Removing the stigma of epilepsy

Emma Renwick, an epileptic, bravely shared her experience of dealing with epilepsy on the ABC Drum program website earlier this year. She did so in an effort to reduce the social stigma associated with epilepsy, in the hopes that her daughter, who also had epilepsy, would inherit a more accepting society.

She provided the full story of her own diagnosis and the lead up to it, as well as her personal and professional struggles coping with the impact of epilepsy.

When driving one Sunday morning she had a momentary 'outage', or loss of time, which almost resulted in a car accident. Weeks later the same thing happened, and again she blacked out while in the shower and almost hit her head on the ground.

She went to the doctor, who ordered a CT scan and referred her to a neurologist. She was diagnosed with epilepsy - Absence epilepsy. While the term epilepsy conjures up images of lying on the ground having fits, there are actually several different forms of epilepsy. They can be divided into two major groups of seizures: focal (partial) or generalised seizures. Most people with epilepsy experience focal seizures. In this type of seizure the activity starts in one area of the brain (often the temporal lobe), and may spread to other brain regions. These can be further divided into:

Focal seizure - awareness retained (formerly known as simple partial seizures): the person experiencing the seizure is conscious and aware of what is happening
Focal dyscognitive seizure (formerly known as complex partial seizures) - awareness altered: the person is unaware of what is happening
Focal seizures evolving to a bilateral convulsive seizure (formerly known as generalised Tonic-Clonic seizures): the seizure activity starts on one side of the brain and them moves to the other hemispere

During generalised seizures the abnormal activity occurs in both brain hemispheres simultaneously. There are numerous types of generalised seizures, one of which is an absence seizure. Absence seizures are of short duration, and can often appear as if the person is 'zoning out'.

There are also 'other' types of seizures, which don't fit within the above categories.

More information can be found here, as well as this useful flowchart:

Epilepsy is the most common chronic brain condition in Australia and affects more than 220,000 people. Yet despite this, Emma reports, there is a high degree of discrimination against people with epilepsy. This includes exclusion, bullying, harassment and even assault at school and in the workplace. This is despite the fact that epilepsy is not contagious, does not develop as a result of any wrongdoing on the part of sufferers, and in many cases, is well controlled with medication.

Emma writes her story in an effort to help end such discrimination, and to further educate people about this very common condition. Read her story here.

ANTS can undertake thorough assessment to help you better understand and manage your epilepsy. Please contact us for more information.

Protecting your brain's 'borders'

With all the current discussion in Federal politics about 'protecting our borders' it's an opportune time to talk about a less controversial border - the one in our brain. It's called the blood-brain barrier (BBB). Our brain houses up to 650 kilometres of blood vessels! These vessels are lined by a structure, the BBB, which regulates the passage of nutrients, proteins, chemical substances and microscopic organisms between the bloodstream and the brain tissue. Basically, it controls what is, and what isn't, allowed to leave the blood supply and enter the brain.

Blood vessels supply our organs with the nutrients that they need, and help to remove waste products. It has long been known that the blood vessels in the brain and spinal cord are particularly good at protecting the brain from harmful substances, through the BBB, but until recently it hasn't been completely understood how this occurs.

Emerging research using imaging techniques has revealed that the blood vessels in the brain

and spinal cord are lined with specialised cells. These cells have molecular passageways embedded in the cell membrane. These passageways will actively block some chemicals, which are likely to be dangerous to the brain, and play a role in pushing other chemicals across into the brain. The entry and exit of these chemicals are controlled by cells called astrocytes and pericytes.

In mouse models, a deficiency in pericytes has been shown to increase the permeability of the BBB to chemicals. And a deficiency in astrocytes has been shown to result in small haemorrhages at the BBB/brain junction.

Using a 'two photon' microscope to probe inside the living brain, researchers have seen these astrocytes and pericytes doing their job, as well as witnessed white blood cells move across from blood vessels into the brain, and back again.

In addition immune system cells, 'microglia', search the brain for harmful substances that have found their way into the brain, and look for damaged or cancerous cells, and remove them.

The practical application of this knowledge is that neuroscientists are now discovering that many neurodegenerative conditions such as Alzhemier's dementia and Parkinson's disease involve defective BBB and related cells.

For example, it is thought that Alzheimer's dementia involves having too much of a chemical called beta-amyloid in the brain. The BBB has a protein that brings the beta-amyloid out of the bloodstream into the brain, and another protein does the opposite. Perhaps keeping the beta amyloid out of the brain might be a prevention, or even a cure, for Alzheimer's dementia.

We look forward to more research in this area, helping us to better understand, and hopefully formulate better treatments for these neurodegenerative diseases.

See-through brain?

The brain is, understandably, a popular topic for research. Traditionally researchers wishing to study the brain have had to use invasive and time-consuming methods of cutting it up. However, recently a team lead by Dr Karl Deisseroth at Stanford University has developed a method to make brains transparent, allowing them to be studied without having to be sliced up. The process can also be used with other organs, "revolutionising the three-dimensional study of important organs within the body".

