These 5 Advances Are Revolutionizing Neurosurgery

For better or worse, neurosurgery is practically synonymous with the scientific cutting edge. “It’s not brain surgery,” is a common response to the complaint that a particular task is difficult or excruciating, for instance. Even among other medical specialists, all of whom are respected as pinnacles of achievement by members of the general public, neurosurgeons are afforded special deference and social prominence.

But that doesn’t mean that neurosurgeons can’t learn, and that the science of neurosurgery can’t advance. In fact, neurosurgery is constantly advancing, and the pace of innovation has actually sped up in recent years. Here’s a look at five of the most consequential recent advances in neurosurgery. What might they mean for you and yours?

http://weillcornellbrainandspine.org/minimally-invasive-neurosurgery

  1. Gamma Knife Radiosurgery

Gamma Knife radiosurgery is a type of stereotactic brain surgery (neurosurgery) harnesses the power of minutely targeted gamma ray beams to deliver powerful doses of radiation to specific areas of the brain. The beams are delivered via a helmet that’s surgically attached to the skull and calibrated to target abnormalities, such as small tumors and lesions. Gamma Knife isn’t indicated for larger tumors or lesions due to its precise nature.

Although Gamma Knife has been in use for some time, it’s gaining popularity thanks to its minimally invasive nature — it doesn’t require a surgical breach of the skull — and relatively low risk of side effects or complications. It’s often possible to complete a Gamma Knife procedure in a single day, possibly with the patient kept overnight for observation. That’s significantly better than more invasive neurosurgeries, which can require days of inpatient recovery.

  1. Endonasal Surgery

Endoscopic neurosurgeries use the nasal passages as entry points for brain or cervical spine procedures. They’re minimally invasive procedures that don’t require an incision through the skull. Instead, they use tiny instruments affixed to the end of a flexible probe. Endoscopic surgeries are ideal for biopsies and tumor excision procedures in regions near the base of the skull or top of the spine. They’re not indicated for tumors or abnormalities found elsewhere in the brain, though this may change as technology advances.

  1. Minimally Invasive Spinal Surgery

Like endoscopic neurosurgeries, minimally invasive spinal surgeries use very small incisions and instruments guided via flexible probe. They’re indicated for procedures at any point on the spinal column, though other forms of minimally invasive surgery may be indicated for areas near the base of the skull.

Like other minimally invasive procedures, minimally invasive spinal surgeries offer the promise of faster recovery times and fewer complications. However, they do present some serious risks, including the low but real chance that the procedure can’t be completed as planned due to unforeseen complications or the limitations of the minimally invasive approach. These are likely to be mitigated as technology advances.

  1. Minimally Invasive Intracranial Surgery

Minimally invasive intracranial surgery applies the same basic principles as minimally invasive spinal surgeries — small incisions, guided instruments, less tissue damage — to cranial neurosurgery. They’re indicated for small tumors and other abnormalities that can be easily accessed through strategically placed entry points in the skull. Their risks, side effects and limitations are similar to minimally invasive spinal surgery. That said, they’re typically preferable to open cranial surgeries, which present a host of serious risks.

  1. Deep Brain Stimulation

Deep Brain Stimulation (DBS) is a nonsurgical treatment that shows tremendous promise for the treatment of certain Parkinson’s Disease symptoms, including tremors, rigidity and stiffness, poor motility and problems with walking. It can also be used to treat essential tremor and dystonia. DBS works via a “brain pacemaker” — an implanted device that delivers regular, low-voltage currents to the thalamus and other movement-related regions of the brain. The goal is to interrupt abnormal signals that affect movement and control, reducing symptoms — though not reversing the progression of the disease.

What Does Neurosurgery’s Future Hold?

 
If your job doesn’t require an expert-level understanding of the human brain, some or all of these advances are likely to come as news to you. Likewise, you’re probably not keeping up with the latest journal articles and research papers on neurosurgical minutiae. Rest assured that the field continues to advance at a brisk, accelerating clip — and that you’ll eventually learn of the most consequential advances. Who knows? You or a loved one might just turn out to benefit from a novel process or treatment.

Hands Numb? Could Be These 5 Things

To experience occasional numbness and tingling in the extremities is to be human. We’ve all felt those uncanny pins and needles before. Such sensations are normal, even welcome, from time to time. They often have pedestrian environmental causes that indicate nothing about our underlying health. More likely than not, transient numbness in the extremities is benign and, if it can be explained at all, not worth anything approaching the worry it typically engenders.

Then again, numbness in the hands isn’t always completely benign. Sometimes, it’s right to be curious about the root causes of unexplained loss or change in sensation — and, if circumstances dictate, even worried.

How can we tell the difference? In many cases, we can’t — at least, not without thorough examination by a medical expert. If you believe the numbness in your hands or other extremities is caused by an acute or emergent condition, consult a physician or visit a care facility at your earliest convenience. Otherwise, familiarize yourself with these five common causes of numbness in the extremities. If you believe your symptoms are caused by one or more of these conditions, schedule an appointment with your care provider.

