Originally established to list my teaching resources for
Neurology at Dartmouth Medical School, this site provides numerous links to neurology, neuroscience,
and other medically related topics. Recently I have added more content in the form of news feeds and a Blog.
Let me also make the disclaimer that these are just references to information. Do not rely on what you
find here to treat yourself or anyone else. Physicians and other health care providers must use their
own judgement and multiple inputs from many sources to reach decisions. Information found here is not diagnostic
or treatment advice from me or from this web site. If you have any suggestions or comments, you may leave them in the
Guestbook.----Thank you.
I friend of a friend sent me this link to an poignant article that he wrote
about his father's struggles with Parkinson's Disease. It is published in Runner's World.
I do not prescribe either Zyprexa (olanzapine) or Seroquel (quetiapine)
very frequently. These are two of the "newer" antipsychotics, though actually they are not very new any more. They
certainly have fewer exrapyramindal side effects than most of the older antipsychotics. Probably there is a lower rate of
tardive dyskinesia development as well (hopefully someone is tracking this). Recently there have been lawsuits related to
the apparent tendency of Seroquel to cause diabetes (see http://online.wsj.com/article/BT-CO-20100219-709678.html?mod=WSJ_World_MIDDLEHeadlinesEurope). Zyprexa has been implicated in diabetes as well (see http://www.attorneyatlaw.com/2009/07/man-sues-eli-lilly-claims-zyprexa-caused-him-to-develop-diabetes/). Both of these also have been linked to sudden cardiac death
(http://www.ncbi.nlm.nih.gov/pubmed/19144938?dopt=Abstract) not unlike many other antipsychotic medications. So it is very important
to review possible side effects when prescribing these to patients and to be very careful with them.
From a neurologist's
perspective, the big difference betwenn Zyprexa and Seroquel is that Seroquel is better than Zyprexa for patients
with Parkinson's disease. By "better" I mean that Seroquel has less tendency to make the Pakrinsonian signs
and symptoms worse than does Zyprexa.
But none of the above prompted this blog entry. The reason I am writing
this is that for years I have always had trouble remembering that Zyprexa is Olanzapine and Seroquel is Quetiapine.
And I'm not the only one. I've heard this time and again from others who prescribe these medications occasionally.
A doctor knows he wants Quetiapine and thinks "Is that Zyprexa or Seroquel?" Or he knows he want Seroquel but the
formula only list the generic names and he's not sure if it is Olanzapine or Quetiapine. Well here is my flash of
insight, Assuming you can remember those four names and assuming that you know that there are two separate drugs and
each of them has two of the four names, Zyprexa and Olanzapine go together because both of them have a "Z". Seroquel
and Quetiapine are the same---they both have a "Q". Now what could be simpler than that?
If I haven't
made any other great discoveries by, say, August 2010, I would appreciate it if some reader of this blog were to communicate
this to the Nobel Prize in Medicine Committee. True, this may not be the greatest, but if it's a weak year, anything could
happen.
New York Academy of Medicine Author Night Series: Superheroes and Superegos Analyzing the Minds Behind the Masks
NYAM Author Night Series: Superheroes and Superegos Analyzing the Minds Behind the Masks
Location: The New York Academy of Medicine,
1216 Fifth Avenue at 103rd Street, New York, NY 10029 Speakers:Sharon Packer, MD
This comprehensive collection of essays written by a practicing psychiatrist shows that
superheroes are more about superegos than about bodies and brawn, even though they contain subversive sexual subtexts that
paved the path for major social shifts of the late 20th century. Psychiatrist and social advocate Fredric Wertham lobbied against comics because of their sexual and sadistic subtext
and their potential to reverse women’s roles and encourage same-sex behavior. However, Wertham’s McCarthy Era
stance forgot that early superhero comics foretold Hitler’s threat—and offered solutions. Superheroes have
provided entertainment for generations, but there is much more to these fictional characters than what first meets the eye.
Superheros and Superegos: Analyzing the Minds Behind the Masks begins its exploration in 1938 with the creation of
Superman and continues to the present, with a nod to the forerunners of superhero stories in the Bible and Greek, Roman, Norse,
and Hindu myth. The first book about superheroes written by a psychiatrist in over 50 years, it invokes biological psychiatry
to discuss such concepts as "body dysmorphic disorder," as well as Jungian concepts of the shadow self that explain
the appeal of the masked hero and the secret identity. Readers will discover that the earliest superheroes represent
fantasies about stopping Hitler, while more sophisticated and socially-oriented publishers used superheroes to encourage American
participation in World War II. The book also explores themes such as how the feminist movement and the dramatic shift in women's
roles and rights were predicted by Wonder Woman and Sheena nearly 30 years before the dawn of the feminist era. Highlights
Looks at cultural psychology as much as individual psychology to analyze the political backdrop
of superhero stories
Explores the importance of the secret self, the shadow self, and myths
of metamorphosis, and shows how superheroes function as wounded warriors in contemporary society
Shows
how the teenage creation of Superman of 1938 was prophetic and speculates whether the rise in superhero cinema in the 21st
century may be equally prophetic of political catastrophes to come
This event is free but pre-registration is required
Copies will be available for purchase. Sharon Packer, MD, is a practicing psychiatrist and
assistant clinical professor of psychiatry and behavioral science at Albert Einstein College of Medicine of Yeshiva University,
Bronx, NY. Her published works include Dreams in Myth, Medicine, and Movies and Movies and the Modern Psyche.
