Patients report seizure freedom and quality of life improvement

Newswise — BOSTON – Clinical trial results are so striking that neurologists should advocate for early surgical evaluation of patients with mesial temporal lobe epilepsy (MTLE), according to physicians at Boston’s Beth Israel Deaconess Medical Center and Harbor-UCLA Medical Center in Torrance, California.

In an editorial in the March 7 edition of the Journal of the American Medical Association, co-authors Donald L. Schomer, MD, a neurologist at BIDMC and Roger J. Lewis, MD, PhD, an emergency medicine physician and expert in clinical trial design at Harbor-UCLA Medical Center, say the results from a trial reported in that issue warrant the recommendation despite the fact the study was terminated early due to low enrollment.

“Seventy-three percent of the patients who had surgery were seizure-free after two years. in the same time period zero patients who were surgery eligible – but for whom surgery was delayed – were seizure-free,” says Schomer, a Professor of Neurology at Harvard Medical School. “That’s a very significant finding and should be taken into account when treating patients early in this disorder.”

More than 2.5 million people in the United States have received treatment for epilepsy in the past five years. about 60 percent of those patients have partial epilepsy where the focus, or place in the brain where the seizure begins, can be identified on radiographic imaging. one of the more common forms of partial epilepsy is mesial temporal lobe epilepsy (MLTE).

In spite of improvements in antiepileptic drugs (AEDs), more than thirty percent of people with epilepsy continue to experience debilitating seizures.

“We know there are risks associated with having seizures and there are often serious adverse effects of medications, so surgery may be a good option for many patients,” says Schomer. “There’s also a lot of documentation about diagnosing MLTE and locating the seizure focus as well as about positive outcomes after surgery, but up until now, there has been only one other prospective study that recommended surgical intervention.”

The study Schomer and Lewis examined looked at patients who had experienced fewer than two years of disabling seizures from MTLE. The study group received a standardized anteromesial temporal resection (AMR), a surgery in which the area of seizure focus is removed from the brain. The control group, while eligible for surgery, delayed surgery and remained on anti-seizure medications.

The intent was to enroll 200 patients, but only 38 total patients had been enrolled in the study before it was terminated by the Data and Safety Monitoring Board. The low enrollment was likely due to the fact that the centers chosen for the study infrequently see and evaluate patients who are within two years of being diagnosed with mesial temporal lobe epilepsy, a requirement to participate in the study. Additionally, patients who have undergone such evaluations and are appropriate for surgery often do not wish to delay this form of treatment

“Studies can be stopped for various reasons. a review board may determine that there is too much associated risk, or the evidence of treatment difference may be overwhelming,” says Lewis. “This study was stopped because there weren’t enough participants, but not before some impressive outcomes were unequivocally identified.”

Not only did three quarters of the patients who received surgery remain seizure-free, but they also reported improved quality of life, which often correlates with seizure freedom. while the patients who received surgery did suffer some memory loss and were no more likely to return to work than the nonsurgical intervention group, Schomer and Lewis believe the benefits of seizure freedom outweigh the deterrents. they also note that the disappointing effect of the surgery on employment may relate more to the lack of availability of appropriate rehabilitative services for both groups of patients.

“We feel pretty strongly that stopping this trial early did not bias the findings and that this study along with we already know about seizures and seizure surgery makes a strong case for recommending surgery for this type of epilepsy when it’s indicated,” says Schomer. Lewis adds, “Although the trial was stopped much earlier than planned—albeit for good reasons—it answered the key question regarding how best to prevent further, disabling seizures in this patient population.”

Though not addressed in the study, Schomer and Lewis also stress the “critical importance of early diagnosis.” they say “recognizing the signs and symptoms of epilepsy early in the primary care setting and getting patients referred to level III and level IV epilepsy centers is essential for patients to receive the attention they need, including medical management, neurosurgical evaluations, counseling, and work training.” Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and currently ranks third in National Institutes of Health funding among independent hospitals nationwide. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. for more information, visit bidmc.org.

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Understanding manic depression symptoms ?s th? first step t? seeking help f?r thi? disorder, wh?ther you or s?meon? ??u love is suffering fr?m it. Manic depression, commonly ?l?? referred t? ?? bipolar disorder, ?s ? type ?f mood disorder exemplified b? periods of depression ?nd periods of elevated mood (mania) including extreme elatedness and/or irritability. during th? low periods, th? classic depression symptoms appear, and dur?ng th? high periods it can often ?pp??r as if th? individual h?? an inflated sense ?f self-esteem – a true contrast.

It i? important to understand th?t people w?th manic depression ar? n?t ?t fault, and th?? ?re not just feeling down or being disruptive bec?us? th?y want t? or choose to. It is a ??rious condition, and millions of people suffer fr?m it. in fact, estimates figure th?t approximately 5.7 million American adults ?re currentl? suffering from bipolar disorder. for most sufferers, manic depression requires medical help.

There are many manic depression symptoms, ?om? m?r? common th?n ?th?rs are. Men ?nd women experience th? disorder fairly equally, ?lthough women experience the depressive symptoms mor? prominently. the depressive symptoms include chronic pain, decreased energy ?nd attention, excessive crying, feelings ?f sadness ?r emptiness, irritability, loss ?f interest, suicidal thoughts, feelings ?f guilt ?r hopelessness, weight loss or gain, ch?ng?s ?n sleep patterns and social withdrawal. the manic symptoms include agitation, decreased ?r increased sleep, denial, distractibility, excessive euphoric feelings, hyper-sexuality, increased energy, inflated self-esteem, poor judgment, impulsive behavior, provocative ?r destructive behavior and talkativeness.

