Migraineurs Suffer Restless Legs

Migraineurs Suffer Restless Legs

TAKE-HOME MESSAGE

  • Poor sleep is a confounder in migraine recovery and tends to increase migraine incidence.
  • Restless leg syndrome (RLS) impairs high quality sleep.
  • In this large study, migraine patients were found to have a higher prevalence of RLS than normal controls and their RLS symptoms were much worse.
  • Efforts to control migraine that also address RLS may lead to better outcomes.

Abstract

BACKGROUND AND PURPOSE:

Our aim was to study not only the prevalence but more importantly the severity and the correlation between sleep quality and restless legs syndrome (RLS) in a large population of well-defined migraine patients as poor sleep presumably triggers migraine attacks.

cervicogenic headacheMETHODS:

In a large cross-sectional and observational study, data on migraine and RLS were collected from 2385 migraine patients (according to the International Classification of Headache Disorders ICHD-IIIb) and 332 non-headache controls. RLS severity (International RLS Study Group severity scale) and sleep quality (Pittsburgh Sleep Quality Index) were assessed. Risk factors for RLS and RLS severity were calculated using multivariable-adjusted regression models.

RESULTS:

Restless legs syndrome prevalence in migraine was higher than in controls (16.9% vs. 8.7%; multivariable-adjusted odds ratio 1.83; 95% confidence interval 1.18-2.86; P = 0.008) and more severe (adjusted severity score 14.5 ± 0.5 vs. 12.0 ± 1.1; P = 0.036). Poor sleepers were overrepresented amongst migraineurs (50.1% vs. 25.6%; P < 0.001). Poorer sleep quality was independently associated with RLS occurrence (odds ratio 1.08; P < 0.001) and RLS severity (P < 0.001) in migraine patients.

CONCLUSION:

Restless legs syndrome is not only twice as prevalent but also more severe in migraine patients, and associated with decreased sleep quality.

Citation

van Oosterhout WP, van Someren EJ, Louter MA, Schoonman GG, Lammers GJ, Rijsman RM, Ferrari MD, Terwindt GM. Restless legs syndrome in migraine patients: prevalence and severity. Eur J Neurol. 2016 Mar 21. doi: 10.1111/ene.12993

Coconut Oil in Prevention of Alzheimer’s Disease

Coconut Oil in Prevention of Alzheimer’s Disease

TAKE-HOME MESSAGE

  • Alzheimer’s disease (AD) is a complex  disease  that  progresses  over  many  years,  such  as diabetes,  heart  disease  and  other  chronic
  • A number of factors may increase or decrease an individual’s chances of developing the AD, including age, genetics, environment, lifestyle and metabolic diseases.
  • Coconut may be beneficial in the treatment of obesity, dyslipidemia, elevated LDL, insulin resistance and hypertension – these are the risk factors for CVD, type 2 diabetes and also for AD

Abstract

Coconut Oil in Prevention of Alzheimer’s DiseaseCoconut, Cocos nucifera L., is a tree that is cultivated to provide a large number of products, although it is mainly grown for its nutritional and medicinal values. Coconut oil, derived from the coconut fruit, has been recognised historically as containing high levels of saturated fat; however, closer scrutiny suggests that coconut should be regarded more favourably. Unlike most other dietary fats that are high in long-chain fatty acids, coconut oil comprises medium-chain fatty acids (MCFA). MCFA are unique in that they are easily absorbed and metabolised by the liver, and can be converted to ketones. Ketone bodies are an important alternative energy source in the brain, and may be beneficial to people developing or already with memory impairment, as in Alzheimer’s disease (AD). Coconut is classified as a highly  nutritious  ‘functional  food’.  It  is  rich  in  dietary  fibre,  vitamins  and  minerals;  however,  notably,  evidence  is  mounting  to support the concept that coconut may be beneficial in the treatment of obesity, dyslipidaemia, elevated LDL, insulin resistance and hypertension – these are the risk factors for CVD and type 2 diabetes, and also for AD. In addition, phenolic compounds and hormones (cytokinins) found in coconut may assist in preventing the aggregation of amyloid-b peptide, potentially inhibiting a key step in the pathogenesis of AD. The purpose of the present review was to explore the literature related to coconut, outlining the known mechanistic physiology, and to discuss the potential role of coconut supplementation as a therapeutic option in the prevention and management of AD.

