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Brain stimulation helps in stroke treatment

Stimulating the part of the brain which controls movement may improve recovery after a stroke new research suggests.

Brain stimulation helps in stroke treatmentStudies showed firing beams of light into the brains of mice led to the animals moving further and faster than those without the therapy.

The research, published in Proceedings of the National Academy of Science, could help explain how the brain recovers and lead to new treatments.

The Stroke Association said the findings were interesting.

Strokes can affect memory, movement and the ability to communicate. Brain cells die when their supply of oxygen and sugars is cut off by a blood clot.

Stroke care is focused on rapid treatment to minimise the damage, but some recovery is possible in the following months as the brain rewires itself.

The team at Stanford University School of Medicine investigated whether brain stimulation aided recovery in animal experiments.

They used a technique called optogenetics to stimulate just the neurons in the motor cortex – the part of the brain responsible for voluntary movements – following a stroke. After seven days of stimulation, mice were able to walk further down a rotating rod than mice which had not had brain stimulation. After 10 days they were also moving faster.

The researchers believe the stimulation is affecting how the wiring of the brain changes after a stroke. They detected higher levels of chemicals linked to the formation of new connections between brain cells.

Lead researcher Prof Gary Steinberg said it was a struggle to give people drugs to protect brain cells in time as the “time window is very short”.

However he said that aiding recovery could be easier: “The advantage of treating during the recovery period is it’s longer, potentially it could be years, so it has huge potential. I predict that the kind of study we’re doing will help to push stimulation as a therapy for stroke and you can image how import that would be for the millions of stroke patients with disability.”

Optogenetics uses an optic fibre to send light into the brain, which specifically activates cells that are genetically engineered to respond to the light. It allows precision stimulation of parts of the brain in experiments.

The team at Stanford argue using optogenetics will allow them to uncover exactly what changes in the brain as it recovers from stroke,

Prof Steinberg said: “We’re also looking to see if optogenetically stimulating other brain regions after a stroke might be equally or more effective. The goal is to identify the precise circuits that would be most amenable to interventions in the human brain, post-stroke, so that we can take this approach into clinical trials.”

However, optogenetics cannot be used in people yet.

It would require genetic modification of the target cells, but Prof Steinberg argues “it may not be too far in the future that you’re doing refined and elegant stimulation” with optogenetics.

Dr Shamim Quadir, from the Stroke Association charity, said: “This is a very interesting study using light to stimulate specific brain cells of genetically altered mice in the early days after a stroke. Using this optogenetic technique could be helpful in improving our understanding of the mechanisms driving stroke recovery, however it is too early to tell exactly how this research might be developed for the treatment of human stroke patients.”

Hair loss reversed for alopecia sufferers

Scientists have completely reversed hair loss in three people by giving them a drug normally used to treat bone marrow disorders.

Hair loss reversed for alopecia sufferersThe patients had alopecia areata – a condition that can cause severe, patchy baldness that is difficult to treat and after five months of taking the medication ruxolitinib, all three saw total hair re-growth.

The findings from Columbia University Medical Center are published in the journal Nature Medicine.

Alopecia areata affects around two in every 1,000 people in the UK and is thought to be caused by the immune system attacking hair follicles.

The US scientists had previously identified a set of immune cells involved in the destruction of hair and conducted a number of successful trials in mice.

They then gave three patients with moderate to severe alopecia areata a twice daily dose of ruxolitinib.

This medication is already approved for use in bone marrow conditions in the United States and European Union.

All three patients had lost at least a third of their hair but saw dramatic hair growth within five months of therapy.

Lead researcher Dr Raphael Clynes said: “We’ve only begun testing the drug in patients, but if the drug continues to be successful and safe, it will have a dramatic positive impact on the lives of people with the disease.”

Prof David Bickers, a dermatologist at Columbia University who has treated many patients with the disease, said: “There are few tools in the arsenal for the treatment of alopecia areata that have any demonstrated efficacy. This is a major step forward in improving the standard of care for patients suffering from this devastating disease.”

Researchers say more work is now needed to see if the drug can be offered more widely.

Alopecia areata can occur at any age but is most often seen in teenagers and young adults.

It is not related to the more common male-pattern hair loss that is thought to be driven by hormones.

