A Healthy Body Makes for a Healthy Brain

It’s 1960. “Eat your vegetables. Don’t you want to grow up strong and smart?”

The boy’s mom dished out this unassailable logic at the dinner table along with the lima beans. What boy wouldn’t want to grow up “strong” and “smart?” And eating the dreaded lima beans surely must be good for you … why else would someone eat them?  But the boy became a young man and forgot his Mom’s dinner table wisdom.

Fast forward to the early 1980s and the young man is a neurologist studying multiple sclerosis, or MS. He knows about an elderly Portland neurologist named Dr. Roy Swank — who had been head of the Department of Neurology at OHSU for two decades — who has been treating MS with a low-fat diet since the year the young man was born. Surely this makes no sense. MS is an autoimmune disease that damages the insulating material of the brain and spinal cord. How could a low-fat diet help the immune system or protect the brain?

So he dives into learning about immunology, conducting research on how to control a rogue immune system and begins caring for people with MS. He looks forward to the day when he can treat his MS patients with drugs that can control their MS. His patients ask him about the Swank diet and he tells them a low-fat diet would help their hearts but probably won’t help their MS.

Fast forward to 1993. The young neurologist is now middle aged and the first drug for treating MS, beta interferon, is Food and Drug Administration approved. It is the first of seven classes of drugs that will receive FDA approval for treating MS over the next 20 years. All of the drugs modify the immune system. The middle-aged neurologist uses these drugs and sees that many of his patients do better. They have to deal with side effects and the medications are expensive but what he had dreamed about when he started his career is coming true. His patients still ask him about diet therapy and he recommends following a low-fat diet. “You will be healthier if you do so. Now here is your prescription.”

Fast forward to 2013. The neurologist is still middle aged — people are living longer after all. But he notices that, despite his armamentarium of drugs, not all of his patients want to take them. And even those who do take them want to do more. They ask him for guidance on diet. He tells them they should follow a low-fat diet because it will make their immune system and brains healthier. He recommends Dr. Roy Swank’s MS diet book, or to follow Dr. John McDougall’s low-fat vegan diet. He even helps organize programs for people with MS to find out how to eat right, exercise and manage stress. “Do this and it will help your MS,” he advises his patients.

So what happened between 1993 and 2013? There were two major changes.

First, the neurologist realized that the medications he was prescribing were helpful but weren’t enough. “Life style medicine” was needed — not just expensive, sometime toxic, medications.

Second, more and more scientific evidence began to accumulate indicating that obesity, smoking, lack of exercise, high blood pressure and diabetes made MS worse. And they made the immune system unbalanced and were bad for the brain. He also realized that adding more medications was not the right answer. Following a healthy diet, exercising, avoiding harmful habits and managing stress were a much more sensible approach. In addition, these approaches to a healthier life were being advocated for reducing the risk of developing a number of neurologic diseases, including stroke and dementia.

So eat your vegetables. Get off the couch and exercise. Don’t smoke. You want a healthy brain, don’t you!

Dennis Bourdette, M.D.
Executive Director, OHSU Multiple Sclerosis Center
Professor and Chair, Department of Neurology
OHSU Brain Institute

Pioneering scientist speaks about brain mapping

This is an example of an fMRI map produced from data collected on the OHSU Brain Institute’s 7 Tesla MRI instrument showing auditory brain areas activated during a passive listening task.

Those of us who work within the OHSU Brain Institute are honored to have Dr. Marcus Raichle visit us May 13 to present an evening seminar in the Brain Awareness Lecture Series, entitled “How Do We Peer Deeply into the Brain.”

Raichle has been at the forefront in the development and application of advanced brain imaging techniques to advance neuroscience for four decades. He is a pioneer in the use of innovative positron emission tomography, or PET, studies to explore brain structure and function relationships.

Functional neuroimaging studies – or studies that show real-time imaging of the human brain in action — have grown tremendously over the last two decades and have contributed substantially to understanding function in the living human brain. Functional magnetic resonance imaging, or fMRI, has found widespread application in neuroscience, surgical planning before brain surgery and even non-medical applications like marketing research.

