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marcjacobs:

Shoesday Tuesday

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neuromorphogenesis:

How a surgeon installs seizure sensors inside a skull

A reporter watches a brain surgeon implanting electrodes inside the skull of a person with epilepsy to pinpoint where his seizures start

A YOUNG man lies unconscious on the table, his head clamped firmly in place. His eyes are closed. The hair over his left temple has been shaved.

I’m in the operating room at University Hospital Zurich in Switzerland with neurologist Thomas Grunwald, who has diagnosed 22-year-old Jeremy Künzler with drug-resistant temporal lobe epilepsy. His symptoms during fits suggest that the seizures begin in the left temporal lobe. Often, this condition can only be treated by surgically removing the errant brain tissue. Unfortunately, brain scans have revealed nothing that would point to the source of Künzler’s seizures – no obvious tumour, scar or lesion.

In ordinary circumstances, Künzler would have to undergo exploratory brain surgery. But instead of this drastic operation, Grunwald is pioneering a technique to pinpoint the problem area. He has asked neurosurgeon Niklaus Krayenbühl to implant electrodes inside Künzler’s skull: a grid electrode over his left temporal lobe, and two strip electrodes beneath the left and right lobes, used to monitor activity bilaterally in the hippocampi and amygdalae. Once they are in place, Grunwald will record brain signals in real time during seizures and use the information to try to identify the epileptogenic tissue.

It’s my first time inside an operating room. I’m anxious, as I have been told not to touch a thing for fear of contamination, especially the giant surgical microscope covered in clear, sterile plastic. “The nurses are very strict,” says Grunwald. “If you touch this, even with your head, they get really angry.”

Krayenbühl swiftly cuts through the scalp and the temporal muscle, cauterising and clamping the edges with plastic clips to prevent bleeding, and peels the tissue back to reveal the skull bone. He drills two holes in it and saws out a circular piece. The sounds remind me of the dentist. Wisps of smoke rise from the heat of metal against bone. The surgeon removes the bone flap, exposing the meninges – the layers of membrane that envelop the brain. To avoid any chance of infection, the nurse helps Krayenbühl slip on a fresh pair of gloves.

He then parts the first, thick layer of the meninges, the dura mater. Below it is the arachnoid layer, beneath which flows the cerebrospinal fluid bathing the brain. Krayenbühl makes tiny cuts in the arachnoid, to let the CSF ooze out and relieve the pressure. “Otherwise the brain will pop out like a mushroom,” he says.

Krayenbühl is working through the microscope and what he’s seeing is projected onto a large screen. The brain tissue is clearly visible: a whitish convoluted surface suffused with blood vessels. Krayenbühl works quickly to slip the electrodes, just 0.7 millimetres thick, between the dura mater and the arachnoid. Once he’s done, he works in reverse, sewing up the dura mater, reattaching the bone with titanium clips, suturing the muscle and scalp. The electrode cables, which exit the skull through the two holes, are drawn out through tiny cuts in the scalp.

The surgical staff then turn the patient over and start working on the right side of the brain.

Two days later, I visit Künzler, recovering at the Swiss Epilepsy Centre across town. He has two black eyes from a surgery-induced haematoma, but they still have a twinkle. His head is heavily bandaged. Künzler’s English is limited, so Grunwald translates.

Though Künzler’s anti-epileptic medication barely has an effect on the frequency of his seizures, it has been reduced to let more occur. “If we are lucky, then we’ll get seizures maybe tonight or tomorrow,” Grunwald tells me. Künzler laughs. He knows enough English to get what Grunwald is saying. I ask him if he’s afraid of the seizures. “I’m not afraid, as long as it’ll help me,” says Künzler.

It is Grunwald’s job to analyse the intracranial EEG signals and locate the source of the seizures. There is no automated process to help him sift through the data, just his own skill and experience. “If you record 24 hours of EEG, then you have to look at 24 hours of EEG,” says Grunwald. “Every second of it.” He hopes they’ll show that Künzler’s seizures are in the left temporal lobe and far away from the Wernicke’s area that is involved in language, which he cannot remove.

