Today’s focus: EDTA (ethyline diamine tetra acetate) for the treatment of cardiac, peripheral and cerebral atherosclerosis.

Reports:

• Basics of EDTA pharmacology
• History of EDTA as a treatment for atherosclerosis
• Trial to Assess Chelation Therapy (TACT)
• Controversies of EDTA chelation for treating atherosclerosis. E.g. U.S. vs. Evers.

Resources for learning more:

• www.drcranton.com/chelation.htm
• www.acam.org
• Saunders textbook: Cardiovascular Drug Therapy - with chapter and many references on EDTA chelation therapy.

Who are the ‘Quackbusters‘? We didn’t have time to cover this question during the show, but this group remains a mystery. It publishes opinions against so-called ‘integrative medicine’ (previously called ‘alternative medicine’), including attacks against the use of EDTA chelation for atherosclerosis. We on the STAT editorial team would appreciate learning who funds this organization. It is not clear from their website.
Next week’s show: We’ll address testosterone for stroke care and the controversial area of bio-identical hormone therapy (versus the use of synthetic/derivatized hormones).

Flow Productions will be producing additional lines of podcasts based on cutting medical news and information. Click for demos: Audio magazine format and video (’enhanced podcast’). If you are interested in sponsoring one of the shows please contact info@flowproductions.org.

Part 1 of 4. This 4-part series focuses on controversies in the area of strokes and TIAs. Future Rife with Strife series will focus on controversies in other areas of neurology.

Hear these reports:

The Role Of Controversies In The Advancement Of Medicine: medical controversies, with criticism and debates, are the way that optimal medical therapies crystallize.

TIA and Stroke Admissions: a study on primary care physicians last year in the journal Stroke showed that even when strokes and TIAs were well recognized as medical emergencies by the PCPs, essentially 30% of them would not admit the TIA patients as a medical emergency.

Immediate Treatment of TIAs: the PROFESS trial is underway comparing clopidogrel (Plavix) with ASA/dipyridamole (Aggrenox) for secondary stroke prevention. Until those results are available, which drug is best to use for the prevention of stroke in TIA patients? Or is Aspirin alone adequate ?

Carotid Stenting Versus Carotid Endarterectomy: Which do you recommend for your patients and why?

Intra-Arterial Thrombolytics for the Treatment of Acute Stroke: You may recall the “Lazarus phenomenon” from STAT episode #61. Dramatic improvement after intra-arterial thrombolytic occurred in twenty-five percent of the patients. Might this ‘emerging therapy’ someday take the place of IV infusions of thrombolytics?

Percutaneous Closure of Patent Foramen Ovales for Stroke Prevention: The relative risk of any thromboembolic event is 4-fold in patients with a PFO. A study in the New England Journal of Medicine 4 months ago support that PFOs and resulting paradoxical emboli are a cause of stroke in both older patients and younger patients. How about this proposition: the large-scale procedural intervention - percutaneous PFO closure - for the prevention of strokes (and migraines)? Now there’s a controversy that society is probably not quite ready to grapple with.

Next week’s show: Controversies about neuroprotection before or after acute ischemic stroke, and EDTA chelation therapy as a preventive and treatment for cerebrovascular and cardiovascular disease.

Flow Productions will be producing additional lines of podcasts based on cutting medical news and information. Click for demos: Audio magazine format and video (’enhanced podcast’). If you are interested in sponsoring one of the shows please contact info@flowproductions.org.

Special title for this installment: Information power forming the future of neurology and medicine.

Hear these reports:

Elsevier’s WiserWiki Allows Physicians To Update Evidence-Based Medical Information With Experience-Based Practice Insights: WiserWiki potentially creates a virtual, living, continually updated medical manual – possibly much more useful and ‘in the now’ – than a periodically updated, edition-based textbook (which only a handful of ‘experts’ edit)!

Illumin8 research tool to help researchers answer complex R&D questions faster and more accurately: The first web-based research tool that integrates ‘natural language search technology’ with the large amounts of content from Elsevier’s scientific articles and web sources.

Education in the third dimension: Enactive learning - ‘learning by doing’ - may be poised for a big comeback because now, thanks to the large, active European Union-funded research network called Enactive.