The brain is surrounded by lipids that help form the membranes around the cells and bind the tissues together. This membrane blocks the view into the brain. The revolutionary new process referred to as CLARITY replaces the lipids with a clear gel, which preserves the tissues while revealing the internal structure of the brain. The gel is injected into the organ and is absorbed into the tissue. The lipids are then removed, while the rest of the brain remains intact, leaving the neurons, axons, dendrites, proteins and synapses in place and able to be viewed.

Previously these structures could only be seen following the brain being sliced up, and only across tiny slivers of tissue. Researchers then needed to reconstruct three-dimensional data from images of these thin slices to form a three dimensional view of the brain.

Using CLARITY scientists can then use fluorescent proteins and neuro-imaging to see neuronal connections, subcellular structures, proteins, nucleic acids and how cells interact and relate to each other. This opens up the possibility of viewing large networks of neurons with unprecedented ease and accuracy.

The procedure has already been used to investigate the nerves in the post-mortem brain of an autistic boy. They noticed unusual patterns in the neurons, which is likely to help advance the understanding of autism.

We at ANTS look forward to hearing more about how this procedure can be used for advancing our understanding of various neurological and neuropsychological conditions.

Living by values

Values are broad preferences concerning appropriate courses of action or outcomes, which guide ethical action. Commonly held values are honesty, equality, justice and commitment. Value identification, value creation and values-based living are the basis for many religions, philosophies and psychological therapies. A good (though maybe somewhat morbid!) way to identify your personal values is to think about what you would like people to say at your funeral. Or alternatively what you'd like your family to say about you on your 80th birthday, or your partner to say on your golden wedding anniversary.

Values play an important role in good psychological health. In his blog Anger in the Age of Entitlement, Steven Stosny, Ph.D and psychotherapist states that "If you devalue more than you value, your life will be bad, no matter how many good things happen to you. If you value more than you value, your life will be good, regardless of how many bad things happen to you".
That is a very interesting concept, and it explains why:

• Often the things we think will make us happy don't
• Why some people who appear outwardly to have everything are not happy, and
• Why some people who appear to have very little do seem to be happy.

Nelson Mandela is one good example of this. He experienced the death of his father as a child, was expelled from one university and dropped out of another for being a poor student, was imprisoned, experienced the death of two of his children, was not allowed to attend the funeral of his mother and one of his children, and was twice divorced. Despite these setbacks he continued to devote himself to his values of democracy and equality, achieved his goal of democracy in South Africa, and created an important legacy. It is likely that he was able to keep pursuing his goals despite his bad experiences because he was living by his values.

On the other hand, daily we hear about various celebrities, who despite their wealth, status and popularity have drug addictions, convictions for various offences and even on occasion attempt or complete suicide. While we do not know what happens in their personal lives, it is likely that they pursued fame and money thinking that it would make them happy, while ignoring or violating their deepest values. Certainly it is highly unlikely that anyone's deepest values include destroying their bodies and harming other people.

Anything involving the brain that is done repeatedly becomes habituated. Repeatedly pursuing a certain mindset creates neural pathways in the brain that become strengthened until that way of thinking is essentially automatic. If we continue to think about the ways we have been wronged for example, complain about other people and pursue revenge, then resentment will become our automatic way of thinking. If we actively choose to see setbacks as opportunities for growth and pursue compassionate understanding, then we are creating values based thinking, which is likely to lead to more happiness.

The upshot is that values-based living will lead to more happiness and better emotional health. In a practical sense, when something happens in our lives that makes us feel devalued, we are likely to recover more quickly and to have a better overall outcome if we strive to value rather than devalue. For instance, when going through a break up it is better to find ways to feel loved and to love others rather than to blame and demonise the other person.

Certainly easier said than done!

Rates of dementia higher in Indigenous Australians

Indigenous Australians have much poorer health outcomes and higher rates of some illnesses than non-Indigenous Australians. Estimates from the Australian Bureau of Statistics (ABS) show than an Indigenous male born in 2005-2007 was likely to live to 67.2 years, about 11.5 years less than a non-Indigenous male (who could expect to live to 78.7 years). An Indigenous female born in 2005-2007 was likely to live to 72.9 years, which is almost 10 years less than a non-Indigenous woman (82.6 years). They also have higher infant mortality rates, at between 5-13 for every 1,000 births (depending on the state), compared to 4 in every 1,000 for the total population.

ABS research also shows that Indigenous Australians on average also have higher rates of cardiovascular disease, cancer, diabetes, kidney disease and asthma.

A ground-breaking recent study has also found that they are more likely to suffer from dementia.

A three-year study titled Koori Growing Old Well Well was conducted between 2009 and 2012 across five urban and regional Indigenous communities in New South Wales. It involved 336 participants aged over 60 years. Preliminary results revealed that at 21 percent the prevalence of dementia is three times the rate of non-Indigenous Australians. It also found that there is an earlier age of onset amongst Aboriginal Australians, with almost three quarters of participants with dementia being aged between 60 and 70 years, compared to other Australians where the majority of people with dementia are aged over 70 years.

