neurodegenerative diseases

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How To Spend All That Ice-Bucket Money? Multiple ALS Research Leads Heat Up

In this image from video posted on Facebook, courtesy of the George W. Bush Presidential Center, former President George W. Bush participates in the ice bucket challenge with the help of his wife, Laura Bush, in Kennebunkport, Maine. (AP)

In this image from video posted on Facebook, courtesy of the George W. Bush Presidential Center, former President George W. Bush participates in the ice bucket challenge with the help of his wife, Laura Bush, in Kennebunkport, Maine. (AP)

I sighed this week when I heard, “Hey, Mom, do we have a clean bucket and some ice?”

Yes, the viral ALS ice-bucket challenge that has swept the country had reached our household as well. And though my daughter averred that she would never have heard about ALS otherwise, it pushed some of my cynic buttons. (My favorite response so far had come from an acidly hilarious Facebook friend who advised celebrities: “Just write a check to support ALS research. If you still need a gimmick and social media attention, set your hair on fire instead.”)

For me, the trouble was that I had looked into ALS research a few years ago and it had struck me then as extraordinarily frustrating. It was the field that first taught me that it’s all too common for a potential treatment to look good in initial testing and then fail to pan out when tried in a bigger clinical trial. That happened with ALS over and over again. And meanwhile, patients faced inexorable neurological degeneration and far too early deaths. (One of my most admired colleagues, Dudley Clendinen, died of ALS in 2012 after eloquently chronicling his time with it.)

But then I thought: Let’s be positive. Whatever the narcissistic elements of the ice-bucket dousings, the challenge is raising millions of dollars — more than $50 million as of Friday, from more than a million new donors, according to the ALS Association. And maybe ALS research has changed?

Indeed it has, say scientists working in the field. Not that it looks like there’s a cure around the corner, but there has been major progress of late, they say, and we can expect more to come.

“In about the last seven years, the genetics of ALS has just exploded the field, and just come up with so many new ideas for how we can tackle the disease,” said Avi Rodal, an ALS researcher at Brandeis University whose work is funded by the Blazeman Foundation for ALS.

Dr. Lucie Bruijn, chief scientist of the ALS Association that is reaping the ice-bucket windfall, also describes a field that is forging ahead in multiple directions. “The understanding of the disease, the research that has gone into it, has grown exponentially,” she says. “So we’re much closer to understanding the complexity of the disease and how to approach it in a very different way from before, when many of the trials were challenging partly because we didn’t understand the disease as closely.”

The Association, she says, is focusing on six main areas, and the ice-bucket money will likely be divided among them: “We want to invest in many areas,” she says, “to be sure not to dilute it too much but to be very strategic that we don’t put all our eggs in one basket.”

Those areas, in brief and lightly edited, as she described them:

1. Genetics:
About five to 10 percent of ALS runs through families, but 90 percent is sporadic. However, we’ve found that many of the genes we identify in familial disease are potential risk factors, and certainly also seem to be involved in the sporadic form. So there’s an underlying genetics in all ALS, but sometimes it’s more dominant than others. Continue reading

Summertime Blues: Pesticide-Laden Strawberries And Your Health

Pesticide spraying at a farm on the North Shore of Massachusetts. (Photo: Alexandra Morris)

Pesticide spraying at a farm on the North Shore of Massachusetts. (Photo: Alexandra Morris)

By Alexandra Morris

This weekend marks the start of the summer season, but I can’t help dwelling on the downside. Each year at this time, crowds from urban Boston descend on the farm next to my parents’ house on the North Shore in Mass. to pick their own strawberries – fresh, sweet, ripe…and coated with toxins.

While the farm staff warns visitors to wash the fruit before eating it, many choose to snack along the way (one group was caught sitting in the strawberry field with a can of “Reddi-Whip” in hand). After all, what’s the cost of a few unwashed strawberries?

Unfortunately, when it comes to our health, the cost may be fairly high.

Over the years, researchers have documented the bad effects of pesticide exposure on human health. Recently, though, and at a forum this week at Harvard, there’s been increased attention on the links between pesticides and neurodegenerative diseases, notably Parkinson’s and Alzheimer’s.

In a study published earlier this year in the journal Neurology, researchers from UCLA identified the way in which certain pesticides can increase the risk of Parkinson’s disease. They also found that people with a common genetic variant are even more sensitive to these pesticides – they are two to five times more likely to develop Parkinson’s if exposed.

“Once you identify the toxicity of these things, getting rid of the bad pesticides…would be a goal, not just for the people that live in the area, but for the workers that use it,” said the study’s lead author, Dr. Jeff Bronstein, a professor of neurology at UCLA.

In a separate report out of Rutgers University, published in JAMA Neurology, researchers found that exposure to the pesticide DDT may increase the risk of developing Alzheimer’s disease. In the study, researchers found that levels of DDE, the chemical compound that develops when DDT breaks down, were higher in the blood of Alzheimer’s patients compared to those without the disease.

And the effects go beyond the risk of Parkinson’s and Alzheimer’s. Marc Weisskopf, an associate professor of environmental and occupational epidemiology at the Harvard School of Public Health, who spoke at the Harvard forum, said there is evidence that pesticides contribute to a host of neurodevelopmental disorders as well, from ADHD and developmental disorders to lowered cognitive performance. Continue reading

Isn’t Parkinson’s Degenerative? How Can Michael J. Fox Be Better?

Actor Michael J. Fox in a 1988 photo (Wikimedia Commons)

“Great news,” I thought when I read that Michael J. Fox was returning to a comic television role, 12 years after he left to focus on treating his own Parkinson’s disease and funding research to help all patients.

“But how can this be? If there’s a big breakthrough in Parkinson’s disease treatment, wouldn’t we have heard about it? And if there isn’t one, isn’t the definition of a degenerative disease that it goes downhill? How can he have climbed back up again?”

Dr. Michael Schwarzschild, a Parkinson’s expert and director of the Molecular Neurobiology Laboratory at the MassGeneral Institute for Neurodegenerative Disease, kindly fielded my questions. First the disclaimers: He is not involved in Fox’s treatment, and has received grant support from the Michael J. Fox Foundation for Parkinson’s Research. Now the answer to my first query: What could it mean that Fox told ABC he “kind of stumbled onto a new cocktail of meds” that made him better enough to work again? Dr. Schwarzschild:

I heard his quote, too, and of course it’s wonderful that he’s making a comeback. In terms of what to make of this somewhat cryptic comment, I don’t think it relates to some new treatment that others don’t know about, or something newly approved and dramatic, because there isn’t anything like that.

‘Someone can improve without breaking the laws of physics about Parkinson’s disease being an inexorably progressive disorder.’

As a clinician who treats patients with Parkinson’s, your impression is right: It’s a progressive neurodegenerative disease. On average, in typical or even not-typical Parkinson’s disease, it’s inexorable.

That being said, it’s not a constant decline even though it goes in that direction, and medication can have a huge effect. Levodopa, when it came around in the sixties and seventies, took people out of nursing homes. Usually, with someone who’s getting reasonable care, you don’t expect, late in the disease, to discover some combination of currently available medications that make a huge difference. But sometimes you do.

I’ll give you a couple of examples even with approved medications in the United States. Continue reading