Dr. Michael Schlitt, Neurosurgeon, Neurosurgery, Seattle

Marijuana and Schizophrenia

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Scientists have been studying the connection between schizophrenia and marijuana use for some time now.  According to a new study done by King’s College in London, increased marijuana use and schizophrenia may have some genes in common.  While still outlawed in most of the world, the legalization of medicinal and recreational marijuana has been a hotly debated topic, which makes research to investigate the health risks from its use that much more important.

Handful of Ganja

A handful of marijuana, which could be directly linked to schizophrenia.

The most common symptoms of schizophrenia include delusions and auditory hallucinations.  It’s still not yet clear what causes the disorder, but scientists believe that a combination of physical, genetic, psychological and environmental factors play a role in its development.  So far, researchers have identified a number of genes linked to schizophrenia, variants of which each slightly increase the risk of development.  For their study, lead author Robert Power and his colleagues analyzed a sample of just over 2,000 healthy individuals, roughly half of whom admitted to using marijuana.  From the number of gene variants linked to schizophrenia that each participant carried, the team assigned each participant a “genetic risk profile” and compared it to marijuana use.

The results of the study revealed that participants whose genetic risk profile predisposed them to schizophrenia were more likely to smoke marijuana, and use it more frequently, than those who didn’t carry schizophrenia risk genes.  Power notes that the findings do not necessarily rule out that marijuana use could directly increase the risk of schizophrenia, but rather suggest that there is most likely an association in the other direction, namely, that a predisposition to schizophrenia most likely increases use of marijuana.  The study, according to him, highlights the complexities of gene-environment interaction in the context of marijuana use and schizophrenia.  Back in December, Medical News Today reported that the use of marijuana is linked to schizophrenia-related brain changes in the thalamus.  This study found that the brain abnormalities persisted long after people stopped smoking.

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Dr. Michael Schlitt, Neurosurgery

The Dangers of Junk Food

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People have been talking about the dangers of smoking for a long time.  However, according to a recent article, unhealthy diets actually pose an even greater risk to global health, and governments should move to tax harmful food products.  In a statement issued on the opening of the annual summit of the World Health Organization (WHO), Belgian professor Olivier de Schutter called for efforts to launch negotiations on a global pact to tackle the obesity epidemic.  Just as the world worked together to tackle the spread of tobacco, he has called for a need to come together to regulate the wide sale of unhealthy foods.

Junk Food

While tasty, junk food like this is extremely harmful to health.

Back in 2005, a UN convention on tobacco control aimed at reducing deaths and health problems caused by the product went into force after a long series of negotiations under the umbrella of the WHO.  In a report to the rights council in 2012, de Schutter claimed that a similar accord on food should include taxing unhealthy products, regulating food high in saturated fats, salt and sugar while cracking down on the advertising of junk food.  It also called for an overhaul on the system of farm subsidies that make certain ingredients cheaper than others, and for support for local production so that consumers will have access to healthy, fresh and nutritious foods.

In a statement made yesterday, de Schutter said that any attempts to promote better diets and fight obesity will only work if the food systems underpinning them are put right.  While governments are focusing on increasing calories availability, they have often been indifferent on what kind of calories are being offered, at what price they’re being offered, to whom they’re made available and how they’re marketed.  Such measures are necessary, in the words of de Schutter, to make sure that people are protected from aggressive misinformation campaigns.

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Dr. Michael Schlitt, Neurosurgery

Cancer-Sniffing Dogs?

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Dogs have long been hailed for their noses, being used to sniff out bombs, drugs and everything in-between.  While humans have about 5 million different olfactory cells in our noses that detect different odors, dogs have approximately 200 million.  However, is it possible that dogs can sniff out prostate cancer as well?  According to a recent study published by Italian researchers, presented at the 109th Annual Scientific Meeting of the American Urological Association in Orlando, specially trained dogs were able to detect prostate cancer from urine samples with an astounding 98% accuracy.

Cancer Dog

A trained cancer-sniffing dog hard at work.

