July 31, 2008

Concern over chemicals brain risk

Toxic chemicals may be causing a pandemic of brain disorders because of inadequate regulation, researchers say.

A report in the Lancet identifies over 200 industrial chemicals, including metals, solvents and pesticides, which have potential to damage the brain.

Studies have shown low-level exposure of some can lead to neurobehavioral defects in children, the US and Danish team behind the report said.

UK experts remained divided over the findings.

One in six children worldwide has a development disability such as autism and cerebral palsy.


The causes are unknown, but the researchers trawled through a range of previous studies and data to show how some chemicals can effect the brain.

The team, from the University of South Denmark and New York's Mount Sinai School of Medicine, said pinning down the effects of industrial chemical pollution was extremely difficult because symptoms may not develop for several years.

The report said lead, which was used in petrol from 1960 to 1980, illustrated the risk of even low exposure of industrial chemicals for children.

Based on what is known about the toxic effects of lead, this may have reduced IQ, shortened attention span, slowed motor co-ordination and heightened aggressiveness.

The researchers said developing brains - defined as from foetus to adolescence - were much more susceptible to toxic chemicals than those of adults.

Chemicals

Several other chemicals, including methylmercury, arsenic and polychlorinated biphenyls, were also studied in depth and shown to cause neurobehavioral problems.

The scientists identified 202 industrial chemicals with the potential to damage the human brain, and said they were likely to be the "tip of a very large iceberg".

More than 1,000 chemicals are known to be neurotoxic in animals, and are also likely to be harmful to humans.

Lead researcher Dr Philippe Grandjean said: "The human brain is a precious and vulnerable organ. And because optimal brain function depends on the integrity of the organ, even limited damage may have serious consequences.

"Only a few substances, such as lead and mercury, are controlled with the purpose of protecting children.

"The 200 other chemicals that are known to be toxic to the human brain are not regulated to prevent adverse effects on the foetus or a small child."

Of the 100,000 chemicals registered for commercial use in the EU in 1981 and the 80,000 in the US, fewer than half had been subjected to even the most basic testing.

Researchers said it was only recently that the tide has started changing with the EU's Reach programme, which will lead to strict regulation of chemicals if there is an early indication of the potential for a serious toxic effect.

Professor Mark Hanson, director of developmental origins of health and disease at Southampton University, said: "The authors have put their finger on something which is important and which will not go away."

But he said the findings were extremely hard to prove as the effect of the chemicals did not seem to lead to gross abnormalities, "but rather change the way that the normal control systems work".

However, Professor Alan Boobis, a toxicology expert at Imperial College London, said: "The authors of this review have raised an issue of significant concern, but some of the evidence in support of the conclusions lacks rigour."


Concern Over Effects of Statins on Brain

Writing in the Wall Street Journal, Melinda Beck reports that at least one neurologist is concerned that statins - popular drugs used to treat high cholesterol - may be affecting the brain. Though the majority of cardiologists have not shown concern, one trial underway at the University of California San Diego is attempting to uncover what, if any, effects statins have on mood, thought processes, and behavior.

The concern arises because the protective sheaths that insulate neurons in the brain could be vulnerable to the actions of statin drugs. These myelin sheaths are composed mainly of cholesterol, which statins are designed to fight.

Critics point out both that the delicate structures of the brain are protected by the blood-brain barrier, which statins are not known to cross, and that other studies have shown that statins may actually help prevent certain neurological diseases like Alzheimer's by reducing the amount of free cholesterol in the body.

Statins are prescribed to lower bad cholesterol (LDL) and may patients with high blood pressure and high cholesterol are treated with these drugs.

Studies are ongoing.

July 19, 2008

How Do I Know if My Neurosurgeon Is Board Certified?

Board certification is an advanced credential
that indicates a high degree of competence and
training in the specialty of neurosurgery. A
neurosurgeon seeking board certification within
the American Board of Neurological Surgery
(ABNS) must submit to a rigorous evaluation
process governed by the American Board of
Medical Specialties. Before board certification
is granted a neurosurgeon must:
• Validate appropriate education and training
• Evidence professional practice skills,
judgment, and knowledge – which includes
opinions by his/her colleagues
• Pass both written and oral examinations
in their specialty
Board certification is considered the “gold
standard.” It is a way for patients to assess the
neurosurgeons they seek for treatment. You
can ensure that your neurosurgeon is board
certified by calling the American Board of
Medical Specialties at 866-275-2267, by
visiting their website (www.abms.org), or by
calling the Physician Referral Service at the
hospital where the doctor is on staff.

What Are the Common Risks of Brain Tumor Surgery?

Brain tumor surgery poses both general and
specific risks. The general risks apply to anyone
going through surgery for any reason and are not
limited to brain tumor surgery. These include:
• Infection
• Bleeding
• Blood clots
• Pneumonia
• Blood pressure instability
Risks specific to brain tumor surgery depend
greatly on the particular location of the tumor.
Particular areas of the brain control functions
such as vision, hearing, smell, movement of the
arms and legs, coordination, memory, language
skills, and other vital functions. The process of
operating on the brain always includes some risk
that nerves or blood vessels serving these areas
will be damaged. This could result in partial or
complete loss of sensation, vision, movement,
hearing or other functions. When a tumor is
located deep within the brain it increases the
risk and range of possible complications.
Additional risks, while generally rare, are also
possible. These brain surgery risks include:
• Seizures
•Weakness
• Balance/coordination difficulties
• Memory or cognitive problems
• Spinal fluid leakage
• Meningitis (infection causing inflammation of
membranes covering the brain and spinal cord)
• Brain swelling
• Stroke
• Hydrocephalus (excessive fluid in the brain)
• Coma
• Death

July 14, 2008

Microscope-Based Devices

Also used during stereotactic surgical procedures
are microscope-based devices. This technology
tracks the exact position of the operating
microscope with the fiducial markers placed on
the head, giving precise coordinates for the tumor.
Previous CT or MRI scans are superimposed
in the microscope so the neurosurgeon can see
the tumor’s image as they work.

Frameless Stereotactic Surgery

Instead of using an external frame as a reference
point, frameless stereotactic surgery uses tiny
markers, called fiducial markers, that are taped
or glued to the head before the brain is scanned.
The scan is then loaded into a planning and
navigation computer, producing a 3-dimensional
representation of the head, brain and tumor.
During surgery these markers are touched with
a pointing device, called a “Wand.” Identified
on the scan, the computer “knows” where the
surgical instrument is during the procedure in
relation to the brain and tumor.

Frame-Based Stereotactic Surgery

With frame-based stereotactic surgery, a lightweight
frame is attached to the skull at four points.
Local anesthesia is used to numb the places where
the pins contact the skull. Once the frame is
attached a CT, MRI or dye scan (angiography) is
done. Since the scan images both the tumor and
the frame, it is able to show the exact location of
the tumor in three dimensions in relation to the
head frame. The neurosurgeon takes these
coordinates and precisely inserts a probe through
a small incision in the skull to perform the biopsy
or other procedure.
It also has some limitations. The frame can
sometimes obstruct the neurosurgeon’s view of
the site; it can be time-consuming to manually
set the frame and read the scans; there is a
limited space to work within the radius of the
arc; and the scans and surgery usually need to
be performed the same day.