The good news is that medical hel? ?s av?il?ble for manic depressive disorder, ?lth?ugh th? treatment methods will vary depending on factors ?uch ?s age, health, extent ?f the disorder ?nd ?ther issues. Treatments ?u?h a? medication, electroconvulsive therapy ?nd psychotherapy ar? ?v??lable options. It is important t? seek treatment early ?n ?nd maintain treatment, however, f?r ?t to be effective.

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A recent study finds that a drug approved by the FDA to treat skin cancer in humans has reversed signs of Alzheimer’s in mice and improvements showed up quickly. Neuroscientist Gary Landreth, one of the co-authors of the study, described that on TALK OF THE NATION: SCIENCE FRIDAY last week.

(SOUNDBITE OF ARCHIVED BROADCAST)

DR. GARY LANDRETH: One of the other bits in this story is that if we looked at mice, at Alzheimer’s mice, with extensive plaque deposition within their brains, what we observed was that the plaques were removed. we lost about 50 percent of the plaques within 72 hours.

CONAN: obviously, researchers hope that what works in mice will work safely in humans, but there have to be tests to make sure it works, and that it’s not dangerous. Even so, Alzheimer’s research and advocacy groups report they’re getting calls from caregivers and patients desperate to try this drug. So, doctors, are you getting pressure from patients and caregivers who don’t want to wait? 800-989-8255. Email us, . you can also join the conversation on our website. That’s at npr.org. Click on TALK OF THE NATION.

Dr. Jason Karlawish is a professor of medicine and medical ethics at the University of Pennsylvania, where he’s also a researcher with the Alzheimer’s Disease Center. he joins us by phone from his office in Philadelphia. Nice to have you back on the program.

DR. JASON KARLAWISH: a pleasure to be here, Neal. Thank you.

CONAN: we should note this is not the first time Alzheimer’s has been cured in mice, but that not all these remedies that are effective in mice prove effective in humans.

KARLAWISH: That’s right. That’s right. We’ve made a lot of progress in treating Alzheimer’s in mice. and though we’re still striving to make similar progress in treating it in humans, nevertheless, these kinds of studies are very important and very essential before we go to humans.

CONAN: Yet, I think you could probably understand someone with Alzheimer’s or somebody treating somebody with Alzheimer’s saying tests in humans could take three, four, five years. I’m not going to be around to wait.

KARLAWISH: Yeah. I know. and that’s frustrating. but there’s – that the time to move from animal to human and then through the trials that involved humans does take several years. and there’s just simply no way, right now, the science doesn’t allow us to do it any quicker.

CONAN: Yet, it’s a drug that’s already approved for skin cancer treatments.

CONAN: It is perfectly legal for a doctor to prescribe it, off label, for something else.

KARLAWISH: Right. and that’s the challenge here. and prima facie, the question, I think, a competent clinician has to sort of ask himself, herself is, you know, when a family approaches them about this drug that’s available for another indication, is, well, what’s the data about this drug for a different indication, which is the treatment of Alzheimer’s disease? and when they look in the literature or ask their colleagues, they’ll find that there’s scant data at all, about how to dose it for the adequate safe treatment – effective treatment of a person with Alzheimer’s disease.

And essentially what’s needed is research, research to figure out what is the safe dose and what is a – is it effective? I think, though, that when a family does come to you and asks about this, there’s a deeper issue going on there, and a regional clinician ought to engage the family on what’s motivating them to ask you about this. I mean, they understand it’s risky, and probably the empathetic thing to do is to talk with them about other ways that they can channel that emotion and that willingness to take risks, like looking at the clinical trials that are available now that are going on.

CONAN: Because there are other drugs that are being tried.

KARLAWISH: Absolutely. there are several drugs in various phases of development now. and one good way to find out about those clinical trials is to reach out to the Alzheimer’s Association’s TrialMatch. the association has put together a wonderful Internet or 1-800 access database where you can put in your information and find out the kinds of clinical trials in your area that are available. I think that a family and a patient who hear about this drug and, unfortunately, find out that’s not available and not useful for treating Alzheimer’s, can instead channel that energy into looking into clinical trials that are available through Alzheimer’s Association’s TrialMatch.

CONAN: This is a skin cancer treatment. and like most cancer treatments, it is not without side effects. So those are things you have to consider too.

KARLAWISH: Well, sure, yes. but, you know, I think that as sort of almost secondary. I, you know, I don’t even know what dose you would take to see if it gets into the brains where you could then begin to measure, does it have an effect on the brain that’s positive or not? you know, I don’t mean to sound like a scientist, but that’s such a basic question that we don’t even have an answer to. So the first studies that need to be done in humans are studies that would involve a few volunteers who simply we want to get a sense of, you know, what’s the drug’s penetration into the brain, et cetera.

CONAN: Volunteers, yet people are willing to call up right now and say, sign me up.

KARLAWISH: Yeah. and again, I think we have to recognize, you know, there’s a – this is a bad disease, and there has been increasing, fortunately, recognition in the public and in – by national leaders that we need to do something about this. and these telephone calls are telling us something that, you know, people want to see that the health care systems, the NIH, the federal government are responding to their desperation. and I think we’re seeing that now. we have a national Alzheimer’s plan in place. President Obama announced a substantial increase in funding that will be available to support Alzheimer’s research. you know, we have a national network of clinical trials in place with the Alzheimer’s Disease Cooperative Study group. but quite frankly, the bottom line is really the bottom line, we need more funding to move this along.

