Heavy methamphetamine users have a higher than normal risk of developing Parkinson’s disease (PD), a new study suggests.  Compared with patients hospitalized for another medical diagnosis, appendicitis, those hospitalized for methamphetamine abuse or dependence had a greater than 2-fold increase in PD risk during follow-up.  “We strongly emphasize the preliminary nature of the findings,” Stephen J. Kish, PhD, from the Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and colleagues note in their report. Nevertheless, they say, the data, “provide some evidence that exposure to methamphetamine of a severity sufficient to contribute to hospital admission might be associated with increased risk of Parkinson’s disease.”

The study findings were published online August 24 in the journal Movement Disorders.

Public Health Concern

Worldwide, it is estimated that 16 million people use methamphetamine, the study authors note. Findings in animals that exposure to the illicit drug can damage brain dopamine neurons “raise the public health concern” that methamphetamine might also damage dopamine neurons in humans, leading to parkinsonism, they write.

To investigate, Dr. Kish and colleagues identified 1863 methamphetamine users, 50 years or older, who were hospitalized in California for a methamphetamine-related condition from July 1, 1990, to June 30, 2000, and were followed up for up to 10 years after discharge.

Roughly 87% of these individuals received a single International Classification of Diseases, Ninth Revision (ICD-9) diagnostic code for either methamphetamine abuse or methamphetamine dependence. The methamphetamine users were matched on demographic variables and follow-up time to 9315 patients hospitalized for primary appendicitis conditions.

In Cox regression analysis, compared with the appendicitis group, the methamphetamine group was at significantly greater risk of being hospitalized with PD during follow-up. The adjusted hazard ratio was 2.65 (95% confidence interval, 1.17 – 5.98, P = .019).

Reached for comment, Tomas R. Guilarte, PhD, who was not involved in the study, said that “it’s important to look at this issue because methamphetamine targets the dopaminergic presynaptic neurons and there is clearly injury to these neurons.

“It is certainly possible that this could modify progression of a disease in a person that has a propensity to develop Parkinson’s disease,” added Dr. Guilarte, who is a professor of neurotoxicology and molecular imaging in the Department of Environmental Health Sciences at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.

Limitations, Caveats

In their article, Dr. Kish and colleagues point to several limitations of the study, chief among them the small sample size limited to hospital admission cases and the uncertainty of whether the hospital diagnosis of PD was confirmed by a neurologist. They also did not have neuropathological data to confirm the diagnosis of PD, and ICD-9 codes do not distinguish between methamphetamine and other amphetamines.

On the other hand, for a variety of reasons, the current study, Dr. Kish and colleagues say, could have underestimated the actual association between methamphetamine use and incident PD.

For instance, methamphetamine users may have been more likely to die during follow-up and less likely to have health insurance, resulting in less access to medical care, compared with the appendicitis group — 2 factors that may have attenuated the incidence rate of PD among methamphetamine users.

In addition, studies have consistently shown that tobacco smoking is associated with a lower incidence of PD. Given that methamphetamine users typically have higher rates of tobacco use relative to the general population, it’s possible that the link between methamphetamine use and PD is stronger than that observed in the current study, Dr. Kish and colleagues note.

More Study Warranted

Dr. Guilarte told Medscape Medical News, “Dr. Kish is a careful researcher and this is a good start. It is not a neuropathologic study, but it certainly suggests there may be a connection” between methamphetamine abuse and parkinsonism.

Dr. Guilarte thinks it would be important to look at the incidence of movement abnormalities in younger methamphetamine abusers.

“In this study, they started looking at people at age 50 or above, when idiopathic Parkinson’s typically presents. Typically, methamphetamine abuse starts in the teen years or early 20s, and it would be interesting to see whether you can express movement abnormalities before 50 years of age. If so, then it might suggest that methamphetamine use is a risk factor,” he explained.

The study was supported by grants from the Ontario Ministry of Health and Long-Term Care to the Centre for Addiction and Mental Health. Dr. Callaghan has received funding from the Canadian Institutes of Health Research, Public Health Agency of Canada, and Ontario Tobacco Research Unit. A complete list of author disclosures (none of which are drug company related) appears in the original article. Dr. Guilarte has disclosed no relevant financial relationships.

