Health Tip: Relief From Carpal Tunnel

(HealthDay News) -- Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist, according to the National Institute of Neurological Disorders and Stroke. The result may be pain, weakness or numbness in the hand and wrist, radiating up the arm.

Some patients are born with an unusually narrow carpal tunnel, which means they're at higher risk. Other contributing factors include trauma or injury to the wrist, an overactive pituitary gland, hypothyroidism, rheumatoid arthritis, work stress or repeated use of vibrating hand tools.

Anti-inflammatory drugs can ease the pain and swelling, while stretching and strengthening exercises can be helpful in people whose symptoms have abated. Surgery may be necessary if symptoms last for six months.

New MS Therapies Show Promise

(HealthDay News) -- Two medications may prove to be advances in the treatment of multiple sclerosis, researchers say.

In one study, an experimental drug called oral fumarate (BG00012) substantially reduced symptoms in patients with relapsing-remitting multiple sclerosis, according to a phase II clinical trial by European and North American researchers.

And in a second trial, researchers found that the leukemia drug alemtuzumab (Campath) was about 70 percent more effective than another drug already widely used to treat MS. However, alemtuzumab also had significant side effects, including bleeding disorders, a greater risk of thyroid disease, and infections. This prompted experts to say that much more research is needed before alemtuzumab can be prescribed to treat multiple sclerosis.

Multiple sclerosis is a nervous system disease that affects the brain and spinal cord. It damages the myelin sheath, the material that surrounds and protects nerve cells. This damage slows or blocks messages between the brain and the body, according to the U.S. National Library of Medicine.

Symptoms of the disease can include visual disturbances; muscle weakness; trouble with coordination and balance; sensations such as numbness, prickling, or "pins and needles;" and thinking and memory problems.

It's not known what causes multiple sclerosis. It may be an autoimmune disease, which happens when the body attacks itself. MS affects women more than men, and it often begins between the ages of 20 and 40. An estimated 400,000 Americans have the disease. Usually, the disease is mild, but some people lose the ability to write, speak or walk. There's no cure for MS, but medicines may slow it down and help control symptoms, according to the National Library of Medicine.

The 24-week study of BG00012 included 257 patients, ages 18 to 55, who were randomly assigned to receive either 120 milligrams of BG00012 once a day (64 patients), 120 milligrams three times a day (64 patients), 240 milligrams three times a day (64 patients), or a placebo (65 patients). The patients were assessed at weeks 12, 16, 20 and 24.

MRI brain scans showed that patients treated with 240 milligrams of BG00012 three times a day had 69 percent fewer new gadolinium enhancing (GdE) lesions -- a marker of MS-related inflammatory activity -- from week 12 to 24 than those who received the placebo. They also had fewer new or enlarging T2-hyperintense and T1-hypointense lesions at week 24.

The study also found that BG00012 reduced the annual relapse rate by 32 percent, but this finding wasn't statistically significant. Patients who received the drug were more likely than those in the placebo group to suffer adverse events such as abdominal pain and hot flush. Dose-related adverse events in patients taking the drug included headache, fatigue and feeling hot, the researchers said.

"Longer-term (phase III) studies of BG00012 in larger patient populations are underway to define its place in the future of relapsing-remitting multiple sclerosis treatment. If these studies show similar relapse rate reductions with BG00012, interferon beta, and glatiramer acetate, BG00012 could be a suitable initial treatment for relapsing-remitting multiple sclerosis," wrote Professor Ludwig Kappos, of University Hospital Basel, in Switzerland, and colleagues.

The study was published in the Oct. 24 issue of the The Lancet.

In an accompanying comment in the journal, Professor Per Soelberg Sorensen and Dr. Finn Sellebjerg of the Danish Multiple Sclerosis Research Center, noted that "BG00012 might have a favorable benefit-to-risk ratio profile compared with its oral competitors and the currently available first-line injectable drugs. However, we will have to await the results from the ongoing large phase III trials to establish the place of BG00012 and of other oral drugs in the treatment of relapsing-remitting multiple sclerosis."

The study of the leukemia drug alemtuzumab, which temporarily depletes white blood cells and is part of a class of drugs called monoclonal antibodies, included 334 patients. Patients were randomly assigned to get either alemtuzumab or interferon beta, a standard MS therapy, for three years.

Alemtuzumab reduced by 74 percent the risk of MS relapse, the researchers reported in the Oct. 23 issue of the New England Journal of Medicine.

"The ability of an MS drug to promote brain repair is unprecedented," Alasdair Coles, of Cambridge University in England, and one of the study's leaders, told the AFP news service. "We are witnessing a drug which, if given early enough, might effectively stop the advancement of the disease and also restore lost function by promoting repair of the damaged brain tissue."

