What's New?
- No coincidence between getting a HPV vaccination and the risk of developing Multiple Sclerosis
- Regarding Alzheimer-disease: the new antibody Lecanemab is NOT a game-changer. It only slows down the disease in a modest way, it is extremely expensive, is has major side-effects, like brain
bleeding and brain oedema and requires a whole infrastructure for infusion treatment which does not make it available to the wider public. Being a homozygote ApoE4-gene carrier (15% of all
Alzheimer patients) is even a contraindication for Lecanemab. Far more effect in treatment and prevention of this terrible disease is a healthy lifestyle: Non-smoking, very minor alcohol
consumption, mediterranean diet, weight control and aerobe exercising and exercising the brain. Early diagnostics is already available: Amyloid PET-scan and lumbar puncture for phosphorilated
tau/amyloid beta 42 ratio in cerebrospinal fluid. Soon available as a blood serum marker and a game-changer in diagnosing early Alzheimers might be pTau217 which might give us the option
not to prevent the disease but to slow it down significantly by then reducing our risk factors.
Risk factors for developing Alzheimer disease - aside of a genetic predisposition:Medical risk factors:
Depression, Diabetes mellitus, Dyslipidaemia, Hearing and visual loss, Hypertension, Obstructive sleep apnoea, Smoking.
Environmental risk factors:
Diet, Loneliness, Physical inactivity, Pollution, Poor education, Sedentarism, Stress.
Korczyn, A.D., Grinberg, L.T. Is Alzheimer disease a disease?. Nat Rev Neurol 20, 245–251 (2024). https://doi.org/10.1038/s41582-024-00940-4
- Regarding migraines and chronic headaches: As our waiting list becomes longer and longer I would give some advice for adult patients with chronic headaches. Please stop taking any medications containing codeine and opioids as they might help short-term but will lead at the end to chronic headaches and widespread pain syndrome becoming worse and worse. Therefore - as a first step - they need to be stopped. Also Triptans being taken more than twice a week need to be discontinued as they lead to chronic headaches after a while. Please talk to your GP about the details how to come of it.The best article about treating migraines is in "Cephalalgia":Puledda F, Sacco S, Diener H-C, et al. International Headache Society global practice recommendations for the acute pharmacological treatment of migraine. Cephalalgia. 2024;44(8). doi:10.1177/03331024241252666
- Evidence based treatment for Carpal tunnel syndrome: conservative treatment with splinting, steroid injections works, but operative treatment is treatment of choice. - (American Academy of Orthopedic Surgery 2016)
- Carotid endarterectomy superior and causes less complications in comparison to carotid stenting in cases of significant carotid artery stenosis (Howard et al.; Lancet 2016;387:1305-11).
- Multiple antiepileptic drugs and especially valproic acid during pregnancy increase the risk for the unborn child.
- Valproic acid as antiepileptic drug in fertile men is not a teratogenic risk factor in contrast to what media report.
- Lamotrigine is safe during pregnancy but the dose needs to be adjusted during and after pregnancy.
- Levetiracetam is also considered to be safe during pregnancy. Again, the dose needs to adjusted during and afterwards.
- Ocrelizumab and Siponimod are the first licenced drugs for secondary progressive MS.
- Constipation, reduced ability to smell, REM-sleep-behavioural disorders with nocturnal shouting, acting out dreams can be first signs of Parkinson's disease, Lewy-body-disease and Multi-system-atrophy and can precede the obvious clinical disease by decades.
- Chronic Intake of Proton-Pump-Inhibitors are a risk factor for developing dementia and can provoke a Vitamin B12 deficiency
- The intake of Metformin is another risk factor for developement of B12 deficiencies.
- Vitamin B12 levels below 350 ng/l do not exclude a hidden B12-deficiency. The appropiate test then is NOT checking the parietal cell antibodies which are not sensitive enough but to check for Methylmalonic acid.
- In order to preserve hearing in severe therapy-resistant vertigo due to Meniere's disease intratympanic Methylprednisolone should be tried first before Gentamicin
- Pregabalin not working for chronic back pain - Mathieson et al.; 2017;Trial of Pregabalin in acute and chronic sciatica;N Engl J Med;376:1111-20.
- Risk factors for unexplained death of Epilepsy - SUDEP - which is mostly due to respiratory arrest: Regular Grand-mal-seizures; respiratory problems after seizures; prone position during sleep; non-compliance with anti-seizure-therapy.