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Under natural conditions, non-human primates sleep from sunset to dawn, thus about 10–12 hours. Humans might be expected to show this same pattern but a 2015 study of hunter-gatherer groups in South America and Africa concluded that they sleep for 6–8 hours. This finding refutes the common assumption that sleep duration in industrialized societies has… Read more »

The health benefits of moderate coffee or tea intake are well-documented. But what if you drink both? According to a new study, the benefits are more than doubled. Those who drank both 2–3 cups of coffee and tea had a reduction in stroke and dementia risk by about 30%. Coffee alone reduced these risks by… Read more »

The largest human exposure to trichlorethylene (TCA) in this nation’s history came from the drinking water at Camp Lejeune between 1956 and 1987. The Camp Lejeune Justice Act of 2002 allows those who were harmed by TCA and other similar toxicants at the camp to seek compensation from the US government. TCA was synthesized in… Read more »

Is there a higher risk of suicide after a diagnosis of dementia? And can it be prevented? In a recent study from the UK, young age at diagnosis (<65), a recent diagnosis (less than 3 months) and psychiatric comorbidities were each independent risk factors. In that group, the risk was almost 7 times higher than… Read more »

The evidence is now overwhelming that Epstein-Barr virus (EBV) causes MS. The “hit-and-run” theory is based upon molecular mimicry. This means the virus fools the immune system into making an immune reaction against myelin which resembles the virus’ proteins or antigens. A second theory is that EBV is the “driver of MS” by continually cycling… Read more »

Women with cognitive symptoms ask whether they should start or continue hormone replacement therapy (HRT) to prevent dementia. Ten years ago, my advice to them was that they should. But times change as does the best available research. A new 12-year study looked at 35,000 women on HRT and compared them to 70,000 controls. The risk… Read more »

Of the 50 million people over age 65 living in the US, 20% have cognitive impairment and 50% of the impaired group have difficulty managing finances. They are at great risk of financial mismanagement. For them, financial well-being really matters. The costs of long-term care can be substantial and this burden often falls on their… Read more »

An implanted (read invasive) spinal cord stimulator has recently been approved by the FDA for refractory painful diabetic neuropathy (PDN). The approval was based on a clinical trial of patients who did not respond to at least two classes of medications used to treat neuropathic pain. Most had suboptimal control of their diabetes. Jack H…. Read more »

Is it possible? You can’t eliminate costly clinical trials but you might be able to avoid drug development costs, now that the amyloid theory is circling the drain. The trick is to re-purpose existing drugs, but it’s not easy. Jack H. Florin MD | Your Neurologist in Orange County. The Alzheimer’s research landscape is littered… Read more »

There are more questions than answers. Jack H. Florin MD | Your Neurologist in Orange County. Research in anti-amyloid beta monoclonal antibodies has been ongoing for 15 years. In the pipeline are 16 anti-amyloid and 11 anti-tau antibodies in clinical trials. What we do know: 1. All the antibodies are effective in removing amyloid or… Read more »

Genetic predispositions are clearly “non-modifiable.”   Jack H. Florin MD | Your Neurologist in Orange County. Protective factors: 1. Length of childhood education (too late for most of you). 2. Avoiding severe weight loss in late life. 3. Maintaining cognitive activities. 4. Mid-life and late-life exercising. 5. Treatment with combination of folic acid and vitamins… Read more »

Well established predictors of relapses or new MRI lesions after stopping DMT’s in stable patients are younger age, less disability and previously “active” MS. But the average age of MS patients has shifted from 20–40 years to 50’s, 60’s and older, as people with MS live longer given new and more effective therapies. Jack H…. Read more »

But until another Florida judge bans “Long Covid,” new studies about diagnosis and treatment of this frequently disabling disorder will continue to be published. Symptoms of long Covid can be gastrointestinal, respiratory, or neurological.   Jack H. Florin MD | Your Neurologist in Orange County. A new study looked at 10 patients with postural orthostatic… Read more »

It is grainy or pixelated vision, resembling a TV static overlay, and can be constant. It can be mistaken for floaters or visual ghosts. Even though the first case was reported in 1995 and only 10 cases by 2014, it clearly not rare. New studies show it affects 3% of everyone. Some people have had… Read more »

Newly diagnosed people with MS in particular want to know.   Jack H. Florin MD | Your Neurologist in Orange County. The answer has been elusive without biomarkers, other than MRI, to evaluate treatment efficacy and disease course. Serum neurofilament light chain protein(sNfL) is a new sensitive and accurate biomarker of damage to neurons and… Read more »