Mov Disord. Published online August 24, 2010.

“Acupuncture is a therapeutic intervention characterized by the insertion of fine, solid metallic needles into or through the skin at specific sites,” write Brian M. Berman, MD, from the University of Maryland School of Medicine in Baltimore, and colleagues. “The technique is believed to have originated in China, where it has remained a fundamental component of a system of [medicine that] espouses an ancient physiological system (not based on Western scientific empiricism) in which health is seen as the result of harmony among bodily functions and between body and nature. Internal disharmony is believed to cause blockage of the body’s vital energy, known as qi, which flows along 12 primary and 8 secondary meridians.”

Tenderness on palpation is thought to be evidence of blockage of qi, and inserting acupuncture needles at specific points along the meridians is believed to restore the proper flow of qi. The analgesic effects of acupuncture appear to be based on neural innervation, because they are completely blocked by local anesthesia at needle-insertion sites. Furthermore, acupuncture stimulates the release of endogenous opioids in brainstem, subcortical, and limbic structures, as well as producing mechanical stimulation of connective tissue and other effects on local tissues. Despite these effects, the mechanisms underlying chronic pain relief by acupuncture are not completely understood.

Acupuncture is seldom regarded as the first choice of treatment, in part because randomized controlled clinical trials and large meta-analyses have not proven it to be more effective than sham acupuncture in relieving low back pain. However, it may be useful as part of a multidisciplinary approach to the management of chronic low back pain, along with physical therapy, pain medication, and/or exercise.

“Acupuncture is a regulated discipline, and patients should be referred only to practitioners who are licensed by the state in which they practice,” the review authors write. “A diploma from the National Certification Commission for Acupuncture and Oriental Medicine is a requirement for licensure in most states. Physicians may practice acupuncture in the United States after completing one of several medical acupuncture programs.”

Before embarking on any treatment regimen, all patients with chronic or recurrent low back pain should have a thorough diagnostic workup to rule out cancer, infection, or other serious spinal disease mandating specific medical or surgical intervention. Contraindications to acupuncture include coagulation and bleeding disorders, use of anticoagulants, severe psychiatric disease, and local skin infections or trauma. Electroacupuncture should not be used at the site of pacemakers or other implanted electrical devices. Pregnant women may undergo acupuncture, but not at specific acupuncture points known to be especially sensitive to needle insertion or at acupuncture points in the abdominal regions.

In traditional Chinese medicine, ancillary procedures such as palpation of the radial artery and other areas, tongue examination, and use of herbal medications may accompany needle insertion, but the effect of these procedures is poorly documented. Selection of insertion points for each patient at each treatment is based on the history and physical examination, but there are certain commonly used acupuncture points for low back pain. Different practitioners and acupuncture schools use varying depths of needle insertion (6.4 – 38.1 mm) and diameter (0.1 – 0.3 mm), length (12.7 – 76.2 mm), and number (4 – 20) of needles used.

Needles are left in place for 15 to 30 minutes while the patient relaxes, and the needles often are stimulated manually to produce de qi (a dull, localized, ache) and “needle grasp,” a tugging sensation noted by the acupuncturist as the needle moves against connective tissue. Additional needle stimulation may be achieved with electrical current (electroacupuncture), moxibustion (burning the herb artemisia vulgaris at the end of the acupuncture needle), or heat.

One treatment is considered to be insufficient, and recent trials of acupuncture for low back pain used at least 12 acupuncture sessions, often starting with 2 sessions a week and tapering off after 4 weeks to once weekly, with booster treatments sometimes used monthly or every other month. Acupuncture should be discontinued if there are no apparent effects after 10 to 12 sessions.

Major adverse effects occur rarely with acupuncture, and significant minor adverse events, such as needle-site pain, nausea and vomiting, dizziness, or fainting occur in less than 0.1% of patients. Nonserious adverse events may include needle-site pain in 3% of patients, hematoma in 3%, bleeding in 1%, and orthostatic symptoms in 0.5%.