Citation

WM Fernando, Ian Martins, KG Gooze, Charles Brennan, Vijay Jayasena, RN Martins.The role of dietary coconut for the prevention and treatment of Alzheimer’s disease: Potential mechanisms of action. The British journal of nutrition (Impact Factor: 3.45). 05/2015; Epub ahead of print(01):1-14. DOI: 10.1017/S0007114515001452

Open Letter to Non-Member Neurologists

Dear Neurologist,

The International College of Chiropractic Neurology (ICCN) is reaching out to chiropractic physicians credentialed in neurology with an offer for membership in our organization.   

The ICCN was formed as and evidence informed neurology association and credentialing board for chiropractic neurologists.  We are currently accepting neurologist for membership credentialed by the following boards: 

  • American Chiropractic Neurology Board (DACNB)
  • International Board of Chiropractic Neurology (DIBCN)
  • American Chiropractic Academy of Neurology (DACAN)
  • Chiropractic Board of Clinical Neurology (DCBCN)

The ICCN maintains a website which explains our mission and strategic plan

Membership services include assisting our members in the satisfaction of their intellectual curiosity. We published over 70 abstracts withcomentary in 2015 in contemporary neurology for our members to review. We are also honored to have the Journal of Chiropractic Medicine as our official journal which is delivered to our members each quarter.  

Our main goal is to provide you with an association focused on member service, a forum for intellectual advancement and a reasonable mechanism for credentials maintenance.  

If you are interested in more information, please contact us to see if we may be of service to you.

Sincerely, 

Richard L. Cole, DC, DACNB, DAAPM, FICCN, FICC(H)

President

International College of Chiropractic Neurology

 

 

 

 

 

Rivermead and Trail-Making Tests Reliably Predict Concussion Recovery

Rivermead and Trail-Making Tests Reliably Predict Concussion Recovery

TAKE-HOME MESSAGE

  • Concussion diagnosis and management continues to be a source of concern for clinicians and there remains a need for valid instruments to predict concussion recovery
  • The Rivermead Post Concussion Symptom Questionnaire (RPQ) and the Trail-making test (TMT) have been proven by this study to substantially predict moderate to severe limitations.
  • The RPQ and TMT instruments are easy to administer and may be helpful to clinicians who diagnose and manage concussion.
RPQ can be Downloaded here
TMT can be Downloaded here.

Abstract

The aim of the study was to determine if the Rivermead Postconcussion Symptoms Questionnaire (RPQ) is a better tool for outcome prediction than an objective neuropsychological assessment following mild traumatic brain injury (mTBI).

The study included 47 patients with mTBI referred to an outpatient rehabilitation clinic. The RPQ and a brief neuropsychological battery were performed in the first few days following the trauma. The outcome measure used was the Mayo-Portland Adaptability Inventory-4 (MPAI-4) which was completed within the first 3 months. The only variable associated with results on the MPAI-4 was the RPQ score (p < .001). The predictive outcome model including age, education, and the results of the Trail-Making Test-Parts A and B (TMT) had a pseudo-R2 of .02. When the RPQ score was added, the pseudo-R2 climbed to .19. This model indicates that the usefulness of the RPQ score and the TMT in predicting moderate-to-severe limitations, while controlling for confounders, is substantial as suggested by a significant increase in the model chi-square value, delta (1df) = 6.517, p < .001.

The RPQ and the TMT provide clinicians with a brief and reliable tool for predicting outcome functioning and can help target the need for further intervention and rehabilitation following mTBI.

Citation

de Guise E1,2, Bélanger S3, Tinawi S4, Anderson K1, LeBlanc J3, Lamoureux J5, Audrit H1, Feyz M3. Usefulness of the rivermead postconcussion symptoms questionnaire and the trail-making test for outcome prediction in patients with mild traumatic brain injury. Appl Neuropsychol Adult. 2015 Nov 16:1-10. [Epub ahead of print]

Author information:

  • 1a Psychology Department , University of Montreal , Montreal , Quebec , Canada.
  • 2b Neurology and Neurosurgery Department , McGill University , Montreal , Quebec , Canada.
  • 3c Traumatic Brain Injury Program , McGill University Health Centre-Montreal General Hospital , Montreal , Quebec , Canada.
  • 4d Rehabilitation Medicine Department , McGill University Health Centre-Montreal General Hospital , Montreal , Quebec , Canada.
  • 5e Social and Preventive Medicine Department , University of Montreal , Montreal , Quebec , Canada.