Is it real? Depression and anxiety are tightly intertwined with cognition. But the distinctive pattern of the deficits supports the conclusion that, in most patients, depression and anxiety are the result and not the cause of the cognitive impairment. What are the symptoms? A new study looked at 740 patients with an average age of… Read more »

Their brains are wired differently. Vestibular symptoms, mainly vertigo and nausea, are seen in 75% in people with migraine, even when they don’t have a headache. A new study showed that increased activity in certain brain regions may explain these common symptoms. The researchers used a simulated roller-coaster ride while patients were undergoing a functional… Read more »

Follow the money. We’re bombarded by TV ads pushing dietary supplements and other forms of pseudo-medicine marketed to our aging population. Enter dubious product claims for “brain protection” and treatment for sports concussions. These products are unproven and often promoted by practitioners and athletes with financial conflicts of interest. Examples are numerous. An industry-funded study… Read more »

More than half of people with MS report chronic pain severe enough to affect daily functioning, employment, and quality of life. For some, it is their worst symptom. One in five turns to opioids for relief. But opioids are a double-edged sword. Opioid users had more pain and fatigue than users. Depression and level of… Read more »

The obvious answer — the response to an unpredictable and potentially disabling disease. But how to explain the fact that levels of depression and anxiety are higher in MS than in rheumatoid arthritis patients with the same level of physical disability. Or that depression, insomnia, fatigue, and cognitive impairment can occur before onset of typical… Read more »

The role of viral infections in causing exacerbations of Multiple Sclerosis is well known. Potential safety concerns about using immunosuppressive MS disease modifying therapies (DMTs) during the COVID-19 pandemic are overstated, according to most MS experts. A new large community-based study found that 57% of people with MS and COVID-19 experience an MS exacerbation during… Read more »

According to Abraham Lincoln, “the problems with alcohol relate not to the use of a bad thing but to the abuse of a good thing.” This, of course, is not news, but what exactly is a “healthy” drinking habit? According to a study from the Mayo Clinic, the key is to drink before or with… Read more »

Vaccination offers the only way out of the COVID-19 pandemic, threatened more by vaccine hesitancy than anything else. Of concern is a recent report of six cases of cerebral venous thrombosis 1–2 weeks after the Johnson and Johnson/Janssen (JJ) vaccine, the first reported such complications despite the use of 7 million doses. Is this a… Read more »

Every study that looked at it found that exercise is beneficial for people with Parkinson’s. What is new is a study that revealed that higher levels of physical activity slow cognitive decline in APOE-4 carriers, an especially high-risk group. Exercise acts as a symptomatic therapy, much like levodopa, meaning that it alleviates motor, mood and… Read more »

The road to a cure for MS is littered with failed supplements. Biotin is the most recent fatality. The latest candidate is N-Acetyl Glucosamine (NAG), a building block of complex sugars and glycoproteins. It is a reasonably priced over-the-counter dietary supplement used to treat joint pain and inflammatory bowel disease, and to prevent cardiovascular disease…. Read more »

Possible causes of this new syndrome include autoimmune reactions, lingering reservoirs of virus, and functional neurological disorders. Several new reports provide some insights. One study found that very few long-haulers were hospitalized and about 30% had no or very mild symptoms. Most were middle-aged and not elderly. Over 40% had depression or anxiety before being… Read more »

Dr Ray Dorsey, a neurologist at the University of Rochester, believes that we are on the tip of an iceberg. The prevalence of Parkinson’s has increased 35% in the last 10 years and may double in the next 25. Trichlorethylene (TCE) may be the driver of this increase. It has been clearly established to be… Read more »

This will be the next home pregnancy test. One third of healthy elderly will have a positive amyloid PET scan but will never show symptoms of dementia because they have adequate brain reserve. Higher educational level, working into old age, maintaining cognitive and social activities, and exercising all help to “preserve the reserve.” But two-thirds… Read more »

Most physicians are convinced that it is 1) pernicious mind control, 2) ineffective, or 3) placebo. In fact, it can teach patients mind and body control. The ability to be hypnotized is a trait possessed by most people who can enter or terminate it at will. It is not effective in schizophrenia, or in people… Read more »

A new study, titled “Lifetime perspective on alcohol and brain health,” provides compelling evidence that alcohol is harmful. These are the three periods of greatest risk: 1. Pregnancy. Even small amounts can harm the developing brain, yet 10% of pregnant women ignore this warning. 2. Late teen-age years (15–19), a period of “synaptic pruning” and… Read more »