CONAN: the research that’s been done in mice, people know these are mice specially bred for this kind of research…

CONAN: …to be as close as possible to their human counterparts, but there is still a big difference between mice and humans.

KARLAWISH: Yeah. Yeah. Unfortunately, you know, mouse models are just that, they’re models. They are not the disease. and, for example, these mice were modeled to have amyloid plaques. They don’t have the tau tangles that are also part of the Alzheimer’s pathology. Nonetheless, mouse models have been very valuable to give us some guidance about what may or may not be a promising intervention in humans.

But again, you know, they have their limitations, and I think this is another example of, we have to recognize both the strengths and limitations of mouse models. their strengths are they can get us data very quickly. the limitations are, you know, they have a very different way of metabolizing amyloid than humans do. their genetically engineered even to have – to develop amyloid in the first place. So there are substantial differences between mice, if you will, and men.

CONAN: and could you give us an example of a drug which appeared very promising in mice to treat Alzheimer’s that did not work out so well in humans?

KARLAWISH: Well, I think probably the – a good example that folks can look up on the Internet because it was, you know, it occurred during just not too long ago, were the earliest treatments that were developed or the drugs that were developed for removal of amyloid using immune modulation techniques, in other words, antibodies that would grab amyloid and take it out of the brain, and the earliest forms of those compounds were very promising in mice. I mean, they really cleaned up the amyloid, and you saw clear changes in the measures that we make of mouse cognition to show that their brains are doing better, like swimming through a water maze and whatnot to get a platform. though extremely promising, but, you know, when deployed in humans in the early stage trials showed some real issues with toxicity, such that the earlier compounds had to be reconfigured and reworked.

Now, fortunately, many years later – and it’s sad to say unfortunately many years later – those compounds now are very promising, and some of them are – the reworked compounds – are in the last phase of testing. and we’ll know within this calendar year whether those compounds were safe and effective in the treatment of patients with mild to moderate Alzheimer’s disease. but sadly, of course, you know, the march of science does take time. I mean, it was somewhat decade ago that those first immune-based therapies were tried that were promising in mice, but unsuccessful in humans.

CONAN: We’re talking with Dr. Jason Karlawish, the professor of medicine and medical ethics at the University of Pennsylvania, about a study of a skin cancer drug approved by the FDA to treat skin cancer that has also proved promising in the treatment of Alzheimer’s, but only promising in studies with mice. and as he just pointed out, there’s a long way from being effective or interesting results in mice to being safe and effective for humans. but we want to hear from doctors. Are you hearing from your patients today and in the past few weeks or so about this drug, and what do you tell them? 800-989-8255. Email: .

We have an email question from David in St. Louis: Aren’t there some skin cancer patients with Alzheimer’s? Can’t we find them and study them?

KARLAWISH: That’s a great question. David’s probably had some training in epidemiology maybe. you know, one thing one could look at would be a database that has a collection of individuals with skin cancers who have received this drug or not – and not received it, and look at whether there was a change in the risk of developing Alzheimer’s disease or the progression of it, although it’d be hard to see that measured in the database, but yeah.

I mean, one of the approaches to seeing – to looking at the validity of this drug is the basic science models, obviously, which we’re seeing with mice, early phase studies in humans are obviously essential, but also let’s look at what data are in existing databases that might describe whether this drug and drugs like it might be beneficial for reducing the risk of developing Alzheimer’s disease. That would not be adequate data to then say we’re ready to go to humans, but it would certainly be data to add to the case that this is a promising drug and worth studying.

CONAN: Let’s go next to Anna(ph). Anna with us from Rochester in New York.

ANNA: hi. I – my grandmother died of Alzheimer’s disease last year, and my grandfather was just diagnosed last week, and I’ve had a lot of experience in the caretaking of both of them. and my question is this – I could be wrong, but I’m wondering – I remember reading about the Salk vaccine that, you know, there were a lot of questions about its safety and, you know, whether it should be used and stuff. but there was also an understanding that this was an epidemic and that it needed to be dealt with. and I guess having seen the effects of Alzheimer’s firsthand and knowing that it’s a death sentence, this is – I think I’m pretty positive that my grandmother would have given anything in the world if there had just been just a chance that something might have worked. and I guess I’ll just take your comments off the air. Thank you very much.

CONAN: OK, Anna. thanks very much. Of course, she’s referring back to the polio vaccine and the panic of the – in the 1950s when that was still so prevalent. and I guess there are some analogies that could also be made to AIDS 10 years ago or so…

CONAN: …and the great pressure put on NIH and other institutions to speed up research on AIDS drugs.

KARLAWISH: Yeah. I think those are two good histories to look at and to try and learn from. I mean, we did do studies of the polio vaccine, though. I mean, evidence was required to show that the vaccine reduced the chances of developing polio. It was not simply prescribed without data. What’s stunning and fascinating is how people stood in line to join those studies. the tremendous outpouring of national interest and enthusiasm to conquer polio using science is a model for I think just the feelings that the caller has, that there’s a lot of interests and enthusiasm out there, and we need to get people into trials.

