In neurology, vitamin D is important in two settings: epilepsy and multiple sclerosis. The older enzyme-inducing anti-epileptic medications, such as phenytoin (Dilantin) and phenobarbital, are no longer widely used in the US. They increase metabolism of vitamin D, resulting in lower levels and thereby increase bone density loss (osteopenia) which increases risk of fractures, especially… Read more »
There is no reliable device to diagnose concussion on the sidelines, despite extensive research. This is the conclusion of the US Food and Drug administration (FDA), outlined in an April 10, 2019 warning letter to parents, coaches, and trainers. Devices currently in use or development include smartphone apps, portable devices that check eye movements and… Read more »
Even though good scientific evidence may be lacking, many migraine sufferers take supplements. Placebo responses are high (nothing wrong with that) but there are occasional safety concerns, especially regarding butterbur. Widely used are magnesium, feverfew, and riboflavin. A new study seems to explain why some but not all patients respond to riboflavin and supports the… Read more »
This is an important advance as it can dramatically reduce the use of CT scans after concussions. Not only do unnecessary CT scans waste health care dollars but they also expose young athletes to unnecessary radiation. Children and teens, compared to adults, are several times more susceptible to the effects of radiation. Emergency room personnel… Read more »
Dermatomal herpes zoster (shingles) has a lifetime risk of over 30% and carries a high risk of post-herpetic neuralgia which can be excruciating and even permanent. Rarely, the virus can disseminate (spread) and may even result in stroke. Further, recent studies have shown that the virus may be the trigger for giant cell arteritis, a… Read more »
Readers of a review article by Giacoppo and others in Multiple Sclerosis and Related Disorders, 2017, pages 22-31, will probably agree with this statement. Sativex is a branded oromucosal spray containing tetrahydrocannabinol and cannabidiol in a 1:1 ratio. It has been available for years in Canada and has been approved in several European countries since… Read more »
A new device provides noninvasive electrical stimulation of the vagus nerve in the neck to treat episodic cluster headaches. It is call gammaCore and was recently approved by the FDA and will probably be available by prescription in the United States in fall 2017. It is about the size of a cell phone, handheld, applied… Read more »
A practice guideline, prepared by the American Academy of Neurology, was published recently in Neurology. SUDEP stands for sudden unexpected death in epilepsy. This has been recognized for many years but the specific risk has not been consistently established. People with epilepsy can die during a seizure, presumably from post- ictal respiratory depression. SUDEP, according… Read more »
There is good evidence that patients with migraine with aura but not without aura have about a twofold increased risk of stroke. Why this is so, however, is not known. According to a new study, the cause may be cardiac embolism. Patients from the ARIC study of over 15,000 participants, aged 45 to 64 years… Read more »
Patients who have migraine with aura, but not those who have migraine without aura, have been found in several studies to have higher risk of cardiovascular disorders, including stroke. That risk may be 2 times that of a control group though low in an absolute sense because patients are relatively young without cardiovascular risk factors…. Read more »
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