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Making Peace With My Abnormal Brain

(Andrew Ostrovsky)

(Andrew Ostrovsky)

By Dr. Annie Brewster
Guest Contributor

What you never want to hear from the radiologist: “I wouldn’t mistake it for a normal brain.”

Yet this is what I recently heard from my radiologist friend who kindly took a look at an MRI of my brain. Let me repeat: it was my abnormal brain under discussion here, and I’ll tell you, his assessment was tough to hear.

The state of my brain isn’t exactly news to me. I have had Multiple Sclerosis since 2001, and I have frequent MRIs. Moreover, as a physician at the hospital where I get my treatment, I have the dubious privilege of having complete and immediate access to my medical chart. As such, I often see the MRI images and read the reports before my neurologist does, and fortunately or unfortunately, I understand “medicalese.” (And I have radiologist friends.)

Every time I get an MRI, I devour these reports as soon as they become available on the computer, scanning optimistically for words like “stable.” I even hold onto the absurdly magical hope that old lesions will have disappeared, and that this whole diagnosis of MS has been a big mistake. Instead, I find mention of new “hyperintense foci of white matter signal abnormality” and “enhancing” lesions, “consistent with actively demyelinating MS plaques.” I fixate on words like “volume loss” and “atrophy” and in one preliminary report generated by a resident, I think I saw the word “diminutive.” Did I imagine this?

Despite the sting of these words, I am able to remain somewhat detached. As a doctor, I spend my days looking at radiology images and reading such reports.

Often — due to the formal and impersonal language that is used — it’s hard to remember that the body part being referred to is actually part of a human being. It is even harder to remember that it is part of me!

“I wouldn’t mistake it for a normal brain” penetrates deeper. I understand. My brain is under attack, and is irreparably damaged.

My first response is to mount a defense. I feel the need to tell you that my brain is still a good brain. It just has a few small blemishes. It still works! I recently passed the required ten year recertification medical boards (apparently I will never escape bubble tests), and I feel smarter than ever. I am the mother of four and the primary logistical organizer in my
household, and my (short term) memory is at least ten times better than my husband’s (no offense, honey). Furthermore, research has clearly shown that MRI findings do not necessarily correlate with clinical symptoms in Multiple Sclerosis. So there is no cause for alarm.

Also, the research is promising. Exhibit A is this massive MS conference currently underway in Boston with many great minds focusing their attention on new approaches, such as potential remyelinating therapies, to tackle the disease. (MS damages the myelin, the sheath around nerve cells, and remyelination would restore it.)

My neurologist, Eric Klawiter, at Massachusetts General Hospital, writes me this:

As a research community, we have gained a great deal of knowledge on the mechanism of remyelination and how that process can go awry in MS. There are several candidate compounds demonstrated to promote the body’s ability to differentiate precursor cells into cells that lay down new myelin (oligodendrocytes). It is yet to be established whether these candidate therapies will work best to promote immediate recovery from relapses or whether they will also be effective in the setting of remote demyelination.

Of course, any potential new therapies are years or more away and don’t do much for me right now.

So, underneath my bravado, there is vulnerability. Continue reading

Cheap, Low-Tech Devices Help Paralyzed Patients ‘Speak Their Minds’

Cathy

Cathy Hutchinson, who had a brainstem stroke, is using a head mouse to type on a prototype keyboard, and has typed that she likes it. (Courtesy SpeakYourMind Foundation.)

By Suzanne Jacobs
Guest contributor

When the man started quoting Shakespeare with his eyebrow, Dan Bacher knew he was on to something.

All it took was an off-the-shelf webcam, a green sticker and an app, and the stroke victim had regained his ability to communicate.

“Before that, what he would do is, someone would stand next to him and literally read through the alphabet, and then he would raise his eyebrow to pick a letter,” Bacher says. “He was fully dependent on someone else, and he couldn’t initiate conversation. Someone had to say, ‘Do you want to say something?’”

So Bacher, an engineer, and his colleagues put a green sticker the size of a pencil eraser on the man’s eyebrow and turned a webcam into a tracking system that could follow the green sticker and register a raised eyebrow as a mouse click. With a custom-made app, the man could then scroll through the alphabet and type on his own.

And then Shakespeare — part of a line from “Henry IV” that goes, “A good wit will make use of anything; I will turn diseases to commodity.”

“It was just like one of those wow moments, where we realized, ‘Wow, what we’re doing here really is making a difference,’” Bacher recalls. The device was just a prototype, but Bacher said he hopes to have something permanent for the patient in the coming months.

