Two recent scientific articles have shed more light on two emerging subjects in the field of neurology:  Vitamin D and the impact low levels have on brain function, and the link between concussions and seizures.

First, a recent study of 1142 patients with a chronic pain condition were evaluated and 911 were found to have low vitamin D levels.  Prior studies have shown that vitamin D acts in the brain to limit the amount of a substance called interleukin 6, which promotes inflammation.  So, it is interesting to wonder if supplementing vitamin D in patients with chronic pain syndromes might lower pain.  Further studies are needed but we at neruOasis are checking our patients for low vitamin D and giving them supplementation therapy when appropriate.  This is a hot topic in my estimation, more to come.

In a second report, we are getting new information on the consequences of concussion.  Many physicians take a cavalier attitude toward concussion, believing that the symptoms will resolve and the patient will be fine.  Well, for the roughly 500,000 concussions seen in the emergency room each year (according to the CDC), we may be missing treatment opportunities by not taking this condition more seriously.  A recent study demonstrated a risk for seizures to be 1.5 after mild injury, 2.9 after moderate injury and 17 after severe injury.  That's 1.5 times more likely, almost 3 times more likely and 17 times more likely!  There are tests such as an EEG (electroencephalogram) and MRI of your brain that your neurologist can perform to determine if you need close monitoring for symptoms of seizures.  Seizure activity can be subtle and difficult to diagnosis if it is not being thought of in the range of possible diagnoses. 

So, if you've had a concussion recently or even in the past year, come see us or your doctor and get an evaluation.

For those of you in my practice taking Gilenya (fingolimod), you may have heard that the FDA has done an extensive review of the drug after a patient died within 24 hours of taking their first dose.  For those of you who have recently been diagnosed and are considering taking Gilenya, the following is the latest update on the drug and new recommendations for its use in patients with multiple sclerosis.  First, I want you all to take a deep breath and relax, it is true that one death has occured but remember, tens of thousands of patients are taking the drug with no problems.  This is a cautionary tale, and we should be grateful that the FDA is fulfilling its mission to monitor the safety and efficacy of medications on the US market.

The patient who died had pre-existing cardiac problems.  The new recommendations are that patients get an EKG (electrocardiogram) prior to starting the medication so we can screen for any potential risk for a drop in heart rate with the first dose.  You still have to be monitored for 6 hours in the doctor's office and get you blood pressure and pulse measured every hour (although I try to check it closer to every 30 minutes) and then at the end of the observation period you need another EKG.  That's it.  Here's how I read this:  if you are over 50 years old and have any risk factors for heart disease or have had a heart attack, you are not getting this drug.  For younger patients who have normal EKG's and no cardiac risk factors, I continue to believe this drug is safe and more effective than anything on the market.

We will keep you informed if new information becomes available.  If you are a patient of mine and are taking Gilenya, we simply are going to get an EKG at your next appointment with me and I would not recommend stopping the drug in the meantime.