  1. Peripheral Neuropathy

Peripheral neuropathy is the result of damage to the nerves in the hands and feet. One of the signature symptoms of peripheral neuropathy is tingling in the extremities; numbness is a common manifestation as well. These and other peripheral neuropathy symptoms can be treated, but reversing the progression of the condition typically isn’t possible.

Peripheral neuropathy has a number of causes, many related to chronic conditions. In some cases, the aftereffects of traumatic injuries, such as car accidents and falls, can lead to peripheral neuropathy. So can infections that affect the nervous system, including those acquired during surgery, and exposure to certain toxins that damage the nervous system.

  1. Multiple Sclerosis

Multiple sclerosis is an autoimmune disease that affects the central nervous system. Multiple sclerosis patients’ immune systems attack the myelin sheaths that surround their nerves, causing irreversible damage. Eventually, the immune system also attacks the nerves themselves. The process causes scar tissue to form in nerves’ myelin, with a host of unpredictable effects for sufferers’ sensation and mobility.

Tingling and numbness in the extremities are just two of the many symptoms of multiple sclerosis. For patients with advanced multiple sclerosis, these symptoms are largely seen as secondary to more debilitating effects, such as loss of motor control and mobility.

  1. Diabetes (Type 1 and 2)

Diabetes is a frustratingly common cause of tingling and numbness in the extremities. These symptoms can present in both Type 1 and Type 2 diabetes; gestational diabetes doesn’t typically progress to this point before the condition resolves itself after childbirth. Over time, high blood sugar levels damage body tissues and nerves, resulting in changes in extremity sensation. It’s important to note that numbness and tingling in the extremities are often accompanied by outright pain, particularly in the feet of longtime diabetes sufferers.

  1. Arthritis

Arthritis affects millions of Americans and causes untold pain and suffering. Its most common symptoms include pain, stiffness, swelling and loss of range of motion, particularly around the joints. Arthritis can be caused by cartilage loss due to age or injury, or by an autoimmune process (known as rheumatoid arthritis). All types of arthritis can cause numbness and tingling in the extremities, though it’s rare for these to be the only symptoms associated with the disease. While it’s possible to treat numbness, tingling and other arthritis symptoms (including joint pain), the condition’s progression is more difficult to halt.

  1. Cold-Weather Injuries

Not all presentations of hand numbness and tingling result from chronic conditions. Sometimes, these symptoms occur due to environmental stresses and injuries.

Cold weather is a common cause of tingling in the extremities. For starters, hands and feet bundled tightly in sturdy boots, socks and gloves tend not to move with the same freedom as unencumbered extremities. Persistent tingling and numbness may result. Left untreated, such sensations — which aren’t directly related to cold itself — can become uncomfortable or even painful.
Cold weather can also directly cause tingling and numbness in the extremities. As fingers and toes get colder, blood flow through their capillaries decreases, starving their nerves of oxygen. Left untreated, these symptoms can progress on a dangerous course, leading to frostbite and tissue necrosis.

Put Me Back In, Coach: Returning to Play After Football Concussions

The field of sports medicine has changed rapidly since the turn of the 21st century. We now know more about orthopedic and neurological sports injuries than we ever thought possible, and we’re continuing to uncover new connections and correlations.

Few sports medicine matters are more controversial than football-related head trauma — in particular, concussions sustained on the field of play. (Repeated subconcussive impacts, though related, present their own pathologies, indications and, of course, controversies.)

Until relatively recently, it was common and, frankly, expected for student and professional footballers to play on after sustaining probable concussions. Veterans of the game speak knowingly of playing past “stingers,” hits that leave stunned players unable to focus their eyes or think clearly for minutes or hours. The NFL didn’t even have a formal concussion protocol until the 2010s, and players — particularly second-stringers desperate for playing time — have long been reticent to report serious injuries for fear of losing spots in the lineup.

At this point, we know enough about the science of head trauma to know that football players shouldn’t continue to play after sustaining probable concussions. We’re a bit fuzzier on exactly when it’s safe for players to return to the field after concussive impacts. Here’s an overview of the NFL concussion protocol and the generally accepted facts around post-concussion recovery for student and professional football players.

