Discoveries Magazine

Cedars-Sinai

Aluminum Foiled

Suspicious of your pots and pans? Wary of your antiperspirant? Since the 1960s, when a few studies pointed to aluminum as a possible cause of Alzheimer’s disease, the ubiquitous element got a villainous reputation it couldn’t shake—no matter how many later studies found no particular link.

Monosodium glutamate, aspartame, electric and magnetic fields, hair dyes: They’ve also seen their share of fingerpointing as possible culprits of neurological trauma. Rumors persist, but study after study fails to convict them of neurotoxic wrongdoing.

People diagnosed with a neurological disorder have many questions as they sort facts from misconceptions. We asked our neuroscience physicians, investigators, and nurses to set the record straight about diseases of the brain.

aluminum-dismissed

Myth: A benign brain tumor can simply be removed.

Fact: False. Any procedure done in the brain has risks, and although truly benign tumors are rarely cancerous, a small percentage have malignant characteristics. Some tumors are considered “premalignant,” meaning they can be removed but may come back at a higher, more aggressive grade. “Just because a tumor is benign doesn’t mean it doesn’t pose a serious threat,” says Suzane K. Brian, certified physician assistant to Keith L. Black, MD, chairman of the Department of Neurosurgery at Cedars-Sinai and the Lawrence Harvey Chair in Neurosciences. “Some, like pituitary tumors, can affect hormones and cause multiple problems throughout the body.”

Other benign tumors exist in tough-to-reach locations adjacent to vital structures. For instance, vestibular schwannomas are tumors of the cells that form a protective sheath around the hearing and balance nerves from the inner ear to the brain. They’re usually benign but can cause hearing loss, balance disturbances, gait changes, vertigo, and tinnitus. As they grow, these tumors can put pressure on nerves affecting the face and the ability to swallow. Large tumors can cause intracranial pressure to rise, leading to headache, vomiting, and altered consciousness.

“Vestibular schwannomas are among the most challenging of brain tumors,” says Ray Chu, MD. “In the neighborhood lies the brain stem through which all motor and sensory pathways run, nerves for facial expression and hearing, and the arteries that supply these structures. It is literally an area where a millimeter can mean a big difference. These surgeries require something that is not often a strong suit of surgeons: patience. It can take hours and hours to painstakingly remove such tumors with minimal injury to these critical structures.”

Myth: Brain tumor surgery is always curative.

Fact: Not necessarily. There is a 5 percent chance that even a benign tumor, such as a meningioma, will recur during a patient’s lifetime. At the other extreme, glioblastoma multiforme invariably returns because it is highly aggressive, has fingerlike projections that invade normal tissue, and consists of cells that can migrate away from the original site. Even when imaging scans show that a tumor has been completely removed, some cells linger—and glioblastomas are able to regenerate from any cells left behind.

One of the biggest challenges neurosurgeons face in the operating room is detecting the irregular borders between tumor and healthy brain tissue. Cedars-Sinai investigators are studying two new in-surgery imaging devices. In one project, they are bringing the same technology used to study planets and galaxies into the operating room. If the ultraviolet camera system works when focused on brain tissue, it could give surgeons a “metabolic map” of tumors, with detail that cannot be seen even with high-powered imaging.

Myth: Cellphones cause brain tumors. Flip-side myth: Cellphones are safe.

Fact: Trick question. To date, studies have found no link between cellphone use and brain tumors, but Dr. Black is among several prominent experts who are not sure all the evidence is in.

“Until the full health impact of wireless phone usage is known, I believe it is wise to err on the side of caution and keep such devices away from the head, if possible,” he says. “I use either my phone’s speaker function or a wired headset when making calls. A wired or corded headset is better than a wireless one because a wireless earpiece still emits some radiofrequency waves, although much less than a cellphone.”

Myth: I have no pain, so I can’t have a brain tumor or a stroke.

Fact: Brain tumors can cause a wide range of symptoms. “Headaches or pain are common symptoms, but they don’t always occur,” says Almar Guevarra, RN, Brain Tumor Program research nurse. “Some symptoms can be very subtle, like visual disturbances, hearing changes, imbalance, tingling, and numbness. One patient we recently saw started to have problems similar to carpal tunnel syndrome in his hand. An MRI of his spine was normal, but a scan of his head showed he had a tumor. If something changes, even if you think it’s not a big problem, it’s better to have it checked to see what’s going on.”

