DBS innovation: Stimulating individual neurons?

This is really quite something to behold: A DBS lead with electrodes small enough to potentially stimulate individual neurons. The genius lies in applying the technology used in semiconductor chip design to create a lead with many tiny electrodes that can then be activated and controlled with an extraordinary level of precision.

Looks like a great buy for one of the major medical device manufacturers.

DBS Surgery: First Person Account

What a terrific article, on the Daily Kos web site. He even answers right up top the unasked question I’ve had for so long: Do you need a catheter, and how exactly is that bit of work performed?

Thank you for writing that article. Very well done. I’ve been trying to conjure the reality of the procedure, the details of what will happen, and this piece takes me there like few others I’ve read.

Exercise Helps Everything

Jane Brody’s column this week pretty much nails it: No matter if you’ve got Parkinson’s, cancer, or are simply getting older, exercise is going to help you. 

“The single thing that comes close to a magic bullet, in terms of its strong and universal benefits, is exercise,” Frank Hu, epidemiologist at the Harvard School of Public Health, said in the Harvard Magazine.

Study after study shows that moderate to vigorous exercise will help you. Haven’t been off the couch in a while? Get started, under the supervision of a personal trainer or physical therapist. Heart problems? Get busy — that’s the best way to pump oxygenated blood to where it’s needed. Depression? Exercise is arguably better than any drug, and it’s drug-free.

Please, read the article. It could save you life — and it will certainly improve the quality of it.

Jamming the Signal: The Effect of Diagnosis on Cognition

The simple act of receiving the diagnosis of Parkinson’s disease blew me out of the water. I’ve met quite a few people in support groups for whom the diagnosis was a singularly traumatic event.

And now comes a study of “chemobrain,” the cognitive problems associated with breast cancer therapies, that indicate that the therapies have little to do with it. The Australian doctors presented their findings at the annual meeting of the American Academy of Neurology earlier this month.
They found that women who were diagnosed as having breast cancer began showing signs of impairment of attention and learning prior to the start of chemotherapy. And most of the women regained most of the lost function by the end of the chemotherapy regime.
There’s no doubt in my mind that the delivery of a grim diagnosis causes problems in and of itself. My mind reeled for weeks after that day in December, 2001, as if the events of Sept. 11 were not upsetting enough. I know the diagnosis was similarly disturbing to Suzanne.
My capacity for evaluating the thicket of choices that confronted me — medication options, implications for my career and family — was definitely limited. Looking back on that time, I wonder how the choices I made would have been affected had I been given the chance to review some comprehensive info from someone who had been there and done that (memo to self …).
But I will be always grateful to my support group friends, who were (and are) there, month after month, eager to help the newly dazed as they search for a way forward.

Problem with Sleep? Only When I’m Not Sleeping

I am so tired.

Knowing that sleep problems are a part of having Parkinson’s disease doesn’t make having a problem any more tolerable. It could be worse: I could be getting no relief at all.

I sleep with a C-PAP, basically a compressor that shoots air under pressure through my nose and into my lungs. The system keeps my upper airways from collapsing at the instant an exhale turns to inhale.

Without it, I would suffer an average of 67 “waking incidents” per hour, all night long, every night. The day after my first night in a sleep lab was bliss, and it only got better as the months went by. My long twilight of ill temper and dulled thought receded into long-term memory.

Every so often, the new routine is disrupted. Maybe it’s the congestion from low-level, seasonal allergies. It could be the new headgear, which gets replaced every few months (the tubing develops pinholes in regular use).

Whatever. The last few days have been tough. I’m slowly gaining more uninterrupted hours each night, but the cumulative effect has been increasingly apparent. Here’s hoping for a good night.

Medications and Cognition

An upcoming paper adds to concerns that anticholinergic drugs can affect cognition in older people. Anticholinergic drugs are often used to treat Parkinson’s, as well as other problems in older people, like incontinence.

Over the years, I’ve taken all three of the anticholinergics, including Artane (aka trihex), and Akineton (no longer available in the US). I’m still taking benztropine, although at a low dosage, due to the common side effect of constipation. My head is clear these days. 
However, Akineton definitely affected my thinking. It was manageable, but it made me weird. I’m glad to be off of it.

The Protein-Levodopa Link

I’d heard about the value of a low-protein diet for many years, and always thought it was over-hyped. Because levodopa is an amino acid, the thinking is that too much protein in the gut would lessen the amount of levodopa taken up by the brain.

I ignored that thinking for the roughly four years I’ve been taking generic Sinemet (carbidopa/levedopa). I exercise heavily, five or six times a week, and paid no heed to protein consumption. If anything, I sought more of it in my diet, thinking it essential to recovery from those workouts.

But my thinking has completely changed during the past six months. Protein matters. The logic slowly crept up on me, as I struggled with managing my symptoms. 

I take a total of seven tabs of generic 25/100 six times a day. I realized that, from time of ingestion to time of wear off, was only two hours. A dose might take from 30 to 90 minutes to kick in, meaning I would get maybe an hour of relief from each tab. That meant I was getting relief for maybe half of my waking hours — and no relief from the tremors for the other half.

I was observing the standard rule of taking levodopa on an empty stomach: wait at least an hour after eating, then wait another half hour before eating. On a two-hour dosing regime, that meant spending a lot of conscious energy on the eating and dosing schedule.

I started supplementing with a protein shake (whey/casein) at bedtime, thinking that would be a good way to assure sufficient protein intake. But by this time, I was finding that more of my doses of levodopa were failing to provide any relief at all. Maybe I couldn’t wait the half-hour until eating. Maybe my meals were too large. 

But the moment of truth arrived in March, when I failed to get any relief at all from my first dose of the morning. This was a crisis: I live for the structure of my days, and the morning carpool to the kids’ school is the key event. Usually, that morning dose kicked in within a half-hour — the fastest of the day. Now I was getting no relief.

An offhand comment from one of my neurologists had primed me for an epiphany. I described a lunch (tomato soup, black bean soup) that I thought was ultra-healthy, but he pointed out that the beans may have had enough protein to screw up the subsequent dose. Hmm.

Then I got to thinking about that late-night shake (sooo yummy). I skipped the shake one night, and the morning medicine uptake was back to normal. Next night, I skipped the shake. Next morning, everything was fine. Within another day or two, I got serious about tracking my diet, my medicine intake, and my response to the meds. 

The results were immediately apparent, and shocking. I’ll elaborate in another post.