Last November, a spotlight feature from Medical News Today spoke about medical detection dogs, and how they can help alert a diabetic owner to high or low blood sugar levels through being trained to detect a specific scent in their breath or sweat, as well as how dogs are currently being used for detecting various different cancers.  According to one study, trained detection dogs were able to detect ovarian cancer in tissue and blood samples by sniffing out volatile organic compounds (VOCs).  Back in 2011, a study conducted by researchers at UK charity Medical Detection Dogs, such compounds could also be biomarkers of bladder cancer.  The authors of this study on prostate cancer note that back in 2010, a study revealed that specially trained dogs were able to smell VOCs released into urine from prostate cancer tumors.  However, this study only involved 33 patients.  Therefore, the Italian research team did a much larger version of this earlier study.

For this study, the team took two highly-trained dogs to see if they could detect prostate cancer-specific VOCs in the urine samples of 677 different participants.  Out of these, 320 of them had prostate cancer ranging from low-risk to metastatic, while 357 were healthy controls.  They discovered that the dogs could detect prostate cancer-specific VOCs in the urine samples with a combined accuracy of 98%.  Sensitivity to the compounds was an astounding 99% accurate, while specificity was 97% accurate.

According to Dr. Brian Stork, a urologist at West Shore Urology in Michigan, dogs are shaping up to be a promising approach to cancer detection.  While using dogs to identify cancer seems unorthodox, and so recently as ten years ago would have sounded ludicrous, “man’s best friend” very well could help save man’s life.  Earlier this year, Medical News Today reported on a study revealing that dogs could also provide new insight into Chiari malformation in humans, while other research published in Genome Biology showed that dogs could serve as a model for OCD in humans.

 

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Dr. Michael Schlitt, Neurosurgery

Henicraniectomy

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According to researchers, amongst stroke patients older than 60 with life-threatening brain edema, henicraniectomy cut the mortality rate by more than half compared with conservative treatment.  The 6-month survival rate without severe disability was 38% in the surgery group, compared to 18% among controls in a 112-patient randomized trial called DESTINY II, according to Werner Hacke, of the University of Heidelberg in Germany.  Overall 6-month survival was 70% with hemicreniectomy patients, as opposed to 33% of those treated conservatively, according to research in the March 20 issue of the New England Journal of Medicine.  Enrollment stopped early after interim analysis showed that the surgery significantly improved survival.

henicraniectomy

A henicraniectomy in progress.

The trial is the first to focus on older recipient of the procedure, in which about one-quarter of the skull is removed to relieve pressure on the brain following a stroke.  Earlier research found that it improved outcomes in younger patients, although its efficacy and safety in the main age group subject to strokes remained unclear.  In an accompanying editorial, Allan Ropper of Brigham and Women’s Hospital in Boston pointed out that survival was still not guaranteed after the procedure, and most patients receiving it still had significant disability.  He pointed out that half of the survivors in both treatment groups ended up with modified Rankin scores of 4, while about one-third of them had scores of 5.

According to Ropper, while these outcomes are bracing, they’re about the same with or without the operation, and it can be said that hemicraniectomy doesn’t increase the number of disabled patients.  The study also doesn’t provide support for previous claims that surgery improves functional outcome.  The investigators acknowledged that the improve surgical outcomes were driven almost exclusively by the reduction in mortality, although they also pointed out that most survivors in both groups reported being satisfied with their outcomes.  This led to Ropper commenting that people seemed content to just come out of the surgery alive.

Inclusion criteria for the trial were a diagnosis of acute middle cerebral artery infarction with onset less than 48 hours before treatment, 61 years or older, NIH Stroke Scale scores at recruitment of more than 14 in those with infarction in the nondominant hemisphere or more than 19 when infarction was in the dominant hemisphere and brain imaging results indicating that ischemia had affected at least two-thirds of the brain served by the middle cerebral artery.  Patients with significant pre-existing disabilities, lacking pupillary reflexes, Glasgow Coma Scale scores less than 6, hemorrhages or an estimated life expectancy of less than 3 years were excluded.  The average age of enrolled patients was 70, ranging up to 82, and were equally split between men and women.  Median NIH Stroke Scale scores at enrollment were around 20, with a range of 15 to 40.

