Tag Archives: brain

neurology

Can anti-psychotic agents reduce brain volume?

Virginia Thornley, M.D.
Neurologist, Epileptologist
October 9, 2019
Can medications cause cerebral atrophy? Atrophy refers to shrinkage of the cells causing the appearance of the brain to have less volume than usual.
This question was asked last week. Anti-epileptics such as phenytoin is well-known in the literature and clinically to cause cerebellar atrophy. But what about other agents such as anti-psychotics.
Animal studies
In one animal study, exposure to anti-psychotic drugs showed a reduced volume of brain on volumetric studies. The number of cells remained the same but the volume was increased for cells in the anterior cingulate gyrus which is in the  limbic lobe. The limbic lobe subserves emotions and has influence on memory. Animal studies do not always correlate with human responses.
Human studies
One small study showed that the thalamic volume was reduced after olanzepine administration. This was a small study of 10 patients (2).
While there is some information in the literature the studies are animal studies and small human studies. More information is needed. Based on the current literature, there are not enough significant studies to correlate atrophy with use of anti-psychotics.
References
  1. Vernon, A.C., Crum, W.R., Lerch, J.P., Chege, W., Natesan, S., Modo, M., Cooper, J.D., Williams, S.C., Kapur, S. Reduced cortical volume and elevated astrocyte density in rats chronically treated with anti-psychotic drugs-linking magentic resonance imaging findings to cellular pathology. Biol Psychiatry. 2014, Jun. 15, 75(12):982-90
  2. Khorram, B., Lang, D.J., Kopala, L.C., Vandorpe, RF.A., Rui, Q., Goghari, V.M., Smith, G.N., Honer, W.G. Reduced thalamic volume in patients with chronic schizophrenia after switching from typical anti-psychotic medications to olanzepine. Am J sychiatry. 2006, Nov. 163 (11):2005-7
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stroke

Stroke: Dealing with Life after Stroke

By Virginia Thornley, M.D., Neurologist
February 15, 2018

Introduction
A stroke occurs when a blood vessel in the brain or neck becomes blocked by a clot which migrated or a plaque that broke interrupting flow to areas in the brain. The neurological symptoms depend on the area involved with the blockage of the artery. A patient who suffered a stroke will often be advised a work-up to determine the etiology of whether the clot came from the heart, aorta or from a large vessel in the neck or brain. Treatment depends on the etiology of the source.

How to manage life after a stroke
Stay healthy
Many risk factors are involved in stroke including diabetes mellitus, hypertension, obesity and high cholesterol. These contribute towards the formation of atherosclerotic plaques in the arteries which can break and block an artery. Ensuring risk factors for stroke are under good control is key. Keep active.

If motor function is involved
If the motor function is involved it is important to have frequent physical therapy to avoid contractions. Contractions occur when a part of your body is not moving, the 19059671_10155427294453841_913446057479861555_nmuscles stay in a contracted state and eventually becomes immobile. Passively moving the limb keeps it supple. Patients can recover function the most in the first 6 months of intense rehabilitation, therefore, the importance of a good physical therapist working cannot be emphasized enough. If large parts of the brain are involved, with intensive physical therapy, sometimes there are other parts of the brain that undergo a process called cortical reorganization where it can overtake the function of the damaged part of the brain. The more intense the therapy the higher the chances of maximal recovery. It is not an exact science but recovery depends on the severity of the stroke.

For many patients, the weakness is persistent even after physical therapy is discontinued. Exercises at home without the physical therapist is still very helpful. Sometimes, the therapist will give a list of exercises to continue at home before services are discontinued. The more therapy is done the chances of meaningful recovery increase. Physical therapy helps with balance and vertiginous (spinning sensations) symptoms as well.

If speech is involved
A good speech pathologist is essential in regaining language. If the problem involves articulation or the motor component of speech, exercises involving the lips, tongue or palate are advised depending on which muscles are affected. With facial muscle involvement, the muscles of the mouth are affected. Exercises with the letter “m” are helpful such as repeating “ma-ma-ma”. Lingual muscles can be strengthened repeating words or sounds with the letter “l” such as “la-la-la”. Palatal muscles are the deeper muscles of the throat. These can be strengthened with guttural sounds such as sounds with the letter “g”, with the hard sound in it such as saying “ga-ga-ga” repetitively.  A speech therapist gives specific exercises to strengthen the weak muscles of articulation.

If verbal output is affected, or the ability to produce sound and words, encouragement to keep speaking even if no sounds occur is important. The more one attempts to speak the more the nerves are engaged and actively firing. With each day, neural connections are strengthened in the brain until eventual language output is achieved. Speech output has the best chances of complete recovery.