And to get people into trials, we need to have the resources to do that. I mentioned earlier that the Alzheimer’s Association’s TrialMatch. the federal government has ClinicalTrials.gov where you can look up studies, but it’s all very well to find these studies, we have to have sites that are doing these studies, and so that gets back to a very basic resource, which is money and time. you know, we need a national investment in Alzheimer’s disease research that is equivalent to the kind of investments that we put into other devastating diseases such as cancer and cardiovascular disease where I think, over time, we have seen real progress.

You mentioned though, Neal, AIDS. I think AIDS is a good example also where, initially, a devastating, utterly frightening disease, still certainly is frightening, but certainly less devastating as a result of the progress made with research courtesy of both public and private investments. What’s interesting in the history of AIDS, of course, is how involved the patients were in helping to shape those clinical trials so that they gathered valid data, but at the same time also respected the rights and interests of those patients. and they made some real contributions to study design that the scientists alone were not able to make. and I think there are similar models that could be thought about with Alzheimer’s disease.

CONAN: Dr. Jason Karlawish. You’re listening TALK OF THE NATION from NPR News. and let’s get to Matt, and Matt’s on the line with us from Farmington Hills in Michigan.

MATT: hi. I’m a neurologist practicing in the Detroit area, and I get a lot of patients whose family members asking me about these trials; they’ve read about it in a magazine and things like that.

CONAN: and what do you have to tell them?

MATT: Well, I have to tell them that it’s, you know, it’s just so preliminary and so early. It would be a great thing if we can possibly do anything to stem the tide of dementia. It’s such a hard disease on the patient’s family, but it’s preliminary, it’s early. a lot more trials need to be done. and for most patients studying for some dementia, I’m just concerned that by the time the drug gets out there in a commercial form it’ll be too late for the current population.

CONAN: and that’s got to be frustrating on both ends.

MATT: It’s incredibly frustrating. We’ve got a handful of drugs out there that we can use right now for dementia of Alzheimer’s type, and they don’t work particularly well.

KARLAWISH: Matt – it’s Matt, right?

KARLAWISH: Yeah. I’m curious. if one of your patients or their family member said, so if we can’t get this drug clinically, you can’t prescribe it. I understand that. I’d love to be in the study. Where would you send them? what would you do?

MATT: you know, that’s a good question. I would love to send them off to a study. I don’t really know where any are being done right now. if I could get any resources…

MATT: …I would love to do anything I can to get interested patients involved.

KARLAWISH: Exactly. So this is a great example. I mean, you’re one, you know, lone light in the wilderness, but, you know, so to speak, but, you know, let’s have HHS and Medicare and the NIH, you know, invest in creating an infrastructure where you can easily refer people to a clinical trial in the Detroit area.

MATT: Exactly. Most of the time I just tell them, well, we can call the local academic centers and see if they have anything going on because I really don’t know.

KARLAWISH: Exactly. Exactly. and, you know, and I think your story is a common story, and, you know, this is changeable. It doesn’t have to be that way.

CONAN: Matt, thanks very much for the call. Good luck.

MATT: thanks.

CONAN: and finally, Dr. Karlawish, we’re getting calls from some doctors saying, this is a very expensive drug. and, yes, it might be legal to prescribe it off-label, but no insurance company is going to pay for it.

KARLAWISH: Well, yeah. you know, money always is a great way to sort of shut down or open up the access. I think, you know, put aside the money, just the data aren’t there, so I would just, you know, it’s not even worth getting into the debate about, is it worth the money? but let’s just pretend that this drug was shown to work in people with Alzheimer’s disease, just wave a wand and clear safety and ethics (unintelligible). It does raise another challenge that Alzheimer’s disease therapeutics present to us, which is we’re talking about a very prevalent common disease, and that means, therefore, an expensive disease. It’s expensive to have it, but it’s also expensive to treat it. and if the treatment slows the progression of the disease, it’ll extend the life of the people with the disease, and, therefore, the cost of that treatment.

Well, I’m simply raising the issue of we need to attend very closely to the economics of this disease and its treatment as we do to developing better treatments for this disease.

CONAN: Dr. Karlawish, thanks very much for your time.

KARLAWISH: You’re very welcome. Thank you, Neal.

CONAN: Jason Karlawish, professor of medicine and medical ethics at the University of Pennsylvania. It’s the TALK OF THE NATION from NPR News.

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(CBS News) 

Some new scientific research is causing quite a stir in the medical community.

The fight is over antidepressants, and whether they work any better than a simple placebo.

In an report airing this Sunday, “60 Minutes” correspondent Lesley Stahl spoke to the psychologist behind the study, Irving Kirsch, associate director of the Placebo Studies Program at Harvard Medical School.

Preview: Treating Depression

He says that his research challenges the very effectiveness of antidepressants. Kirsch says the difference between the effect of a placebo and the effect of an antidepressant is minimal for most people.

In her interview with Kirsch, Stahl asks, “You’re saying if (patients taking antidepressants) took a sugar pill, they’d have the same effect?”

Kirsch replied, “They’d have almost as large an effect, and whatever difference it would be, would be clinically insignificant.”

Stahl presses, “But people are getting better taking antidepressants, I know them. we all know them.”

“People get better when they take the drug, but it’s not the chemical ingredients of the drugs that are making them better,” Kirsch said. “It’s largely the placebo effect.”

Kirsch’s specialty has been the study of the placebo effect — the taking of a dummy pill without any medication in it, that creates an expectation of healing that is so powerful, symptoms are actually alleviated.