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Source: newscientist.com
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neuromorphogenesis:

Building a Better Brain

The next generation of brain-machine interfaces (B-MI) may rapidly enhance health and improve the quality of life for those with reduced function due to disease or disability. They may also allow people to control drones with just their thoughts or even add new human senses, which raise important ethical considerations.

At the recent meeting of the American Association for the Advancement for Science in Boston, neuroscientists outlined several lines of promising B-MI research. Advances in microprocessors, computing, and materials science, for example, have facilitated the development of “epidermal electronics,” which combine wireless communications, neural sensors, and other medical sensors into patches small and flexible enough to serve as temporary tattoos. These electronics have obvious clinical use, such as for unobtrusive monitoring of vital signs or symptoms of brain disease, said principal investigator Todd P. Coleman of the University of California, San Diego. In fact, he has created a company, Neuroverse, to commercialize this type of application. But Coleman also sees more wide-ranging deployment in the near future. His work was partially inspired by previous experiments in which people controlled virtual or model airplanes via a cap of electrodes; flexible B-MIs might provide similar abilities without tying people down to bulky electronics. Applying the tattoos near the vocal cords might also allow for subvocal wireless communication with electronics such as smartphones. “The things you can pick up non-invasively are much richer than you might imagine at first glance,” he said. “Things we thought were hoaxes and science fiction are fast approaching fruition.”

And that may only be the tip of the iceberg: Miguel Nicolelis and his colleagues at Duke University have developed a means to create entirely new sense modalities. They connected infrared light sensors to dense three-dimensional arrays of electrodes implanted into the somatosensory cortex of rats. This allowed the rats to track food by “feeling” light that they physiologically have no way to detect. Think of it as an artificially induced form of synesthesia, Nicolelis said. “The rats learned to ‘touch’ a source of invisible light — they acquired new modality of touch.” The researchers have already extended the research to monkeys, raising the possibility that people might eventually be able to “augment” themselves with new abilities using this technology. “When you deliver signals from devices directly to brain,” Nicolelis said, “you can create a new sensation, a new feeling.”

The ethical implications of these B-MI projects and similar technology were not lost on session participants. All medical innovations raise legal and moral questions, said neuroethicist Martha Farah of the University of Pennsylvania. However, B-MI and other fields such as neuropsychiatry that directly affect people’s abilities raise particularly difficult questions about what it means to be human and what kind of relationship people have with technology. It’s difficult not to draw on iconic images of cyborgs from science fiction when discussing the long-term possibilities of B-MIs, which might include providing people new ways to sense the world, methods of augmenting cognition and memory, and even the ability to communicate brain-to-brain or merge identities.

“Ethical considerations such as those raised in the B-MI panel are important for all scientists,” said Michael Zigmond, professor of neurology at the University of Pittsburgh and secretary of the AAAS Neuroscience Section. “As scientific development and technological advances increasingly change the ways we deal with the human condition, we must continue to have conversations about how those changes might affect society. Such discussions are well-informed by the wide array of scientists who attend the AAAS annual meeting and can provide valuable insights and guidance.”

Additionally, Farah noted that focusing only on “sexy sci-fi long-term issues” ignores many serious short-term challenges more relevant to the day-to-day life of brain researchers and policymakers. “I’m not dismissing concerns about radically altered human brains that push us beyond what a human being is,” she said. “Before we get there, there are some other pretty serious ethical challenges — mundane, yet very important issues,” such as funding sources, conflicts of interest, and intellectual property protection. For example, rethinking clinical trial rules and practice might be necessary. In the United States, medical devices are regulated differently than pharmaceuticals, even though B-MIs are increasingly serving as a substitute for testing and treatment. Who funds current B-MI research may also have a disproportionate influence on the field, as aggressive pursuit of patents might constrain many promising avenues of research.