A total of 49 subjects were randomized to hemicraniectomy and 63 to conservative treatment.  The latter consisted of usual ICU support with osmotherapy, sedation and ventilation.  hemicraniectomy involved the removal of skull bone at least 12 cm in diameter.  The primary outcome was modified Rankin score at 6 months.  Secondary outcomes included survival, NIH Stroke Scale score, quality of life scores from two instruments, Hamilton Depression Rating Scale score and adverse events such as surgical complications.

After 6 months, amongst those who underwent a hemicraniectomy, there were 6 deaths, 33% who had a 5 Rankin score, 28% with a 4 and 32% with a 3.  In the control group, there were 6 deaths, 70% had a 5 Rankin score, 13% had a 4 and 15% had a 3.  After a full year, an additional 6% of the control patients and 10% of the surgery group were dead.  The proportions of those with Rankin scores of 3 or 4 were about the same as they had been six months earlier.  Secondary outcomes for 1-year survivors were about the same in both groups, with large impairments in quality of life and persistent symptoms.  However, overt depression was rare, with no hemicraniectomy survivors showing Hamilton scores of 20 or higher, and only 17% of controls had scores in that range.

Family members gave consent for participation in the trial.  After the 1-year follow-up, Hacke and his colleagues asked the surviving patients themselves if they would have agreed to participate in the study.  63% of the hemicraniectomy patients and 53% of the controls gave their “retroactive consent” to this.

 

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Dr. Michael Schlitt, Neurosurgeon, Neurosurgery, Seattle

Lacrosse in Seattle

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I recently came across an article about Drew Snider, one of the most talented lacrosse players to come out of Seattle.  A two-time prep All-American, a key player in two Maryland runs at a national championship and a current finalist for a spot on the US men’s national team, he’s got quite an impressive track record.

Drew Snider

Drew Snider, shown here playing lacrosse.

However, Snider has admitted that he almost didn’t make it through his first year of lacrosse at Maryland.  While he could play the game naturally, he didn’t understand any of the terms, and as a result his lacrosse IQ was very low.  This is one of the main reasons that Snider has taken a head-coaching position of the O’Dea lacrosse program in its first year of existence.  Snider wants to give young lacrosse players the opportunities that he never had growing up.  O’Dea’s program is one of 14 new teams that has joined the varsity level in Washington in the past two years; there are now a total of 93 squads in the state.  In the past fifteen years or so, lacrosse has exploded in popularity.  Previously restricted to the Northeast and Mid-Atlantic, it’s been gaining quite a following in the west.  While the Washington Interscholastic Activities Association hasn’t officially sanctioned lacrosse yet, O’Dea is one of the few schools to name its lacrosse team a varsity-level sport, instead of just a club.

Back when Snider was in high school, O’Dea had flirted with adding lacrosse to their sports, and really started considering it about three years ago.  O’Dea wanted to offer the sport before last season, but several things didn’t work out.  Now, however, they have opportunities for kids to play this rapidly growing sport.  The number of participants at O’Dea is rising, and Snider also created City Side LAX, a program aimed to teach kids the fundamentals of lacrosse.  The idea is to instill an understanding of the game, so that kids’ lacrosse IQs are higher.  Back when he was a kid, Snider used to walk around with his lacrosse stick and people had no idea what it was.  Now, however, you can drive around the Seattle area and see kids playing lacrosse at fields.

 

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Dr. Michael Schlitt, Neurosurgeon, Neurosurgery, Seattle

Does Brain Training Actually Work?

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The Internet has recently been abuzz with talks about Luminosity, a new website where, for a $14.95 monthly fee, you perform various exercises that “train” your brain.  For example, users perform small exercises that test attention span or memory.  Although Lumosity is the best-known of the brain-game websites, the “brain train” business is booming.  Competitors like Happy Neuron, Neuronix and Cogmed are all springing up, with claims ranging from brain fitness for life to a new hope for Alzheimer’s Disease.  The Centers for Medicare and Medicaid Services even began seeking comments on a proposal that would reimburse the cost of “memory fitness Brain Trainactivities”.

