Lithium and tinnitus

Posted on November 25, 2024 by Maurice Preter MD

Lithium has shown some potential in helping with tinnitus, though research is still limited. Here’s what we know about lithium and tinnitus:

## Potential Benefits

Some individuals have reported improvements in their tinnitus symptoms after taking lithium:

– One user on a tinnitus forum noted that lithium carbonate (1,200 mg daily) prescribed for bipolar disorder seemed to reduce the bothersomeness of their tinnitus after a few weeks of use[1].

– Lithium is thought to potentially exert a pharmacological effect in the inner ear that could be beneficial for reducing tinnitus[2].

## Proposed Mechanisms

While the exact mechanisms are not fully understood, there are some theories on how lithium may help with tinnitus:

– Lithium may modulate neurotransmitter activity in the auditory system, potentially reducing hyperactivity associated with tinnitus[2].

– Its mood-stabilizing effects could indirectly reduce the emotional impact and perception of tinnitus symptoms[1].

## Research Status

Currently, lithium is not an approved or standard treatment for tinnitus. More research is needed to establish its efficacy and safety specifically for tinnitus:

– Some clinical trials have explored lithium’s potential, but large-scale studies are still lacking[2].

– Other medications and approaches are more commonly studied and used for tinnitus management[3].

## Considerations

It’s important to note that:

– Lithium is a powerful medication primarily used for bipolar disorder and requires careful medical supervision.
– Individual responses to lithium for tinnitus may vary significantly.
– Potential side effects and interactions need to be carefully considered.

Anyone considering lithium for tinnitus should consult with a healthcare professional, preferably one experienced in both tinnitus management and psychiatric medications. They can provide personalized advice based on an individual’s overall health, tinnitus characteristics, and other factors.

Citations:
[1] https://www.tinnitustalk.com/threads/lithium-possibly-helping-tinnitus-%E2%80%94-feeling-hopeful.16630/
[2] https://patents.google.com/patent/US20070219272A1/en
[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC3136369/

Posted in News, Psychiatry/Neurology | Tagged , , , |

The Brain Injury Guidelines (BIG)

Posted on November 25, 2024 by Maurice Preter MD

The Brain Injury Guidelines (BIG) classify traumatic brain injuries into three categories – BIG 1, BIG 2, and BIG 3 – based on the severity of the injury and imaging findings. Here are the key differences between these categories:

## BIG 1

– Smallest/mildest injuries
– Intracranial hemorrhage ≤ 4 mm in size
– No skull fractures
– No anticoagulation/antiplatelet therapy
– No intraventricular hemorrhage (IVH)
– Managed with 6-hour observation in the emergency department
– No planned neurosurgery consultation or repeat head CT

## BIG 2

– Moderate injuries
– Intracranial hemorrhage 4-7 mm in size
– May have non-displaced skull fractures
– No anticoagulation/antiplatelet therapy
– No IVH
– Admitted to the hospital
– No planned neurosurgery consultation or repeat head CT

## BIG 3

– Largest/most severe injuries
– Intracranial hemorrhage ≥ 8 mm in size
– May have displaced skull fractures
– May be on anticoagulation/antiplatelet therapy
– May have IVH
– Admitted to the hospital
– Mandatory neurosurgical consultation
– Repeat head CT at 6 hours
– Frequent neurological checks

The key differences lie in the size of the intracranial hemorrhage, presence of skull fractures, use of anticoagulants, and the management approach. BIG 1 patients can potentially be discharged after brief observation, BIG 2 patients require hospital admission but not necessarily neurosurgical consultation, while BIG 3 patients need the most intensive management with neurosurgical involvement and repeat imaging[1].