NFL Concussion Protocol

The NFL’s concussion protocol has several game-day components for evaluating, treating and clearing players suspected of sustaining in-game concussions. These include:

 

  • Removal to the Locker Room: Players who sustain an obvious injury (“big hit”) on the field of play, or who exhibit symptoms of probable concussion (e.g. wooziness, blank staring, loss of coordination) after a play, must be removed from the field of play and taken to a quiet area for evaluation, generally the locker room.
  • Evaluation by Team Staff: Team medical staff subject concussion-suspected players to a full neurological evaluation using the NFL’s Sideline Concussion Assessment Tool.
  • Evaluation by Unaffiliated Neurotrauma Consultant: Unaffiliated neurotrauma consultants (not on the payroll of any team, booster organization, or other group with a potential conflict of interest) must be present at all NFL games and independently assess players for concussion signs and symptoms. The neurotrauma consultant conducts assessments in parallel with team medical staff, auditing their work to maintain process integrity.
  • Spotter Evaluation: Independent spotters review video footage of the impact and aftermath to gather more information about the injury and its potential symptoms, corroborating or contradicting medical analysis and players’ verbal feedback.
  • Recurring Examinations: If necessary, players are to be evaluated at regular intervals for the remainder of the game and beyond. These recurring examination help plot players’ return to baseline function and/or indicate if further treatment is necessary.

 

Clearing Players to Return

There’s a multi-step process for clearing players to return to play or practice following concussion protocol participation:

  • Players must return to prior baseline, as judged by team medical staff and the unaffiliated neurotrauma consultant (with exams conducted separately)
  • Players must successfully complete a “graduated exercise challenge” to ensure that they’re capable of performing safely on the field
  • Players must be formally cleared, and then subjected to on-field observation until team medical staff have judged that recovery is complete

Best Practices For Non-Professionals

Non-professional players typically aren’t bound by the NFL’s concussion protocol, particularly in amateur settings that don’t have concussion protocol analogues (e.g. high school football leagues). As such, it’s important for players and their parents to understand when it’s appropriate to seek evaluation and treatment for potential concussions, and when it’s okay to return to the field of play.

Parents concerned about their kids’ exposure to concussions can:

  • Obtain a preseason baseline cognitive evaluation
  • Send the child to an unaffiliated specialist to ensure that there’s no conflict of interest in return-to-play procedures and to obtain an all-important second opinion
  • Speak with coaching staff about using extra safety equipment
  • Lobby coaching staff for equal sideline treatment, e.g. not penalizing the child for voluntarily sitting out after being cleared to return to play

Everyone Is Different

Every human is different. It’s worth reiterating that adults and children have very different neurological profiles. What make sense for a highly paid NFL player might not fly for a 10-year-old child. While the medical community is more than capable of issuing recommendations around these issues, it’s ultimately up to parents and role models to set the bounds of acceptable behavior and participation for young athletes. The future of American sports quite literally depends on it.

Vacation at the Hospital? 5 Benefits of Hospital Spas

The words “hospital” and “spa” don’t often appear together in the same sentence — or paragraph, for that matter. For patients and loved ones alike, going to the hospital typically isn’t a relaxing experience. Very often, it’s just the opposite. In many layperson’s minds, hospitals are filled with stress, trauma, disease and death. No one wants to kick back, take a load off or indulge the senses in such an environment.

While some hospitals certainly remain remote and unfriendly to patients and families, increased competition for desirable patients — not to mention a growing body of evidence that suggests amenity-rich facilities produce better outcomes — has prompted many hospitals to invest in creature comforts not usually associated with medical treatment facilities. One of the biggest trends: hospital spas, either tucked into existing facilities, integrated into newly built facilities, or constructed adjacent to hospitals, often amid larger medical complexes.

Here’s a look at the what, why and how of the hospital spa movement — and five potential hospital spa benefits for you and your family.

  1. Spa Use Improves Mood

A long-period study of more than 3,000 Japanese workers recently revealed that spa treatments improve mood and morale, boosting performance and reducing the negative side effects commonly associated with career-track work. Although similar studies have yet to be undertaken on hospital patients, it’s not unreasonable to extrapolate that spa use would have similar effects for that population as well. By taking participants out of their daily routines — whether said routines involve office drudgery or medical treatments — spas serve as fertile ground for reflection and mental restoration.

  1. Spas Promote Regular, Restful Sleep

Traditional hospitals aren’t great places to get sleep. Depending on the nature of their conditions and the care plans outlined by medical staff, hospital patients may have no more than two or three consecutive hours to themselves throughout the day. For patients consigned to long stays in the hospital, such circumstances can have dramatic effects on long-term sleep patterns. Spa treatments have been shown to improve patients’ sleep cycles — helping them fall asleep more quickly and reducing their propensity to sleep and wake ceaselessly through the night. Patients who sleep better tend to recover better from illness and injury; those with chronic conditions are better able to face aggressive treatment schedules.

  1. Some Spa Treatments Have Demonstrable Skin Benefits

Spa treatments come in all manner of forms. One of the most popular classes of spa treatments is skin treatments. These vary from spa to spa, of course, but most have something unsurprising in common: They’re great for the skin. Peer-reviewed studies have shown promising spa treatment benefits for patients suffering from psoriasis, cellulitis and other common skin conditions. It’s important to note that such benefits are often transient — the dimple-reducing effects of spa treatments for cellulitis patients tend to fade after a few days or weeks.