Med Schools Adjusting to Millennial Students: Medical educators are looking into a variety of different ideas on how to best teach this new tech-savvy, team-oriented generation. We predict that collaborative approaches - including wiki technology - and audio and video podcasting, and the use of iTunes U - will be important parts of their modern teaching approaches!

Thoughts on the ‘Global Brain’: Medical ideas here on Earth (thanks to information technology) are now well interconnected by a web of ‘synapses’ - the billions of nodes of the world wide web. It’s like a ‘global brain.’ Stored information on blogs and wikis - like WiserWiki – are analogous to stored memory in the brain’s synapses. And podcasting (‘audioblogging’) is like the ‘voice’ for the global brain!

Next week’s show will be the first of a new series of STAT special-topic installments: Rife with Strife – uncertainties and controversies in neurology and medicine. The focus will be on the cerebral vascular disorders and stroke.

Flow Productions will be producing additional lines of podcasts based on cutting medical news and information. Click for demos: Audio magazine format and video (’enhanced podcast’). If you are interested in sponsoring one of the shows please contact info@flowproductions.org.

This week’s show: The I.T. Sword has Two Edges: benefits and Risks of I.T. for neurology

Hear these reports:

Double-edged Sword of I.T.: It’s reaching into physician practices whether they’re ready for it or not. The government’s seeing to that. Is it a ‘brave new world’ for neurology and medicine? One possibly with significant risks and benefits: clinical practice guidelines and electronic medical records. Ninety (90)% of authors of clinical practice guidelines had financial relationships with the pharmaceutical industry (according to JAMA back in 2002). See the Association of American Physicians and Surgeons (AAPS) website.

Will you recommend that your patients put their health records in the hands of Google, Microsoft or Wal-Mart? You may soon be getting requests to do so. See this Newsweek story.

The National ePrescribing Patient Safety Initiative (NEPSI): This software is available to equip every physician in the US with electronic prescribing software. Created by a coalition of health insurers and software companies, it’s compatible with the software in 99% of the nation’s pharmacies. It’s easy to learn and free of charge. Could there be future privacy and control-related risks with this technology as well?

CaringBridge.org: Patients or their families easily create - for free - their own private website so that family and friends can provide the patients and caregivers with support through guest book messages and photos.

I.T. for Autism: This is a must-see video produced by Amanda Baggs who has autism. We became aware of the video thanks to Wired Magazine. Ms. Baggs might otherwise be considered mute and retarted, if not for technology. She shares amazing insights with us from her valuable and intelligent perspective using her computer and synthetic voice technology from Dynavox. Dr. Mike Merzenich, neuroscientist at UC San Francisco is quoted: the idea that 75 percent of autistic people are mentally retarded is “incredibly wrong and destructive.” Let’s see if many more autistics start ’speaking out’ through information technology.

Next week’s show: It’s the second part of this two-part series on Information Technology for Neurology: new learning enhancements available through I-T, the use of ‘Wikis’ for the establishment of independently developed clinical practice guidelines, and more.

On this show: You’ll hear insights from sleep apnea patient Mr. Sam Frank for whom proper diagnosis and treatment of his obstructive sleep apnea (OSA) - especially the use of continuous positive airway pressure (CPAP) during sleep - has dramatically changed his life for the better. There’s a good chance that Mr. Frank (prior to his treatment) typifies numerous OSA sufferers in your practice for whom sleep apnea remains undiagnosed and untreated.

Next week: The installment topic will be a surprise. We’re sure you’ll find that it’s interesting, timely and important neurology and medical news information. Hint: information technology (IT) for neurology reigns supreme.

Thanks for staying subscribed to STAT! — The Podcast of Neurology News and Medicine.

Flow Productions will be producing additional lines of podcasts based on cutting medical news and information. Click for demos: Audio magazine format and video (’enhanced podcast’). If you are interested in sponsoring one of the shows please contact info@flowproductions.org.

On this show: We conclude the 3 interviews with Sleep Medicine experts Dr. Michael Littner and Dr. Jay Puangco. How important is sleep medicine in the practice of neurology? Might we expect significant increases - or decreases - in the use of sleep labs, what with Medicare’s likely reimbursement for home sleep apnea studies? And finally: Dr. Littner and Dr. Puangco provide us with take-to-the-office clinical pearls we may be able to use to help our patients.