Chiropractor Identifies Dissection in Process

Chiropractor Identifies Dissection in Process

TAKE-HOME MESSAGE

  • Neck pain and headache are common complaints that respond well to chiropractic cervical manipulation.
  • Cervical manipulation has recently been blamed as a causative factor in vertebral artery dissections.
  • Vertebral artery dissection in process primarily presents as neck pain and headache.
  • Recent research suggests that cervical manipulation does not cause vertebral artery dissections but that patients with dissections in process enter with neck pain and headache and the dissection is overlooked.
  • This article reports on a patient entering for manipulation with vertebral dissection in process. This article challenges chiropractic physicians to consider dissection as a possible diagnosis for patients entering with neck pain and headache.

Abstract

A 30-year-old woman presented to an emergency department with sudden onset of transient loss of left peripheral vision. Owing to a history of migraine headaches, she was released with a diagnosis of ocular migraine. Two days later, she sought chiropractic care for the chief symptom of severe neck pain. The chiropractor suspected the possibility of vertebral artery dissection (VAD). No manipulation was performed; instead, MR angiography (MRA) of the neck was obtained, which revealed an acute left VAD with early thrombus formation. The patient was placed on aspirin therapy. Repeat MRA of the neck 3 months later revealed resolution of the thrombus, without progression to stroke. This case illustrates the importance for all healthcare providers who see patients with neck pain and headache to be attentive to the symptomatic presentation of possible VAD in progress.

Citation

Futch D, Schneider MJ, Murphy D, Grayev A. Vertebral artery dissection in evolution found during chiropractic examination. BMJ Case Rep. 2015 Nov 12;2015. pii: bcr2015212568. doi: 10.1136/bcr-2015-212568.

Low Vitamin D Associated With Accelerated Cognitive Decline

Low Vitamin D Associated With Accelerated Cognitive Decline

From JAMA Neurology

TAKE-HOME MESSAGE

  • In this study, Hispanic and African-American study participants had lower Vitamin D (VitD) levels than whites.
  • Lower VitD levels was associated with accelerated Cognitive decline.
  • This study did not evaluate whether D2 or D3 supplementation would prevent or reduce cognitive decline. That has yet to be established.
  • The wise neurologist ensures that 25HOD levels are in the range of 40-50 ng/mL

Abstract

Importance

Vitamin D (VitD) deficiency is associated with brain structural abnormalities, cognitive decline, and incident dementia.

Objective

To assess associations between VitD status and trajectories of change in subdomains of cognitive function in a cohort of ethnically diverse older adults.

Design, Setting, and Participants

Low Vitamin D Associated With Accelerated Cognitive DeclineLongitudinal multiethnic cohort study of 382 participants in an outpatient clinic enrolled between February 2002 and August 2010 with baseline assessment and yearly follow-up visits. Serum 25-hydroxyvitamin D (25-OHD) was measured, with VitD status defined as the following: deficient, less than 12 ng/mL (to convert to nanomoles per liter, multiply by 2.496); insufficient, 12 to less than 20 ng/mL; adequate, 20 to less than 50 ng/mL; or high, 50 ng/mL or higher. Subdomains of cognitive function were assessed using the Spanish and English Neuropsychological Assessment Scales. Associations were evaluated between 25-OHD levels (as continuous and categorical [deficient, insufficient, or adequate]) and trajectories of cognitive decline.

Main Outcomes and Measures

Serum 25-OHD levels, cognitive function, and associations between 25-OHD levels and trajectories of cognitive decline.