  1. Spa Treatments Help Patients Deal with the Stress of Medical Challenges

Anyone who’s ever indulged at the spa knows a self-evident truth of spa treatments: They’re incredibly relaxing. While this is certainly useful for workaday spa visitors who look forward to massaging or treating their cares away, it’s also great for hospital patients who struggle with the stress of treatment regimens and medical challenges. While spa treatments can’t resolve primary medical problems on their own, they can certainly strengthen patients’ wills to face whatever may come.

  1. Spa Treatments Soothe Patients’ Family Members

The same stress-reducing principle applies to hospital patients’ family members — folks who often need even more support and relaxation than their brave, afflicted loved ones. Family members who avail themselves of onsite hospital treatments are better-prepared to face the travails of consulting with clinicians, supporting their patients through physical challenges, and facing emotionally painful situations with dignity, grace and ample reserves of mental strength.
If you’re looking for a relaxing, all-inclusive getaway to a destination spa or resort, your nearest hospital spa probably isn’t your best option. On the other hand, there are plenty of circumstances in which you could find yourself in need of hospital spa services. Your spa experience might not make the trip to the hospital worthwhile, but it could actively improve the quality of your experience. Who can argue with that?

Can the Polio Vaccine Really Fight Brain Tumors?

Franklin Delano Roosevelt, the United States’ longest-serving president, was known for many things: architect of his country’s World War II victory, savior of the Great Depression, last sitting president to die in office of natural causes. What many casual students of history don’t remember is that FDR was confined to a wheelchair in the later years of his life due to a childhood battle with polio, a then-common viral affliction that can cause permanent nerve and muscle damage.

Today, polio is unheard of among Americans of any age. The disease has been all but eradicated in most of the world, a microbiological victory that stands nearly alone with the eradication of smallpox as a total win for public health. The most potent weapon in the fight against polio was the polio vaccine, which empowers the immune system to rally against invading polio viruses.

Today, the urgency around polio is gone, and the polio vaccine’s original purpose has largely been fulfilled. But science may have found a new use for this cure — one that could prove just as game-changing as the near-eradication of polio itself. According to recent research, the polio vaccine shows tremendous promise in the fight against certain brain tumors, though it might be a bit premature to say that the vaccine actually cures brain tumors. Here’s what we know — and what could be coming down the road in the years to come.

Cancer’s Acquired Defenses

Malignant tumors are truly devious in their ability to evade the body’s impressive natural defenses. Over time, cancer cells develop molecular defenses — in simplified terms, complex protein coatings — that literally render them invisible to the human immune system. Cancer’s invisibility allows it to grow without facing overwhelming resistance.

Glioblastoma, a particularly deadly form of brain cancer, is no different. Until very recently, a glioblastoma diagnosis was little better than a death sentence; the condition’s five-year survival rate is truly abysmal. While glioblastoma remains one of the most difficult forms of cancer to treat, genetically engineered polio viruses may provide some hope for at least some sufferers.

How Engineered Polio Viruses Disarm Tumor Cells

These engineered polio viruses, part of the “oncolytic virus treatment” family, turn cancer cells’ natural defenses against them. First, the virus breaks through each cell’s natural defenses, causing an infection that cripples and ultimately kills them. While this process is certainly beneficial for patients, the real benefit of the oncolytic treatment is the engineered virus’s ability to recruit the body’s immune system to attack cancer cells. Initially, the immune system is spurred to action by the presence of polio viruses, but its activities over time appear to stall and even reverse the growth of tumors.

What’s Next for Brain Cancer Treatment?

Per Duke University, the concept of cancer-fighting viruses has existed for at least 100 years, but we’ve only been able to manipulate viral genomes effectively since the late 20th century. The polio virus treatment is one of the first truly promising oncolytic viruses. If its early promise pans out, it’s basically a foregone conclusion that similar treatments — possibly for glioblastoma, possibly for other tricky forms of cancer — will follow.

Oncolytic polio viruses aren’t the only promising avenue for brain cancer treatment, of course. Advances in targeted radiotherapy, such as Gamma Knife radiosurgery treatments, have made it possible to target small tumors deep within the brain without damaging surrounding tissue. Customized therapies that leverage the human immune system are gaining steam as well.

Such advances are likely to accelerate in the years to come. One day in the not too distant future, the now near-miraculous oncolytic polio virus treatment could well seem primitive and blunt.

Never a Panacea

Last century, the polio vaccine helped eliminate one of the world’s most common and devastating childhood diseases. This century, it could dramatically improve our ability to combat devastating brain tumors.
But it’s important to note that the polio vaccine isn’t a panacea. It’s proven effective at preventing one particular disease, and may soon help fight a handful of closely related cancers. Unfortunately, there’s no evidence that the polio vaccine can fight any other types of cancers or prevent other viral infections that still plague humanity. In short, it’s just one more weapon in our medical arsenal — not a weapon to end all wars, as the world’s most famous polio sufferer infamously said about another revolutionary technology developed under his watch.