Bacher is the founder and CEO of the SpeakYourMind Foundation, a nonprofit organization based in Providence, Rhode Island, that’s developing low-cost and easy-to-use communication devices for people with neurological disorders who are “locked in,” virtually unable to move.

So far, the organization has only worked with about 12 clients and is still experimenting with prototype devices, but ultimately, Bacher says, he wants to have products that are widely available. Already, he says, people have been contacting him from around the country asking for help.

SpeakYourMind is far from the cutting edge of research on “brain-computer interfaces,” but that’s the point. Having worked in Brown University’s BrainGate Lab, one of the leading research centers for advanced brain-computer interface technology, Bacher knows all about the cutting edge, and that’s why he decided to start SpeakYourMind — to give people a simpler option, at least for now. Continue reading

Pop Awake At Night? Researchers Blame ‘Sleep Switch’ In Your Aging Brain

(eflon via Compflight)

(eflon via Compflight)

If you’re on the older side and find yourself popping hideously awake in the middle of the night or far-too-early morn, here’s your line for the next time it happens: “Oh, that darned ventrolateral preoptic nucleus of mine! How I miss my old galanin!”

Researchers have just reported in the journal Brain that they’ve found a group of neurons — in the aforementioned nucleus — that function as a kind of “sleep switch,” and whose degeneration over the years is looking very much like the cause of age-related sleep loss. It’s also looking pivotal in the insomnia that often causes nocturnal wandering in people with Alzheimer’s disease.

“This is the first time that anyone has ever been able to show in humans that there is a distinct group of nerve cells in the brain that’s critical for allowing you to sleep,” said the paper’s senior author, Dr. Clifford Saper, chair of neurology at Beth Israel Deaconess Medical Center and professor of neurology at Harvard Medical School.

You may well be wondering exhaustedly how soon this insight — based on the post-mortem analysis of 45 human brains — will lead to better sleeping pills for older folks. I asked Dr. Saper that, too. No promises with timeframes at this point, but he does see the prospect for better-targeted sleeping pills for seniors, with fewer side effects like Ambien’s balance-related problems.

Our conversation, lightly edited:

Can this group of neurons actually explain the lion’s share of sleep problems that older people and people with Alzheimer’s disease have?

It really can. Let me give you a little background. We discovered this cell group in the brains of rats in 1996. We found that there’s a group of of nerve cells in a part of the brain called the hypothalamus that fire when animals are asleep. And we later found that if you eliminate those nerve cells, that animals lose up to 50 percent of all their sleep time, and the remaining sleep is fragmented. They can’t sleep for long bouts at a time; they keep waking up all the time.

At that time, we weren’t sure whether this would be the same in other species. So we looked at the brains of half a dozen other species — of mice and cats and monkeys — and we found that all of them have this cell group and that the cells were active during sleep in all of them. In every species we looked at, this same cell group had a particular neurotransmitter in it, called galanin.

I’ve never heard of that neurotransmitter before… Continue reading

‘I’m Not Stupid, Just Dyslexic’ — And How Brain Science Can Help

Sixth-grader Josh Thibeau has been struggling to read for as long as he can remember. He has yet to complete a single Harry Potter book, his personal goal.

Growing up with dyslexia: Josh Thibeau, 12, imagines his brain as an ever-changing maze with turns he must learn to navigate. Here he is with his mother, Janet. (George Hicks/WBUR)

Growing up with dyslexia: Josh Thibeau, 12, thinks of his brain as an ever-changing maze with turns he must learn to navigate. Here he is with his mom, Janet. (George Hicks/WBUR)

When he was in first grade, Josh’s parents enrolled him in a research study at Boston Children’s Hospital investigating the genetics of dyslexia. Since then, Josh has completed regular MRI scans of his brain. Initially, it seemed daunting.

“When we first started, I’m like, ‘Oh no, you’re sending me to like some strange, like, science lab where I’m going to be injected with needles and it’s going to hurt,’ I’m like, ‘I’m never going to see my family again,’ ” says Josh, who lives in West Newbury, Mass.

Josh and his three biological siblings all have dyslexia to varying degrees. Pretty much every day he confronts the reality that his brain works differently than his peers’. He’s even shared scans of his brain with classmates to try to show those differences. Some kids still don’t get it.

“There was a student that said, ‘Are you stupid?’ Because my brain was working in a different way,” Josh says. “And I’m just like, ‘No, I am not stupid…I’m just dyslexic.’ ”

The Pre-Reading Brain 

On average, one or two kids in every U.S. classroom has dyslexia, a brain-based learning disability that often runs in families and makes reading difficult, sometimes painfully so.