Results

Participants (N = 382 at baseline) had a mean (SD) age of 75.5 (7.0) years; 61.8% were women; and 41.4% were white, 29.6% African-American, 25.1% Hispanic, and 3.9% other race/ethnicity. Diagnosis at enrollment included 17.5% with dementia, 32.7% with mild cognitive impairment, and 49.5% cognitively normal. The mean (SD) 25-OHD level was 19.2 (11.7) ng/mL, with 26.2% of participants being VitD deficient and 35.1% insufficient. The mean (SD) 25-OHD levels were significantly lower for African American and Hispanic participants compared with white participants (17.9 [15.8] and 17.2 [8.4] vs 21.7 [10.0] ng/mL, respectively; P < .001 for both). The mean (SD) 25-OHD levels were similarly lower in the dementia group compared with the mild cognitive impairment and cognitively normal groups (16.2 [9.4] vs 20.0 [10.3] and 19.7 [13.1] ng/mL, respectively; P = .006). The mean (SD) follow-up was 4.8 (2.5) years. Rates of decline in episodic memory and executive function among VitD-deficient (episodic memory: β = −0.04 [SE = 0.02], P = .049; executive function: β = −0.05 [SE = 0.02], P = .01) and VitD-insufficient (episodic memory: β = −0.06 [SE = 0.02], P < .001; executive function: β = −0.04 [SE = 0.02], P = .008) participants were greater than those with adequate status after controlling for age, sex, education, ethnicity, body mass index, season of blood draw, vascular risk, and apolipoprotein E4 genotype. Vitamin D status was not significantly associated with decline in semantic memory or visuospatial ability. Exclusion of participants with dementia did not substantially affect the associations between VitD status and rates of cognitive decline.

Conclusions and Relevance

Low VitD status was associated with accelerated decline in cognitive function domains in ethnically diverse older adults, including African-American and Hispanic individuals who exhibited a high prevalence of VitD insufficiency or deficiency. It remains to be determined whether VitD supplementation slows cognitive decline.

Citation

Joshua W. Miller, PhD2; Danielle J. Harvey, PhD; Laurel A. Beckett, PhD; Ralph Green, MD, PhD; Sarah Tomaszewski Farias, PhD; Bruce R. Reed, PhD; John M. Olichney, MD; Dan M. Mungas, PhD; Charles DeCarli, MD. Vitamin D Status and Rates of Cognitive Decline in a Multiethnic Cohort of Older Adults.  JAMA Neurol. 2015;72(11):1295-1303. doi:10.1001/jamaneurol.2015.2115.

 

 

Statin Therapy May Impair Memory

Statin Therapy May Impair Memory

TAKE-HOME MESSAGE

  • A comparison was performed between patients on statin Lipid Lowering Drugs (LLDs), people on non-statin LLDs and controls.
  • There was found a strong association between initiation of LLD therapy using statins and non-statins and acute memory loss within 30 days of starting therapy.
  • Unfortunately, both statin and non-statin therapy groups demonstrated memory impairment
  • It is not clear at this point whether the LLD therapy caused the memory loss or whether there was detection bias.

Abstract

IMPORTANCE

Reports on the association between statins and memory impairment are inconsistent.

OBJECTIVE

To assess whether statin users show acute decline in memory compared with nonusers and with users of nonstatin lipid-lowering drugs (LLDs).

DESIGN, SETTING, AND PARTICIPANTS

MemoryUsing The Health Improvement Network database during January 13, 1987, through December 16, 2013, a retrospective cohort study compared 482 543 statin users with 2 control groups: 482 543 matched nonusers of any LLDs and all 26 484 users of nonstatin LLDs. A case-crossover study of 68 028 patients with incident acute memory loss evaluated exposure to statins during the period immediately before the outcome vs 3 earlier periods. Analysis was conducted from July 7, 2013, through January 15, 2015.

RESULTS

When compared with matched nonusers of any LLDs (using odds ratio [95% CI]), a strong association was present between first exposure to statins and incident acute memory loss diagnosed within 30 days immediately following exposure (fully adjusted, 4.40; 3.01-6.41). This association was not reproduced in the comparison of statins vs nonstatin LLDs (fully adjusted, 1.03; 0.63-1.66) but was also present when comparing nonstatin LLDs with matched nonuser controls (adjusted, 3.60; 1.34-9.70). The case-crossover analysis showed little association.

CONCLUSIONS AND RELEVANCE

Both statin and nonstatin LLDs were strongly associated with acute memory loss in the first 30 days following exposure in users compared with nonusers but not when compared with each other. Thus, either all LLDs cause acute memory loss regardless of drug class or the association is the result of detection bias rather than a causal association.