“There is continuing debate in the medical community regarding the role of the placebo effect in acupuncture,” the review authors write. “The most recent well-powered clinical trials of acupuncture for chronic low back pain showed that sham acupuncture was as effective as real acupuncture. The simplest explanation of such findings is that the specific therapeutic effects of acupuncture, if present, are small, whereas its clinically relevant benefits are mostly attributable to contextual and psychosocial factors, such as patients’ beliefs and expectations, attention from the acupuncturist, and highly focused, spatially directed attention on the part of the patient.”

Joint clinical practice guidelines from the American College of Physicians and the American Pain Society recommend that clinicians consider acupuncture as one possible treatment option for patients with chronic low back pain refractory to self-care (level of supporting evidence, fair). According to the North American Spine Society, acupuncture offers better short-term pain relief and functional improvement than no treatment, and adding acupuncture to other treatments is more effective than other treatments alone, but high-quality, randomized controlled trials are still needed comparing acupuncture with no treatment and with sham acupuncture.

The UK National Institute for Health and Clinical Excellence has also endorsed acupuncture as a treatment option for patients with low back pain lasting more than 6 weeks, with up to 10 sessions of acupuncture during a period of 12 weeks.

“The National Certification Commission for Acupuncture and Oriental Medicine and the American Academy of Medical Acupuncture are potential resources for finding a qualified local practitioner,” the review authors conclude. “At the end of treatment, we would assess the patient’s response, particularly his level of pain, mood, and general activity level, and make a determination about whether he should receive additional acupuncture treatments.”

One of the review authors reports being a member of the board of directors of Stromatec and receiving grant support and payment for travel and accommodation expenses from Stromatec. The other study authors have disclosed no relevant financial relationships.

N Engl J Med. 2010;363:454-461.

“We’re looking at patients who failed first-line treatment,” Marc Ettensohn, a medical student at the University of Louisville in Kentucky, who presented the results, told Medscape Neurology. The stability or improvements in patients in this series, he said, “is saying a lot about the drug and its efficacy. I think this is probably one of the most effective drugs for those who fail first-line treatments.”

The results were reported here at the Consortium of Multiple Sclerosis Centers 24th Annual Conference and the Third Joint Meeting of Americas Committee for Treatment and Research in Multiple Sclerosis.

Tried and Failed DMTs

Natalizumab has previously been shown to reduce new or newly enlarging T2-hyperintense lesions (T2 lesions) and improve EDSS scores in treatment-naive RRMS patients. However, most patients receiving natalizumab have received DMTs that have failed.

Natalizumab, considered very effective, is still viewed as an alternative treatment because of cases of progressive multifocal leukoencephalopathy that have been reported with treatment.

In this report, the researchers conducted a retrospective medical record review of 39 RRMS patients in whom previous treatments have failed. Patients were followed up for a minimum of 6 months to a maximum of 24 months.

Neurologic examinations and the EDSS were performed every 6 months. Eleven patients were previously treated with glatiramer acetate (Copaxone), 16 with interferon beta-1b (Betaseron), 11 with interferon beta-1a (Avonex: 3 patients; Rebif: 8 patients), and 1 with azathioprine (Imuran). Some patients may have received concomitant steroid treatment.

Participants had a median EDSS score of 3.0 and median counts of T2 lesions and black holes of 18 and 4. The researchers found no statistically significant changes in EDSS scores or MRI changes at 6, 12, 18, and 24 months.

At 24 months, 54% of patients had unchanged T2 counts, whereas 38% had improved counts, and 8% had worsened counts compared with month 0. There were no changes in black holes in most patients.

Overall, 87% of RRMS patients showed stable to improved MRI scans, and 59% had stability or improvement in EDSS scores.

Alternatives Important

“It’s important to know [that there are alternatives] in a disease like MS,” Robert P. Lisak, MD, professor of neurology at Wayne State University, Detroit, Michigan, who attended the presentation, told Medscape Neurology.

“If a drug is no longer working or the patient doesn’t want to take it, the physician isn’t stuck in a position of saying, ‘there’s nothing I can do for you,’” he added.

The study was supported by the Consortium of Multiple Sclerosis Centers. Mr. Ettensohn has disclosed no relevant financial relationships. Disclosures for coauthors appear in the abstract. Dr. Lisak reports he is part of a group that receives funding from Novartis, makers of natalizumab.