Between 10 and 30 years from now, people will need to make difficult decisions about access to B-MI technology, its appropriate uses, and risks, Farah added. Cochlear implants, retinal implants, and similar devices are already used regularly, but deciding what level of impairment is appropriate for treatment is not easy — especially as temptations grow to use this technology for frank enhancement or “making a person better than normal.” B-MIs that communicate wirelessly also expose people to hackers, computer viruses, and similar cybersecurity risks. “What if they hack into your brain?” Farah asked. With B-MIs, such inference could affect eyesight, memory, or even vital functions such as heart rate. People will also have to decide how to manage the costs of B-MI technology to ensure fair access. “Undoubtedly these technologies will be available to the rich before anyone else,” Farah said. “How would we like our society to manage these? How much do we guide the scientists and the health system to enforce as much equity as we can?”

(image: At the recent meeting of the American Association for the Advancement for Science in Boston, neuroscientists outlined several lines of promising brain-machine interface research.)

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Source: sfn.org
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neuromorphogenesis:

RESEARCHERS FORM NEW NERVE CELLS - DIRECTLY IN THE BRAIN

The field of cell therapy, Which AIMS to form new cells in the body in order to cure disease, has ceilings another important step in the development towards new treatments.A new report from travel researchers at Lund University in Sweden shows That it Is Possible to re-program other cells to Become nerve cell, directly in the brain.

Two years ago, researchers in Lund were the first in the world to re-program human skin cells, known as fibroblasts, to dopamine-producing nerve cells - without taking a detour through the stem cell stage. The research group has now gone a step Further and shown That it Is Possible to re-programming bothering skin cells and support cells Directly to nerve cells, in place in the brain.

“The find insertion are the first important Evidence That it Is Possible to re-program other cells to Become nerve cells inside the brain,” said Malin Parmar, research group leader and Reader in Neurobiology .

The travel researchers Distressed genesis designed to be activated or de-activated using a drug. The genes were inserted into two types of human cells: fibroblasts and glial cells - support cell That are naturally present in the brain. Once the travel researchers had transplanted the cells into the brains of been, the genes were activated using a drug in the animals’ drinking water. The cell then Began Their transformation into nerve cells.

In a separate experiment on mice, where similar genes were injected into the mice’s brains, the research group overpriced succeeded in re-programming the mice’s own glial cell to Become nerve cells.

“The research find insertion have the potential to open the way for alternatives to cell transplants into the Future, Which would remove previous obstacles to research, Such as the difficulty of getting the brain to accept foreign cells, and the risk of tumor development,” said Malin Parmar.

All in all, the new technique of direct re-programming in the brain could open up new possibilities to more Effectively replace dying brain cells in conditions Such as Parkinson’s disease.

“We are now Developing the technique so That it can be distressed to create new nerve cell That replace the function of damaged cells. Being Able to carry out the re-programming in vivo makes it Possible to imagine a future in Which we form new cells directly in the human brain, without taking a detour via cell cultures and transplants, “concluded Malin Parmar.

Source: lunduniversity.lu.se
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Home recipe. Twice baked chicken. Add broccoli, snap peas, & carrots. With any gravy you chose!

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neuromorphogenesis:

Bad Memories? 8 Ways to Detox Yourself

Steven, 25, fails again at school. There are many reasons; he is distractible, he smokes too much weed, and he doesn’t really like to study. But, what sticks in his head are ancient words from his long gone father: “Steven, you’re lazy. You’ll never amount to much.” His narcissistically inclined father may have said these words in exasperation, but it’s now part of Steven’s identity. “I really won’t amount to much.”Suzanne, 33, remembers her deceased mother very well; it’s just not pretty. Her Mom yelled – a lot. No doubt, many mothers (and fathers) are “yellers” but Suzanne’s mother was truly scary. She’d be okay one minute and fire a nasty missile the next. Now, Susanne remembers fear; and she brings this fear to her adult life. She trusts little and runs a lot.