However, in an accompanying journal editorial, Dr. Stephen L. Hauser, a neurologist at the University of California, San Francisco, said the "toxic effects associated with alemtuzumab considerably dampen any enthusiasm for its routine use in patients with multiple sclerosis until more is known about its long-term safety and sustained efficacy."

More information
The U.S. National Institute of Neurological Disorders and Stroke has more about multiple sclerosis.

Treadmill Workouts Help Stroke Survivors

(HealthDay News) -- Working out on a treadmill improves brain function and fitness for people who have survived a stroke and gone through the usual rehabilitation program, a new study found.

"You address two problems these patients have," said study researcher Dr. Andreas Luft, a professor of clinical neurology and neurorehabilitation at the University of Zurich in Switzerland. "One is that they don't know how to walk. Not walking, they become deconditioned and lose cardiovascular fitness. With the treadmill type of training, you improve walking and also increase fitness."

Luft worked with physicians at Johns Hopkins University, the University of Maryland and the Baltimore Veterans Affairs Medical Center on the study. It compared the brain and physical function of 37 people who had had strokes and worked on a treadmill three times a week, with 34 people who were given traditional stretching exercises.

After six months, peak walking velocity increased by 51 percent in the treadmill group and just 11 percent in the stretching group. Cardiovascular fitness increased by 18 percent with the treadmill routine, but decreased by 3 percent in the group limited to stretching.

And magnetic resonance imaging showed an increase of blood flow carrying more oxygen to the brainstem and cerebellum for those who worked on the treadmill.

"The most important clinical aspect of the study is that it is saying recovery can occur long after a stroke and can occur even after all the routine therapies have been tried," said Dr. Daniel Hanley, professor of neurology at Johns Hopkins. "Scientifically, the most important point appears to be that rewiring of the brain may be involved in this process, not just body conditioning."

The average age of study participants was 63, and the average time they began the treadmill program was 50 months after the stroke, Hanley noted.

"The average stroke patient now has about eight physical therapy sessions over six to 12 weeks," Hanley said.

The study, published in the Aug. 29 issue of the journal Stroke, shows that treadmill work "should be part of standard treatment for every stroke survivor who has a walking habit," Luft said.

That may not be an easily achievable goal, Luft acknowledged. "Most physical therapy departments have treadmills, but they don't use them to the extent that we used them in the study," he said.

And stroke survivors can't just climb on a treadmill and start walking, Luft said. "Because this is exhausting, it should always be done under supervision," he said. "There is always the risk of running into heart problems and falling. We used special treadmills with handrails and also monitored the heart rate to achieve the level of exertion we needed."

Nevertheless, Hanley said, "the study defies current practice."

More information
Learn more about stroke rehabilitation from the National Institute of Neurological Disorders and Stroke.

Stroke Risk Increases With Antipsychotic Drugs

All types of antipsychotic drugs increase the risk of stroke.

All drugs used to treat psychosis are linked to an increased risk of stroke, and dementia sufferers are at double the risk, according to a study published in the British Medical Journal.

Concerns about an increased risk of stroke among people taking atypical antipsychotic drugs were first raised in 2002, particularly in people with dementia, prompting the UK’s Committee on Safety of Medicines to recommended in 2004 that these drugs not be used in people with dementia.

Previous research has shown that second generation (atypical) antipsychotic drugs can increase the chances of patients having a stroke. But the risk of stroke associated with first generation (typical) antipsychotics, and whether the risk differs in people with and without dementia, is not known.

A team of researchers from the London School of Hygiene and Tropical Medicine, examined data from the General Practice Research Database (GPRD), which contains the clinical information of more than six million patients registered at over 400 general practices in the UK.

They assessed the effect of exposure to antipsychotic medication on the incidence of stroke in 6 790 patients with a recorded incident of stroke and at least one prescription of any antipsychotic between January 1988 and the end of 2002.

The authors found that during periods when patients were receiving an antispychotic drug they were 1.7 times more likely to have a stroke, whereas people with dementia were 3.5 times more likely to have a stroke whilst taking any antipsychotic.

The likelihood of having a stroke was slightly higher for people taking atypical antipsychotics than people taking typical antipsychotics.
Previously, the risk of stroke associated with typical antipsychotics was unclear, say the researchers, but “we have established that all types of antipsychotics carry an increased risk, although the risk might be somewhat higher with the atypical drugs.”

They conclude: “We reaffirm that the risks associated with antipsychotic use in patients with dementia generally outweigh the potential benefits, and in this patient group, use of antipsychotic drugs should be avoided wherever possible.”

The study did not look at the specific mechanisms linking antipsychotics and stroke or why the risk is greater with atypical antipsycotics.

Source
British Medical Journal