Citations:
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC7264829/
[2] https://www.law-wv.com/blog/2021/february/the-3-levels-of-brain-injuries/

Posted in Forensic Neuropsychiatry, Health, keto | Tagged , |

Low Vitamin D and risk of delirium

Posted on November 25, 2024 by Maurice Preter MD

Title: Vitamin D levels and risk of delirium: A mendelian randomization study in the UK Biobank

Published in: Neurology, 2019

## Objective

– To estimate the effects of vitamin D levels on incident delirium hospital admissions using inherited genetic variants in mendelian randomization models

## Methods

– Study design: Longitudinal analysis using the UK Biobank cohort
– Participants: 313,121 community-based volunteers of European descent aged 60+ years
– Follow-up period: Up to 9.9 years (mean 4.6 years)
– Outcome: Incident hospital-diagnosed delirium (ICD-10 F05)
– Genetic variants used:
– 6 single-nucleotide polymorphisms (SNPs) associated with vitamin D levels
– APOE variants
– Analysis: Cox competing models accounting for mortality

## Key Findings

1. Incident delirium cases:
– 544 participants were hospitalized with delirium during follow-up
– Mean age at delirium diagnosis: 71.6 years (SD 4.12 years)

2. Vitamin D genetic associations:
– Vitamin D-increasing alleles were associated with decreased risk of delirium
– Hazard ratio (HR) = 0.74 per 10 nmol/L increase in genetically instrumented vitamin D (95% CI 0.62-0.87, p=0.0004)
– No evidence for pleiotropy (MR-Egger p>0.05)

3. APOE associations:
– Participants with ≥1 APOE ε4 allele were more likely to develop delirium
– APOE ε4ε4 homozygotes: HR = 3.73 (95% CI 2.68-5.21, p=8.0 × 10^-15) compared to ε3ε3
– No interaction between APOE status and vitamin D variants

4. Sensitivity analyses:
– Results remained consistent after adjusting for time spent outdoors, excluding related participants, and adjusting for calcium genetic risk score
– Excluding prevalent dementia cases did not affect the associations

## Conclusions

– Genetic evidence supports a causal role for vitamin D levels in incident delirium
– The study suggests that trials of vitamin D supplementation for delirium prevention may be warranted

## Limitations

– Study limited to participants of European descent
– Delirium diagnoses based on hospital discharge data, potentially missing milder cases
– Unable to account for potential environmental confounders

## Implications

– Findings suggest that maintaining adequate vitamin D levels may help reduce the risk of delirium in older adults
– Further research needed to determine optimal vitamin D levels for delirium prevention

Citations:
[1] https://ppl-ai-file-upload.s3.amazonaws.com/web/direct-files/27176464/d014149f-dad3-43af-aa71-c61a27d034c3/NEUROLOGY2018905778.pdf

Posted in Aging, dietary, epigenetics, Health, keto, News, Psychiatry/Neurology | Tagged , , , , |

LED strobe lights to potentially treat Alzheimer’s disease by clearing amyloid plaques in the brain.

Posted on November 25, 2024 by Maurice Preter MD

Recent research has shown promising results in using LED strobe lights to potentially treat Alzheimer’s disease by clearing amyloid plaques in the brain. Here’s a summary of the key findings:

## The Discovery

In 2016, researchers at MIT led by Dr. Li-Huei Tsai found that exposing mice to LED lights flickering at 40 hertz (40 times per second) could significantly reduce beta amyloid plaques in the visual cortex[1]. This frequency induces gamma oscillations in the brain, which are associated with cognitive functions and appear to be impaired in Alzheimer’s disease.

## How It Works

The 40 Hz light stimulation appears to work through two main mechanisms:

1. **Reducing beta amyloid production**: The gamma oscillations induced by the light seem to suppress the production of beta amyloid proteins[1].

2. **Enhancing plaque clearance**: The treatment activates microglia, the brain’s immune cells, making them more effective at clearing out amyloid plaques[1][2].

## Expanded Research

Subsequent studies have shown that:

– Combining light and sound stimulation at 40 Hz can extend the effects to other brain regions, including the hippocampus, which is crucial for memory[2].
– Prolonged treatment (3-6 weeks) not only cleared plaques but also prevented neuron death and preserved synapses[2].
– The treatment may work by stimulating the brain’s “glymphatic system,” which helps clear metabolic waste[5].

## Human Trials

While most research has been conducted on mice, early-stage human trials have begun:

– Initial studies have confirmed the safety of the approach in humans[5].
– A large biomarker study called HOPE is currently underway, with results expected by 2025[5].

## Challenges and Controversies

It’s important to note that not all attempts to replicate the original findings have been successful. Some researchers have reported only small effects or no significant changes in amyloid levels or plaque formation[4]. This highlights the need for further research and larger-scale human trials.