Next week: Part 4 of the 4-part series. Hear insights from sleep apnea patient Mr. Sam Frank for whom proper diagnosis and treatment of his OSA - especially the use of continuous positive airway pressure (CPAP) during his sleep - has dramatically changed life for the better. PS: There’s a good chance that Mr. Frank (prior to his diagnosis and treatment) exemplifies numerous people in your practice who’s OSA remains undiagnosed and untreated.

Thanks for staying subscribed to STAT! — The Podcast of Neurology News and Medicine.

Sponsor: Flow Productions. Flow will be producing additional lines of podcasts based on cutting medical news and information. If you are interested in sponsoring one of the shows please contact info@flowproductions.org. Click here to see and hear an example of our next-generation video podcasts.

On this show: We continue our interviews with Sleep Medicine experts Dr. Michael Littner and Dr. Jay Puangco. Cardiologists regularly use home testing for arrhythmia detection on a relatively large scale. Is it time for neurologists and other physicians to do likewise for testing sleep apnea? If Medicare completes the final approval of payment for home testing for sleep apnea, this may provide access (to this extremely important testing) to a huge number of patients. But do you think you can become a sleep apnea expert - employing home apnea testing for your patients - after just a weekend certification course? Think again!

Upcoming 2 shows: On Part 3 and 4 (next two weeks) we’ll complete our 3 interviews with Dr. Littner and Dr. Puangco, and hear insights from sleep apnea patient Mr. Sam Frank for whom proper diagnosis and treatment of his OSA - especially the use of continuous positive airway pressure (CPAP) during sleep - has dramatically changed his life for the better.

On this show: Interview with Sleep Medicine experts Dr. Michael Littner and Dr. Jay Puangco. We’ll have an overview of Sleep Medicine, and highlight the importance Sleep Medicine as a medical specialty. Also: what percent of the population is estimated to have sleep apnea? And what fraction of those may remain undiagnosed? Is ’snoring’ and ‘excessive daytime sleepiness” (EDS) on your history intake form? If not, maybe it should be! Would you be eligible for a sleep medicine fellowship? And finally: insights into formal training in Sleep Medicine, from neurologist Dr. Puangco who’s in the Sleep Medicine fellowship at UCLA.

Upcoming 3 shows: On Part 2 and 3 (next two weeks) we continue our interviews with Dr. Littner and Dr. Puangco discussing the new and revolutionary home testing technologies for sleep apnea. And we’ll address what’s probably the current hottest topic in Sleep Medicine. Hint: the topic is ‘hot’ because of potential for significant reimbursement for efficient diagnostics coming soon.

On Part 4 we’ll hear insights from sleep apnea patient Mr. Sam Frank for whom proper diagnosis and treatment of OSA has changed his life for the better.

Today’s show: Second part of the interview with Dr. Daniel Amen, MD and Dr. Douglass. They discuss the accuracy of SPECT images for ‘imaging human behavior,’ and the accuracy of SPECT scans for diagnosing preclinical and clinical Alzheimer’s disease. They’ll also touch upon the potential quagmire of neuroethical issues related to the health insurance industry, particularly when insurance companies may discriminate against patients who test positive for Alzheimer’s based on SPECT neuroimaging, or based on positive tests for the APO E-4 allele (the Alzheimer’s ‘risk gene’).

For more information about SPECT scanning and the Amen Clinics: www.AmenClinics.com.

Next week’s show: It will be the first of a four-part Reap the Sleep series on Sleep Medicine - with focus on sleep apnea. We’ll interview sleep medicine experts Drs. Michael Littner and Jay Puangco.

Today’s show: Interview with Dr. Daniel Amen, MD. SPECT scanning has dramatically changed the way Dr. Amen looks at and sees (and treats) his patients.

Psychiatrists remain the only doctors who never look at the ‘organ’ they treat (the human brain). We make psychiatric diagnoses today essentially like our predecessors did back in 1840. Might SPECT scanning change that?

‘Imaging human behavior’ with SPECT is considered a new frontier for the entire field of neuropsychiatry since we can now literally see functional imbalances in the brain, and then do what we can to try to correct those imbalances.