Compared to other neurodevelopmental disorders like ADHD or autism, research into dyslexia has advanced further, experts say. That’s partly because dyslexia presents itself around a specific behavior: reading — which, as they say, is fundamental.

Now, new research shows it’s possible to pick up some of the signs of dyslexia in the brain even before kids learn to read. And this earlier identification may start to substantially influence how parents, educators and clinicians tackle the disorder.

Until recently (and sometimes even today) kids who struggled to read were thought to lack motivation or smarts. Now it’s clear that’s not true: Dyslexia stems from physiological differences in the brain circuitry. Those differences can make it harder, and less efficient, for children to process the tiny components of language, called phonemes.

And it’s much more complicated than just flipping your “b’s and “d’s.” To read, children need to learn to map the sounds of spoken language — the “KUH”, the “AH”, the “TUH” — to their corresponding letters. And then they must grasp how those letter symbols, the “C” “A” and “T”, create words with meaning. Kids with dyslexia have far more trouble mastering these steps automatically.

For these children, the path toward reading is often marked by struggle, anxiety and feelings of inadequacy. In general, a diagnosis of dyslexia usually means that a child has experienced multiple failures at school.

But collaborations currently underway between neuroscientists at MIT and Children’s Hospital may mark a fundamental shift in addressing dyslexia, and might someday eliminate the anguish of repeated failure. In preliminary findings, researchers report that brain measures taken in kindergartners — even before the kids can read — can “significantly” improve predictions of how well, or poorly, the children can master reading later on.

Implicated in dyslexia: The arcuate fasciculus is an arch-shaped bundle of fibers that connects the frontal language areas of the brain to the areas in the temporal lobe that are important for language (left). Researchers found that kindergarten children with strong pre-reading scores have a bigger, more robust and well-organized arcuate fasciculus (bottom right) while children with very low scores have a small and not particularly well-organized arcuate fasciculus (top right). (Zeynep Saygin/MIT)

Implicated in dyslexia: The arcuate fasciculus is an arch-shaped bundle of fibers that connects the frontal language areas of the brain to the areas in the temporal lobe that are important for language (left). Researchers found that kindergarten children with strong pre-reading scores have a bigger, more robust and well-organized arcuate fasciculus (bottom right) while children with very low scores have a small and not particularly well-organized arcuate fasciculus (top right). (Zeynep Saygin/MIT)

Pinpointing The White Matter Culprit

Using cutting-edge MRI technology, the researchers are able to pinpoint a specific neural pathway, a white matter tract in the brain’s left hemisphere that appears to be related to dyslexia: It’s called the arcuate fasciculus.

“Maybe the most surprising aspect of the research so far is how clear a signal we see in the brains of children who are likely to go on to be poor readers.”
– MIT neuroscientist John Gabrieli

“It’s an arch-shaped bundle of fibers that connects the frontal language areas of the brain to the areas in the temporal lobe that are important for language,” Elizabeth Norton, a neuroscientist at MIT’s McGovern Institute of Brain Research, explains.

In her lab, Norton shows me brain images from the NIH-funded kindergartner study, called READ (for Researching Early Attributes of Dyslexia).

“We see that in children who in kindergarten already have strong pre-reading scores, their arcuate fasciculus is both bigger and more well organized,” she says. On the other hand: “A child with a score of zero has a very small and not particularly organized arcuate fasciculus.”

She says we’re not quite ready to simply take a picture of your child’s brain and say “Aha, this kid is going to have dyslexia,” but we’re getting closer to that point. Continue reading

Tracking Dyslexia In The Preschool Brain

By Karen Weintraub
Guest Contributor

Roughly one child in 10 will struggle to learn to read, but no one can tell which one until he or she starts to fall seriously behind.

At that point – often in 3rd grade – they’ve already taken a hit to their self-esteem and they’re too old for early intervention that can make the biggest difference.

This conundrum has troubled MIT professor John Gabrieli for years.

The area highlighted in yellow, called the arcuate fasciculus, is less robust in children at high risk for dyslexia, according to a new study.

The area highlighted in yellow, called the arcuate fasciculus, is less robust in children at high risk for dyslexia, according to a new study.

Today, the neuroscientist and colleagues published a study that begins to address the problem. They showed on brain scans that kindergartners at risk for dyslexia also had less robust connections between two key language areas on the left side of the brain.

Previously, researchers weren’t sure whether the differences they saw in the brains of people with dyslexia were causes of the condition, or effects of their struggle to read. Because Gabrieli’s group saw the distinction in children too young to read, their brain differences must predate reading problems.