Scientists say as the mechanisms behind this condition are different, the therapy is less likely to prove effective for this more common problem.

Alcohol tax suggested to fund rehab and health service for addicts

Drink and drug addicts should be treated in rehab treatment centres paid for with a new tax on alcohol.

Alcohol tax suggested to fund rehab and health service for addictsThe Centre for Social Justice (CSJ) said that by 2024, a ring-fenced “treatment tax” would put up the cost of alcohol bought in shops by 2p per unit- it is among a number of measures recommended to tackle addiction.

The Department of Health said councils’ £5.4 billion public health budgets would help them address alcohol harm.

The CSJ, which seeks to tackle poverty and its causes wants the government to fund treatment centres for 58,000 addicts per year by 2024.

Its report says 300,000 people in England are addicted to opiates and/or crack, 1.6 million are dependent on alcohol and one in seven children under the age of one lives with a substance abusing parent.

The measures set out in its Ambitious for Recovery report include:

  • Scrapping the drug advice site FRANK, which it says does not send “a strong signal to young people about the risks of experimenting with drugs”
  • Involving job centres in identifying and helping addicts, with jobseekers “screened for addiction”
  • Offering benefit claimants with addiction problems support and “abstinence-based” treatment with the threat of sanctions if help is refused
  • Piloting a charge card for long-term unemployed parents with serious addiction problems to restrict how they spend any income support to essential items only
  • Doing more to tackle so-called legal highs and educate young people and parents about their dangers

The treatment tax proposal would see a levy of 1p per unit of alcohol added on drinks purchased outside pubs by the end of the next Parliament, rising to 2p by 2024, the CSJ said.

This could mean about 18p added to the price of a bottle of wine after 2024.

The think tank estimated it would raise £155 million a year from 2015, rising to about £520 million a year from 2024.

A Department of Health spokesman said: “We are not considering a tax on particular drinks.  Instead, we are reducing alcohol harm by giving local authorities a £5.4 billion budget to help them manage public health issues including alcohol and drug services. We have also banned sales of the cheapest cut price alcohol.”

Local authorities had the best understanding of local needs to be able to assess, plan and deliver alcohol and drug services and treatment in their areas, he added.

Sally Marlow, an alcohol addiction specialist, said there were “problems with the proposal”.

But she added: “If we’re going to sell it, if we’re going to legitimise it and say we sanction alcohol then we have a duty also to say to the people who get into trouble with it, ‘we’ll help you with it – we’ll help you get out of the trouble that you’re in’.”

Raised depression risks after Parkinson’s diagnosis

Depression and anxiety are twice as common in people newly diagnosed with Parkinson’s disease compared with the general population new research suggests.

Raised depression risks after Parkinson's diagnosisWriting in the journal Neurology, US researchers say depression increases in frequency in Parkinson’s patients and is often left untreated. Previous research suggests that the disease’s impact on the brain can be a trigger for depression.

Parkinson’s UK said depression could be due to a number of causes.

Researchers from the University of Pennsylvania School of Medicine examined 423 newly-diagnosed Parkinson’s patients and tracked their mental health over two years.

At the outset, 14% of patients with Parkinson’s disease were found to have depression, compared with 6.6% of a group of healthy volunteers.

During the follow-up, there was a small rise in the frequency and severity of depression in the group with Parkinson’s, while in the control group a decrease was noted.

At the start of the study, 16% of patients with Parkinson’s were taking an anti-depressant, and this increased significantly to 25% two years later.

But 65-72% of patients who screened positive for depression were still not being treated with medication, the study said.

Dr Daniel Weintraub, associate professor of psychiatry and neurology at the Perelman School of Medicine at the University of Pennsylvania, said depression in Parkinson’s disease was under-recognised.

“There are psychological reasons why people who have been diagnosed with a neuro-degenerative disease like Parkinson’s can become depressed, but their brain pathways are also affected by the disease and these are closely associated with mood.”

Prof David Burn, from the University of Newcastle, who is funded by Parkinson’s UK, said depression can be a sign of Parkinson’s.

“It is well-recognised that people do get depression and anxiety up to 10 years before they develop Parkinson’s disease. People recognise the tremor and movement problems of Parkinson’s, but the disease actually starts in the brain, affecting certain chemicals. This can cause sleep problems initially and can also lead to minor forms of depression.”