According to Dr. Amen, SPECT neuroimaging opens the minds of doctors who employ it, and it opens many doors for possible therapeutic options for neurobehavioral disorders (not just medications). SPECT can apparently document brain changes (improvements) from treatments like acupuncture/acupressure, hyperbaric oxygen, dietary supplements and even transcranial magnetic stimulation.

For more information about SPECT scanning and the Amen Clinics: www.AmenClinics.com.

Next week’s show: Part 2 of the interview with Dr. Daniel Amen (and Dr. William Campbell Douglass). The doctors will discuss the accuracy of SPECT images of the brain, and their accuracy for diagnosing pre-clinical Alzheimer’s disease. They’ll also discuss the potential quagmire of issues related to likely discrimination by health insurance companies after people test positive for Alzheimer’s based on SPECT neuroimaging (or based on positive tests for APO E4, the Alzheimer’s risk gene).

Hear these reports:

A New Method Has Been Developed to Efficiently Identify the Apo E4 Genetic Determinants of Alzheimer’s Disease: You may soon have a way to rapidly, accurately and inexpensively determine if your patients have the APO E4 genotype.

Politics of Genetic Testing and Genetic Discrimination: If the new method (above) becomes highly available and affordable, what might be some of the consequences of using the assay on a wide-scale basis? Might a ‘perfect storm’ for a huge wave of medical-political problems be brewing?

Affiris Has Been Granted European Patent for Alzheimer’s Vaccine: Learn why this vaccine has significant potential for safety and efficacy in humans. Hint: less autoimmune attack on the brain.

How A Stressful Life Can Contribute to Development of Alzheimer’s Disease: Acute stress increases corticotropin-releasing factor (CRF) from the brain, which results in increases in amyloid plaque.

Alzheimer’s Disease and Memantine: On STAT episode #80 we mentioned that this newer Alzheimer’s drug acts primarily on glutamatergic neurotransmission. We may have been wrong. According to this story Memantine actually works similarly to the drugs that boost acetylcholine-related signaling. So even though Memantine is known to block glutamatergic NMDA receptors, Memantine actually has stronger effects on acetylcholine receptors and weak effects as a glutamate antagonist. And unless Memantine is used in narrow concentration ranges, it has adverse effects on the brain’s neuronal communications. Bottom line: It may be unlikely that glutamate receptor blocker drugs will ever be used successfully on a wide scale in neurology, since perhaps major side-effects should be expected.

Hebrew University Ph.D. Student Named Winner of Kaye Award for ‘Natural Protection’ to Reduce Spread of Alzheimer’s Disease: Who’s this winner? Erez Podoly. And what’s the remarkable source of the ‘natural protection’? Hint: the substance is a protein normal to the body, and the mammalian genus Capra (as in ‘Capricorn’) has come to the rescue to produce it for us.

Rapid-Fire Review Quiz: As icing on the cake we’ll stimulate your synapses with a quiz, covering some of the key points we’ve made during the last 4 weeks.

Next week’s show: Our 2nd installment of Imagery for Neurology - Imaging and images for neurology professionals. It’s the 1st part of a 2-part series during which we interview SPECT neuroimaging expert Dr. Daniel Amen. We think you’re in for a treat. Before the interviews we encourage you to go back and listen to STAT episode #45 when we covered Dr. Amen’s work, and also visit www.AmenClinics.com to see his remarkable SPECT ‘Images of Human Behavior.’ You may also want to listen to episode #54 on the neuroethics of neuroimaging before next week’s show!

Hear these reports:

Lipids in the brain: an important factor for Alzheimer’s disease? Researchers at VIB Switch Laboratory in Switzerland recently discovered that a certain brain fat promotes formation of Alzheimer’s peptide, the neurotoxic protofibril. Key concept: concentrations of various lipids in the brain strongly affect biological equilibriums between senile plaques of Alzheimer’s disease and toxic protofibrils.

Omega-3 supplements in mild to moderate Alzheimer’s disease: effects on neuropsychiatric symptoms. The omega-3 fats used in this study helped combat depression and agitation in Alzheimer’s patients who received the supplements.