Strokes don’t always cause pain. The five warning signs include:

  1. Sudden numbness or weakness of the face, arm, or leg on one side of the body.
  2. Sudden confusion, trouble speaking or understanding.
  3. Sudden trouble seeing on one side.
  4. Sudden, severe difficulty walking, dizziness, loss of balance or coordination.
  5. Sudden, severe headache with no known cause.

Any of these symptoms can occur in a mild, fleeting way and not be worrisome, but if onset is sudden and quite severe, it could signal onset of a stroke.

“It’s very common for people who are having a stroke to think the symptoms are going to go away because they’re not experiencing pain,” says Traci Babcock, RN, board-certified adult and neurology nurse practitioner. “A common symptom is weakness on one side of the body, and a common thought is, ‘My arm fell asleep, so I don’t need to go to the hospital.’ But this is a huge problem because the treatments we have are time-based. To have the best possible results, we have to start treatment within about three hours of stroke onset, and we need time to do tests and scans before treatment can even begin.”

aspartame-dismissed

Myth: I had a ministroke but no permanent damage, so I’m in the clear.

Fact: A ministroke, or transient ischemic attack (TIA), occurs when part of the brain is briefly deprived of blood. Although symptoms are similar to those of a stroke, they typically go away within minutes or hours; most last less than five minutes. But a TIA should be considered a red flag for the possibility of an impending stroke. “Up to 40 percent of people who experience a TIA will go on to have a full stroke, often within days or weeks,” says Michael J. Alexander, MD, professor and vice-chair of Neurosurgery and director of the Neurovascular Center. “Because it is impossible to know at onset if a person is having a TIA or a stroke, it is imperative to get them to a specialized stroke center quickly for evaluation so interventional or preventive measures can be started right away.”

Myth: After my stroke, I’ll never regain the abilities I had.

Fact: No one can predict how much progress a patient can make. Tami Zorge, RN, Neurovascular Program research nurse, says: “Every patient is different. Every stroke is different. Time to treatment matters—brain cells die with every passing minute—and rehabilitation takes hard work, but the brain has surprising abilities to create new connections. Some patients regain abilities faster than others, but nothing is more important than staying motivated and optimistic.”

Patrick Lyden, MD, chair of the Department of Neurology, director of the Stroke Program, and the Carmen and Louis Warschaw Chair in Neurology, is leading an international multicenter study of therapeutic hypothermia—brain cooling—as a way to prevent neurological damage after stroke. Investigators employ a state-of-the-art system that transfers body heat out, slowing metabolism, keeping tissue swelling in check, and giving the brain time to rest.

Study participants are covered with a blanket that makes them feel warm, and temperature sensors in the skin and a mild sedative help suppress shivering. Body temperature is cooled to 33 degrees Celsius (about 91 degrees Fahrenheit) for 24 hours before the patient is gradually warmed. The rapid, controlled cooling of a patient’s body temperature is intended to reduce long-term neurological damage.

Myth: Since there is no treatment or cure for ALS, there is no point in seeking medical care.

Fact: Although there currently is no cure for amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease) and the only approved treatment extends life expectancy by only a few months, medical interventions can make a big difference in patients’ quality of life. New technologies—power wheelchairs with communication hubs, battery-powered respiratory equipment that provides mobility, an eye-movement communication device— help patients maintain their abilities and independence longer than before.

Most patients with ALS are eager to join clinical trials—even drug trials where they know they are just as likely to receive a placebo as experimental medicine—in the hope that their experience will help the next generation of patients. ALS scientists and clinicians at Cedars-Sinai encourage patients to consider joining clinical trials but also to allow the multidisciplinary team to treat and manage the disease’s effects along the way.

“Our patients are always enthusiastic about participating in any clinical trials that become available, but we also work very hard to treat their symptoms as they occur, to be sure they continue to have the best possible quality of life,” says Hope Gruendler, certified neuroscience registered nurse and clinical nurse specialist. “I think everyone diagnosed with ALS knows their chances of beating it are slim, but all patients hold on to hope, and I think our doctors do a very good job of balancing— making sure the patients understand the disease and making sure they know what to expect next, but not taking away the hope that a treatment or cure may come along while they are still alive. They might be the person who receives it.”

electro-dismissed

Myth: Botox? Really?!