TBI Patients Heal Faster When They Do This

Traumatic brain injuries are more common than most people realize. They have numerous primary causes: car crashes, slips and falls, interpersonal violence and war, sports activities, workplace accidents and more. They’re exacerbated by numerous other factors, many of which we don’t fully understand or appreciate.

Every traumatic brain injury is different, as is every recovery period. It’s difficult to generalize about dissimilar cases. That said, John Gorecki MD finds evidence that suggests that there are certain actions traumatic brain injury patients — and their caregivers, if necessary and appropriate — can take to speed and smooth the recovery period, and improve overall quality of life on a sustainable basis.

One such action: getting up and moving around. (Okay, that’s technically two actions.) Traumatic brain injury patients that ramp up and sustain physical activity as conditions allow tend to recover more quickly than patients who, though capable of light, moderate or even heavy exercise, choose to remain sedentary. Here’s a quick look at why we think activity is good for traumatic brain injury patients and what caregivers can do to encourage swift recoveries.

Why Is Physical Activity Good for TBI Recovery?

It has long been assumed that patients who’ve recently suffered head trauma need to rest and lay low. Overstimulation, this old line of thinking went, could interrupt the long process of rebuilding neural connections and repairing damaged brain tissue.

A recent NPR points to emerging evidence that bed rest is actually counterproductive, or at least not overly helpful, for patients recovering from traumatic brain injuries. Physically active patients tend to progress more quickly toward their prior baseline than sedentary patients with comparable injuries.

In a 600-patient study, scientists separated TBI patients into two cohorts. One cohort was physically active, with some patients getting out of bed as early as their first day in the hospital. The other followed a more traditional recovery program. Evidence gathered from regular progress assessments indicated increased blood flow to the injured areas of active patients’ brains, clearly demonstrating the benefits of physical activity. Patients also indicated that they felt better — both physically and emotionally — after getting up and moving about.

At Patients’ Own Pace

Investigators faced many logistical challenges during the course of this study. In particular, many TBI patients’ substantial problems with cognition and mobility made it difficult to pursue aggressive programs of physical activity, especially early in the recovery period. Patients who struggle to get out of bed on their own or control their limbs find it difficult to “exercise” in any traditional sense. For patients recovering from serious TBIs, and the family members responsible for directing their care, it’s critical to advocate for physical therapy enrollment as early as possible — even if it’s not brought up by the care team. And it’s just as important to recognize that mobility and communicative ability may return slowly.

More Tips to Speed TBI Recovery

Physical exercise isn’t a cure-all for TBI patients, and it’s also far from the only recovery tactic recommended by neurologists. Other tips and tactics to speed TBI recovery include:

  • Following Diets Rich in Protein and Beneficial Fats. Good nutrition is critically important for recovering TBI patients. In particular, diets rich in omega fatty acids and brain-building proteins promote faster neurological recovery. They’re also great complements to active lifestyles.
  • Eating Regular, Small Meals. It’s common for TBI patients, particularly early in the recovery process, to fall out of eating rhythm. To ensure that they’re eating the right amount at the right time, patients or care providers should set aside small, pre-prepared meals for consumption at regular intervals — every 3 to 4 hours, ideally — and set alarms or pair meals with other predictable activities to stay on schedule.
  • Avoiding High-Impact Activity. Some exercise is good for recovering TBI patients, but too much, too soon is likely counterproductive. Patients should avoid activities that can aggravate their existing injuries or cause new ones.

Limits to Recovery
Recovering from a traumatic brain injury is a frustrating, often lengthy process that depends heavily on the severity and morbidity of the initial injury. While the patient’s attitudes and actions play a critical role in the progression and ultimate outcome of his or her recovery, the blunt truth is that recovery is very often destined to be incomplete or unsatisfying, both for the patient and his or her family. It’s important to launch into the rehabilitation process with open-minded optimism — and, by the same token, to be realistic about the prospects.

6 Things to Know About Youth Concussions – John Gorecki MD

Concussions are a hot-button topic these days. We know substantially more about the science of concussions today than we did even 10 or 15 years ago, and our understanding continues to advance, almost by the day. We have been able to parlay this understanding into player-friendly rule changes in the NFL and other professional sports leagues. While it is impossible to completely reduce the risk of concussion at the professional level, our enhanced understanding is good for everyone involved in athletics.

Perhaps because there isn’t as much money or media bandwidth at stake, the issue of youth sports concussions — and youth concussions in general — doesn’t captivate the public’s attention in the same fashion.

Sure, President Obama went on the record a few years back with a telling, off-the-cuff, comment about not letting his hypothetical son play football. But the millions of parents who actually need to make those decisions largely do so anonymously, far from the glare of the limelight.