The COVID-19 pandemic is the elephant in the room for MS patients. Does their disease or their treatment make them more likely to be infected or to have a more severe or even a fatal course? Only older age, obesity and more severe disability are independent risk factors which also apply to all chronic diseases…. Read more »

Understanding the role of the pain peptide CGRP has led to advances in treatment of migraine not seen since the triptans (Imitrex and others) were approved in the early 1990’s. The “gepants” (Ubrelvy and Nuretec, with more to come) and the “ditans” (Reyvow) are starting to replace the triptans as acute treatment, owing to better… Read more »

Cannabis is still classified by the US government as a Schedule 1 substance, along with heroin, even though an increasing number of states allow medical and recreational use of marijuana. It is considered effective for chronic pain in cancer, chemotherapy-induced nausea, spasticity in multiple sclerosis and some forms of epilepsy. In fact, there are FDA-approved… Read more »

This may not be as gloomy as once thought. We now recognize that “subtypes” vary greatly. An important distinction is age at onset. Forty percent of patients are of late-onset (after age 70). Fifty percent are middle-onset (aged 50 to 69 years), and only 10% are younger than 50 years at onset. The second distinction… Read more »

Can MS be cured? Based on a recent case report, maybe. A young man with very severe MS was treated with stem cell transplantation (HSCT), the real thing, and not the scam at your local strip mall. His level of disability did not improve but he went into a long-term remission. In MS this is termed NEDA,… Read more »

If poor quality sleep increases risk of dementia, as some studies suggest, why not take benzodiazepines to improve sleep? Well, other lines of research conclude that use of this class of medication may also increase dementia risk. Confused? Practice good sleep hygiene and avoid sleeping pills. A new study seems to explain the effect of insufficient… Read more »

Early-life cognitive enrichment is based on socioeconomic status in early life, cognitive resources at 12 years of age, cognitively stimulating activities at 6 years of age and early life foreign language instruction. This looks a lot like the classic proxy measures of cognitive reserve which are years of education, life-long occupation, IQ, and adult reading…. Read more »

In this strange Covid-19 world, we all worry if the upcoming vaccine will be safe. The story of vaccines and Alzheimer’s is instructive. Dr Hugh Fudenberg, whose license was revoked in 1995, claimed that the flu vaccine increases the risk of Alzheimer’s. Two new studies, presented at the 2020 Alzheimer’s international conference, demonstrate that, in… Read more »

Herpes simplex virus type1 (HSV-1 or oral herpes) causes cold sores, and, less commonly than type 2, it can also cause genital herpes. Herpes zoster is the virus that causes chicken pox and shingles, and is not a suspect here. All herpes viruses are widespread in human populations. According to a controversial hypothesis, sporadic but… Read more »

Benign paroxysmal positioning vertigo (BPPV) is the most common cause of vertigo. Symptoms are a brief spinning feeling, lasting a minute or two, and provoked by movement, especially turning over in bed or sitting up from bed. Responses to three questions out of a 6-item questionnaire were accurate in confirming or ruling out a diagnosis of… Read more »

This truly is a big deal. The accuracy of the clinical and MRI diagnosis of Alzheimer’s, even by experienced specialists, is no better than 80%. Disorders that can be mistaken for Alzheimer’s are many, especially vascular (strokes), Lewy body dementia, and frontotemporal degeneration. PET scans (expensive) and spinal fluid analysis (invasive) detect amyloid and tau deposition in… Read more »

What could possibly be the connection? The first step is to understand personality traits. These tend to be lifelong and not amenable to psychotherapy of psychotropic medications. These are grouped as clusters but keep in mind that one size doesn’t fit all: Cluster A traits include paranoid and schizoid. Cluster B traits are histrionic, antisocial,… Read more »

I’m receiving daily calls from my MS patients who are understandably worried that their disease-modifying-therapy raises their risk of being infected with, and dying from, Covid-19. In my opinion and that of most MS specialists, they should continue their medication, especially the highly effective drugs, such as Tysabri, Ocrevus, and Mavenclad. They were started on… Read more »

Southern California is bracing for a tsunami of COVID-19 cases but people with neurological disorders still need care and support. Here are two updates. 1. A treatment for Alzheimer’s may be here soon. After more than a decade and billions of dollars spent in clinical trials, aducanumab, a monoclonal antibody that effectively clears amyloid from the… Read more »

This is the title of a recent documentary by director Susan Styron. Its mission is to reduce the stigma of migraine, often wrongly stereotyped as a lifestyle disorder of nervous white middle-class women. Migraine, in fact, is a complex, genetically determined neurological disorder, the second most important cause of disability, after low back pain. It… Read more »