Consortium of Multiple Sclerosis Centers (CMSC) 24th Annual Conference and the Third Joint Meeting of Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS): Abstract S35. Presented June 4, 2010.

Autism (pronounced awt-izm) is a mental condition that can start in childhood.
A child with autism becomes very self-focused, loses the ability to relate to others, and has trouble with language and reasoning. A child with autism will have trouble with imaginative play, and will engage in repetitive behaviors and activities.
No one knows why children get autism. It seems to occur more often in boys than in girls. It happens more often in some families. Autism may be due to differences within the brain. It may be caused by conditions that affect brain development before, during, or after birth. These include rubella in the mother, lack of oxygen at birth, and complications of childhood illnesses.
While the cause of autism is not known, it isn’t due to bad parenting, a behavior disorder, or mental illness.

What are the symptoms of autism?
The symptoms vary from child to child. Some children only have mild symptoms. In other children, the symptoms are worse.
Some parents start to see symptoms when their babies are very young, sometimes as young as 1-2 years of age. At first, the baby doesn’t seem to respond much to the caregiver. They often describe their baby as not making eye contact, smiling, or cuddling.
Babies with autism want to remain alone in their crib, sometimes for many hours at a time. They don’t want to be disturbed, and they don’t want attention. They are quiet and passive, unless their activity is uninterrupted. They may have stereotyped and repetitive mannerisms, such as flicking fingers, hand flapping, arranging objects, and insistence on rituals.
Older children with autism may be extra-sensitive to sounds, smells, touch, or taste. Their play activities lack imagination. They may not learn speech at the expected age.
Children with autism tend to react to changes in the home, or in the usual routine, with temper tantrums. Sometimes though, there is no apparent reason for the tantrum.
After about 5 to 6 years of age, the self-isolation, tantrums, and rituals tend to be less frequent. Even then, however, children with autism don’t learn language and social skills normally.
What tests are needed?
There is no specific test for autism. Instead, a team of health care professionals works together to make the diagnosis. This team includes a neurologist, psychologist, developmental pediatrician, speech/language therapist, and a learning consultant.
Tests may be done to rule out other illnesses.
What treatment is needed?
There is no known cure for autism. However, early intervention can help to improve quality of life.
Therapy may include speech and language therapy, occupational therapy, and physical therapy. A speech pathologist who specializes in the diagnosis and treatment of language and speech disorders can help your child learn how to communicate better. Occupational therapy focuses on helping your child improve fine muscle movement. With physical therapy, therapists work on improving motor skills, and on developing strength, coordination, and movement.
There are many creative ways to help your child cope with the symptoms. Your child’s doctor and counselor may suggest music therapy, behavior modification, medicine, and specific diet therapies.
There are no medicines that can be used to treat autism. Sometimes, though, your doctor may recommend medicine to treat very specific symptoms your child might have.
Do
• Do provide a strict unchanging routine in your home. This helps to reduce repetitive behaviors
• Do enroll your child in a treatment program that is directed by a team of doctors and counselors
• Do check out support services and local support groups for parents or caretakers
• Do call your doctor if you have questions about your child’s health or need information about services available for autistic children
• Do call your doctor if your child has any problem associated with medicine, or if symptoms worsen
Don’t
Don’t deny your child the opportunity to reach full potential. Children with autism can be creative, but they need structure. Many types of treatment are available that may be helpful.
Recovery time
There is no cure for autism, but with proper help your child can learn to cope with the symptoms.
Early intensive interventions are the most successful. Generally, lifelong follow-up care will be needed.
Some children are capable of attending regular schools after about 10 years of age. Some adults with autism are able to hold jobs and live independently.
Unfortunately, though, autism can result in a lifelong developmental disorder of the brain.
What can be done to stop it from happening again?
There is no known way to prevent autism.
Further information on autism can be found from:
Autism Society of America
7910 Woodmont Avenue, Suite 300
Bethesda, MD 20814-3067
Tel: (1-800) 3-AUTISM or (301) 657-0881
Website: Click here
Autism Research Institute
4182 Adams Avenue
San Diego, CA 92116
Tel: (619) 563-6840
Therapeutic Nursery for Autistic Children
New Bellevue 21
South Bellevue Hospital Center
462 First Avenue at 27th Street
New York, NY 10016-9198
Tel: (212) 562-4504
Center for the Study of Autism
Website: Click here
Reproduced with permission from PDxMD – Clinical Information for Quality Care – www.pdxmd.com