Because of the range of possible causes, Parkinson’s UK says it is important that patients speak to their healthcare professional if they are worried about their symptoms.

After Robin Williams died in an apparent suicide last week, it emerged the actor – who had depression – was in the early stages of Parkinson’s disease.

Robin Williams’ death raises mental health debate

The sad death of Robin Williams has raised a wider debate about depression and how society deals with mental illness.

Robin Williams' death raises mental health debateDiscussions have ranged around the sad circumstances of the Hollywood star’s suicide and the fact that he had suffered with depression for some years – and the news on this week that he may have been in the early stages of Parkinson’s raises even more questions.

But his death has also raised wider questions about whether mental health is given the same priority as physical disorders as most people know very little about mental illness.

The new President of the Royal College of Psychiatrists Sir Simon Wessely has highlighted the fact that society found it “apparently acceptable” that while with illnesses such as high blood pressure or cancer the vast majority of people were getting treatment or were known to medical services, the equivalent for mental disorders was no higher than 40%.

Prof Wessely acknowledged that the issue was complicated and that people who knew they had mental health problems often did not want to come forward for fear that their jobs would be at risk. But he argued that the waiting list for advanced psychological therapies was long and that the mental health situation needed to be higher up the political agenda.

In an unrelated development, Health Service Journal published conclusions they had drawn from Freedom of Information Act requests to 52 mental health trusts in England.

These included an overall reduction in nursing staff of 6% between 2011-12 and 2013-14 as well as a fall in the number of doctors employed and the number of beds. Charities and experts in the field described the analysis as painting a “worrying picture” and providing a “warning signal”.

In response to the HSJ report, a Department of Health spokesperson said: “We have gone further than ever before to put mental health on a par with physical health and have instructed the NHS to make sure every community does the same.”

The department points out that the mandate to NHS England states that every community must develop plans to ensure no one in mental health crisis will be turned away.

Calls for a higher profile for mental health and the need for a wider discussion on priorities and resources for patients suffering with depression are increasingly being heard. The sad case of Robin Williams has given new impetus to the debate.

NHS funding debate call by health experts

How the NHS is funded should be a national debate according to leading health experts.

NHS funding debate call by health expertsIn a letter to The Times, they say challenges from an ageing population mean the system is “creaking at the seams” and cannot continue as it is.

Signatories include the heads of the Royal College of Physicians and Royal College of Nursing.

Without action an extra £30 billion will be needed by 2020 to fund the NHS at current levels their letter adds.

They are asking for a cross-party, independent conversation on the way forward for the “scope, provision and funding of health and social care”.

The nine signatories say that in 50 years’ time, at least two-and-a-half times as many patients will suffer from multiple health problems.

Their letter says: “The status quo is not an option. We are already seeing the signs of the system creaking at the seams.”

Warning that “business as usual won’t do”, they assert there needs to be “an honest, open dialogue between politicians and citizens”.

“We need a new settlement; a fundamental, holistic agreement with the country on what health and social care should be, how and where it is delivered to maximise the quality of care, and how it should be paid for.”

This “national conversation” should start now and be completed by the end of 2015, the letter concludes.

Two signatories – Ciaran Devane, chief executive of Macmillan Cancer Support, and Turning Point chief executive Lord Adebowale – are non-executive directors of NHS England.

It is also signed by: Sir John Oldham, who chaired the Independent Commission on Whole Person Care; Jeremy Hughes, chief executive of the Alzheimer’s Society; Peter Carter, chief executive of the Royal College of Nursing; Maureen Baker, chairwoman of the Royal College of GPs; Sir Richard Thompson, president of the Royal College of Physicians; Jean-Pierre van Besouw, president of the Royal College of Anaesthetists, and Chris Hopson, chief executive of the Foundation Trust Network.

Obesity and diabetes drugs cost needlessly harms NHS

NHS Scotland has spent nearly £230 million on drugs to treat diabetes and obesity within the last three years figures have shown.

Obesity and diabetes drugs cost needlessly harms NHSThe diabetes drugs bill was £75.7 million in 2013-14, £73.2 million last year and £74.2 milion in 2011-12.  Another £6.1 million went on obesity prescriptions in the three year period.

