Neurology

Neurologists and physicians writing on KevinMD about the brain: dementia and Alzheimer's disease and the biomarkers that now find it early, stroke and what recovery really allows, autism, Parkinson's disease, gait and balance as vital signs, and caring for a spouse or parent with a neurological illness. Three maintained records draw on this archive: Aging and dementia: what physicians say, in their own words, Heart disease: what physicians say, in their own words, and Mental health: what psychiatrists and physicians say, in their own words.

CBD oil: Natural does not mean it is safe

Sarah Fraser, MD

Medications

December 30, 2019

At the age of three months, Charlotte Figi had her first seizure. She was later diagnosed with Dravet Syndrome, a rare form of epilepsy. Her seizures continued, increasing in both frequency and severity. In a CNN interview, Charlotte’s mother Paige said that at the age of three, Charlotte was having up to 300 seizures per week. They could last for up to four hours.

After all other medical treatments had failed, …

Drugmakers discover tardive dyskinesia. And they profit in it.

Martha Rosenberg

Medications

November 30, 2019

Before direct-to-consumer ads, physicians tried to reassure patients they were probably fine. Today, drug ads and online symptom checkers do just the opposite. The most insidious are “unbranded” ads that scare people about a disease without mentioning the drug they are trying to sell. Notable unbranded disease campaigns sell the obscure exocrine pancreatic insufficiency, shift work sleep disorder, and non-24-hour, sleep-wake disorder. Unbranded advertising is designed to appear like a …

A possibly fishy complication of an Alaskan cruise

Deepti Bhandare, MD

Conditions and Diseases

November 13, 2019

A 69-year-old man with a medical history of hypertension, diabetes, and obesity with a body mass index of 33 was admitted with altered mental status. He and his wife were returning from a 14-day Alaskan cruise. On their return, the wife started noticing that her husband was behaving strangely and acting forgetful and had short-term memory loss. This gradually progressed to generalized confusion and altered mental status leading him to …

Are our senior presidential candidates mentally fit?

Michael Brant-Zawadzki, MD

Conditions and Diseases

November 3, 2019

Did you know, one in four people over 65 have abnormal memory impairment? This is the finding from screening with an objective test. In half of those who test abnormal, there were common conditions – such as depression and medication interactions – which can be addressed and even reverse the memory problem. But for the other half, the memory problem is a sign of mild cognitive impairment, which can be …

How to make compassion your personal pain reliever

Michael Maddaus, MD

Physician

October 30, 2019

Five months ago, “little kids” started visiting my father-in-law, stealing things. The hallucinations and dementia progressed, and we were forced to move him to a memory care unit.

Memory care unit is the polite term for a lockup unit for people with dementia. Walking through the locked doors for the first time triggered in me an intense urge to run away.

First, you encounter the “dementia parking lot” with the “inmates” parked …

What does cable news do to your brain? A neurosurgeon explains.

Marc Arginteanu, MD

Conditions and Diseases

October 25, 2019

The availability of up to the minute information, presented 24/7/365, could assist a democratic society in making the best choices in determining its future. That was the promise of cable news. Unfortunately, cable news has fallen short of its potential and has led to the further polarization of America. More than that, it has changed the way your brain works. Not for the better!

The various cable …

A neurologist explains why delaying school start time is important

Jay Puangco, MD

Conditions and Diseases

October 24, 2019

Do teenagers know how to sleep? If you’re the parent of a teen, you might be laughing to yourself. That’s all they know how to do. In truth, teens (and their parents) might not know enough about how to sleep, when to sleep, and why.

California recently became the first state to require most middle and high schools to start no earlier than 8:30 a.m. As a neurologist specializing in sleep …

Will Alzheimer’s disease researchers miss seeing the forest from the trees?

Ron Louie, MD

Conditions and Diseases

October 14, 2019

The National Institute of Aging (NIA) just announced $73 million over five years to fund two new research centers. “The Alzheimer Centers for the Discovery of New Medicines are designed to diversify and reinvigorate the Alzheimer’s disease drug development pipeline,” says the NIA online. The AlzForum.org has more details, quoting researchers saying they will change the direction away from amyloid-beta and tau (the presumed …

Football and concussions: Define the risks first

Munro Cullum, PhD

Conditions and Diseases

October 7, 2019

Awareness about concussions has never been greater among high school athletes and coaches, thanks to the spotlight shone on some former NFL players who’ve experienced problems later in life. But a downside to this heightened awareness is the fear it has sown among parents that their children who play sports like football, soccer, or hockey may end up the same way.

As a parent, I understand that fear. My …

Taking away a senior’s smartphone is a complicated issue

Judith Graham

Conditions and Diseases

October 4, 2019

At first, Dr. Robert Zorowitz thought his 83-year-old mother was confused. She couldn’t remember passwords to accounts on her computer. She would call and say programs had stopped working.