However, Langhammer and Stanghelle (2000) carried out a randomised conrolled trial. This compared the Bobath approach (facilitation/inhibition strategies) and the Motor Relearning Programme (task oriented strategies) in stroke rehabilitation. 61 acute stroke patients were randomly assigned to 2 groups. Group 1 (33 patients) received physiotherapy according to the Motor Relearning Programme (MRP) and group 2 (28 patients) received physiotherapy according to the Bobath approach. The patients were tested 3 days after admission, 2 weeks after admission and 3 months post stroke by using four different assessment scales: the Motor Assessment Scale (MAS), the Sodring Motor Evaluation Scale (SMES), the Barthel ADL Index and the Nottingham Health Profile (NHP). The authors also recorded length of stay in hospital, use of assistive devices for mobility and the patient’s accommodation after discharge.

The results showed that both groups improved in MAS and SMES but improvement in motor function was significantly greater in the MRP group. The patients receiving MRP were discharged, on average,12 days prior to those receiving Bobath (21 days versus 34 days). Both groups improved in the Barthel ADL Index but the women in the MRP group improved more in ADL than the women in the Bobath group. There were no differences between groups in the life quality test (NHP), use of assistive devices or accommodation after discharge from the hospital. The authors concluded that in the acute rehabilitation of stroke patients, physiotherapy treatment using the MRP is preferable to that using the Bobath approach.

There have been several surveys recently carried out amongst physiotherapists in order to develop an insight into current practice and the perceived theoretical basis behind treatment of stroke patients.

Carr et al (1994) carried out a survey of Australian physiotherapists’ choice of treatment in stroke rehabilitation. This was based on a previous study amongst Swedish physiotherapists (Nilsson & Nordholm, 1992). The aims, as with the Swedish study, were to establish: 1) Choice of treatment in the rehabilitation of individuals following stroke; 2) factors influencing the choice of treatment; 3) The theoretical bases for choice of treatment; 4) Attitudes towards changing interventions.
Results from this survey showed that as regards choice of treatment, the most common treatment category was “functional activities”. In terms of factors influencing choice of treatments, respondents ranked “experience through working with patients” as the most important factor and professional literature and basic training as the least important factors. This was similar to the Swedish physiotherapists.
As regards the theoretical basis for treatment, 10% of physiotherapists did not even attempt to describe their theoretical basis and of those who did, 38% of responses were not theoretically based. The majority described a movement science theoretical basis, which is different from the Swedish study in which the majority of respondents listed a combination of approaches.
As regards attitudes towards changing interventions, 64% (Sweden: 75%) were very interested in attending a course on the application of movement sciences as an indication of their attitude towards change, 31% rather interested (Sweden: 16%) and 5% not at all interested (Sweden: 9%). The authors concluded that the difficulty physiotherapists have in describing the theoretical basis for development may hinder the development of physiotherapy as an ongoing science.

A further survey was carried out in a similar fashion by Sackley and Lincoln, (1996), this time amongst physiotherapists in the Trent region of the UK. This study used interview techniques as well as questionnaires.

The results of this study showed that the “Bobath” approach was the most frequently used (80%) and the “functional approach” and the “motor learning approach” were only used by 10% and 4% respectively. Once again, the physiotherapists found it difficult to describe a theoretical basis for their choice of treatment and the reason for choosing a particular approach was again through experience rather than through the use of published results.

The consensus seemed to be that the Bobath approach was the best because “it appeared effective”, although nobody could explain how this would be acheived. The subjects seemed unaware of the lack of evidence supporting the Bobath approach, apart from 2 respondents in the “functional” group. The authors agreed with those of the previous studies in concluding that a change in culture is required, with implementation of research results, in order to progress the physiotherapy treatment of stroke patients.