The fundamental experimental design strategies inherent in these studies can be traced to work from Raichle and his colleagues, who have used water that has been scientifically “marked” to allow the researchers to watch and investigate changes in blood flow in various parts of the brain as it performs specific tasks.

Raichle’s work has consistently shifted neuroscience paradigms. Studies from Raichle’s group have quantified blood flow and glucose utilization and found that these increase to a greater extent than oxygen utilization in activated brain areas — a principle central to essentially all fMRI experiments.

Most recently, Raichle and his colleagues have turned their attention to studies of the “resting” brain — that is, the brain not engaged in any outward directed activity. Remarkably, these neuroimaging studies have revealed that the brain is quite active – even at rest.  Indeed, the amount of energy expended at rest is much greater than incremental energy change required to attend to a specific task. Additional studies have revealed common modes of activity in the resting brain — a “default mode” that is deactivated during task-specific demands.

These findings have generated substantial excitement in the neuroscience community. We at the OHSU Brain Institute are actively pursuing research based on what Raichle has discovered, as are other top neuroscience institutions throughout the world.

That research, and further advances that spring from it, could lead someday to better treatments — and even cures — for a wide range of brain diseases and disorders.

Raichle will speak at 7 p.m. Monday at the Newmark Theater, 1111 S.W. Broadway in downtown Portland.

Bill Rooney, Ph.D.
Director, Advanced Imaging Research Center
OHSU Brain Institute

 

Recovering from concussion: a long haul but I’m getting there

OHSU concussion patient Jamie Wirth

The first time I got hit was November 15, 2008, during my freshman year at Aloha High School, at basketball practice. I dove, a girl moved her knee and I smashed into it with my forehead. I was dizzy, confused, nauseated and my head was pounding.

Three weeks later, I was shooting around with a friend when a basketball hit me on the head. Since I was not symptom free from my first concussion, my symptoms only became worse. This is called second impact syndrome.

My first concussion was right before finals. I tried my best, but my grades slipped. I had problems with short-term memory, fatigue and concentration. Months passed and my pediatric neurologist (not at OHSU) prescribed bed rest and medication that caused awful side effects. Their approach was “time and rest.”

I had many different symptoms — lights and noise bothered me, and my eyes hurt whenever I used the computer or watched TV. I had a constant migraine, which caused me to wake up 10 to 12 times a night in pain. Nothing helped.

I went without any improvements for over a year. I often felt as if no one, not even the doctors, believed me when I described my problems. It became apparent during the few speech and physical therapy sessions I received that their philosophy was to teach me how to deal with my symptoms, not expect any improvements.

In January 2010, my family switched our insurance plan and we were able to go to Dr. James Chesnutt and the concussion rehab team at OHSU. For the first time, we felt there was hope. Dr. Chesnutt had me evaluated by a speech therapist and a physical therapist. I was also diagnosed with severe whiplash from my initial injury. This had never been diagnosed or treated, and I had to see a neck therapist who specialized in strengthening my neck. I went through seven months of intense physical therapy as well as 13 months of speech therapy.

The speech therapist gave me tools to help my memory, concentration and to improve my thought processing. Dr. Chesnutt also referred me to a neuro-ophthalmologist who discovered previously hidden vision problems. Six weeks of vision therapy and three months of at-home online vision therapy got my eyes working together, which further decreased my headache pain.

My OHSU therapists not only believed me — they believed in me. Instead of hoping I would get better, they actually made it happen. Although it took me two years to recover, Dr. Chesnutt’s first priority was my safety. Time was passing, but he was patient and made sure I didn’t rush back too soon. At the same time, he helped lead me back to a regular life again.

I ended up missing about a year of school altogether, and was told I would not graduate with my class because I was so far behind. It seemed impossible, but I was determined to work hard to catch up. I put in numerous extra hours throughout the year. And along with my regular classes, a combination of online classes, summer school and having a home tutor, I was able to graduate with my class in June of 2012.

In the fall of 2012, I started full time at Portland Community College. Community college was a perfect fit for my situation; I am slowly adjusting to the college routine. I am also working on writing a book about my concussion journey and turning all the pain I went through into a purpose. To give hope to those who feel hopeless.