But over time, Zorowitz realized his mother — a highly intelligent woman who was comfortable with technology ― was showing early signs of dementia.

Increasingly, families will encounter similar concerns as older adults become reliant on computers, cellphones, and tablets: With cognitive impairment, …

Primary care could hold the key to preventing Alzheimer’s disease

William R. Shankle, MD

Conditions and Diseases

October 3, 2019

To delay or prevent the onset of memory loss, talk to your doctor. It can really be that simple.

Among the diseases that Americans fear most, Alzheimer’s and dementia consistently rank at the top of the list. What people don’t always realize is that many causes of memory loss are treatable and preventable, and the first line of defense is your primary care physician.

I recently had the opportunity to present findings …

Most of what you learned in medical school is wrong. And that’s OK.

Joshua Y. Yang, MEng

Medical Education

September 10, 2019

“90 percent of what you will learn over the next four years will be wrong in a couple of decades from now.”

Speaking to a lecture hall of 120 first-year medical students, our professor’s prophecy seemed to fall on deaf ears. Looking around, I saw no concerned students, no diminishment of our collective enthusiasm. For me, however, his words of caution struck a chord on that first day of medical school.

As …

MKSAP: 49-year-old-man with right arm weakness

mksap

Conditions and Diseases

August 24, 2019

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 49-year-old-man is evaluated 1 day after having an episode of right arm weakness without pain that lasted 5 minutes. He is now asymptomatic. The patient has type 2 diabetes mellitus and dyslipidemia. Medications are aspirin, metformin, and atorvastatin.

On physical examination, blood pressure is 126/68 mm Hg, pulse rate …

How a neurosurgeon uses a No Room for Error mentality when making life decisions

Marc Arginteanu, MD

Physician

August 16, 2019

As a doctor that specifically deals with brain and spine surgeries, I have adopted a No Room for Error mentality in the operating room. I believe this same mentality can be helpful in making the best possible life decisions.

What do I mean by No Room for Error?

It is natural to visualize the successful achievement of a goal. For instance, prior to performing the most common surgery I perform, resection of …

Arm yourself with new dementia information

Marc Rothman, MD

Conditions and Diseases

August 14, 2019

Everyone knows someone today who’s dealing with dementia. And as a geriatrician — that means a lot of questions come my way. Questions about parents who recently had cognitive testing, about the role of assisted living, about prevention — you name it. Dementia is out there in a way it never was before. People have questions, and they need answers.

Dementia is not a normal part of aging

This is where I …

The re-education of a physician into the school of pain

Heather Finlay-Morreale, MD

Physician

July 27, 2019

Since childhood, I have suffered from severe stabbing headaches. Then in my first year of medical school in anatomy, as we peeled back the scalp of our cadaver, I saw a nerve poking out of a muscle on the back of the skull. With a flash, I knew that I was seeing the source of my pain. But despite identifying it, it would be another five years before I …

When a physician becomes the control subject in a study

Richard Plotzker, MD

Physician

July 25, 2019

When I was on staff at a large medical center, the CEO established four core values for the institution which he arranged in a diamond pattern: safety at the apex — think of yourself as a patient expectedly at the bottom.

While it seems hard to assess how seriously this widely displayed mission statement was taken, or if anyone really remembered which value went in which corner, the institution expanded. Thinking …

Dealing with the pressures of learning as a physician-in-training

Linda Nguyen

Medical Education

July 22, 2019

The other day, I happened across a YouTube video called the “Try Not to Look Away Challenge.” There were some obvious video clips, such as a person vomiting, a spider, and a spooky video game. What struck me was a clip from a movie in which a middle-aged woman forgets where the restroom in her house is located. After letting her husband know that she was headed to the restroom, …

Don’t lower the voting age, says this neurosurgeon

Marc Arginteanu, MD

Conditions and Diseases

July 19, 2019

On several occasions, most recently during a press conference in March 2019, Speaker of the House Nancy Pelosi has advocated changing the voting age to 16. Pelosi told reporters that lowering the voting age would increase engagement in politics among younger Americans and would help drive a higher level of voter awareness and turnout.

Speaker Pelosi is not the only prominent lawmaker to advocate for a lowered voting age. Also in …

When “do no harm” is no longer textbook

Jim deMaine, MD

Physician

July 7, 2019

A call came about noon a few years ago that a patient I’ll call Stella was being admitted once again. She had come into the ER from her nursing home to receive transfusions. These were now needed every two weeks to keep her alive. The problem was that every time Stella was moved she decompensated. Her Alzheimer’s was severe. She no longer recognized her family. She was now 83 and slowly …

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When “do no harm” is no longer textbook