If you are weighing the evidence about youth concussions or assessing the risks and benefits of allowing your children to play contact sports, here’s what you need to know:

  1. The Issue May Be More Common Than We Realize

According to a study in JAMA Pediatrics (reported by the IB Times), one in 30 youth football players aged five to 14 will sustain at least one concussion this season. Put another way, about three percent of youth football players are at risk of sustaining a concussion in any given year. The risk rises for players at certain positions and in styles of play involving lots of open-field running and tackling.

To put this in perspective, concussions are more common in youth football than ankle sprains and knee injuries — injuries that, while painful and potentially career-ending, don’t have the potential to cause neurological damage.

  1. …But We’re Not Quite Sure How Common

Since it is among the most popular youth sports and has a well-documented record of causing neurological damage at the professional level, football is more closely studied than other sports. For this reason, we have a decent handle on the rate of reported concussion incidence among youth football players.

We are not nearly as sure about concussion incidence in other sports. While most youth sports leagues follow concussion protocols, under reporting is an issue. This is particularly true in contact sports that don’t require pad usage, such as soccer and basketball.

Even football isn’t as well-studied as we would like it to be. According to a report by the University of Iowa’s medical school, Iowa’s youth football system is currently undergoing its first thorough, scientific head injury study. For casual observers who had assumed that the concussion issue had been on the medical community’s radar years ago, this is certainly a troubling state of affairs.

  1. Recovery Takes Time

It’s often assumed that young people who experience concussions can return to the field of play as soon as their acute symptoms fade. This is a potentially dangerous mistake. Full recovery can take weeks, particularly after serious concussions that result in loss of consciousness. During the recovery period, headaches, difficulty concentrating, fatigue, and other symptoms may be attributable to the initial incident.

  1. Successive Blows to the Head Are Particularly Troublesome

As the medical community learns more about the neurological impacts of professional football and other contact sports, we are discovering that patients who sustain repeated blows to the head in short succession face elevated risks of lasting neurological damage. This is true even in the case of “subconcussive” impacts — blows that don’t result in concussion symptoms. Over the course of a youth football career, a young blocker might sustain thousands of subconcussive impacts that can dramatically impact brain development and function.

  1. Concussions Can Occur Without Loss of Consciousness

One of the most common questions I receive from my Neurology Answers patients is: “can I sustain a concussion without losing consciousness?”

The short answer is: “absolutely.” Be sure to educate your children on the symptoms of concussions, which can include:

  • Dizziness and grogginess
  • Double vision or other vision changes
  • Headache or skull pressure
  • Sensitivity to light and noise
  • Difficulty concentrating or thinking
  • Mood changes
  • Sleep problems

Likewise, stress that they should be mindful of their conscious state (perception, awareness, cognition) after an impact, even if they haven’t lost consciousness.

  1. Rule Changes Can Have a Big Impact For Student-Athletes

There is light at the end of the youth concussion tunnel. Thanks to lobbying by concerned parents, many youth sports leagues have implemented player-friendly rule changes designed to reduce the frequency and severity of blows to the head. Examples include:

  • Requiring helmets with more head protection in football, baseball, and hockey
  • Changing the rules of play to eliminate or reduce high-speed impacts (such as during kickoff returns)
  • Stiffening penalties for illegal tackles or blocks in football and hockey
  • Educating players and parents about the symptoms of concussion

Safety Always Comes First

Parents and policymakers who ignore clear scientific evidence do so at their own peril. At the same time, parents and other laypeople should pair what science tells them about concussions with common sense. If the thought of allowing your child to play a contact sport that presents a serious risk of head injury makes you uncomfortable, no one can tell you to violate that feeling. Safety always comes first, not the expectations of your friends, colleagues, or family.

What’s your feeling about the risks associated with youth concussions?

Is Your Cell Phone Killing You?

People have worried about a possible link between cell phones and brain tumors since the first boxy phone debuted back in the 1980s. It’s certainly reasonable to worry about the effects of holding what is effectively a powerful radio transmitter to the side of one’s head, and no more than a few centimeters from one’s brain.

Radio waves are a form of electromagnetic radiation. They occupy a different part of the same spectrum that includes microwaves, X-rays, gamma rays, and other forms of radiation that have undeniably negative effects on living tissues.

As such, is it fair to say that using a cell phone regularly is akin to getting a CT scan every few minutes for the rest of your life? Not exactly. But there is evidence that it is not great for you. Here is a look at where the science stands and what, if anything, you should do about it.

Landmark Cell Phone Cancer Studies: An Overview

The Mayo Clinic has put together a helpful list of some of the key studies exploring the link between cell phones and cancer. The most notable include:

  • A massive, long-term study that followed about 420,000 regular cell phone users for 20 years. It found no measurable increase in cancer rates relative to the population of non-users.
  • A smaller study that found a small but statistically significant increase in salivary gland tumors among habitual cell phone users. Few tumors were malignant, leaving the implications open to interpretation.
  • A study that showed a possible link between heavy cell phone use and glioma, a brain malignancy. The same study showed no increased risk for lighter cell phone users.