In addition to an interview with Kirsch, Stahl interviewed doctors who don’t agree with Kirsch’s study.

On “CBS This Morning,” Friday Stahl called the report “explosive.”

She said, “Basically (this report) is saying that — except for those very severely depressed, because everybody says that these antidepressants do work if you’re — if it’s a depression that you just can’t get over. But if you’re moderately depressed or mildly depressed, a sugar pill would be just as good.”

“It’s the placebo effect,” Stahl continued. “And part of our story involves how the mind is so powerful over the body that the placebo effect shows up even if you have knee surgery, with osteoporosis, if you have Parkinson’s disease. All these diseases that somehow involve the mind and it’s not just in the mind. A sugar pill can actually change your blood pressure, they’ve monitored the brain, it can change the brain chemistry and the doctor giving you the pill, if it’s a sugar pill, just telling you he cares and, ‘Yes, I know you’re sick and here’s something to help you, that doctor is part of the placebo effect.’”

So are doctors prescribing sugar pills?

Stahl said she asked that question throughout her reporting, but learned it’s not an ethical practice.

“There are side effects with antidepressants,” she said. “It’s not ethical. But you know, in my head, to give a pill that is as good as a placebo with side effects isn’t ethical either. So I think why not give a sugar pill. But they don’t do it, they won’t do it.”

For more with Stahl on her upcoming report, including what it means for people taking antidepressants and the companies that make these prescription drugs, watch the video in the player above.

Checking for clogged arteries doesn’t help inveterate smokers kick the habit if they are already in a quit-smoking program, Swiss researchers have found.

Yet that’s sometimes the justification when doctors recommend the expensive scan, called carotid plaque screening, which experts say has no proven benefits in people without symptoms of heart disease.

“When people get a very good smoking cessation program, carotid plaque screening does not add anything,” Dr. Nicolas Rodondi, who led the new study, told Reuters Health.

Some previous research had suggested that showing people dire pictures of cholesterol buildup, or plaque, in their arteries might be the stick they need to make healthy changes to their lifestyle.

But at least for smokers, the new study slashes those hopes.

“It proves that in trying to motivate smokers to quit, this strategy is not going to be useful,” said Dr. Patrick O’Malley of the Uniformed Services University in Bethesda, Maryland, who wrote an editorial about the findings.

During carotid plaque screening, doctors use ultrasound to get a picture of the arteries that supply blood to the brain. The procedure is gaining popularity both in the U.S. and in Europe, but it’s not clear that it actually helps patients.

“There is absolutely no proven benefit,” O’Malley told Reuters Health. “It’s still a promising test, but it is being overutilized in practice.”

While some organizations currently recommend the routine carotid plaque screening, the government-backed U.S. Preventive Services Task Force advises against it when people have no symptoms of heart disease.

Scans vs. counseling

The new study, published in the Archives of Internal Medicine, is based on more than 500 long-time smokers aged 40 to 70 who all wanted to quit and had no symptoms of heart disease.

All of them had six sessions of counseling over a year, plus a phone call, nicotine patches and brochures on smoking cessation. In addition, half were randomly chosen to be screened for carotid plaque, which most turned out to have.

Although smoking contributes to plaque, which is a risk factor for heart attack and stroke, the ultrasound pictures didn’t seem to have any effect.

After one year, a quarter of those who got screened had been smoke-free for at least a week based on their own reports as well as breath analyses. for those who didn’t get screened, the number was 22 percent — a difference that could easily be chalked up to chance.

And whether or not people had plaques visible on the scans didn’t make a difference either.

“Smokers are a different breed, they tend to have a different psychological profile,” said O’Malley. “They are more recalcitrant.”

According to Rodondi, carotid artery screening costs $400 in Switzerland — about the same as six sessions of quit-smoking counseling with a doctor.

And while the scan may not be worth its price tag, the smoking cessation program is, he added.

“We are very successful with the smoking cessation program,” Rodondi told Reuters Health. “When smokers try to stop smoking by themselves they only get a five-percent smoking cessation rate at one year.”

In an earlier study, O’Malley found that heart scans don’t seem to be of much help in changing risk factors for heart disease either.

While he said it’s still possible that medical scans might motivate some non-smokers to lead healthier lives, he said the new technology mostly distracts from establishing a good rapport between doctors and smokers — something that might ultimately help them kick the habit.

“It’s just difficult — It’s an addiction,” O’Malley said. “But I think people underestimate the value of building a relationship with patients and a longitudinal plan.”

Jan. 18 update: the day after TODAY reported on the baffling case of 12 teenage girls at one school who mysteriously fell ill with Tourette’s-like symptoms of tics and verbal outbursts, a doctor who is treating some of the girls has come forward to offer an explanation. Dr. Laszlo Mechtler, a neurologist in Amherst, N.Y., says the diagnosis is “conversion disorder,” or mass hysteria.

“It’s happened before, all around the world, in different parts of the world. It’s a rare phenomena. Physicians are intrigued by it,” Mechtler told TODAY. “The bottom line is these teenagers will get better.”

Tuesday on the show, psychologist and TODAY contributor Dr. Gail Saltz noted that just because the girls’ symptoms are psychological in origin doesn’t make them any less real or painful.

“That’s not faking it. They’re real symptoms,” Saltz continued. “they need a psychiatric or psychological treatment. Treatment does work.’’