Citation available

http://archinte.jamanetwork.com/article.aspx?articleid=2301148

 

 

Childhood Concussion Symptoms May Linger

Childhood Concussion Symptoms May Linger

TAKE-HOME MESSAGE

  • Childhood concussion, recovery from mild traumatic brain injury (mTBI) and return to play guidelines remain a serious point of discussion in the healthcare community.
  • In this study, 11.8% of patients remained symptomatic 3 months after the injury.
  • A subset of patients had symptoms return after resolution.
  • Inconsistent reporting of symptoms between patients and caregivers was identified.

ABSTRACT

BACKGROUND

Pediatric ConcussionImproving our knowledge about the natural history and persistence of symptoms following mild traumatic brain injury is a vital step in improving the provision of health care to children with postconcussion syndrome. The purposes of this study were to (1) determine the incidence and persistence of symptoms after mild traumatic brain injury and (2) ascertain whether Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, symptom criteria for postconcussion syndrome in adults are appropriate for use in children.

METHODS

A tertiary care pediatric emergency department was the setting for this study. This was a prospective observational follow-up cohort study of children (ages 2 to 18 years) with mild traumatic brain injury. Data were collected in person during the acute presentation, and subsequent follow-up was performed by telephone at 7-10 days and 1, 2, and 3 months postinjury. Postconcussion Symptom Inventory for parents and children was used. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria for postconcussion syndrome were explored using receiver operating characteristic curve analysis.

RESULTS

A total of 467 children (62.5% boys, median age 12.04, range 2.34-18.0) with mild traumatic brain injury participated. The median time until symptom resolution was 29.0 days (95% confidence intervals: 26.09-31.91). Three months after injury, 11.8% of children with mild traumatic brain injury remained symptomatic. Receiver operating curve characteristic analysis of the postconcussion syndrome criteria successfully classified symptomatic participants at three months postinjury; the adolescent receiver operating characteristic curve was excellent with the area under the curve being 0.928 (P < 0.001, standard error 0.019).

CONCLUSIONS

Consistent with our previous study, 11.8% of children presenting to the emergency room with a mild traumatic brain injury remain symptomatic at 3 months postinjury. This is the first study to demonstrate stable incidence rates of postconcussion syndrome in children and that modified Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria can be used to successfully classify postconcussion syndrome in children. Although most children report a decay in symptoms over time, 10% of children develop symptoms even though they initially had a good outcome. Caution should be used when using only parent report as a surrogate for childhood outcomes following a concussion.

Citation

KM Barlow, S Crawford, BL Brooks, B Turley, A Mikrogianakis  The Incidence of Postconcussion Syndrome Remains Stable Following Mild Traumatic Brain Injury in Children.  Pediatr. Neurol. 2015 Jun 10

No Neck Artery Damage From Chiropractic Manipulation

No Neck Artery Damage From Chiropractic Manipulation

TAKE-HOME MESSAGE

  • Chiropractic physicians have been accused of damaging arteries in the neck with spinal manipulation.
  • Recent epidemiologic studies have called that assertion into question. In fact, research has proven that exposure to chiropractic manipulation causes no more damage to neck arteries than exposure to a general medical practitioner.
  • In this study, researchers measure the stress placed on vertebral arteries during cervical ROM and during manipulation.
  • Manipulation places less stress on a cervical artery than normal cervical rotation.
  • The stress an artery from cervical ROM and manipulation is much lower than the strain rates required to cause arterial failure.

Abstract

BACKGROUND:

Cervical ArterySpontaneous vertebral artery dissection has significant mortality and morbidity among young adults. Unfortunately, causal mechanisms remain unclear. The purpose of this study was to quantify mechanical strain in the vertebral artery while simultaneously capturing motion analysis data during passive movements of the head and neck relative to the trunk during spinal manipulation and cardinal planes of motion.

METHODS:

Eight piezoelectric crystals (four per vertebral artery) were sutured into the lumen of the left and right vertebral arteries of 3 cadaveric specimens. Strain was then calculated as changes in length between neighboring crystals from a neutral head/neck reference position using ultrasound pulses. Simultaneously, passive motion of the head and neck on the trunk was captured using eight infrared cameras. The instantaneous strain arising in the vertebral artery was correlated with the relative changes in head position.