Sadly, Suzanne’s relationships don’t last long.

Complex Trauma: Acute trauma and Post Traumatic Stress Disorder (PTSD) are well known to the public. You experience a terrible event. Perhaps you were in Afghanistan and saw your best friend disintegrate in front of your eyes. That’s acute trauma. Months, if not years later, you have flashbacks and nightmares about the event; that’s PTSD. But what about being hurt with a thousand little cuts and being unable to escape? That’s complex trauma.

Steven could not escape his critical father.

Susanne could not escape her moody, angry mother.

Both were traumatized.

Think about it. When a small child is attacked by a grown adult – it hurts.

When a small child is attacked by the person she counts on for nurturance – that’s damaging.

When a small child is belittled or frightened and has no escape – that triggers fight, flight or freeze.

Steven Freezes: Like a deer in headlights, Steven freezes in the face of academic challenge. He already has some strikes against him. He has attention issues, and clouds his mind with weed. But, he also BELIEVES that he is destined to fail. So, what does he do? Freeze.

When the work gets a little hard, he can’t study. His brain shuts down. And, his deceased father talks to him loud and clear; “You are a failure.”

Steven needs to let his dead father rest in peace.

Suzanne Runs: Like an animal sensing danger, Suzanne flees at the first sense of anger or disappointment from a lover, a co worker or a boss. It is ruining her life. She tells herself that “I just don’t like confrontation.” But, it’s really about trauma from her deceased mother.

All relationships involve some conflict; and often anger. Suzanne keeps it all at bay. She only dates docile men. And, when she feels attacked she bolts; with no relationship lasting past one or two fights. “I just hate it.”

Suzanne needs to let her dead mother rest in peace.

Death is Final – But is it? People we love die. People we hate die. It is the way of the world. But, do they die in our hearts? And, why do we hold on for too long?

The Past is the Present:  The great American playwright, Eugene O’Neill made an important observation in Long’s Day Journey into Night and A Moon for the Misbegotten. It’s about how the past can dominate the present - only to become the future.

The past is the present, isn’t it? It’s the future too.
                         — Long Day’s Journey Into Night

There is no present or future, only the past, happening over and over again, now.
                         — A Moon for the Misbegotten

The Past becomes the Future – Yes or No? You may identify with Steven or with Suzanne. Or, you may have had an alcoholic parent orexperienced a nasty divorce  or perhaps, you were beaten or worse. These past events all qualify for complex trauma – if not more. Are you easily triggered?

You fight too much – only to alienate those who you love.

You run too easily – frustrating those who you love.

You freeze too easily – becoming ineffective and shutting down.

Consider 8 Ways to Heal:

1. Psychotherapy can help identify past trauma. Steven may talk about his father; and how that relationship gets played out in his life. Suzanne will have to deal realistically with her deceased mother. She may have been loved, but she was hurt as well.

2. Grief requires dealing with your deceased parent; warts and all.You accept that you were traumatized; you may even forgive. But, you become determined not to let those wound ruin your life today.

3. Identify your triggers. Everyone who’s been traumatized has triggers and responses. Get to know yours. For Steven, it’s hard assignment that puts him back in the headset of a worried ten year old. He freezes. For Suzanne, it simply can someone who raises his or her voice. She is, once again, like a six year old overwhelmed by an enraged mother. She runs.

4. The Trigger-Response recreates the past. When you run, freeze or attack, you end up recreating and therefore, re-enforcing the past. You freeze and people think you are cold and stonewalling. If you run, nothing will last. And, if you rage in response to being triggered, you are doing what was done to you. People will withdraw or be injured; not a good outcome.