In fact, it is now mainstream, based on a century of research in animals. Caloric restriction reduces ageing effects and increases lifespan in animals, presumably by limiting production of damaging oxygen free radicals. With fasting, metabolism is switched from liver-derived glucose to adipose cell-derived ketones. Periodic flipping of this switch by intermittent fasting leads to… Read more »

It’s no longer news that e-cigarettes and vaping devices can cause severe lung problems, including deaths. What is new is a report from the FDA in August 2019 of over 100 cases of epileptic seizures in young people with no prior history of epilepsy and no other recognized triggers. Not to condone marijuana vaping, it… Read more »

Orthostatic hypotension, meaning a fall in blood pressure with standing, is an underrecognized cause of faints and falls in the elderly. Risk of traumatic brain injury and hip fracture is substantial and can increase mortality. Parkinsonism and diuretics used for hypertension or heart failure predispose. Midlife hypertension is a powerful risk factor for ischemic and… Read more »

Whether alcohol promotes or prevents dementia has been studied for years but results are conflicting. A new study tries to resolve the issue by looking at 3000 people (median age 78 and a 6-year follow-up), and separating them into two groups, with or without baseline mild cognitive impairment. For the cognitively unimpaired group, no amount… Read more »

In neurology, vitamin D is important in two settings: epilepsy and multiple sclerosis. The older enzyme-inducing anti-epileptic medications, such as phenytoin (Dilantin) and phenobarbital, are no longer widely used in the US. They increase metabolism of vitamin D, resulting in lower levels and thereby increase bone density loss (osteopenia) which increases risk of fractures, especially… Read more »

There is no reliable device to diagnose concussion on the sidelines, despite extensive research. This is the conclusion of the US Food and Drug administration (FDA), outlined in an April 10, 2019 warning letter to parents, coaches, and trainers. Devices currently in use or development include smartphone apps, portable devices that check eye movements and… Read more »

Even though good scientific evidence may be lacking, many migraine sufferers take supplements. Placebo responses are high (nothing wrong with that) but there are occasional safety concerns, especially regarding butterbur. Widely used are magnesium, feverfew, and riboflavin. A new study seems to explain why some but not all patients respond to riboflavin and supports the… Read more »

This is an important advance as it can dramatically reduce the use of CT scans after concussions. Not only do unnecessary CT scans waste health care dollars but they also expose young athletes to unnecessary radiation. Children and teens, compared to adults, are several times more susceptible to the effects of radiation. Emergency room personnel… Read more »

Dermatomal herpes zoster (shingles) has a lifetime risk of over 30% and carries a high risk of post-herpetic neuralgia which can be excruciating and even permanent. Rarely, the virus can disseminate (spread) and may even result in stroke. Further, recent studies have shown that the virus may be the trigger for giant cell arteritis, a… Read more »

Readers of a review article by Giacoppo and others in Multiple Sclerosis and Related Disorders, 2017, pages 22-31, will probably agree with this statement. Sativex is a branded oromucosal spray containing tetrahydrocannabinol and cannabidiol in a 1:1 ratio. It has been available for years in Canada and has been approved in several European countries since… Read more »

A new device provides noninvasive electrical stimulation of the vagus nerve in the neck to treat episodic cluster headaches. It is call gammaCore and was recently approved by the FDA and will probably be available by prescription in the United States in fall 2017. It is about the size of a cell phone, handheld, applied… Read more »

A practice guideline, prepared by the American Academy of Neurology, was published recently in Neurology. SUDEP stands for sudden unexpected death in epilepsy. This has been recognized for many years but the specific risk has not been consistently established. People with epilepsy can die during a seizure, presumably from post- ictal respiratory depression. SUDEP, according… Read more »

There is good evidence that patients with migraine with aura but not without aura have about a twofold increased risk of stroke. Why this is so, however, is not known. According to a new study, the cause may be cardiac embolism. Patients from the ARIC study of over 15,000 participants, aged 45 to 64 years… Read more »

Patients who have migraine with aura, but not those who have migraine without aura, have been found in several studies to have higher risk of cardiovascular disorders, including stroke. That risk may be 2 times that of a control group though low in an absolute sense because patients are relatively young without cardiovascular risk factors…. Read more »

Eight open-label studies and four placebo-controlled studies addressed this question. Seven of the eight open-label showed improvement in motor symptoms, but the placebo-controlled studies were all negative. A new study was presented at the 4th World Parkinson Congress by Gabriel Villafane. It involved high doses (90 mg per day) of transdermal nicotine and measured the… Read more »