What Does the WHO Say?

The World Health Organization is a well-respected non-governmental entity that makes reasoned, evidence-based pronouncements on a wide variety of hot-button medical topics. The WHO was recently in the news for announcing, after years of study and meta-study, that processed meats are likely carcinogenic.

In fact, the WHO keeps a detailed classification scheme for known carcinogens. Processed meats make the cut, as do “usual suspects” like tobacco and alcohol. And so do “radiofrequency electromagnetic fields”, or radio waves. Your home WiFi system, in-car Bluetooth speakers, and cellphones all generate radiofrequency electromagnetic fields that the WHO believes (or at least strongly suspects) to be carcinogenic.

Listen to the Numbers

On the other hand, the virulence of known carcinogens varies widely. It is worth noting that while the evidence for classifying processed meats as carcinogens is statistically significant (and that processed meats cause other health problems, strengthening the argument against consuming them in large quantities), the actual figures behind the link are rather unimpressive. Out of many thousands of people surveyed, only a handful developed tumors that could conclusively be linked to processed meat consumption. In other words, there hardly appears to be a public health emergency here on the scale of, say, tobacco consumption.

As more long-term studies about the link between cell phones and cancer come out, the medical community may well strengthen its conviction that holding a phone an inch or two from your brain is a risk factor for certain tumors. It may also turn out that this causative link, while real, is not particularly jarring.

If it turns out that heavy cell phone use does elevate tumor risk over years or decades, but only very slightly, policymakers are unlikely to clamor for the abolition of cell phones or the mandatory use of radiation-blocking devices, and most people are likely to continue using cell phones as before.

Can We Tune Out Statistical Noise?

The organizations we are fortunate enough to work with, including Northside Hospiyal and Neurosurgery Answer, are ironclad proponents of evidence-based medicine. We are aware that every study is vulnerable to confounding variables that obscure causative links and make definitive conclusions more difficult to reach. In some cases, such variables are relatively easy to brush aside. In other cases, the variables present serious challenges that demand the utmost caution.

Unfortunately, it is likely that the link between cell phones and cancer won’t be established with crystal clarity for many years, if ever. This is due to a number of factors, including:

 

  • The apparent weakness of the causative link, if any: It took years to establish a convincing causative link between tobacco use and cancer risk — a link that we all take for granted today. The relationship between cell phone use and cancer risk appears, at present, to be significantly weaker. Science moves slowly in the best of circumstances, so lay people shouldn’t expect swift answers.
  • The relatively short period of time during which cell phones have been in use: Though they first appeared a decade earlier, cell phones and wireless indoor telephones have only been in widespread use since the early 1990s. That’s probably long enough to draw convincing conclusions about heavy use from the population of early-adopting, heavy users, but it’s not quite sufficient for a population-wide look at the situation. Truly convincing work may have to wait until the first crop of digital natives — people who have used transmitting electronics for their entire lives — approaches retirement age.
  • The most sensational reports don’t directly measure tumor incidence: Some of the most sensational reports about the possible link between cell phone use and cancer don’t directly measure tumor incidence. Instead, they extrapolate about potential “downstream” risks (i.e., tumor growth) based on observed biological changes attributable to cell phone radiation. While it is reasonable to make such assumptions in a general sense, it is dangerous to do so in scientific studies, particularly when the processes by which the observed changes encourage tumor growth aren’t fully understood.

 

Cell Phones Aren’t Going Away

Whatever your opinion on the dangers of cell phones (or the science of the interaction with the human brain), one thing is clear: cell phones aren’t going away, at least not anytime soon. It is possible that, decades from now, portable handheld communication devices will be rendered obsolete by the relentless pace of technological change. But there is no sense in speculating about a day that’s not even close. For now, we are at the mercy of the radio-transmitting computers in our pockets — for better or worse.

The Science of Cell Phones and Brain Tumors

The first cell phones hit the U.S. market in the 1980s. Almost immediately, consumer advocates raised questions about their potential to adversely affect users’ health over long periods of time. During the 1990s, as cell phones became cheaper and more reliable, the pitch and intensity of this questioning gained steam.

Now that cell phones and their powerful smartphone successors — which resemble the first bulky, functionally limited mobile phones about as much as 18th-century surgery, performed without antibiotics or reliable anesthesia, resembles modern neurosurgery — have become an integral part of our modern economic and social fabric, it’s hard to imagine turning back the clock and returning to a time without mobile technology. (You certainly wouldn’t be willing to undergo major surgery without antibiotics or anesthesia, and no ethical surgeon would agree to such a procedure anyway.)

But the questions continue — and they’re worth addressing. Here’s a look at the science behind the oft-repeated claim that cell phones cause brain tumors.