5. Good therapy also helps you to rediscover your strengths. We are not just damaged creatures, but also living beings with power and talents. Many people discover strength they never knew they had in treatment. This, in turn, gives you more motivation to overcome  the trauma of your youth. With competent psychotherapy you may be able to gain the strength to deal with being triggered, without harming others – or yourself. Happiness is that important.

6. Alternative treatments like EMDR, Somatic Experiencing and DBT may help as well. These treatments help with muting the triggers that are neurologically embedded in your brain. Remember that the fight, flight and freeze response has an evolutionary purpose. It protects the organism from dangerous situations. You may need specialized expertise to overcome this programming.

7. Often trauma is found alongside other psychiatric disorders like Anxiety or Depression. An intelligent use of psychiatric medications can reduce the trigger-response effect and give you an opportunity to create a future response that is not dictated by your past.

8. Spirituality can be invaluable. No one can tell you HOW to be spiritual, but for many, some form of faith can truly detoxify. (As long as you are not in a faith that makes you more anxious and burdened.) People may have hurt you, but a new life is yours for the taking. Look up at the stars. Smell the fresh air. Sense the opportunity in every moment. And, know that you are part of something larger than you. It settles the soul. 

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Source: neuromorphogenesis
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neuromorphogenesis:

Hours after death, we can still bring people back

Resuscitation specialist Sam Parnia believes we can bring many more people back to life after they die – it’s just a matter of training and equipment

Are the people you resuscitate after cardiac arrest really dead? Isn’t the definition of death that it is irreversible?
A cardiac arrest is the same as death. It’s just semantics. After a gunshot wound, if the person haemorrhages sufficiently, then the heart stops beating and they die. The social perception of death is that you have reached a point from which you can never come back, but medically speaking, death is a biological process. For millennia we have considered someone dead when their heart stops beating.

People often confuse the terms cardiac arrest and heart attack. Clearly, they’re very different.
A heart attack happens when a clot blocks a blood vessel to the heart. The portion of the heart muscle that was supplied blood and oxygen by that vessel will then die. That’s why most people with a heart attack don’t die.

What is the biggest problem in bringing someone back to life?
Reversing death before the person has too much cell damage. People die under many different circumstances and under the watch of many different medical specialists. No single speciality is charged with taking and implementing all the latest advances and technology in resuscitation.

How long after they die can someone still be resuscitated?
People have been resuscitated four or five hours after death – after basically lying there as a corpse. Once we die the cells in the body undergo their own process of death. After eight hours it’s impossible to bring the brain cells back.

What is the best way to bring people back?
The ideal system – and they do this a lot in South-East Asia, Japan and South Korea – is called ECPR. The E stands for extra corporeal membrane oxygenation (ECMO). It’s a system in which you take blood from a person who has had a cardiac arrest, and circulate it through a membrane oxygenator, which supplies oxygen and removes carbon dioxide. Then you pump the blood back into circulation around the body. Using ECMO, they have brought people back five to seven hours after they died. ECMO is not routinely available in the US and UK, though.

So, when I go into cardiac arrest, ideally what steps do I want my doctors to take?
First, we start the patient on a machine that provides chest compressions and breathing. Then we attach the patient to a monitor that tells us the quality of oxygen that’s getting into the brain.

If we do the chest compressions and breathing and give the right drugs and we still can’t get the oxygen levels to normal, then we go to ECMO. This system can restore normal oxygen levels in the brain and deliver the right amount of oxygen to all the organs to minimise injury.

At the same time you also cool the patient. This slows the rate of metabolic activity in the brain cells to halt the process of cell death while you go and fix the underlying problem.

How do you cool the body?
It used to be ice packs. Today a whole industry has grown up around this, and there are two methods. One is to stick large gel pads onto the torso and the legs. These are attached to a machine that regulates temperature. When the body reaches the right temperature, it keeps it there for 24 hours. The other way is to put a catheter into the groin or neck, and cool the blood down as it passes by the catheter.