Concussions change you emotionally, physically and mentally. In the two years of having this concussion I lost a lot, but I have gained even more. As strange as it sounds, I’m thankful this happened. The injuries helped shape me into a better person and have opened up many opportunities.

Jamie Wirth

Jamie Wirth, 19, is a patient of OHSU’s sports medicine program and James Chesnutt, M.D. She lives in Aloha.

Violence in the brain? And beer …

Physicians and researchers have some pretty amazing ways of peering inside the human brain.

And some of those methods — and what they might show us — have been in the news a lot lately.

A couple of neurosurgeons at Boston University, who have studied former NFL football players and others who have received repeated hits to the head, say that the brain of alleged Boston bomber Tamerlan Tsarnaev should be studied in a special autopsy procedure. Tsarnaev, who along with his brother is suspected to have planted bombs near the finish line of the April 15 Boston Marathon, was later killed in a shootout with police.

boxing and the brainThe Boston neurosurgeons’ previous research has found that people who sustain repeated hits to the head can develop a brain disease called chronic traumatic encephalopathy, or CTE. The disease can lead to depression, aberrant behavior, emotional instability and lack of impulse control, the researchers say. Tsarnaev was a former amateur boxer.

The researchers say they don’t necessarily believe CTE caused Tsarnaev’s behavior in the bombing, but believe his brain still should be studied.

Meanwhile, brain researchers led by New Mexico neuroscientist Kent Kiehl have published a study suggesting that brain scans of convicted felons can predict which of them are most likely to get arrested after they get out of prison.

The study tested the impulse control of a group of 96 male prison inmates and found that those with low impulse control were roughly twice as likely to get re-arrested after they were released from prison.

And finally, two physicians who were parents of one of the children killed in the Connecticut school shooting last December have formed a foundation that will fund brain research into the possible underpinnings of violent behavior. The Avielle Foundation, which will be guided by three internationally known brain researchers, is named for first-grader Avielle Richman, who was among the 20 children and six adults killed in the Dec. 14, 2012, shooting in Newtown, Conn.

And … neuroscientists are also finding ways to explore less tragic issues. In other words, beer.

Neuroscientists have just published a study that found that just a tiny taste of beer makes us — or at least men — want more. The study found that just a swig of beer — not nearly enough to cause intoxication — prompted the release of the neurotransmitter dopamine in the reward centers of male brains. The taste induced the brain to want more of that taste. Researchers say the results may suggest one mechanism for increased alcoholism risk.

Todd Murphy
Senior Communications Specialist
OHSU Brain Institute

Smarter brain ‘glue’ — glia cells take the spotlight

Many neuroscientists will tell you that nerve cells in the brain (called neurons) are the most important part of the nervous system. They are, after all, the primary cells of the nervous system, responsible for conducting electrical currents to encode and process our senses, thoughts, memories and emotions.

But there is a growing contingent of neuroscientists who study other brain cells called glia, named for the Greek word for glue. For much of the last century of neuroscience research, glia were second-class citizens to neurons, thought of simply as brain “glue” — a structural support system for neurons. That opinion has been changing in the last 20 years or so. Neuroscientists have discovered that these cells are essential for brain development, proper metabolic brain function, neuronal health, and now, perhaps, for intelligence itself.

Last month, scientists at the University of Rochester in New York published exciting new data that human glial cells could be at least partly responsible for advanced intelligence in humans, compared to lower species. The researchers transplanted human glial stem cells directly into the brains of young mice, a technique that may sound like science fiction but that is actually fairly common in neuroscience research. When these mice reached adulthood, their brains contained mouse neurons and human glial cells. Compared to ‘control’ mice that had mouse neurons and mouse glial cells, the mice with human glia performed better in behavioral learning and memory tasks, and their neurons were able to encode and process information faster and more efficiently. In short, the mice that had human glial cells in their brains were “smarter.”