Fact: It’s best known for its cosmetic effects—relaxing facial muscles and smoothing wrinkles. But to the surprise of many patients, botulinum toxin (Botox®) is studied and used to treat conditions that are much more than skin deep. In fact, the neurotoxin became a treatment for muscle spasms and contractions before it debuted as a temporary wrinkle fix. Evgeny I. Tsimerinov, MD, PhD, associate director of the Clinical Neurophysiology Laboratory, treats a variety of disorders—spasticity, tremors, hypersalivation in patients with ALS, excessive sweating, and severe intractable headache—with Botox. Michele Tagliati, MD, director of the Movement Disorders Program, uses it to treat symptoms of dystonia, Parkinson’s disease, and other conditions. “

People know about Botox and wrinkles,” says Dr. Tagliati. “They ask, ‘Oh, you can use it to treat dystonia, too?’ and I tell them, ‘No, you can use it for wrinkles, too.’”

Myth: Alzheimer’s disease can be definitively diagnosed only through autopsy results.

Fact: True—at least for now. Neurologists have little more than physical exams and IQ tests to identify memory and comprehension problems that fit into an Alzheimer’s diagnosis. But several disorders and disease processes can cause similar cognitive issues. The hallmark of true Alzheimer’s is the accumulation of sticky beta-amyloid protein plaques in the brain. But as these do not show up on CT or MRI scans, there is still no practical, humane, or accurate way to view these plaques while a patient is alive.

However, Cedars-Sinai scientists confirmed that these plaques occur not only in the brain but also in the retina in the back of the eye, and the plaques can be seen in the retina even before they begin to accumulate in the brain. With these discoveries, investigators developed a device that enables doctors to look through the eye—just as an ophthalmologist looks through the eye to diagnose retinal disease—and see the amyloid plaques. Good outcomes in laboratory studies have led to clinical trials in patients. If these studies confirm earlier findings, the system could provide a quick, inexpensive, noninvasive way to screen for Alzheimer’s early in the destructive process.

Myth: Multiple sclerosis (MS) can be triggered by a reaction to an environmental allergen.

Fact: This is not true. People with MS are as likely as anyone to suffer from allergies, but the National Multiple Sclerosis Society says the following have been ruled out as causes: a specific allergen; dogs carrying canine distemper; exposure to heavy metals; physical trauma (although having symptoms of MS, such as poor balance, can trigger physical accidents); and aspartame. It’s possible that a virus plays a role, but no evidence has surfaced.

“Current research points to multiple factors that may contribute to the risk of developing MS. Genes, particularly those related to the body’s immune function, most likely play a role along with environmental factors, such as sun exposure and possibly vitamin D, that can influence how the immune system reacts,” says Nancy Sicotte, MD, director of the Multiple Sclerosis Program and an expert on imaging techniques for the disorder. “There is also evidence that childhood exposure to certain pathogens is involved—some parasitic infections might actually be protective—and the timing of certain common infections, such as having mononucleosis as a teenager, may be related. One thing is clear: The cause of MS is unlikely to be a single, obvious factor. We would have figured it out by now.”

MS symptoms vary widely from person to person, but depression is common and can have a major impact on quality of life, thought processes, and long-term health. Dr. Sicotte has received a $506,000 grant from the National Multiple Sclerosis Society to study the underlying cause of MS-related depression. In previous research, she found evidence of tissue loss in an area of the brain called the hippocampus, which is important for memory processes.

More Myths Debunked

  • Myth: Hitting your head on something can cause a brain tumor.

    Fact: Brain tumors are caused by genes, molecules, and cells gone awry, not blows to the head.

    head

  • Myth: If I have a brain tumor, my children are likely to eventually develop one, too.

    Fact: Familial traits may be involved in some types of tumors, but this is very rare and risk is only slightly increased.

    Myth: A tumor originating in the brain will spread to other parts of the body.

    Fact: Not true. For one thing, brain tumors grow from tissue that is specific to the brain and not compatible with other parts of the body.

  • Myth: If you biopsy a brain tumor, you will “make it angry” and cause it to spread.

    Fact: Taking a sample of brain tumor tissue helps doctors decide how to treat it and has no effect on the tumor’s aggressiveness.

    Myth: Taking hormone replacement therapy can cause brain tumors called meningiomas.

    Fact: Some studies have suggested a correlation, but no conclusive evidence has been found to date.

  • Myth: Microwave ovens should be avoided because they generate radiation.