This measures neurofilament-light chain levels. They are a maker to neuroaxonal damage, as the neurofilaments function as a lattice for axons. In the past, lumbar puncture was needed. Now, a blood test has been developed. This studied patients undergoing treatment with fingolimod. Another study involved patients treated with natalizumab. With treatment, levels of the neurofilament-light… Read more »

Essential tremor is common, thought to affect 1 in 10 people over the age of 70, and may be severe, causing significant functional disability. It is difficult to treat. Available medications reduce tremor only partly and do not work in a significant number of patients. Further, they may have adverse effects. They include mainly beta-blockers,… Read more »

Botox is the only approved prophylactic chronic migraine medication, although anticonvulsants, tricyclic antidepressants, and beta-blockers are often used off-label in chronic migraine, whereas several are on-label for episodic migraine. More effective treatment for chronic migraine is a great unmet need. Vagal nerve stimulation is approved for epilepsy and depression. Anecdotal reports of epilepsy patients treated… Read more »

Many patients with migraine use “complementary and alternative medicine” and often do not discuss this with their physicians. There have been guidelines from various professional societies, and recommendations often conflict. The greatest number of studies has been done with riboflavin, coenzyme Q10, magnesium, butterbur, feverfew, and omega-3 polyunsaturated fatty acids. Nutraceuticals are lightly regulated by… Read more »

There are now 4 monoclonal antibodies that block calcitonin gene-related peptide (CGRP) or its receptor in clinical trials. A post-hoc analysis of a phase II trial, which was reported in Lancet Neurology, November 2015, and showed positive results, now found that the highest dose of the medication shows an effect within the first 3 days… Read more »

New daily persistent headache is a diagnosis seen frequently at headache centers. These are patients with no previous history of headache who recall a particular day when they developed a headache which has never improved. They are usually seen several months later after they have had normal neuroimaging and been treated with analgesics. In a… Read more »

Certainly, not by multiple sclerosis patients or their physicians. The more MS treatments that are available, the more complicated and confusing is the tiered system of drug prices. A pharmacy benefit provider contracted by an insurer is allowed to decide what is “preferred,” “nonpreferred,” or “not covered.” These decisions are made solely on the basis… Read more »

A new study has shown that men but not women who have higher urate concentrations had a lower future risk of developing Parkinson’s. It suggested that urate could be protective against risk for Parkinson’s and possibly could slow disease progression during the preclinical stage. Urate is an antioxidant. Several studies have shown that patients with… Read more »

Several studies presented at the 2015 ECTRIMS Conference addressed the issue of how to assess treatment response after the first year, specifically whether the appearance of new MRI lesions or new relapses is reliable. At least 7 studies have shown that newly diagnosed patients, started on interferon and assessed at 1 year, have very high… Read more »

Stem cell pseudomedicine is on the rise, becoming highly profitable as patients and families are desperate for a cure for devastating and incurable neurological diseases, such as amyotrophic lateral sclerosis and multiple sclerosis. Treatment with “cellular therapy” usually costs between $15,000 and $20,000, is not covered by insurance, and is more widely available overseas than… Read more »

Fifteen percent of the population has migraine and 2% to 8% fibromyalgia, with both disorders more common in women than men and with fibromyalgia being more common with increasing age, especially around 50 years old. In a recent study published in Neurology, September 2015, ten percent of migraine patients in a headache clinic had fibromyalgia…. Read more »

The evidence for low vitamin D levels being a risk factor for development of MS is becoming more compelling. In fact, some studies have shown that low vitamin D early in the disease course predicted worse MS clinical and MRI activity and disease progression. A new study sheds light as to why this might be…. Read more »

There are now 11 medications, FDA approved, for relapsing and remitting MS. Other than Novantrone, which is no longer used because of safety issues that were worse than initially predicted, no medication has been approved for progressive MS. The current thrust of research is neuroprotection rather than anti-inflammatory effects. Below is the summary of studies… Read more »

Coffee has been consistently shown when drunk in large amounts to reduce the risk of developing Parkinson’s. Also, patients who smoke cigarettes have a lower risk of Parkinson’s. It has been hard to understand why this should be so, but recent studies point to the fact that Parkinson’s disease patients, because they have less dopamine… Read more »

This device is in clinical trials but seems likely to be approved by the FDA and may be available in 1 to 2 years. The therapy is called CVT-301. It is inhaled as one would use an asthma inhaler. Patients with long-standing Parkinson’s almost always develop motor fluctuations, also called on-off effects. Manipulating the levodopa… Read more »