## Potential as a Treatment

If proven effective in humans, this non-invasive treatment could represent a significant breakthrough in Alzheimer’s therapy:

– It’s non-invasive and potentially affordable[5].
– The treatment uses a very low intensity, ambient soft light that is barely perceptible[3].
– It could potentially be administered through special goggles or light-emitting devices that patients could use at home[3].

While these findings are exciting, it’s crucial to await the results of ongoing human trials before drawing definitive conclusions about the effectiveness of this approach in treating Alzheimer’s disease in humans.

Citations:
[1] https://news.mit.edu/2016/visual-stimulation-treatment-alzheimer-1207
[2] https://neuro.gatech.edu/simulated-brain-waves-offer-possible-treatment-alzheimers-disease
[3] https://www.bbc.com/news/health-38220670
[4] https://www.alzforum.org/news/research-news/does-flashing-light-really-lower-cortical-amyloid
[5] https://www.forbes.com/sites/williamhaseltine/2024/02/29/light-and-sound-may-help-treat-alzheimers-disease-heres-how/

 

See also: https://psychiatryneurology.net/2020/10/25/led-strobe-lights-clear-alzheimer-plaques/

Posted in keto, News, Psychiatry/Neurology | Tagged , , |

Antiseizure medication (ASM) withdrawal in seizure-free patients

Posted on November 25, 2024 by Maurice Preter MD

Here’s a very detailed summary of the practice advisory update on antiseizure medication (ASM) withdrawal in seizure-free patients:

Objective and Methods

  • Update the 1996 American Academy of Neurology practice parameter
  • Systematic review of literature published from January 1991 to March 2020

Key Findings

Adults

  • Long-term (24-60 months) risk of seizure recurrence:
    • Possibly higher among those who taper ASMs vs. those who don’t
    • 15% vs. 7% recurrence rate (Class I study)
    • Hazard ratio for recurrence: 2.9 (95% CI 1.8-4.6) in one Class III study

Children

  • No significant difference in seizure recurrence between:
    • Tapering ASMs after 2 years vs. 4 years of seizure freedom
    • Tapering at 18 months vs. 24 months (insufficient evidence)

Risk Factors for Seizure Recurrence

  • Adults:
    • Shorter seizure-free period (2 years vs. longer)
    • Abnormal psychiatric examination
    • Specific ASMs (valproate, phenobarbitone, primidone, phenytoin)
  • Children:
    • Epileptiform activity on EEG possibly increases risk

Status Epilepticus

  • ASM withdrawal possibly does not increase risk in adults

Quality of Life

  • ASM weaning possibly does not change quality of life in seizure-free adults

Mortality

  • Insufficient evidence to support or refute changes in mortality risk

Speed of ASM Withdrawal (Children)

  • No significant difference in recurrence risk between:
    • 25% reduction every 10 days to 2 weeks
    • 25% reduction every 2 months

Recommendations

  1. Clinicians should inform adults who have been seizure-free for 24 months or more that:
    • There is a possibility of increased seizure recurrence risk with ASM withdrawal
    • Recurrence risk is likely low overall but may double compared to those who continue ASMs
    • There is uncertainty about the exact risk increase
  2. Clinicians should advise children who have been seizure-free for at least 2 years that:
    • There is probably no additional risk reduction by waiting 4 years vs. 2 years to withdraw ASMs
  3. Clinicians should counsel children and caregivers that:
    • An epileptiform EEG abnormality may be associated with increased seizure recurrence risk
  4. Clinicians may advise patients that:
    • ASM withdrawal possibly does not increase the risk of status epilepticus (adults)
    • ASM withdrawal possibly does not change quality of life (adults)
  5. When withdrawing ASMs in children, clinicians may consider:
    • Using a withdrawal rate of 25% reduction every 10 days to 2 weeks
    • Or using a withdrawal rate of 25% reduction every 2 months

Limitations and Considerations

  • Limited high-quality evidence for many aspects of ASM withdrawal
  • Individualized decision-making is crucial, considering patient preferences and risk factors
  • Further research needed on specific electroclinical syndromes and post-epilepsy surgery patients
  • EEG type and duration for assessing recurrence risk not specified in studies

This summary provides a comprehensive overview of the key points from the practice advisory update on ASM withdrawal in seizure-free patients.

Source: Gloss et al. 2021

Posted in Psychiatry/Neurology | Tagged , |