Cooling benefits the heart and all the tissues, but we focus on the brain. There are also new methods in which people are cooled through the nose. You put tubes in the nostrils and inject cold vapour to cool the brain down selectively before the rest of the body.

If I had a cardiac arrest today, what are the chances I would get all of that?
Almost zero.

Why isn’t this type of care routine?
Cardiac arrest is the only medical condition that will affect every single one of us eventually, unfortunately. What’s frightening is that the way we are managed depends on where we are and who is involved. Even in the same hospital, shift to shift, you will get a different level of care. There is no external regulation, so it’s left to individuals.

There is disagreement over the interpretation of near death experiences (NDEs) – such as seeing a tunnel or a bright light. When a person dies, when do these experiences shut off?
One of the last things to fall into the realm of science has been the study of death. And now we have pushed back the boundary of death. In order to ensure that patients come back to life and don’t have brain damage, we have to study the processes that go on after they die. Whether we like it or not, we have gone into the “afterlife” or whatever you want to call it.

For people who have NDEs, they are very real. Most are convinced that what they saw is a glimpse of what it’s like when we die. Most come back and have no fear of death, and are transformed in a positive way – becoming more altruistic. As a scientific community we have tried to explain these away, but we haven’t been successful.

So how can a doctor, or any person of science, deal with such otherworldly experiences?
We have to accept that these experiences occur, that they are real to the people who have them, in the same way that if a patient has depression you would never say, “I know that you are feeling depressed but that is just an illusion. I’m the doctor. I’m going to tell you what your feelings really mean.” But with NDEs, we do this all the time: “I know you think you saw this, but you really didn’t.”

Aren’t NDEs just hallucinations?
We know from clinical tests that the brain doesn’t function after death, therefore you can’t even hallucinate. It’s ridiculous to say that NDE people are hallucinating because you have to have a functioning brain. If I take a person in cardiac arrest and inject them with LSD, I guarantee you they will not hallucinate.

For your study of out of body experiences (OBEs), you placed images in hospital rooms on high shelves only someone floating near the ceiling could see. So far, two patients have had OBEs, but neither in a room with a shelf…
That’s right. We had 25 hospitals that had an average of 500 beds working on the study. To put a shelf above every single bed, we would have to put up 12,500 shelves. That was completely unmanageable. We selected areas where cardiac arrest patients are frequently treated but even with that, at least half of those who had cardiac arrests and survived were in areas without shelves.

Are you continuing the experiment?
Yes. It’s part of an overall package to improve resuscitation to the brain. We are trying not to forget during resuscitation that there’s a human being in there.

In your book, you imply that death might be pleasant. Why do you think that?
The question is, what happens to human consciousness – the thing that makes me into who I am – when my heart stops beating and I die? From our external view, it looks like it simply disappears. But it sort of hibernates, in the same way as it does when you are given a general anaesthetic. And it comes back. I don’t believe that your consciousness is annihilated when you reach the point of death. How far does it continue? I don’t know. But I do know that at least in the period of time in which we can bring people back to life that entity of the human mind has not been annihilated.

What does this mean?
Those people who have pleasant experiences after death suggest that we should not be afraid of the process. It means there is no reason to fear death.

(Image: Martin Adolfsson)

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Source: newscientist.com
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neuromorphogenesis:

Nerve damage may underlie widespread, unexplained chronic pain in children

Massachusetts General Hospital (MGH) investigators have described what may be a newly identified disease that appears to explain some cases of widespread chronic pain and other symptoms in children and young adults. Their report that will appear in the April issue of the journal Pediatrics, and has received early online release, finds that most of a group of young patients seen at the MGH for chronic, unexplained pain had test results indicating small-fiber polyneuropathy, a condition not previously reported in children. The MGH investigators call this new syndrome juvenile-onset small-fiber polyneuropathy or JOSeFINE.