FINDINGS:

Strain in the contralateral vertebral artery during passive flexion-rotation compared to that of extension-rotation is variable ([df=32]: -0.61<r<0.55). Peak strain does not coincide with peak angular displacement during spinal manipulation and cardinal planes of motion. Axial rotation displayed the greatest amount of strain. The greatest amount of strain achieved during spinal manipulation was comparably lower than strains achieved during passive end range motions and previously reported failure limits.

INTERPRETATION:

The results of this study suggest that vertebral artery strains during head movements including spinal manipulation, do not exceed published failure strains. This study provides new evidence that peak strain in the vertebral artery may not occur at the end range of motion, but rather at some intermediate point during the head and neck motion.

Citation

Piper, Howarth, Triano, Herzog. Quantifying strain in the vertebral artery with simultaneous motion analysis of the head and neck: a preliminary investigation. Clin Biomech (Bristol, Avon). 2014 Dec;29(10):1099-107. doi: 10.1016/j.clinbiomech.2014.10.004. Epub 2014 Oct 23.

 

 

 

Chiropractic Manipulation Not Associated With VBA Stroke

Chiropractic Manipulation Not Associated With VBA Stroke

TAKE-HOME Message

  • Spinal Manipulative Therapy (SMT) has been accused of causing vertebrobasilar dissection (VBD) and stroke. In his Ontario study, Cassidy found an association between VBD and chiropractor visits, but the association was identical to the association between VBD and primary care provider (PCP) visits.  This led to the conclusion that there was no causal relationship between SMT and VBD.  It was determined that patients with a VBD in progress and went to a chiropractor or a primary care provider for neck pain and headache.
  • This study evaluates the vertebrobasilar stroke (VBS) incidence for 14.7 million people over three years. This study is 5 times larger than the Cassidy study.
  • In its results, this study found no significant association between chiropractic office visits and VBS. There was an association between VBS and PCP visits. This association is assumed to be in relation to patients seeking care for a VBS in progress and not causative.

Abstract

Background

There is controversy surrounding the risk of manipulation, which is often used by chiropractors, with respect to its association with vertebrobasilar artery system (VBA) stroke. The objective of this study was to compare the associations between chiropractic care and VBA stroke with recent primary care physician (PCP) care and VBA stroke.

Chiropractic Manipulation Not Associated With VBA StrokeMethods

The study design was a case–control study of commercially insured and Medicare Advantage (MA) health plan members in the U.S. population between January 1, 2011 and December 31, 2013. Administrative data were used to identify exposures to chiropractic and PCP care. Separate analyses using conditional logistic regression were conducted for the commercially insured and the MA populations. The analysis of the commercial population was further stratified by age (<45 years; ≥45 years). Odds ratios were calculated to measure associations for different hazard periods. A secondary descriptive analysis was conducted to determine the relevance of using chiropractic visits as a proxy for exposure to manipulative treatment.

Results

There were a total of 1,829 VBA stroke cases (1,159 – commercial; 670 – MA). The findings showed no significant association between chiropractic visits and VBA stroke for either population or for samples stratified by age. In both commercial and MA populations, there was a significant association between PCP visits and VBA stroke incidence regardless of length of hazard period. The results were similar for age-stratified samples. The findings of the secondary analysis showed that chiropractic visits did not report the inclusion of manipulation in almost one third of stroke cases in the commercial population and in only 1 of 2 cases of the MA cohort.

Conclusions

We found no significant association between exposure to chiropractic care and the risk of VBA stroke. We conclude that manipulation is an unlikely cause of VBA stroke. The positive association between PCP visits and VBA stroke is most likely due to patient decisions to seek care for the symptoms (headache and neck pain) of arterial dissection. We further conclude that using chiropractic visits as a measure of exposure to manipulation may result in unreliable estimates of the strength of association with the occurrence of VBA stroke.

Citation

(open Access)

Thomas M Kosloff, David Elton, Jiang Tao and Wade M Bannister. Chiropractic care and the risk of vertebrobasilar stroke: results of a case–control study in U.S. commercial and Medicare Advantage populations.  Chiropractic & Manual Therapies 2015, 23:19  doi:10.1186/s12998-015-0063-x