The figures were obtained by the Conservatives who said the conditions were harming both sufferers and the NHS.

The Scottish government said obesity and diabetes were on the rise across Europe and Scotland was no exception. It said the problem was being taken seriously and a range of measures had been implemented to try to tackle it.

The most recent statistics suggested nearly a quarter of a million people in Scotland now have diabetes, almost 5% of the population. The majority of sufferers, about 220,000, have type 2 diabetes.

A total of 3.34 million items were dispensed to treat diabetes in Scotland in 2013-14.

The official figures revealed that obese patients were prescribed more than 52,000 items in the same period – about 1,000 a week – at a cost of £1.9 million.

That is up from the cost of £1.5 million in 2012-13, but lower than the previous year, when £2.7 million was spent on obesity prescriptions.

Conservative health spokesman, Jackson Carlaw, who obtained the figures, said: “Of course, not every case of diabetes is related to weight, there are a range of reasons. But the fact prescriptions for both diabetes and obesity are rising at an alarming rate year-on-year cannot be ignored.”

“While we need the NHS and Scottish government to do all they can to force through messages on healthy living, it isn’t just down to them.  There has to be a level of personal responsibility.”

“Obesity generally isn’t something you catch on a bus, and people know that a healthy diet and active lifestyle are what’s required to keep the weight down.  If they don’t, diabetes is just one of the serious conditions lurking round the corner.”

A Scottish government spokesman said: “Our diabetes action plan, which will be updated this summer, sets out a clear commitment to the prevention and early detection of diabetes and to improve the treatment and care of people with diabetes.

“Although the number of people with Type 2 diabetes has increased in the last year, the number of prescriptions per person has remained at the same level.

“We are supporting child healthy weight interventions and are increasing opportunities for children to get involved in sport and physical activity, through active schools and our target of all primary children having two hours of PE lessons a week.”

Dying need free social care cancer campaigners say

Free end of life social care is needed to save the NHS money and improve patient care claim cancer campaigners.

Dying need free social care cancer campaigners sayMacmillan Cancer Support says it could save the NHS in England £69 million a year on the care of cancer patients alone. Its analysis is based on a review of patient surveys, official NHS spending data and interviews with senior decision-makers.

Social care is currently means tested, but ministers are considering providing it to everyone at the end of life.  About half of people end up dying in hospital despite eight in 10 saying they would prefer to die at home.

Macmillan’s analysis said this equated to about 180,000 people spending their last days in hospital against their wishes.

The cost to the NHS of this was estimated to be £685 million a year, Macmillan said.

If those patients were cared for in the community via a combination of community NHS services and social care the cost would be £340 million – a saving of £34 5million.

Of those 180,000 patients, about 36,000 are cancer patients. This would equate to a saving of £69 million if they were able to die at home, Macmillan said.

Earlier this week the Association of Directors of Adult Social Services warned the current system of social care was “unsustainable” because of a lack of funding and rising demands.

Macmillan chief executive Ciaran Devane said: “We urgently need to reform end-of-life services in England. Every day around 100 cancer patients die in expensive hospital beds when they wanted to die at home.

“This is both morally wrong and a scandalous waste of precious NHS resources.”

A Department of Health representative said: “We want to make sure that people nearing the end of their lives can choose where to spend their last days and have more of a say on how they are cared for.  We are currently reviewing how to improve the quality and experience of care at the end of life and the system for funding it.”

Higher stroke and heart attack risk linked to faulty gene

Researchers have identified a gene that may put people at greater risk of strokes and heart attacks.

Higher stroke and heart attack risk linked to faulty gene Published in PLOS ONE The PlA1/A2 Polymorphism of Glycoprotein IIIa as a Risk Factor for Myocardial Infarction: A Meta-Analysis they say the gene fault may encourage the formation of blood clots – the ultimate cause of most heart attacks and strokes.

Scientists hope gene tests may help doctors one day to pinpoint individuals more likely to suffer these conditions, but experts say lifestyle factors such as smoking and exercise have the greatest influence on risk.

Around one in 10 people in the Caucasian population carries this variation of the gene, named PIA2.

And researchers from King’s College London reviewed more than 80 studies involving about 50,000 people – the largest analysis of this genetic fault to date.