While this is particularly exciting for neuroscientists who study glia, all of neuroscience has a lot to gain from these new findings. Not only does this work suggest a much deeper connection and complex interaction between neurons and the billions of non-neuronal cells in your brain; it also may provide a clue to advanced intelligence in humans compared to mice.

Personally, these new insights have changed the way I think about my own research. My research focuses on Parkinson’s disease, which is thought to be a purely neuronal disease. In light of these data on the impact of human glia on learning and memory, I can’t help but wonder if glial cells have a more important role in many other neuronal processes, including neuronal health and survival in Parkinson’s. We still have much to discover about the brain, and no doubt glial cells will continue to take the spotlight as we move forward as a field.

Kateri Spinelli, Ph.D.
Post doctoral fellow, Dept. of Neurology
OHSU Brain Institute

 

Brain imaging in Parkinson’s disease

Traditional brain imaging with CT and MRI scans do not show changes in the brain when someone has Parkinson’s disease and are generally not helpful in diagnosis.  A new kind of brain scan, called a DaT scan, does show changes in persons with Parkinson’s disease and may someday become an important tool in diagnosing Parkinson’s.

The dopamine transporter, or DaT, scan uses a chemical that labels the dopamine transporter in the area of the brain known as the striatum. Dopamine is a neurochemical that is decreased in persons with Parkinson’s disease.

The dopamine transporter, which moves dopamine in and out of cells, is also decreased in the striatum in persons with Parkinson’s disease and related disorders. The chemical that labels the transporter is injected into the vein and can be imaged by using something called single photon emission computerized tomography, or SPECT scanning. This technique has been registered in the European Union since 2000 for differentiating a diagnosis of essential tremor and a parkinsonian syndrome. It was approved by the Food and Drug Administration in 2011 for this same indication and recently became available at the OHSU Brain Institute.

There are a number of things that are important to know about DaT scanning. DaT scans are not able to distinguish between idiopathic Parkinson’s disease (typical Parkinson’s disease) and the syndromes known as atypical parkinsonian syndromes. These include progressive supranuclear palsy, multiple system atrophy, and cortical basal degeneration. There also can be some uncertainty in the interpretation of scans. In one fairly large study, even after DaT scanning, about 10 percent of persons had not received a clear diagnosis or there was disagreement between the scan and the physician’s diagnosis. The data we have at this time indicate a diagnosis made by a clinician based on an exam, or a radiologist based on a DaT scan, is about as likely to be correct or incorrect. Neither is perfect.

DaT scans may become a critical tool is assisting in the diagnosis of Parkinson’s disease and related disorders. However, at this point, Parkinson’s disease is still something a physician, ideally a neurologist, must diagnosis. For classic cases of Parkinson’s disease, it is unlikely that most neurologists would order a DaT scan as they would feel confident in the diagnosis.

It is again important to state that the DaT scan is not going to be helpful in differentiating Parkinson’s disease from the related atypical parkisnonian syndromes. Still, if you are curious if a DaT scan may be appropriate for you, it is best to talk with your neurologist and discuss the pluses and minuses of pursuing this testing.

Amie Peterson, M.D.
Assistant Professor of Neurology
OHSU Parkinson Center of Oregon
OHSU Brain Institute

OHSU Brain Institute experts at the cutting edge of treating stroke

With stroke, time is brain. When people suffer strokes, they need certain medical treatments within a limited amount of time, or their brains can be so damaged that they will have permanent disabilities.

That’s why the OHSU Telemedicine Network is so vital in stroke treatment for hundreds of thousands of rural Oregonians. The network allows experts with the Oregon Stroke Center at the OHSU Brain Institute to use a two-way audio-video robot to collaborate with physicians at hospitals throughout Oregon seeing patients who might have suffered strokes. The network allows the OHSU stroke experts to quickly assess a patient’s condition through the audio-video link and prescribe immediate treatments if they are needed.

Read more about it at OHSU’s 96K blog.

New technology also is allowing doctors to see inside the brains of stroke victims in new ways — and help patients completely recover from stroke in cases where a full recovery would have been impossible before.

The technology allows stroke experts to see which parts of the brain have been too injured by the stroke to save, and which parts were affected by low blood flow but can be saved if treated immediately. You can also read more about this life-changing technology at the 96K blog.