A lot of the focus on the brain fitness business has been on helping children with attention-deficit problems, as well as on improving cognitive function and academic performance in children and adults.  A truly effective way to stave off memory loss or prevent Alzheimer’s, especially with something as simple as a game or website, would be a “holy grail” of neuroscience.  The problem, however, is that the science of cognitive training hasn’t kept up with the hype around it.  Almost all of the marketing claims made by these companies aren’t backed up by any data.  Before you can conclude that something like this truly works, you need large national studies to take a look at it.

For hundreds of years, scientists believed that most brain development occurred in the first few years of life, while the brain was largely immutable by adulthood.  But in the past couple decades, studies on animals and humans have shown that the brain continues to form new neural connections throughout life.  However, it is as of yet unclear as to whether or not an invention that challenges the brain can really raise intelligence and stave off normal memory loss.  Recent studies suggest that certain types of game training can improve a person’s cognitive performance.  Last February, however, an analysis of 23 of the best studies on brain training concluded that while players do get better, increase in skill wasn’t shown to transfer to other tasks.

Other studies, however, have been far more encouraging.  Last September, the journal Nature published a study that showed a driving game did improve short-term memory and long-term focus in older adults.  The research found that improvements in performance weren’t limited to the game, but were also linked to a strengthening of older brains, helping them perform better at other memory and attention tasks.  Brain monitoring during the study also showed that in older participants, game training led to bursts in attention-associated brain waves, similar to those seen in significantly younger brains.

Back in January, the largest randomized controlled trial of cognitive training in healthy older adults discovered that gains in reasoning and speed through brain training lasted as long as 10 years.  The study recruited 2,832 volunteers with an average age of 74, who were then divided into three training groups for memory, reasoning and speed of processing, as well as one control group.  Over five to six weeks, these groups took part in 10 sessions of 60 to 75 minutes, while researchers measured the effect of training five times over the next 10 years.  Five years after training, all three groups still demonstrated improvements in the skills in which they had trained.  However, these gains did not carry over into other areas.  After 10 years, the only groups that continued to show improvement were the reasoning and speed-of-processing groups.  Researchers also found that people in the reasoning and speed-of-mental-processing groups had 50 percent fewer car accidents than those in the control group.

Earlier in 2014, the National Institutes of health invited applications to more thoroughly test brain training.  Researchers hope that it will help establish a consistent standard for determining whether this method works.  Though even as the science isn’t yet clear, entrepreneurs have taken a great interest in this marketing opportunity.

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Dr. Michael Schlitt, Neurosurgery

The Benefits of Chocolate

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There are many people out there whose weakness is chocolate.  However, according to a recent study presented at an American Chemical Society meeting, it turns out that bacteria in the stomach eat chocolate, which CHOCOLATEproduces anti-inflammatory compounds that are beneficial to the heart.  The naturally occurring antioxidants flavanols are found in cocoa products, but until now, scientists didn’t really know what happens to them in the lower gastrointestinal tract.  There have been many different health benefits linked to chocolate, but the exact reason for this has been unclear for a while.

Researchers from Louisiana State University tested three cocoa powders with a series of modified test tubes, which modeled the human digestive tract and simulated normal digestion.  According to one of the researchers, there are both “good” and “bad” microbes.  Good microbes, for example Bifidobacterium and lactic acid bacteria, feast on chocolate.  When you eat dark chocolate, they grow and ferment it, which in turn produces anti-inflammatory compounds.

John Finley, who led the study, explains that cocoa powder contains flavanol compounds of catechin and epicatechin, as well as a small bit of dietary fiber.  Even though both of these are poorly digested and absorbed, good microbes begin to process them once they enter the colon.  After subjecting the non-digestible materials to anaerobic fermentation, Finley says that he observed certain changes.  The fiber is fermented, and the large polyphenolic polymers are metabolized to smaller molecules, which in turn are more easily absorbed.  Then, these smaller polymers exhibited anti-inflammatory activity.  When these compounds decrease inflammation of cardiovascular tissue, it actually reduces the risk of stroke.

In addition, eating prebiotics along with the fiber in cocoa could improve somebody’s overall health by converting polyphenolics in the stomach into compounds that serve as anti-inflammatories.  Prebiotics are naturally found in foods, but are also available as dietary supplements.

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