They found individuals with PIA2 were more likely to have a stroke – caused by a blood clot blocking blood supply to the brain – than those without the gene.

Scientists calculate the gene increases a person’s risk of having a stroke by 10-15%.

But how significant this increase is depends on an individual’s baseline risk – influenced by factors such as smoking, diet, weight and exercise, the scientists say.

For people with two copies of the gene the risk rises by up to 70% from this baseline.

In a second study published in the same journal, the scientists show PIA2 is also linked to an increased risk of heart attacks in people under 45.

More research is needed to see whether this holds true for the whole population, they say.

About 150,000 people have a stroke in the UK each year and more than 100,000 heart attacks are recorded annually.

Both thrombotic strokes (the most common kind) and heart attacks are caused by blockage of blood vessels in the heart and brain – ultimately through the formation of clots.

The faulty gene appears to affect a protein called glycoprotein IIIa – present on platelets, natural clotting cells in the blood.

Platelets help trigger the formation of clots to stop bleeding after injury. But scientists say carrying the gene may render them overactive.  They caution that overall the genes play a smaller role in risk than more established factors, such as high blood pressure and obesity.

But developing a genetic test could help predict people at highest risk, allowing doctors to suggest more potent medication or lifestyle changes, they say.

Prof Albert Ferro, of King’s College London, who led the research said: “We would now need to validate this test and see how useful it is in the clinical world.

Leonardo da Vinci still teaching us about the heart

After Leonardo da Vinci dissected the heart of a man he produced the first known description of coronary artery disease.

Leonardo da Vinci still teaching us about the heartMore than 500 years later, coronary artery disease is one of the most common causes of death in the western world.

“He had a great mind, and he was willing to really look and see,” says Mr Francis Wells, a consultant cardiothoracic surgeon at Papworth Hospital in Cambridge, who has spent years studying Leonardo da Vinci’s anatomical drawings, which form part of the Royal Collection in Windsor.

His diagrams and sketches of the skull, skeleton, muscles and major organs fill countless notebooks while his theories on how they function fill many more pages.

But it was the heart that appeared to particularly fire his interest, from 1507 onwards, when he had reached his 50s.

In those drawings, he used his knowledge of fluids, weights, levers and engineering to try to understand how the heart functions. He also looked closely at the actions of the heart valves and the flow of blood through them.

Mr Wells’ book, ‘The Heart of Leonardo’, explores the artist’s drawings and writings on the organ, and he says his insights are “quite astonishing. The more we look, the more right we realise he was.”

Many of Leonardo’s conclusions, such as the description of how the arterial valves close and open – letting blood flow around the heart – holds true today, but is not widely known.

“Even cardiologists get this wrong now,” Mr Wells says. “Only with the use of MRI technology has knowledge of this subject been revisited.”

Many of Leonardo’s drawings were based on studies of hearts from ox and pigs. It was only later in life that he had access to human organs, and these dissections had to be carried out quickly in winter before the body began to degrade.

Contemporary dissections of the heart show he was correct on many aspects of its functioning. For example, he showed that the heart is a muscle and that it does not warm the blood.

He found that the heart had four chambers and it connected the pulse in the wrist with the contraction of the left ventricle.  He worked out that currents in the blood flow, created in the main aorta artery, help heart valves to close. And he suggested that arteries create a health risk if they fur up over a lifetime.

Mr Wells also believes that Leonardo realised that the blood was in a circulation system and may have influenced William Harvey’s discovery in 1616 that blood was pumped around the body by the heart.

Yet none of Leonardo’s theories or drawing were ever published during his lifetime. In fact, his notes were not rediscovered until the late 18th century – more than 250 years after his death.

With hindsight they may have had the potential to revolutionise surgery.

In the 16th century, for example, there was no treatment for cardiac disease, or many other diseases, and surgeons occupied a low status in society.

If people survived surgery, it was more by luck than judgement. Heart surgery has transformed in the past century, but Leonardo’s insights could have made a huge difference if they had been made public earlier.

Even now, however, there is common consensus that we have barely scratched the surface of what we know about the heart.

According to Mr Wells, Leonardo’s legacy is that we should follow the Renaissance Man’s example and continue to challenge, question and enquire rather than listen to accepted wisdom.