A diet enriched with the omega-3 fatty acid docosahexaenoic acid reduces amyloid burden in an aged Alzheimer mouse model: Mouse study. From Journal of Neuroscience (2005). Researchers employed the omega-3 fatty acid DHA (docosahexaenoic acid) and demonstrated that DHA-enriched diets reduce total amyloid-beta by more than 70%. Overall plaque burden was reduced by 40%, compared to mice on a low-DHA or control diet.

NIH study on DHA in Slowing Progression of Alzheimer’s Disease: Four hundred (400) Alzheimer’s patients are being studied, based on evidence that omega-3 fatty acids appear to have anti-amyloid, anti-oxidant and neuroprotective properties. This study has huge implications and may provide hope for delaying onset of Alzheimer’s, and for fending off the impending Alzheimer’s crisis, saving billions of health care dollars.

Plight of natural product therapies in US medicine: we discuss some of the underlying politics and possibilities.

Alzheimer and trans fatty acids from hydrogenation of vegetable oils: There’s a possible link. We discuss some of the evidence and current efforts by many of the States to ban trans fats, and require warnings about their damaging health effects. University of Maryland researcher Dr. Mary Enig has done extensive research in this area.

Next week’s show: It will be our 11th installment of Defeating Dementia. During the 3rd of this 3-part mini series we’ll discuss Alzheimer’s-related genetics news and some research discoveries related to diagnosis and treatment of Alzheimer’s. We’ll also have more news and information on prevention of Alzheimer’s.

Promising news and approaches for progressive brain disorders - Part 1 of a 4-part mini series.

Hear these reports:

• Multifaceted Aspects of Alzheimer’s Disease: From Social to Molecular Problems. We touch upon the many insights presented in this report from a special issue of the Journal of Alzheimer’s Disease.
• ‘Young-Onset’ Alzheimer’s Is Increasing: Increased awareness of young-onset Alzheimer’s - in 55 to 65-year old patients with memory problems - is important because these people are experiencing delays in correct diagnosis of their dementia, and therefore treatment and support for these relatively young patients is delayed.
• Brain-Injured War Veterans Show A Faster Decline In Cognitive Functioning As They Age. What was especially interesting about the findings from this research was that the rate of cognitive decline could be predicted – at least in part - by how intelligent the veterans were, and their level of education, before they sustained their brain injuries. The research results may stress the importance of the concept of ‘brain reserve’ and maximizing that reserve with intellectual stimulation, for prevention of dementia.
• Borrelia Bug Revisited: We review the evidence and resources to further understand the paradigm of Borrelia Burdorferi as a cause of Alzheimer’s disease. STAT listeners will recall Dr. Alan MacDonald’s comment that “Round things happen in neurodegeneration.” For an overly packed, but useful view into this paradigm go to www.MolecularAlzheimer.org.

Next week’s show: It will be our 10th installment of Defeating Dementia - Promising news and approaches for progressive brain disorders. During the second of the 2-part mini series we’ll discuss the importance of good and bad lipids in the brain (as factors in Alzheimer’s), and we’ll report on research linking genetic mutations to frontotemporal dementia. We’ll also discuss and review important comorbidities with Alzheimer’s – like diabetes and sleep apnea. And we’ll cover more research news related to Alzheimer’s diagnosis, treatment and prevention.

Hear these reports:

• Fibrates and Statins Cut Peripheral Neuropathy Risk: in a subgroup of 530 people, fibrates reduced the risk of neuropathy by essentially 50%, and statins reduced the risk by 35%.
• Monofilaments for Peripheral Neuropathy Testing Often Inaccurate: current monofilaments are rarely accurate – with up to 100% false positives (for some monofilaments). A new, more reliable monofilament device was described and endorsed in the story.
• Fibromyalgia Pain May Be Caused by Neuron Mismatch: unexplained pain experienced by patients with fibromyalgia is the result of a mismatch between sensory and motor systems.
• Opiod System Controls Pain, Reward and Addictive Behaviors: The report supports the idea that any further research on - and development of - morphine-related drugs may necessarily result in more addictive analgesics; also that blocking the mu-receptor may hold promise for the treatment of drug abuse and addiction. Another key point was made regarding the delta opiate receptor: that delta-agonists may be useful to alleviate affective disorders, to improve emotional states.
• Morphine: should it be a comfort measure for the dying or pain control for the living? Between 40-70% of cancer patients may not have sufficient pain control, and misconceptions about morphine may be a contributing factor.
• Postpartum Headache Requires Stepwise Approach: We present the breakdown of the diagnoses in 95 cases of post-partum headaches. The original story provides a detailed algorithm for the workup.