The surgery that changed my life: controlling the seizures

Leigh with her mom Leslie

Seventeen-years old, waking up on a Sunday morning wondering who I was, where I was, and how I became that way. That was the first time memory loss had become part of my life.

However, it was not the first time I had been overcome by confusion. In fact, that cycle began at age four — on the night I had my first epileptic seizure.

Epilepsy is a neurological condition that produces seizures affecting one’s mental and physical functions. The night my epilepsy began, I was sleeping in my room when my parents heard me breathing rather oddly. When they went to check on me, my eyes were rolled back, I was smacking my lips, and my body was limp. When I woke up, I was in the hospital.

All my life, I have taken medicine to control my seizures. Between the ages of 4 and 12, I would have grand mal or tonic clonic seizures, which would occur a couple times each year. As I continued to grow, my seizures changed to complex partial and nocturnal seizures, which eventually resulted in severe memory loss.

Medicine has kept me stable and safe, and thus, I never minded taking it. However, the medicine began to become less affective and by the time I was 21 years old, I began having more seizures than usual. The problem with this is that every time an epileptic seizure occurs, there is a possibility that damage can be done to the brain. Therefore, the change that would soon occur in my life would be brain surgery.

When I first heard this, I laughed. I have always looked at epilepsy as an adventure — as the factor that simply makes me special. I have never thought of myself as disabled or sickly, and always try to remember that it could be worse. With these thoughts, I disassociated myself from the idea of brain surgery, thinking that it would always be unnecessary. However, the circumstances continued changing. My seizures began occurring two or three times per day, rather than once a month.

The daily seizures were complex partial seizures, during which I would shake and drool, lasting from 30 seconds to 2 minutes. Afterward I would speak very slowly, be somewhat confused and forgetful, and my head would hurt immensely, always in the same area. Because the seizures were happening so often, I had to convince myself to follow through with the brain surgery, which occurred on September 17, 2012.

My surgery was performed by Dr. Kim Burchiel, head of the neurological surgery department at within the OHSU Brain Institute. The surgery lasted four hours and went extremely well. I spent five days in the hospital and improved a little bit each day. I was told from the beginning that it will take me at least a year to recover, and that I need to be patient.

It has been six months since surgery, and my seizures have changed immensely. I now have about two or three seizures per week, as opposed to every day, and can usually predict when they will occur. I also stay awake during the process and no longer lose my memory. Although my seizures still cause headaches and slow speech, I am continuing to improve each week, and am very thankful for all that has occurred.

I have received so much support throughout my experience as an epileptic, which is why I began volunteering for the Epilepsy Foundation Northwest. Because I was able to go to college and major in sociology and Spanish, I have always wanted to use my skills to support other cultures. Group support is extremely important in regard to any illness, which is why I would like to continue supporting and helping others who have experienced epilepsy.

Although I do not know what will happen in regard to the stability of my seizures, I have decided to look at this change as a positive factor and use my past experience to help others who need inspiration.

Leigh Schommer, Portland

Schommer, 24, is currently studying and teaching English in Puebla, Mexico. The story of her epilepsy, her brain surgery and recovery was recently chronicled by the Oregonian.

So what is a Comprehensive Stroke Center anyway?

Wayne Clark, M.D.
Director, Oregon Stroke Center

This week the Oregon Stroke Center at the OHSU Brain Institute was very pleased to receive the following notification from our hospital accreditation organization: “Effective Immediately The Joint Commission has officially certified OHSU as a Comprehensive Stroke Program!”

OHSU is the first hospital in the Pacific Northwest and one of only 27 hospitals in the U.S. to receive this certification.

Well, this all does sound exciting — but what does it mean for a patient who is having a stroke? Taking a step back, there are several different levels of treatment for someone who is having a stroke that is being caused by a blocked artery in the brain. The first is to make sure basic care is provided for the patient. Are they breathing safely? Is their blood pressure too high or low? What kind of stroke is happening and when did it occur?