Officials from the LeRoy Junior-Senior High School in upstate new York, where all the girls attended when their symptoms began, have released environmental reports, conducted by an outside agency, showing no substances in any of the school buildings that could cause health problems.

Related: Click here to read the school district’s statement and full environmental reports

But some of the girls’ parents say they’re not satisfied with the explanations so far.

“Obviously we are all not just accepting that this is a stress thing,” Jim Dupont, father of one of the affected girls, told TODAY. “It’s heart wrenching, you fear your daughter’s not going to have a normal life.”

Read the original story, below.

By Scott Stump

High school cheerleader and art student Thera Sanchez  took a quick nap one day last October, and when she woke up, the life she had known was gone.

In its place, she was plagued by uncontrollable body movements, tics and verbal outbursts, similar to Tourette’s syndrome. It turned out Sanchez was not alone, as she is one of 12 girls from LeRoy Junior-Senior High School in upstate new York who has been exhibiting symptoms of a mysterious condition that has baffled doctors.

“I’m very angry,’’ Sanchez told TODAY’s Ann Curry during an interview Tuesday. “I’m very frustrated. No one’s giving me answers.’’

Sanchez appeared on TODAY alongside her mother, Melisa Phillips, as well as another one of the girls experiencing the symptoms, Katie Krautwurst, and her mother, Elizabeth Miller.

The mothers of the two girls are fighting for answers after state health officials determined that nothing at the high school itself could have triggered the mass illness. each girl has been examined by a private doctor and given a diagnosis. after a three-and-a-half month investigation, health officials ruled out carbon monoxide, illegal drugs and other factors as potential causes.  Officials say no one at the school is in any danger.

Related: Click here to read the school district’s statement and full environmental reports

“We have conclusively ruled out any form of infection or communicable disease and there’s no evidence of any environmental factor,’’ Dr. Gregory Young of the new York Department of Health told NBC News.

“Where’s the proof?’’ Phillips asked on TODAY. “Where’s the data? Where’s the testing? when has this been done? Nothing’s been collectively done for our daughters. Everything has been done individually. Testing they say that all the girls have had, they have not had. the facts that they’re stating just aren’t true.’’

The girls did not say what diagnosis they have been given, only that doctors have told them the onset of their symptoms was stress-related.

Sanchez, a 17-year-old senior and former cheerleader, displayed uncontrollable movements and verbal tics during the interview, while the symptoms of Krautwurst, a high school junior, were not as pronounced.  

“Mine’s more advanced, I think, because I’ve had it longer, but it’s definitely gotten better,’’ said Krautwurst.  Meanwhile, Sanchez said her own condition is getting worse.

On Oct. 7, Sanchez took a power nap, and when she woke up, she started stuttering uncontrollably and has been exhibiting her symptoms ever since, according to her mother. Since then, she has quit cheerleading and regularly attending her beloved art classes.

“mostly that it’s stress-induced,’’ Sanchez said about what doctors told her. “I was fine. I was perfectly fine. There was nothing going on, and then I just woke up, and that’s when the stuttering started.”

“I can’t explain it,’’ Krautwurst said. “they told us it was traumatic, but I really don’t think any of us had that traumatic of a life before.’’

Psychologist and TODAY contributor Gail Saltz said she could not make any specific diagnosis having just met the girls, but she stressed that just because the cause may be psychological doesn’t mean the symptoms – or the pain the girls are experiencing – is fake.

“when you’ve ruled everything out and they’re saying to you it’s stress-related, then you might call it something called ‘conversion disorder’ or ‘psychosomatic illness,’ which means that symptoms have been converted from something psychological into something physical,’’ Saltz said. “It usually is predated by stress.”

“That’s not faking it. They’re real symptoms,” Saltz continued. “they need a psychiatric or psychological treatment. Treatment does work.’’

For Sanchez, all she wants is to know what is happening to her and why.

“I want an answer,’’ she said. “a straight answer.’’

 What’s your theory on this medical mystery? Discuss on our Facebook page.

Aman Foundation launches second health initiative.

KARACHI: At least 40% of deaths in Pakistan are preventable, said the chief executive officer for Aman Foundation, Ahsan Jamil at the launch of the organisation’s latest initiative Aman Telehealth. “Most of these deaths occur due to three major factors – lack of transport to a healthcare facility, affordability and lack of decision makers being present at time of the emergency.”

In a previously conducted study, Dr Sadiqua N Jafery concluded that the most common of the three reasons was the lack of decision maker ie husband, mother-in-law, father or mother being present. according to Jamil, the launch of a system whereby you can receive an initial diagnosis and prescription for non-chronic symptoms on the telephone is therefore most opportune. the telehealth project has been in the works for several months now with ongoing training for the 26-strong staff to attend to a caller’s medical queries. the service will be in operation 24 hours, seven days a week on 111-113-737.

“At present we have the capacity to attend to 1,000 to 1,200 calls a day, with 10 attendants in the morning, 10 in the evening and six overnight,” said Dr Zahid Ali Faheem who is heading Aman Telehealth.

The call is answered by a registration officer who notes the caller’s name, address, gender and age. the call is then transferred to a health advice officer ie nurse or doctor where a list of your symptoms are noted in a system. if the programme is unable to generate a suitable response the call is then passed on to a medical officer who further questions the caller about their symptoms.

In case of emergency, the call is routed to the ambulance service.