A survey was done by Davidson & Waters, (2000) on physiotherapists working with stroke patients in the U.K. The aims of the study were to 1) Gather demographic information about physiotherapists working with stroke patients. 2) Identify assumptions surrounding physiotherapy intervention. 3) Investigate issues of conflict between physiotherapists and medical/nursing staff. 4) Identify types of approach used.

Results came from 973 physiotherapists with varying clinical experience in several different work locations. 88% of respondents primarily used the Bobath approach although 87% adopted an eclectic approach. Only 4% used Carr & Shepherd’s motor relearning approach despite it being described extensively in literature. Most of these therapists were from Scotland.

When asked about the theoretical basis underlying treatments, respondents gave various answers for the same approach. This could suggest that therapists interpret different concepts in their own way resulting in a lack of consistency in treatment methods.

16% of respondents agreed with the statement “ I am frequently in conflict with nurses and/or doctors because I prevent patients from walking even though they are able to do so.” 22% agreed with the statement “ I am frequently in conflict with nurses and/or doctors over early discharge of stroke patients.” (Davidson & Waters, 2000).

The main finding from this survey is that although therapists claim to be using specific approaches in treatment, many of their assumptions are unsubstantiated. They also seem unclear as to what constitutes individual approaches. By interpreting concepts in their own way, they may be using an approach or approaches which are quite different from the original concept.
Carr, (1996), suggests that approaches are dynamic and moving whilst the concept stays the same. It would appear from these surveys that it is time to redefine the concepts of each approach and establish theoretical bases for them. This could lead to more consistent treatments from physiotherapists based on established theories which have been researched.

REFERENCES

CARR J. AND SHEPHERD R. (1989) A Motor Learning Model for Stroke Rehabilition Physiotherapy July Vol. 75, 7
CARR ET AL (1994) Physiotherapy in Stroke Rehabilitation: Bases for Australian Physiotherapists’ Choice of Treatment Physiotherapy Theory and Practice Vol. 10 201-209
DAVISON I. AND WATERS K. (2000) Physiotherapists working with stroke patients: A national survey Physiotherapy 86 2 69-8
LANGHAMMER B. AND STANGHELLE J. (2000) Bobath or Motor Relearning Programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomised control study Clinical Rehabilitation 14 361-369
SACKLEY C. AND LINCOLN N. (1996) Physiotherapy Treatment for Stroke Patients: A survey of Current Practice Physiotherapy Theory and Practice 12 87-96

By analysing the symptoms of stroke attack we are able to redefine this condition within the non western framework of Traditional Chinese Medicine (TCM) as Wind Stroke, which can be interpreted as an attack on the meridians or organs in a specific energetic manner.
Acupuncture then seeks to redress and rebalance this energetic condition through three levels of intervention. Initially acupuncture can be applied at the level of first aid reducing spasms, blood pressure, and assisting resuscitation. Subsequent treatment can follow a traditional five element approach clearing blockages and working with the individuals’ dominant energetic to improve well being. On a longer term basis acupuncture can be used to help prevent reoccurrence by regulating the underlying imbalances that are the root cause of stroke attack (Maciocia 2004)
Supporting Evidence – Research
The three leading research papers which have documented beneficial intervention of acupuncture treatment in stroke victims are Hopwood & Lewith 2005, Johanson 1993, and Sallstrom et al 1996. Each study clearly identifies a statistically significant trend towards long term post stroke recovery in areas such as, remaining and having greater independence within the home, motor function, and quality of life. Additionally subsequent trials were carried out on some of the above sample groups indicating a continual long term improvement which was not found in the appropriate placebo groups.
Whilst there is a vast amount of data from China in relation to the treatment of strokes, there are no trials at present which have been conducted within the Western research framework. However, as acupuncture intervention within the east is generally accepted as common practice it could potentially offer a valuable area for further research and study.
In summary one, the common thread between all the studies regardless of origin, is that the sooner acupuncture intervention is applied the greater the response and long term well being of the patient.
Supporting Evidence – Clinical Practice
Acupuncture has proved successful in treating Stroke patients in practice for example:

Post (2009) has successfully treated numerous Stroke patients with acupuncture, including scalp acupuncture, with specific benefits for limb motor control, facial paralysis and speech. Early and frequent treatment is preferable. The appropriate selection of scalp or body points or a mix of both depends on the type of stroke, symptoms and extent. Electroacupuncture and moxa are also very effective treatment options.