A Long-Term Rise in Tumor Incidence

According to the Mayo Clinic, providers have documented a small but statistically significant (and steady) rise in the incidence of benign and malignant head tumors since the 1970s. While this at first blush appears to correlate with the adoption of cellphones and other radiation-emitting electronics, it’s more likely that the correlation is incidental. The more likely explanation for the increase is a dramatic improvement in imaging technologies and diagnostic techniques.

However, there is enough uncertainty in the data to prompt legitimate questions and necessitate further investigation.

What Can Landmark Studies Tell Us?

During the more than three decades that cell phones have been in use — including the second half of that period, when cell phone use became commonplace — several highly regarded studies have shed some light on the correlation between radio-transmitting electronics and head/neck tumors. The most noteworthy include:

  • A small but statistically significant correlation between cell phone use and salivary gland tumors, though a small sample size and other complicating factors cast some doubt on the results’ applicability
  • A statistically weak correlation between heavy cell phone use and a specific type of brain tumor (glioma), but no general correlation between phone use and overall tumor incidence
  • A two-decade mega-survey of more than 400,000 cell phone users that found no statistically significant correlation between phone use and brain tumors

Benefits of Common Safety Devices and Regulations

It’s also worth noting that some authorities aren’t waiting for a consensus to emerge. The city of Berkeley, California, recently made headlines ( CNN) for enacting a strict law requiring cell phone vendors to inform consumers of existing federal regulations regarding cell phone emissions and provide detailed guidance on safe use (including safety equipment, such as hands-free devices and ear protection) — either by handing out a special pamphlet or displaying a sign in-store. While it’s unclear how or if this new local rule will change consumer behavior, there’s no denying that consumers remain suspicious of the ever-present cell phone.

Is Depression a Symptom of Parkinson’s Disease?

Parkinson’s disease is far more complex than we knew just 10 or 20 years ago. In fact, clinicians like John Gorecki MD, increasingly view Parkinson’s as a “family” of conditions — distinguishing discrete processes and symptoms formerly lumped together under the Parkinson’s aegis.

That said, Parkinson’s expansiveness doesn’t mean it’s difficult to diagnose. In fact, Parkinson’s and related conditions carry an array of symptoms that, taken together, support such a diagnosis. Neurologists and other clinicians involved in the diagnosis and evaluation of Parkinson’s patients are increasingly attentive to the presence of a particular symptom — depression — that could serve as an early indicator (or even future predictor) of Parkinson’s disease.

Classic Parkinson’s Disease Symptoms

Parkinson’s is a common condition: According to the Parkinson’s Disease Foundation, more than 60,000 Americans are diagnosed with PD every year, and as many as 10 million people worldwide are afflicted at any given time. Given the disease’s chronic nature, long duration and often striking presentation, it’s no surprise that many “classic” Parkinson’s symptoms are widely recognized and understood. Some such symptoms include:

  • Tremor, particularly in the hands and fingers
  • Slow movements and rigid muscles
  • Impaired posture and speech
  • Cognitive impairment (dementia)
  • Sexual dysfunction and bladder control issues
  • Sleep problems
  • Swallowing problems and constipation

These symptoms arise and become more noticeable as the disease progresses.

Depression and Parkinson’s Disease

Depression is not a “classic” Parkinson’s disease symptom. In fact, it’s arguably the least-known and most often overlooked symptom. Nevertheless, the Parkinson’s Disease Foundation reports that as many as 60 percent of those diagnosed with Parkinson’s experience “mild or moderate depressive symptoms” at some point during the disease’s progression.

Parkinson’s-related depression may occur at any point, sometimes the patient has been formally diagnosed. It’s a physical process caused by disease-related changes to the brain, specifically the area responsible for producing the mood-regulating chemical serotonin and the frontal lobe, which is responsible for regulating higher-level brain functions like mood and impulse control. Parkinson’s patients typically have under-active frontal lobes and lower levels of serotonin than non-Parkinsonian peers.

Parkinson’s-related depression can affect the overall progression of the disease as well as the quality of life of those afflicted. In particular, depressive Parkinson’s patients report lower levels of satisfaction with everyday tasks, find such tasks more difficult, and (on average) begin chemical treatment for Parkinson’s-related motor symptoms earlier than patients without symptoms of depression.

Pharmaceutical Treatment and Cognitive Therapy

Like many other presentations of depression, Parkinson’s-related depression is treatable with commonly prescribed pharmaceuticals. There’s also evidence that cognitive behavioral therapy, used in conjunction with or independently of pharmaceutical treatment, may ameliorate symptoms and improve quality of life. In fact, patients who take steps to treat their depression symptoms may notice an improvement in their motor and cognitive symptoms as well.

More to Learn About Parkinson’s Disease

It is now clear that there’s a link between depression and Parkinson’s disease. Given the complexity of the family of conditions known as “PD,” it is also a foregone conclusion that other links and correlations will emerge in the years to come. Such discoveries will teach us more about Parkinson’s and related conditions — and could provide some measure of hope (or at least set reasonable expectations) for Parkinson’s sufferers and their families.