a de novo source of low back pain. He recommends including oblique plain X-rays of the pelvis and axial CT scans of the pelvis as part of the process of diagnosing SI joint disease. In my practice, I order a low back MRI that extends through the sacrum, I take close notes ofpatient complaints and history, perform provocative testing using 5 or 6 provocative tests with the highest sensitivities and specificities, and I have a minimum of 2 diagnostic SI joint blocks performed to rule out false positives. When reviewing surgical options, the iFuse is an ideal minimally invasive option for fusing the SI joint due to its unique design and ability to stabilize the joint.… [Continue Reading]

Subthalamic deep brain stimulation with a constant-current device in Parkinson’s disease

Okun MS; Gallo BV; Mandybur G; Jagid J; Foote KD; Revilla FJ; Alterman R; Jankovic J; Simpson R; Junn F; Verhagen L; Arle JE; Ford B; Goodman RR; Stewart RM; Horn S; Baltuch GH; Kopell BH; Marshall F; Peichel D; Pahwa R; Lyons KE; Tröster AI; Vitek JL; Tagliati M;
Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida College of Medicine, Gainesville, FL 32607, USA. okun@neurology.ufl .edu

BACKGROUND: The effects of constant-current deep brain stimulation (DBS) have not been studied in controlled trials in patients with Parkinson’s disease. We aimed to assess the safety and efficacy of bilateral constant-current DBS of the subthalamic nucleus.… [Continue Reading]

Oscillations in sensorimotor cortex in movement disorders

Crowell AL ; Ryapolova-Webb ES ; Ostrem JL ; Galifianakis NB ; Shimamoto S ; Lim DA ; Starr PA
Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA.

Movement disorders of basal ganglia origin may arise from abnormalities in synchronized oscillatory activity in a network that includes the basal ganglia, thalamus and motor cortices. In humans, much has been learned from the study of basal ganglia local field potentials recorded from temporarily externalized deep brain stimulator electrodes. … [Continue Reading]

Discontinuing Donepezil or Starting Memantine for Alzheimer’s Disease

Lon S. Schneider, M.D.
N Engl J Med 2012; 366:957-959

Donepezil, the most frequently prescribed cholinesterase inhibitor for the treatment of Alzheimer’s disease, was marketed in 1997 on the basis of the results of 3-month and 6-month clinical trials showing that patients had improvements in cognitive test scores and in the ability to perform daily activities, and subsequent trials indicated that the drug had efficacy over the course of 1 to 2 years.About half of the patients who are prescribed cholinesterase inhibitors, however, discontinue them within a year, apparently because of a perceived lack of efficacy and adverse effects such as anorexia, weight loss, agitation, bradycardia, and syncope.… [Continue Reading]

Higher Glioma Risk Not Seen for Regular Cell Phone Users

Roxanne Nelson

March 21, 2012 — The controversy surrounding the health risks related to cell phones continues to evolve.

A new study, published online March 8 in BMJ, suggests that there is little evidence linking cell phone use to a higher risk for glioma. The researchers note that the higher risks seen previously are not consistent with the incidence trends they found in the American population.

“Our study looked at actual rates of glioma in the United States, in comparison to projected or expected rates of glioma based on observations from the INTERPHONE study [Int J Epidemiol. 2010;39:675-694] and a study in Sweden explained lead author Mark Little, DPhil, senior scientist at the National Cancer Institute (NCI) in Rockville, Maryland. “We found that actual glioma rates declined over the study period.”… [Continue Reading]

Brain Food: Fending Off Mental and Neurologic Illness With Diet

Which Foods Are Best for the Brain?

Diet is inextricably linked to conditions such as heart disease, obesity, and diabetes. However, what we consume also seems to have significant implications for the brain: Unhealthy diets may increase risk for psychiatric and neurologic conditions, such as depression and dementia, whereas healthy diets may be protective. Based primarily on recent Medscape News coverage, the following slideshow collects some of the more prominent investigations on nutrition and the brain into a single resource to aid in counseling your patients.

Make for Malta in Depression, Stroke, and Dementia

A 2009 study published in Archives of General Psychiatry found that people who follow Mediterranean dietary patterns — that is, a diet high in fruits, vegetables, nuts, whole grains, fish, and unsaturated fat (common in olive and other plant oils) — are up to 30% less likely to develop depression than those who typically consume meatier, dairy-heavy fare.[1] The olive oil-inclined also show a lower risk for ischemic stroke[2,3] and are less likely to develop mild cognitive impairment and Alzheimer disease, particularly when they engage in higher levels of physical activity.… [Continue Reading]

Neuroanatomy and Cortical Landmarks

Focusing on the clinical applications of fMRI, this chapter will present methods to identify characteristic anatomical landmarks, and describe the course and shape of some gyri
and sulci and how they can be recognized on MR imaging.

Some redundancy is desired in order to course over cortical landmarks. If fMRI is not performed during clinical routine imaging, usually a 3D data set is acquired to overlay the results. Nowadays, fMRI is performed using echo planar imaging (EPI) with anisotropic distortion, whereas 3D T1-weighted data sets, such as MPRage (magnetization prepared rapid acquisition gradient echo) or SPGR (spoiled gradient recalled acquisition in steady state) sequences, are usually isotropic.… [Continue Reading]

Medical Food May Improve Cognition in Alzheimer’s

By Deborah Brauser

March 20, 2012 (Washington, DC) — AC-1202 (Axona, Accera Inc) may help improve practical cognitive tasks in patients with Alzheimer’s disease (AD), new research suggests.

In an analysis from a randomized controlled trial of elderly patients with mild to moderate AD, those who received AC-1202 for 90 days showed significantly higher performance improvement scores on constructional praxis/drawing tasks than the patients who received placebo.

In addition, the improvements persisted for 2 weeks after last administration.

“This suggests real-world benefit,” principal investigator David W. Crumpacker, MD, adult and geriatric psychiatrist in private practice in Plano, Texas, and former assistant chief of psychiatry at Baylor Medical Center in Dallas, told Medscape Medical News.… [Continue Reading]

A New Biomarker of Cognitive Decline in Alzheimer’s

by Megan Brooks

March 8, 2012 — In a study of patients with very mild Alzheimer’s disease (AD), baseline levels of visininlike protein 1 (VILIP-1) in cerebrospinal fluid (CSF) strongly predicted the rate of cognitive decline over roughly 3 years, report researchers at Washington University School of Medicine in St. Louis.

Memory and other cognitive abilities declined faster in patients with the highest levels of VILIP-1, a neuronal calcium-sensor protein that is a sign of neuronal injury.

“VILIP-1 appears to be a strong indicator of ongoing injury to brain cells as a result of Alzheimer’s disease,” lead author Rawan Tarawneh, MD, now an assistant professor of neurology at the University of Jordan, in Amman, said in a statement. “That could be very useful in predicting the course of the disease and in evaluating new treatments in clinical trials.”… [Continue Reading]

Epidural Steroid Injections

Author: Boqing Chen, MD, PhD Clinical Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Epidural steroid injections (ESIs) have been endorsed by the North American Spine Society and the Agency for Healthcare Research and Quality (formerly, the Agency for Health Care Policy and Research) of the Department of Health and Human Services as an integral part of nonsurgical management of radicular pain from lumbar spine disorders.… [Continue Reading]

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