The poorer overall health of Aboriginal Australians plays a role in their higher rates of dementia. Risk factors for some forms of dementia include high blood pressure, obesity, smoking and diabetes.

The lead researcher, Professor Tony Broe reported "Aboriginal people in urban areas have a high incidence of many of the risk factors that have been linked to dementia in studies around the world".

Some issues with research in this field are that some Indigenous people are reluctant to share their health issues and do not want to accept that their loved ones have dementia.

These results have prompted doctors to call for appropriate services tailored specifically for the Indigenous community. Professor Broe says the findings will be used to develop education and services for older Indigenous people with dementia and for their families.

Could previous researchers have been wrong about the role of amyloid in Alzheimer's disease?

Amyloid proteins in the brain have long been implicated as the culprit behind Alzheimer's disease. Amyloid are insoluble protein aggregates that arise from inappropriately folded proteins and polypeptides. These form tangles or plaques. They have been associated in the pathology of more than 20 serious neurodegenerative disorders, including Alzheimer's disease. They’re thought to disrupt the seamless workings of the neurons responsible for memory and movement.
Recent studies in the US and in Australia, have however found that amyloid may not be as destructive as previously thought.

Two recent US studies have found that amyloid proteins may in fact play a protective rather than a destructive role in the brain. The studies run by Professor Lawrence Steinman of Stanford University found that treating mice with multiple sclerosis (MS) with amyloid proteins reduced brain inflammation and reversed MS-related paralysis.

A second study extended the finding to show that small portions of several notorious amyloid-forming proteins (including tau and prion proteins) can also alleviate symptoms in mice with the condition — despite the fact that the fragments can and do form the long tendrils, or fibrils, previously thought harmful to nerve health. This supported previous research showing that Alzeimer's disease is much worse in animals born without the genes that produce amyloid.

He reported, "we were so fixated on the idea that amyloid is bad for the brain that if one goes back and looks at the old literature and the new literature, one finds there's a lot of publications where people have ignored these kinds of experiments in humans where, for instance, lower levels of amyloid are associated with earlier dementia".

In another recent Australian study run by Dr Bryce Vissel of the Garvan Institute of Medical Research, researchers have found that the amyloid plaques that are characteristic of Alzheimer's disease appear much later in the disease than previously thought, and after the development of cognitive symptoms. This indicates that neurodegenerative processes such as memory loss and executive dysfunction occur independently of amyloid plaques.

Instead it is proposed that inflammation in the brain is the leading cause of brain damage and neurodegeneration in Alzheimer's disease. Lawrence suggested that amyloid proteins may soak up harmful molecules that are responsible for inflammation.

The studies suggest that anti-amyloid therapies may not be the best way to manage the disease, and that therapies focusing on reducing inflammation may be more beneficial.

The importance of wearing helmets

Australia is one of the few countries in the world with mandatory helmet laws for motorcyclists and bicycle riders. They were introduced in 1991 in New South Wales and have been the subject of controversy since. A recent study provides evidence supporting the importance of wearing helmets in reducing the risk and severity of head injury, particularly for bicycle riders.

Dr Michael Dinh from the University of Sydney and colleagues studied 348 adult patients admitted to hospitals following bicycle and motorcycle accidents in Sydney for one year between 2008-2009.

They found that cyclists who didn't wear helmets were almost 6 times more likely to suffer a head injury than those wearing helmets, and more than 5 times more likely to suffer a severe head injury. The benefits for motorcyclists were not as marked but still significant, with those without helmets 2 times more likely to suffer a head injury and 3.5 more likely to suffer a severe head injury compared to those without helmets.

Head injuries are rated on a scale from mild to extremely severe, based on a ranges of factors including level of consciousness following the incident and length of coma.

These outcomes also have implications for hospital care. The study found that patients who suffered severe head injuries from not wearing a helmet cost hospitals 3 times as much in treatment. For those who suffered a severe head injury, median hospital costs for non-helmeted patients were $72,000 while for those with helmets the figure was $24,000.

Older riders were more likely to wear helmets than younger riders. The average age of helmet wearing cyclists was 41, compared to 35 for non-helmet wearers, and for motorcyclists the average ages were 31 for those wearing helmets and 25 for those who did not.

The study was published in the Medical Journal of Australia. It supports previous research on the subject. In 2011 Dr Jake Oliver and colleagues from the University of New South Wales and the Sax Institute studied the number of head injuries before and after the mandatory helmet laws came into effect. They found that head injuries fell by up to 29%.

There are clear benefits from helmet wearing that clearly outweigh concerns about mandatory helmet laws reducing the number of cyclists. Studies such as those by Dr Dinh and Dr Oliver have also prompted debate about the usefulness of mandatory helmet laws in the US. More information can be found here.