Next week’s show: It will be our 9th installment of Defeating Dementia - Promising news and approaches for progressive brain disorders. During the first of another 2-part mini series we’ll cover important dementia-related news on Alzheimer’s disease markers, genetic discoveries around dementia, how stress may contribute to developing Alzheimer’s and a lot more.

Hear these reports:

• Migraine patients are at high risk for Serotonin Syndrome: consider the syndrome in any migraine patient with flu-like signs and symptoms, who is also taking combination of triptan plus an SSRI (or plus another serotonin agonist drug). Also: Seratonin Syndrome, and Libby Zion are what let to the changes in US residency training (from the Libby Law).

• One-third of migraineurs can expect complete pain relief. This is promising news. Also in this study, over a12-year follow-up period only 1.6% of migraineurs developed chronic migraines.

• Role of the Stem Cell Factor (SCF) gene (for the factor and it’s receptor) in our sensitivity to pain: the discovery may lead to new approaches for treating pain, the drug Gleevac for example, which blocks the SCF receptor.

• Evidence is lacking that shoe insoles prevent general back pain: better methodologies and studies needed to study whether insoles useful in treating existing backpain or in secondary prevention.

Next week’s show: Our 8th installment of Reign Over Pain - Commanding news you can use to benefit your hurting patients. This will be Part 2 of the 2-part mini series on pain medicine. A few of the news topics we’ll cover: Fibrates and statins appear to cut the risk of neuropathy; fibromyalgia may be caused by a sensory-motor neuron mismatch; insights into the opiod pain control system; morphine as a comfort measure for the dying - or should it be for pain control for the living? And finally, the stepwise approach to managing postpartum headache.

After we give you a quick recap on Part 1 from last week…

Hear these reports:

1. Neurons Can be Generated From Glial Cells. Glia cells are stem cells in the brain, and using specific transcription factors they can be induced to differentiate into functional nerve cells. With this remarkable discovery, we have yet another means of potentially replacing – regenerating - damaged brain cells after injury or disease, by transforming the endogenous glia cells into neurons.
2. Getting closer to being able to transplant stem cells into the human brain. Stem cells implanted into the hippocampi of mice increased new nerve cells by 65% and new astrocytes rose by essentially 125%.
3. Implanted cardiac stem cells prevented life-threatening arrhythmias. Essentially 100% of the control mice developed V-tach (the mice that had myocardial infarctions, but were not given the stem cells). But the mice that were given the stem cells (after having an MI) had the same risk of developing V-tach as healthy mice which did not have MIs. Explained by stem cell gene’s ability to synthesize cellular protein Connexin 43.
4. Human embryonic heart stem cells condition – bring health to - mice hearts after MIs. The stem cells - epicardium derived stem cells - had what was described as “an almost instant stimulating effect on the surrounding heart tissue.”
5. Elsevier Launches New Journal: “Stem Cell Research.” The new journal will focus on “high-quality research in all aspects of stem cell science. Report describes stem cell therapy (regenerative medicine) as “a field growing faster than any other in the life sciences.”
6. Stem cell therapy rescues motor neurons in ALS model. The researchers saw almost 100 percent protection of the motor neurons. However, the motor neurons apparently could not maintain their synaptic connections with the muscles they control. More research needed to explain why.
7. Nanomedicine Opens The Way For Nerve Cell Regeneration. Researchers at the university of Miami demonstrated that magnetic nanoparticles result in ‘mechanical tension’ that stimulates the growth of axons. And researchers at University of California, Berkeley use nanofibers containing growth factors to provide what is described as a ‘bioactive matrix’ on which neurons can regrow.

Next week’s show: Our 7th installment of Reign Over Pain - Commanding news you can use to benefit your hurting patients. Here are a few topics on which we’ll be presenting news: Migraine and Serotonin Syndrome, Postpartum Headache, fibromyalgia and peripheral neuropathy.

Hear these reports: