Always interesting if never-ending discussion. Hope to get around to putting some remarks on paper and sending them off to JNNP (or at least post them here).
Meanwhile, two favorite quotes come to mind:
When I asked the neurologist for a prognosis, he soberly declared, it could get better, it could get worse, it could stay the same. I burst out laughing. He did not see the joke.
Siri Hustvedt, The Shaking Woman or A History of My Nerves
I solve the mind-body problem by stating that there is no such problem. There are, of course, plenty of problems concerning the “mind”, and the “body”, and all intermediate levels of integration of the nervous system. What I wish to emphasize is that there is no problem of “mind” versus “body”, because biologically no such dichotomy can be made. The dichotomy is an artefact; there is no truth in it, and the discussion has no place in science in 1943… The difference between psychology and physiology is merely one of complexity. The simpler bodily processes are studied in physiological departments; the more complex ones that entail the highest levels of neural integration are studied in psychological departments.
Stanley Cobb, Borderlands of Psychiatry (1943)
+ Author Affiliations
Contributors JS conceived the article, all authors contributed to writing.
Oliver Sacks, the well known neurologist and writer, published his fourth book, ‘A Leg to Stand On’, in 1984 following an earlier essay ‘The Leg’ in 1982. The book described his recovery after a fall in a remote region of Norway in which he injured his leg. Following surgery to reattach his quadriceps muscle, he experienced an emotional period in which his leg no longer felt a part of his body, and he struggled to regain his ability to walk. Sacks attributed the experience to a neurologically determined disorder of body-image and body ego induced by peripheral injury. In the first edition of his book Sacks explicitly rejected the diagnosis of ‘hysterical paralysis’ as it was then understood, although he approached this diagnosis more closely in subsequent revisions. In this article we propose that, in the light of better understanding of functional neurological symptoms, Sacks’ experiences deserve to be reappraised as a unique insight in to a genuinely experienced functional/psychogenic leg paralysis following injury.
Fabulous slide shows from the Tropical & Travel Medicine Seminar Series of the University of Minnesota (sic!)
This is an interesting finding. We have shown that people (even “normal” people) with early separation events (early parental divorce, parental loss) have a totally different endogenous opioid reactivity in a challenge test. It would make sense if they therefore were predisposed to more severe TBI and mTBI symptomatology.
Morphine protects for head trauma induced cogn… [Neurosci Lett. 2006] – PubMed – NCBI.
Abstract:
Victims of minor traumatic brain injury (mTBI) can show long lasting cognitive, emotional and concentration difficulties, amnesia, depression, apathy and anxiety. The symptoms are generally known as a post-concussive syndrome without clear morphological brain defects. Endogenous opiates are released after impact to the brain, suggesting they may play a role in TBI pathophysiology. Furthermore, the administration of opiates to the brain of injured animals has been shown to affect the injury, induce cellular changes and also have protective qualities for neurological impairments. Here, we examined the protective properties of the opiate morphine on cognitive performances following minimal brain injury in mice. For this purpose, we have used our non-invasive closed-head weight drop model in mice, which closely mimics real life mTBI and examined mice performance in the Morris water maze. Our procedure did not cause visible structural or neurological damage to the mice. A single morphine injection administrated immediately after the induction of minimal TBI protected the injured mice from cognitive impairment, checked 30, 60 and 90 days post injury. However, mice injected with morphine that were examined 7 days after the injury did not show better performance than the saline injected mice. Our results indicate that morphine has long but not short-term effects on the cognitive ability of brain-injured mice. Although the exact nature of opioid neuroprotection is still unknown, its elucidation may lead to the much-needed treatment for traumatic brain injury.
This was posted on www.neurologyreviews.com here.
SLEEP 2012 MEETING
Short Sleep May Increase Stroke Risk
2012;20(7):1,17.
BOSTON—Regularly sleeping for less than six hours quadruples the rate of stroke symptoms among middle-aged and older persons with a normal BMI and a low risk of sleep-disordered breathing, according to a study that was presented at the 26th Annual Meeting of the Associated Professional Sleep Societies.
Researchers found no association between a six-hour sleep duration and stroke symptoms among overweight and obese persons.
Unadjusted results indicated that a sleep duration of less than six hours as well as a sleep duration of nine hours or more were strong predictors of stroke symptoms, but the predictive strength of these factors decreased when the data were adjusted, said Megan Ruiter, PhD, a postdoctoral fellow in preventive medicine at the University of Alabama at Birmingham. She and her colleagues noted a significant interaction between sleep duration and BMI, however.
Sleep duration of less than six hours was strongly associated with a greater incidence of stroke symptoms in the fully adjusted data model for participants with normal BMI. Sleep loss is associated with endothelial dysfunction, and it could increase stroke risk by this mechanism. “Perhaps this short sleep duration in these relatively healthy individuals might be a precursor to more traditional stroke risk factors down the road,” said Dr. Ruiter.
Analysis of Data From the REGARDS Study
Dr. Ruiter and her colleagues analyzed data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study to determine whether sleep duration predicted self-reported stroke symptoms among individuals at low risk for sleep-disordered breathing. The longitudinal, nationwide cohort study encompassed 30,239 participants age 45 and older. The investigators collected self-reports of each person’s average sleep duration. At six-month intervals, the researchers obtained subjects’ self-reported stroke symptoms.
A total of 5,666 participants had no history of stroke, transient ischemic attack, or stroke symptoms and were not at high risk for sleep-disordered breathing. Participants’ mean age was 61, and about a third were African American. Most of the individuals in the study were employed. Average follow-up time was two years, and 244 participants reported at least one stroke symptom.
Dr. Ruiter’s team estimated the hazard ratios predicting time from measurement of sleep duration to first stroke symptom. Models were adjusted for demographic information, Framingham stroke risk factors, depressive symptoms, anxiety, and various health behaviors such as physical activity and diet quality.
Sleep Fragmentation’s Effect on Stroke Symptom Risk Is Unclear
In the fully adjusted model, participants of normal BMI who slept for less than six hours had a fourfold greater risk for stroke symptoms, compared with normal-weight participants who slept for seven to eight hours. The analysis of the results suggests that improving sleep might lower stroke risk in persons with normal BMI, said Dr. Ruiter. “It might be important to increase physician awareness” of sleep problems, she added.
One of the study’s limitations is that most of the sample population was employed. “People who were not employed, or [who were] retired or homemakers, likely didn’t answer the sleep duration question, because it was asking about how much sleep they would get on their work and nonwork days,” noted Dr. Ruiter.
Because the study asked for participants’ perception of their sleep, it is unclear whether participants reported their total amount of sleep, or their total amount of time in bed, attempting to sleep. The researchers need to analyze the data further to determine whether the increased stroke risk is associated with short sleep or sleep fragmentation, according to Dr. Ruiter.
More evidence is required to validate the results, and Dr. Ruiter and her colleagues will continue to follow the participants in the REGARDS study and look at actual stroke events.
—Erik Greb
Suggested Reading
Eguchi K, Hoshide S, Ishikawa S, et al. Short sleep duration is an independent predictor of stroke events in elderly hypertensive patients. J Am Soc Hypertens. 2010 Sep-Oct;4(5):255-262.
Matthews KA, Strollo PJ Jr, Hall M, et al. Associations of Framingham risk score profile and coronary artery calcification with sleep characteristics in middle-aged men and women: Pittsburgh SleepSCORE study. Sleep. 2011;34(6):711-716.
Maurice Preter, MD is a European and U.S. educated psychiatrist, psychotherapist, psychopharmacologist, neurologist, and medical-legal expert in private practice in Manhattan. He is also the principal of Fifth Avenue Concierge Medicine, PLLC, a medical concierge service and health advisory for select individuals and families.
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