His ultimate hope, of course, is to use these differences to identify children before they begin to struggle, and get them into early intervention programs. Continue reading

Why To Exercise Today: Better Grades

Granted, this is a study about kids, but don’t we all want better grades in life, too?

Reuters reports here today:

“Children who get more exercise also tend to do better in school, whether the exercise comes as recess, physical education classes or getting exercise on the way to school, according to an international study. The findings, published in the Archives of Pediatrics & Adolescent Medicine, come as U.S. schools in general cut physical activity time in favor of more academic test preparation.”

Dr. John Ratey, a Cambridge-based psychiatrist and author of the excellent book “Spark,” is all over the topic of how exercise helps children learn, and I see on his Website that it even hosts a documentary called “Brain Gains” about the effects of pilot exercise programs in schools.

Reuters reports:

Three of the four studies involving an exercise intervention found that students given more exercise time scored higher on measures of academic performance. Continue reading

Why To Exercise Today: A Revitalized Brain

Well-exercised mice were found to have re-energized brain cells

Here’s a great motivating piece by Gretchen Reynolds in The New York Times today looking at a brain study involving exercising versus sedentary mice.

For eight weeks, a group of mice were placed on a treadmill to run, while their control-group colleagues lounged around. After two months, both sets of mice were made to run on the treadmill, and, not surprisingly, the runners far outpaced the slackers on endurance. But, the story says:

More interesting, though, was what was happening inside their brain cells. When the scientists examined tissue samples from different portions of the exercised animals’ brains, they found markers of upwelling mitochondrial development in all of the tissues. Some parts of their brains showed more activity than others, but in each of the samples, the brain cells held newborn mitochondria.

There was no comparable activity in brain cells from the sedentary mice.

This is the first report to show that, in mice at least, two months of exercise training “is sufficient stimulus to increase mitochondrial biogenesis,” Dr. Davis and his co-authors write in the study.

And even cooler is the kicker:

Best of all, the effort required to round your brain cells into shape is not daunting. A 30-minute jog, Dr. Davis says, is probably a good human equivalent of the workout that the mice completed.

Daily Rounds: Caritas Hearing Today; Motherhood Triggers Brain Growth; Lifestyle Influences Genetics; The Oldest Galaxy Discovered: House Calls On Facebook

Cerberus has history of tough decisions – The Boston Globe “Over the past decade, it has shut down a Houston mortgage company and fired nearly 800 employees, after first canceling their health insurance. It took a bottling company public without disclosing that it had just lost a major client, then let go hundreds of workers. And it shuttered a Wisconsin paper mill three years after entering the paper business…This morning, at a Massachusetts Supreme Judicial Court hearing, Caritas and Cerberus face the final hurdle in an approval process that began in the spring.” (Boston Globe)

The real 'mommy brain': New mothers’ grew “Motherhood may actually cause the brain to grow, not turn it into mush, as some have claimed. Exploratory research published by the American Psychological Association found that the brains of new mothers bulked up in areas linked to motivation and behavior, and that mothers who gushed the most about their babies showed the greatest growth in key parts of the mid-brain.” (EurekAlert)

Lifestyle Factors May Alter Genetic Traits, Study Finds | WBUR & NPR“Morris set up an experiment with lab rats to see if the biological consequences of a father overeating could somehow get passed on to his daughters.” Incredibly, it seems, they could. When the researcher looked specifically at the daughters, he found that “all of them had a similar genetic makeup, but those with overweight fathers had some of the same problems that their dads did. They weren't overweight, but their production of insulin was impaired. The finding, says Andy Feinberg, at the Johns Hopkins School of Medicine in Baltimore, is "a way it's saying the metabolic sins of the father can be visited on the daughters.” (WBUR | 90.9 FM)

Astronomers Say They've Found Oldest Galaxy So Far – NYTimes.com “Hidden in a Hubble Space Telescope photo released earlier this year is a small smudge of light that European astronomers now calculate is a galaxy from 13.1 billion years ago. That's a time when the universe was very young, just shy of 600 million years old. That would make it the earliest and most distant galaxy seen so far.” (The New York Times)

Nurse spots cancer on Facebook picture | News | Nursing Times (nursingtimes.net) “Nurse Nicola Sharp…was browsing through friend Michele Freeman’s profile when she saw a flash photo of Michele’s daughter Grace. It showed the two-year-old with a white pupil in her left eye instead of the usual “red eye” effect. Ms. Sharp knew this could indicate an eye tumour and, as a result, the child was diagnosed and treated for retinoblastoma.