As the writer for this neuroscience website, I feel impelled to comment
on the tragedy in Alabama which allegedly has been perpetrated by a, a "Harvard trained neuroscientist" as
she is now commonly called in the media. I am a neuroscientist partially trained at Harvard. Though I doubt this
gives me any special insight, it does make me feel somewhat connected to this. There is even another connection. A friend
of mine with whom I have co-authored one paper is also a co-author on several papers and abstracts with this person. In fact,
her name seemed strangely familiar to me, though I am quite sure I have never met her. But I had read (or at least perused)
the papers she co-authored with my friend and that is probably why I remembered her name.
Who knows what to say
about such horrible things? Should schools have courses in how to cope with career problems? Would that have helped? She did
not get tenure. To those of you who have ever been on an academic track, you know how tough that is. But it's not
terrible enough for it to make any sense to kill someone. Most of us are going to have to get through many unfortunate
events. We are going to lose contracts, grants, and---yes---jobs. We are going to submit papers and some of them are
going to be rudely rejected with unflattering comments about our abilities. Loved ones will reject us and, yes,
people we love are going to die and/or be killed. Is there a way to learn to cope with these things? Or do we say that
most people can cope and the few who cannot are crazy? I don't know.
Speaking of coping, think of the
families of those who were killed. Think of those who were injured. Think of the perpetrator’s own family. All this because
someone did not get tenure? There is a huge disconnect here. What I am going to write next may sound ridiculously obvious
and it is probably one of those things that will not do anyone any good. But just in case it might help someone, I am going
to write it anyway.
Even if you lose that job, that grant, that contract, or whatever wonderful thing you
want and deserve due to the total and complete unfairness of another person or persons, it is never going to be helpful to
try to kill or injure that person. If you start thinking that it would be worthwhile to do so, go immediately to a competent
mental health provider. If you ever think doing something like that is a good idea, something has gone wrong with your thinking
and you need to get help right away. I know this sounds obvious, but perhaps we should have courses that just drum this
into everybody's head to give them something to hold onto when their thinking goes astray. Maybe in such a case, it would
not work. But in any case, if anyone tellls you that he or she is going to do such a thing, then get help for that person
immediately. At least if you are sane you can hopefully recognize when someone else might be going astray. While I do not
like the idea of "snitching" on people in general, if you think that someone is likely to hurt himself or others,
you just have to do it.
Sorry for the moralizing, but this story really "hit a nerve."
This is a bit of an esoteric post but I think it has interesting
implications. In Curr Opin Neurobiol. 2009 Aug;19(4):415-21. Epub 2009 Aug 10, SP Brown and S Hestrin
of Stanford discuss how to determine the function of neuronal circuits in the nervous system. It’s one of those
things that seem obvious in a sense but are really very difficult to do. The title of their paper is “Cell-type
identity: a key to unlocking the function of neocortical circuits.” What they show and discuss is the idea that one
has to precisely identify the type and individual behavior of both the presynaptic and postsynaptic neurons in any given neuronal
circuit and then test the circuit by activating and recording from the cells in order to figure out what the circuit is doing.
Of course, cell identification is becoming more and more doable with specific antibodies and stains to identify receptors
and other neuronal structures. And the equipment and methods for neuronal stimulation and recording are becoming better
and better. This type of study would have been impossible ten years ago. The implications are that eventually we can decipher
the functioning of the nervous system on a precise neuronal circuit level so that we can look at it in almost the same way
that we look at a computer filled with numerous computer chips. In a sense we have been thinking about it that way for a long
time. But a lot of the ideas about the individual circuit level have been speculative. Perhaps if we know precisely how certain
subunits transmit information we could replace them by articifical neural circuits. There is some of that going on already
with the visual system but it is not as precise as it might eventually become.
You can find a link to the abstract of their article at
A new medication, dalfampridine (sold under the name Ampyra) has been approved
by the FDA for multiple sclerosis. The new medication does not cure MS or even block the MS attacks. But it reportedly helps
patients with MS to walk faster (and presumably better).
How does it do this? Dalfampridine is a potassium channel blocker. In the process
of nerve conduction, the potassium channel opens at a certain point to shut off the action potential. Blocking the channel
a bit allows the potential to last a little longer and this helps the impulse to propagate through areas of damaged myelin.
For
many years this drug as been known under another name, 4-aminopyridine (4-AP). Previously it had been believed
that 4-AP was too toxic to use clinically. But Biogen seems to have reduced the toxicity by using a time
released formulation. Thus it was approved by the FDA. The list of possible side effects is long, however,
and includes such nasty items as seizures and relapses of MS itself. So this is not something to be taken lightly. But
as clinical experience accumulates, Ampyra may take its place as another tool in the MS treatment toolbox. By
the way, if you look this up you may encounter the name fampridine rather than dalfampridine.They are
the same drug. Fampridine=dalfampridine=4-aminopyridine=4-AP.They are all names for the same chemical.