According to Faheem, among other objectives they hope to achieve greater empowerment for women, early-stage intervention and reduce incidence of medical emergency through this initiative. “In three to five years we hope to increase our attendants to 150.” but the process of increasing staff as well as advertising the service needs to be gradual for a sustainable setup cautions executive director for Aman Health Dr Junaid Razzak.

“The most important thing is to fill the void of missed opportunity,” Razzak said. the most difficult part for a medical professional is not the medical life saving procedures they give but delivering the news to loved ones of the patient’s condition or demise, he added. “It is with the hope to decrease these conversations by early intervention and diagnosis that Aman Telehealth has been launched.”

The service also provides a medical directory to hospitals, laboratories and other medical facilities in the city. While the service is available to people calling from all over the country the medical directory has thus far only been compiled for Karachi.

Published in the Express Tribune, January 2nd,  2012.

Attorney Colleen Gorman has a holiday ritual that doesn’t involve buying presents or counting down to midnight: she goes online to look for new hangover remedies she hasn’t tried.

She already has scratched off those big “prevention” pills, vitamins and chugging sports drinks, along with more quirky folk remedies including peanut butter sandwiches.

“My fiance says I should probably just drink less,” said Gorman, 28, of Chicago.

Experts say that’s good advice for everyone.

“The only way to prevent a hangover is to not get drunk,” said Boston University researcher Jonathan Howland.

That might be too radical a remedy for many revelers, but it’s the only one proven to work. still, there are strategies that can soften the blow.

Topping the list? Don’t drink on an empty stomach, said Sam Zakhari, director of the National Institute on Alcohol Abuse and Alcoholism’s metabolism and health effects division. Food helps absorb alcohol and delay its toxic effects on the body.

Drinking plenty of water before, during and after also helps because alcohol can dehydrate the body.

Kim Khan teaches at the American Professionals Bartending School in Villa Park, Ill., and devotes a class to serving responsibly. That includes encouraging bar patrons to drink water. Khan, who also tends bar, says alternating drinks with glasses of water helps and is a method she uses “because I’ve been doing this way too long.”

Some people think choosing clear alcohols is safer, because darker-colored drinks contain more compounds called congeners. That is based on an unproven theory that those compounds cause the body to make toxins that upset the stomach and cause other hangover symptoms, said Howland, a researcher in the emergency medicine department.

But no one really knows what causes hangovers, which makes preventing them a challenge, Howland said.

He’s hoping to find a clue in his research into why some people don’t get hangovers. About 1 in 4 drinkers never feel yucky after overindulging. In Howland’s lab, that includes study subjects given normally “intoxicating” doses – about six beers for men and five for women.

That may seem enviable, but Howland said those 25 percenters also may be more likely than the rest of us to become alcoholics.

Some experts think hangover symptoms are caused by toxins from methanol after the body breaks down the ethanol alcohol in booze. That’s why some people swear by “the hair of the dog” – more alcohol the next day. but Howland says if that helps, it only delays the inevitable.

The list of purported remedies for preventing or treating hangovers includes a witch’s brew of products, including milk thistle, honey, bitters and soda, Pedialyte, cranberry juice and Tabasco sauce. none has been scientifically proven to work, Howland said.

Brian Chui, a 23-year-old Los Angeles publicist, says he’s tried a lot of them, but so far, “nothing works that great for me.” this year, Chui says he may try new anti-hangover pills combining aspirin and caffeine that his friends have been touting.

Zakhari, the government expert, said the product may or may not be harmful, but could give drinkers “a false sense that `I can drink as I wish because I have the cure.’”

Some people think popping a couple of Tylenol tablets after a night of drinking will help prevent hangover symptoms, but experts warn that can be dangerous. both alcohol and acetaminophen, the active ingredient in Tylenol, are broken down in the liver, and taking them together can cause irreversible liver damage.

The risk of combining the two is small in a healthy person taking a recommended dose of Tylenol. but Zakhari says aspirin and ibuprofen are safer alternatives to treat hangover-related ills, and the best advice is to avoid Tylenol for a couple of days after drinking because even some healthy people may be vulnerable. Plus more than 600 over-the-counter medicines contain acetaminophen, so it’s pretty easy to accidentally take too much.

Alcohol can irritate the stomach and aspirin and ibuprofen can cause stomach-bleeding, so they should be used with caution, a govermment publication on hangovers advises.

A study to be published in the February edition of the journal Drug Safety found that cases of liver damage linked with accidental overdoses of acetaminophen more than doubled between 2000 and 2007. The analysis of data from the American Association of Poison Control Centers found a rise in liver damage caused by acetaminophen alone, and in medicine combining it with opiate drugs, which includes the painkiller Vicodin.

The study lacked data on alcohol use, but it’s likely some cases involved drinking, said study author Randall Bond, a medical toxicologist at Cincinnati Children’s Hospital Medical Center. most liver damage seen in the study was minor, he said.

Of course, routine, excessive use of alcohol alone can cause liver damage, so making hangovers a habit is not a good idea.

Time is really the only cure, Zakhari said. because drinking alcohol can cause fitful sleep, getting extra sleep the next day can help. Zakhari advises calling in sick if it happens to be workday.

“I have seen some people go to work with a hangover and their output is somewhere between zero and 1,” he said.

As for Zakhari, he’s never even been drunk. he can’t tolerate alcohol.

“If I drink more than one drink, I get nauseous and vomit,” he said.

So to celebrate this year, he’ll probably have a “casual glass of wine with dinner with friends and watch the ball drop.”