Davis (2009) has successfully treated Stroke patients primarily with scalp and electroacupuncture. One patient regained the motor control of left arm following scalp acupuncture. Two patients treated 2 weeks and 6 months post stroke respectively had noticeable improvements in depression and mood. Consultant permission was required to treat patients in hospital, but this took time and prompt treatment is required for best effect, particularly for motor control recovery.

Although prompt treatment is most beneficial, later treatment may still offer benefits. Dean (2009) has treated a patient who still had post-stroke circulation problems and numbness in his right limbs 5 years post stroke. The practitioner found significant energetic (Akabane) imbalances between the stroke and non stroke sides and when these imbalances were corrected along with treating the patient’s broader constitutional imbalance (CF), the circulation balanced and the patient no longer has numb right limbs.

Conclusions
Traditional Acupuncture is a viable treatment option for Stroke and should be offered alongside Western Medicine treatment as part of the multi-disciplinary team response in primary care and community rehabilitation services
As with all other stroke treatment, the maximum treatment benefit is gained from early intervention to aid long term recovery and prevent recurrence
The benefits of acupuncture are holistic. Acupuncture doesn’t only address the physical symptoms of Stroke but can also treat mental issues such as depression and mood changes as well as improving the energetic balance and general well-being of the patient.
Fiona Lee and Nige’ Cowey

References

Acupuncture for acute stroke (Review) (2008) The Cochrane Collaboration Available at http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003317/pdf_standard_fs.html Accessed 01/02/09
British Acupuncture Council / Acupuncture Research Council 1999 Briefing Paper No 2 Stroke and Acupuncture Available at http://www.acupuncture.org.uk/content/Library/doc/cva_bp2.pdf#search=%22briefing%20paper%20no%202%22 Accessed on 01/02/09

Chan (2007) Acupuncture for stroke rehabilitation – three decades of information from China Boulder: Blue Poppy Press
Davis J (2009) Acupuncture in Stroke Rehabilitation – case study telephone conversation with Fiona Lee 27/03/ 2009
Dean M (2009) Acupuncture in Stroke Rehabilitation – conversation with Fiona Lee 04/02/2009
Hopwood V & Lewith GT (2005) Does acupuncture help stroke victims become more independent? The journal of alternative and complementary medicine Volume 11, Number 1, 2005, pp 175-177
Hopwood V & Lewith GT (1997) The effect of acupuncture on the motor recovery of the upper limb after stoke Physiotherapy December 1997 vol 83, no 12
Johansson et al (1993) Can sensory stimulation improve the functional outcome of stroke patients Neurology 1993:43:2189-92
Maciocia G (2004) The Practice of Chinese Medicine Nanjing; Churchill Livingstone
NICE (2008): Stroke – Diagnosis and initial management of acute stroke and transient ischaemic attacks (TIA) (Nice Clinical Guideline 68)
Available at: http://www.nice.org.uk/nicemedia/pdf/CG68NICEGuideline.pdf
Accessed 15/02/2009

Sallstrom S et al (1996) Acupuncture in the treatment of stroke patients in the sub acute stage Complement Therapies in Medicine 7:157 – 60

Stroke Association (2006)
Available at http://www.stroke.org.uk/ Accessed 01/02/09

Patient UK (2008a) Cerebrovascular Event Rehabilitation
Available at: http://www.patient.co.uk/showdoc/40000149/ Accessed 15/02/2009

Patient UK (2008b) Stroke
Available at: http://www.patient.co.uk/showdoc/23068830/ Accessed 15/02/2009

Post D (2009) Acupuncture in Stroke Rehabilitation – emails to Fiona Lee 31/03/2009; 26/04/2009 and telephone conversation 26/04/2009

In a longitudinal cohort study, Dr. Avshalom Caspi, of Duke University, Durham, North Carolina, and colleagues analyzed the occurrence of psychotic symptoms, including self-reported hallucinations and delusions, in a nationally representative birth cohort of 2232 British twins followed since age 5.