These needs can be met at excellent, local “stroke ready” hospitals around the state. Here the patient is first examined and decisions are made on whether the patient should be treated locally or whether he or she needs to be transferred to facilities for more advanced care. Some of these local hospitals can give the specific stroke treatment “clot buster” therapy — “tissue plasminogen activator,” or TPA —  in an attempt to open up the artery causing the stroke. The decision to give TPA often involves discussing the case with a remote stroke specialist by phone or more recently by using video “telestroke” evaluations. OSHU currently has a nine-hospital “telestroke” network where we can evaluate the patient and assist local hospitals around the state. After the TPA is started, the patient is frequently transferred to a larger hospital for further care and and management.

The next level of stroke care capability is a “primary stroke center.” These hospitals have been certified by The Joint Commission — a non-profit that accredits more 20,000 health care organizations across the country — to be fully capable of delivering acute stroke treatment, including TPA, and providing extensive evaluation and detailed management of the patient. This includes having intensive care beds and being able to provide rehabilitation services. Currently, 14 hospitals in Oregon are primary stroke center certified. OHSU has been a primary stroke center since 2007.

However, for many patients, TPA alone may not be sufficient. In these cases, more advanced “interventional” techniques are required to try to pull out the clot that is causing the stroke. In addition there are other types of stroke that can be caused by an artery breaking inside the brain (a cerebral hemorrhage) or an artery popping on the surface of the brain (a subarachnoid hemorrhage). For these very critical patients, specialized “neurointerventionalists” and cerebrovascular neurosurgeons are required to stop the bleeding, using special clips or coils. In addition, the patients need to be managed very closely in a specialized neurosciences intensive care unit. This is where a “comprehensive stroke center” is required.

To meet the Joint Commission criteria, the Oregon Stroke Center had to prove that we had all of these capabilities — 24 hours a day, 365 days a year. In addition, we had to demonstrate that our complication rates for all these procedures were better than the national guidelines. Another big part of the comprehensive stroke center criteria is that we monitor the care and outcome of our patients not only in the hospital but during outpatient follow-up for three months!

Having this hierarchical hospital approach to stroke care — stroke ready, primary stroke center, comprehensive stroke center — allows patient throughout the state to start receiving immediate appropriate treatment locally while providing a tertiary referral center for advanced stroke care for Oregon.

Wayne Clark, M.D.
Director, Oregon Stroke Center
OHSU Brain Institute

 

 

Autism rates increasing — but why?

Autism spectrum disorders are severe neurodevelopmental disorders affecting young children that are usually detected in the first years of life. Autism is now recognized as one of the most common developmental disorders — likely to affect about 10,000 youth under age 18 in Oregon.

Meanwhile, epidemiological studies have shown increasing rates of autism in most countries.  On Tuesday, April 2, as part of the OHSU Brain Awareness Season lecture series, I will speak about my work over the last 25 years in studying autism. And I will talk about the factors that might account for the upward trends and rates, including the role of prenatal factors or childhood immunizations.

Major progresses have been achieved in the last few years with large-scale genetic studies on autism. An increased proportion in cases of autism — about 25 percent — can now be traced back to known genetic causes.

The new genetic discoveries are paving the way for identifying novel treatments and drug therapies currently under development that might become available in the not-too-distant future.

The outcome of autism has changed since the development of early intensive behavior programs that can significantly improve the developmental trajectories of children with autism — provided that they are accessed early and with sufficient intensity. On Tuesday, I will also talk about treatments that work and how available those treatments are.

Capitalizing on existing strengths in basic and clinical sciences, OHSU is now  developing a Center for Excellence in Autism that will act as a resource center for health-care providers and families in the community while contributing through research to a new understanding of the causes and treatments of autism.

Eric Fombonne, M.D.
Professor of Psychiatry
Director, Autism Research Center, OHSU Brain Institute

OHSU Brain Institute Profile image

OHSU Brain Institute

We are a national leader in brain disease treatment and research.

Read more

Participation Guidelines

Remember: information you share here is public; it isn't medical advice. Need advice or treatment? Contact your healthcare provider directly. Read our Terms of Use and this disclaimer for details.