(Medical Xpress) — former Olympian Jarrod Shoemaker was in the middle of the swimming portion of a triathlon in Hamburg, Germany, when the swimmer in front of him accidentally kicked him in the face. Shoemaker finished the race, but could tell something was wrong with how his body was working. Three weeks later, he crashed hard from his bike onto wet pavement during a race in London, adding to his list of injuries.

“Upon returning home I knew that something was wrong besides me just feeling lethargic, apathetic and generally off,” says Shoemaker, a resident of Sudbury, Mass. “I wanted to make sure that there were no long-term problems, especially in a sport like triathlon, where perception and balance are key.

“My coach and I did some reading online about sports concussions and returning from them, and one of the names that we saw over and over was Dr. John Leddy. we did some research on Dr. Leddy and found that he was at the University at Buffalo. Coincidentally, we were headed to Buffalo for U.S. Nationals in two days. It was an amazing piece of fate for me.”

John Leddy, MD, internist, medical orthopedist and associate director of UB’s Sports Medicine Institute, met with Shoemaker at the UB institute’s Concussion Management Clinic to perform a series of tests to discover just how much damage had been done.

One such test involved Shoemaker choosing a target in the room, then shutting his eyes and moving his head, and then attempting to hit the target with a laser pointer while his eyes were still closed. This test measures how well a patient is able to tell where his or her head is facing, which is a sensation controlled by the neck.

“Jarrod could not run fast because his neck injury was aggravated by his posture and by the forces incurred during running,” Leddy says. “Upper neck injuries can produce the same symptoms as a concussion, which is a brain injury.”

Some of these symptoms include poor balance, poor sleep, personality change, nausea and headache, all of which are indicative of how the brain is affected by the injury.

“The brain is a unique organ,” adds Leddy. “You only have one, and you need it for almost everything else.”

After meeting with Shoemaker, discussing his symptoms and putting together the timeline of his injuries, Leddy concluded that Shoemaker’s concussion occurred when he was kicked in the face, and probably was made worse by his crash to the pavement. “Until this time, I had not even thought about these two events as being related,” Shoemaker says. “We came to the realization that the concussion and an upper cervical strain were causing me to have both physical and mental problems. I had never had a concussion before, but it was really interesting seeing how a concussion can really affect everything.”

According to Leddy, athletes who suffer repeated concussions, who do not recover properly, then continue to play with symptoms, are at risk for having permanent brain damage complicated by premature cognitive and emotional dysfunction that affects their lives and their families.

“This can lead to premature death,” Leddy explains. “There is no such thing as a minor concussion. all concussions are significant and must be treated appropriately by physicians familiar with concussion assessment and treatment. with such treatment, most athletes will recover, and be able to return to play safely.”

UB’s Concussion Management Clinic opened in 2007 and serves roughly 150 patients a year, including professional and amateur athletes and people injured at work, home or in car accidents.

When concussion is diagnosed, some patients, like Shoemaker, receive a standardized and scientifically validated exercise treadmill test to determine their degree of recovery from the concussion. Those with prolonged symptoms are prescribed an individualized exercise rehabilitation program based upon the results of the treadmill test.

Leddy and colleagues were the first to use the Balke treadmill protocol, a test usually used for cardiac stress testing, to help physicians determine whether an athlete is ready to return to play.

During the test, the incline of the treadmill is increased by a specific rate every minute. The athlete exercises until the point at which his or her concussion symptoms (headache, for example) become more severe.

“We feel that the best method of determining when athletes are physiologically ready to go back and play sports to maximum intensity is the treadmill test, because the exercise test replicates the physiology of what athletes have to do during sport,” Leddy says.

Based on the UB research, team physicians from around the country are beginning to change the way they manage athletes who have suffered a concussion.

“Dr. Leddy said that I could continue to train, but had to be very careful with how much running I did because of the pounding on my neck,” Shoemaker says.

“For me, taking the time out to finally figure out why my body was feeling so ‘off’ helped me make a big change in the last few races of my season,” he adds. “I raced in Buffalo two days after Dr. Leddy and I met, and I was careful while running, but could feel my body protecting my neck and head. I raced again two weeks later and my body was feeling a lot more like normal. I actually ended up winning the race and winning the U.S. Elite Series.”

Provided by University at Buffalo (news : web)

NEW YORK, Nov. 30 (UPI) — Cadets whose stress hormone cortisol increased the most at waking were more likely to show stress symptoms later as police officers, U.S. researchers say.

Dr. Charles Marmar of the new York University’s Langone Medical Center, in collaboration with the San Francisco VA Medical Center and the University of California, San Francisco, assessed 296 police recruits during academy training for salivary cortisol at first awakening and after 30 minutes.

The difference between the two levels is known as cortisol awakening response. the study found the greater cortisol awakening response during academy training predicted greater peritraumatic dissociation and acute stress disorder symptoms over the first three years of police service.

Police academy recruits who showed the greatest rise in cortisol after waking up were more likely to show post-traumatic stress disorder in response to trauma years later as police officers, Marmar said.

“This study is significant as a potential indicator in determining when people may exhibit stress symptoms in the future,” Marmar said in a statement.

“Few studies have prospectively examined the relationships among pre-exposure hypothalamic-pituitary-adrenal activity, acute stress reactions and PTSD. the findings may lead us to new insights on how to identify those who are at a higher risk of PTSD.”

The study is to be published in Biological Psychiatry.