If the problem is related to reception or comprehension of language, a speech therapist is helpful in rehabilitation. Other ways to rehabilitate include the following:

1. Have conversations with the patient in order to engage with him or her.
2. Label objects at home will so he or she absorbs, reads, recognizes the word and understand.
3. Speak to patients slowly and enunciate well.
4. Teach the functions of items, for example, ask the patient what does an iron do? Proceed to demonstrate and explain it takes out wrinkles.

5. Have a corkboard with pictures with names and functions written under each picture. Go over them each day.  This can be changed frequently.
6. Point to objects and name them. Explain the functions while out and about or even at home.

The more a patient with language difficulties is engaged, the more the cortex will rewire to form new connections. Early and intense rehabilitation is key.

If the weakness is mild
Sometimes a stroke can affect a small yet vital part of the body with a very important function such as the dominant hand. In cases like these, occupational therapy is very useful.  Exercises that can be done at home include picking up cards, putting small objects in a box and taking them out or squeezing and squeezing a ball. Picking up small coins few times a day in several sets can help.

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The best recovery is seen within the first few months of a stroke. However, the brain is still capable of recovering long after a stroke depending on the size and location but starts to slow after longer periods of time. It varies per individual. The motor component for language meaning the ability to say words is easier to recover than the comprehensive function meaning the ability to understand words.

Every stroke is unique and special services depend on the area of the brain involved and the function that is affected. While the brain still has the ability for cortical reorganization, or the ability of some parts of the brain to take over the function of the damaged part of the brain, early and intense rehabilitation is vital.

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Alzheimer's disease

Alzheimer’s Disease: Living with Alzheimer’s Disease

By Virginia Thornley, M.D., Neurologist
February 15, 2018

Introduction
Alzheimer’s disease is a neurodegenerative disorder affecting memory. It is thought to be caused by progressive loss of cells that control memory and cognition. A substance called acetylcholine is secreted which enhances memory, cognition, and attention. In Alzheimer’s disease, a destructive process occurs in the brain cells with accumulation of plaques composed of beta-amyloid. When this destruction of acetylcholine-producing cells occurs then there is less of the acetylcholine which is necessary for transmitting signals that control memory, attention, and cognition. Risk factors include the presence of certain genes such as the APOE gene.

Keeping Mentally Fit
Engaging in activities that involve the thought processes such as doing crossword puzzles, reading engaging books or novels or doing soduko puzzles may help boost the

 

13887115_10154408543428841_2788314143123562305_n (1)neural connections. The more brain cells are utilized the more their capacity is exercised. This is the reason why those in mentally rich occupations where lifelong complex decision-making skills are made, Alzheimer’s disease is not detected until later stages because the brain was constantly engaged for decades. Engaging in conversations, being social by going out and talking to people increase neural connections. Appreciating the arts, going to the theater engaging your brain will help boost neural connections.

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Talking to neighbors or even buying at the convenience store activate mental processes. Engaging in listening, comprehending and speaking during conversations and interactions also sustain rich neural connections.

Someone sitting at home all day long will perform significantly worse than someone who is actively out and about speaking and engaging. The old adage use it or you lose it rings true.

Staying healthy
It is always a good idea to stay fit and active, even more so when diseases affecting the brain are present. Diseases that affect and constrict the small blood vessels will also affect the end terminal cells.  Therefore, high blood pressure, high cholesterol and diabetes mellitus which all affect small vessels can also cause small blockages in blood flow to the brain. This does not help with Alzheimer’s disease. Consulting with a physician is helpful to ensure that any risk factors are under control.

Cues to help remember
A medicine box helps with memory. Bringing a friend or relative to doctors’ appointments helps with not forgetting medical advice. Writing a list helps with tasks that need to be done for the day. Placing medicine by the toothpaste helps with remembering to take important medications. Writing down doctors’ appointments and placing on the refrigerator in bold letters is another good idea. Little things may be remembered by using cues such as these. However, if forgetting extremely important details such as turning off the stove, leaving the water running or not locking the door at night occur, living alone is not feasible. Supervised living conditions are appropriate. Consult with a physician who can direct towards the correct resources and assistance.

Discussing long-term issues
If a loved one has been diagnosed with Alzheimer’s disease, it is a good time to get affairs in order. It is a difficult topic to discuss but it is the optimal time to formulate long-term plans, while preferences are known. If the disease is progressing such that decline is imminent resulting in greater supervision, steps to come up with long-term plans for care are beneficial.

Another subject which is difficult to broach are wishes in the event anything happens and preferences in the hospital for resuscitation. There are many families who come together during an event such as this only to sadly discover that this topic was never discussed. This results in lengthy discussions during an already trying and emotional time. Preparation for the future is key.

Consult with a neurologist
At this point in time, there are no medications that cure Alzheimer’s disease. Generally speaking, some may slow the progression depending on the severity and can enhance the availability of acetylcholine. Ongoing research continues.

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