In the April Archives of General Psychiatry, they report that when the children were 12 years old, their prevalence of psychotic symptoms was 5.9%, which was similar to the reported prevalence of childhood psychotic symptoms in other contemporary community samples of adolescents.

The most frequently reported psychotic symptom was hallucinations.

The children’s symptoms were heritable and familial, according to the authors. They were also associated with home-rearing risk factors (e.g., maternal expressed emotion, chaotic households) and social risk factors. Children with psychotic symptoms were more likely than those without symptoms to live in an urban environment and to come from disadvantaged families.

Development of psychotic symptoms was also linked with cognitive impairments at age 5; these children also tended to have more behavioral, emotional, and educational problems at age 5, and more comorbid conditions, including self-harm.

“The presence of psychotic symptoms in preadolescence adds support to the hypothesis that symptoms may signal a longstanding trait diathesis, which in some but not all individuals converts to clinical disorders during adolescence or adulthood,” the researchers say.

Although there is no cure for essential tremor, Medtronic Deep Brain Stimulation (DBS) Therapy for Essential Tremor is safe and effective when used for appropriate patients,1 and has been proven to reduce tremors associated with ET.2

Drug Therapies
Most people with essential tremor benefit from drug therapy. The approach to the treatment needs to be balanced, taking into account the patient’s history, response to previous treatment, coexisting diseases, and other factors. The initiation of drug treatment is based on the evaluation of the benefits and side effects of particular medications.3

Thalamotomy
A type of brain surgery that involves making a lesion (controlled destruction of brain tissue) in the area of the brain that produces tremors. Thalamotomy has been shown to effectively reduce tremor in some people. The potential complications may include problems with speech, balance and numbness.

Medtronic DBS Therapy for Essential Tremor Control
Medtronic DBS Therapy for Essential Tremor is a surgical treatment that has been proven to reduce the severity of the tremor in your arms and hands associated with essential tremor (ET).2

The treatment uses an implanted medical device, similar to a pacemaker, to deliver electrical stimulation to precisely targeted areas of the brain. This stimulation blocks the brain signals that cause the symptoms of essential tremor.

References
1.Zesiewicz TA, Elble R, Louis ED, et al. Practice parameter: therapies for essential tremor: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2005;64:2008-2020.
2.Schuurman PR, Bosch DA, Bossuyt PMM, et al. A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor. N Engl J Med. 2000;342:461-468.
3.Approaches to Treatment. Available at: www.wemove.org. Accessed July 15, 2008.

Often misdiagnosed as Parkinson’s disease, essential tremor is very common. In fact, 1 in 5 people over age 65 may have it.1 If essential tremor is affecting your ability to live an active lifestyle, a therapy from Medtronic may be able to help manage your symptoms.
Definition
Essential tremor (ET) is a movement disorder that usually affects the hands, but can also affect the head, voice, and legs.

Essential tremor is not a life-threatening disease, but it can be a life-altering condition. People with essential tremor often lose the ability to perform simple tasks like driving or going to work. Coping with the resulting feelings of isolation can be difficult.

Among more than 20 different kinds of tremor, essential tremor is the most common. As many as one in 20 people older than age 40 and one in five people over 65 may have essential tremor.1 Although the average age of onset for essential tremor is 40, ET may first appear at any age between childhood and old age.2

Symptoms
Essential tremor is characterized by rhythmic shaking that occurs during voluntary movement or while holding a position against gravity. Essential tremor is often misdiagnosed as Parkinson’s disease.

The two types of tremor include:

•Action tremor – a voluntary movement such as lifting a cup to one’s mouth
•Postural tremor – a voluntary holding of a position against gravity such as reaching or extending one’s hand or arm
Most people with essential tremor experience both postural and action tremor.

Causes and Risk Factors
Essential tremor is the result of abnormal communication between certain areas of the brain, including the cerebellum, thalamus, and brain stem. The cause of essential tremor is unknown, but there is evidence that for some people the disorder is genetic. However, people with no family history of tremor can also develop essential tremor.

References
1.What is Essential Tremor? Available at: www.essentialtremor.org. Accessed July 14, 2008.
2.At what age does ET start? Available at: www.essentialtremor.org. Accessed July 14th, 2008.