“We’ve found the beginnings of a way to better evaluate young patients with otherwise unexplained widespread body pain,” says Anne Louise Oaklander, MD, PhD, director of the Nerve Injury Unit in the MGH Department of Neurology and corresponding author of the Pediatrics paper. “By identifying the tests that are useful for diagnosing this condition, we hope to reduce the use of unnecessary, expensive, sometimes painful and potentially harmful testing that many of these children have undergone.”

Small-fiber polyneuropathy (SFPN) involves widespread damage to the type of nerve fibers that carry pain signals from the skin and also control autonomic functions such as heart rate, blood pressure and sweating. Most commonly associated with diabetes, SFPN can be caused by other disorders in older adults or by exposure to toxic substances. Typical symptoms include chronic pain in several parts of the body, often beginning in the feet or lower legs, along with symptoms of autonomic dysfunction such as gastrointestinal problems, dizziness or fainting when standing, rapid heart rate, and changes in the appearance of skin. Specific diagnostic criteria have been established for SFPN, and accurate diagnosis can guide appropriate treatment choice.

Although polyneuropathy has been considered rare in children, occasional cases have been described. To get a better sense of the possible contribution of SFPN to chronic pain in children, Oaklander and her co-author Max Klein, PhD, a research fellow in Neurology at MGH, reviewed the records of 41 patients treated by Oaklander between 2007 and 2011 for persistent widespread pain in several parts of the body that began before age 21. In a search for the cause of their symptoms, all of the patients had undergone a range of diagnostic tests at the MGH and other leading institutions.

Recommended diagnostic tests for SFPN include a type of skin biopsy that characterizes the number and condition of nerve fibers in the lower leg and autonomic function testing, including monitoring the heart rate and blood pressure when an individual breaths deeply, blows out when the airway is blocked or is placed on a tilt table. A control group of 38 age- and gender-matched volunteer children underwent the same autonomic function tests that the patients had received, and control values for neurodiagnostic skin biopsies were based on samples from healthy age- and gender-matched volunteers collected at MGH.

The analysis revealed that 24 of the 41 patients met criteria for a diagnosis of SFPN, meaning that results of at least one test clearly indicated the presence of the disease. Of the remaining 17 patients, 16 were determined to possibly or probably have SFPN, based on less seriously abnormal test results. Among the autonomic function tests, sweat production – a sensitive diagnostic test for SFPN – was reduced in 82 percent of patients, compared with 34 percent of controls. In contrast, results of other tests that the patients had undergone – including magnetic resonance imaging, spinal taps and gastrointestinal endoscopy – provided no useful diagnostic information.

Many of the patients participating in the study had reported that their symptoms began after an earlier illness or injury. A third had some history of autoimmune illnesses, and around half had family histories of autoimmunity. Tests of blood and other body fluids revealed hints of disordered immunity – particularly low levels of complement, a protein involved in the innate immune system. Oaklander notes that these observations are preliminary and require further investigation.

“The importance that families placed on finding an accurate diagnosis and effective treatment for their sick children is illustrated by how many of them traveled thousands of miles, including some from other countries, in a desperate search for answers,” Oaklander says. “Because everyone wanted to help these children, they had undergone myriad tests, two thirds had been hospitalized, and some had tried many medications, usually without benefit.

“Based on our findings we now take a two-part approach to evaluating such patients: first, evaluation by a neurologist for the possibility of small-fiber neuropathy, and if that is confirmed, specific blood tests to pinpoint the cause. It’s important to consider this diagnosis, since there are treatments for many symptoms of neuropathy – including medications that increase blood pressure and improve gastrointestinal function – and for some of the underlying causes.” Oaklander is an associate professor, and Klein is an instructor in Neurology at Harvard Medical School. The study was supported by U.S. Public Health Service grant K24NS059892, Department of Defense grant GW093049 and the Bradley and Curvey Family Foundations.

Chronic pain disorder

Source: medicalxpress.com