    Fact: The Food and Drug Administration (FDA) has regulated microwave oven manufacturing since 1971, and most scientists agree that the type and amount of radiation generated are safe. The FDA limit for microwave leakage is far below the level known to be harmful, and microwave energy exposure drops dramatically as you move away from the source. The oven door should fit tightly, and the device should shut off immediately if the door is opened. As an added precaution, experts say, adults—and especially children—should avoid leaning against an operating oven.

    microwave

  • Myth: People having a stroke always smell burnt toast.

    Fact: Not true, although olfactory hallucinations (phantosmia) sometimes occur with strokes and other disorders affecting brain function.

    toast

  • Myth: Only old folks have strokes.

    Fact: Almost one in five strokes occurs in people younger than age 55, and a recent study found that people in the 20 to 54 age range accounted for 18.6 percent of first strokes in 2005—a 5.7 percent rise in little more than a decade. Not only is stroke the fourth leading cause of death in America, it is the No. 1 cause of adult disability. When it strikes young people, it can destroy their ability to make a living even as they must pay for the costs of treatment, rehabilitation, and sometimes long-term care.

    Myth: If a person is in a persistent vegetative state, his or her brain is no longer functioning.

    Fact: A person in a persistent vegetative state has some level of brain function, but it may be nothing more than low-level activity in the brain stem that maintains breathing. “Brain death” is the term for complete loss of brain function.

  • Myth: If you have a stroke, not much can be done about it.

    Fact: Many strokes are treatable, but most go untreated because therapy must be started right away. “Clot-busting” drugs make it possible in some cases to stop a stroke in progress and even reverse damage done. If given within three hours of onset, the drug improves outcomes by about 30 percent. But the clock starts ticking when the stroke happens. Considering transport time and the rapid but thorough tests and scans that must be done at the hospital, the window of opportunity closes quickly.

    Cedars-Sinai was one of the first five medical centers in the nation, and the first in Los Angeles County, to achieve Comprehensive Stroke Center Certification from The Joint Commission and the American Heart Association/American Stroke Association. This designation identifies hospitals that have the equipment, infrastructure, staff, and training programs needed to diagnose and treat the most challenging stroke cases. Research is a major component.

  • Myth: “Brain foods” can stimulate mental alertness and fend off brain disorders.

    Fact: It’s a safe bet that most “superfood” claims are hype. Feasting on the latest fad food will not guarantee a passing grade on the next exam, nail down a Nobel Prize, or stop a neurological disorder in its tracks.

    Brain disorders, such as Alzheimer’s disease, stem from complex processes that involve genetics, molecular changes, and possibly immune factors and other influences yet to be discovered. But scientists do see parallels suggesting some disease processes may have similar foundations and mechanisms. And brain researchers are catching up to what heart doctors have said for a long time: Diet matters. Reducing fats, simple carbohydrates, sugars, and salt; boosting intake of fruits and vegetables; eliminating excess body fat; and increasing exercise often can make a difference in plaque deposits and heart health. It turns out that what’s good for the heart tends to be good for the brain.

    Brain cells need sugar for fuel, but they don’t need the peaks and valleys that come from hits of simple carbohydrates like table sugar and corn syrup. Complex carbohydrates from fruits, vegetables, and whole grains combined with a lean source of protein provide long-lasting energy for the brain.

    Growing evidence shows that components of some foods—eaten as part of a balanced diet over time—may help protect the brain. Some of the more promising candidates are omega-3 fatty acids in fish oil, walnuts, flaxseed oil, soybean oil, and canola oil; curcumin found in the spice turmeric; and the antioxidant phytochemicals in vegetables and fruits, particularly berry fruits.

  • finger

    Myth: Memory loss is a normal, unavoidable part of aging.

    Fact: True—and false. A certain amount of slowing is to be expected. But memory lapses that interfere with everyday life and commitments—forgetting how to get to a common destination, repeatedly asking the same question, having trouble following directions—may be signs of Alzheimer’s or another form of dementia.

  • Myth: With no cure and no treatment, there is no hope in the fight against Alzheimer’s disease.

    Fact: Alzheimer’s takes an enormous toll on patients—and devastates families and caregivers. Some experts believe effective treatments will be available in just a few years. Because the disease starts to damage the brain years or decades before symptoms are seen, any treatment that slows the process might serve as a cure. It’s conceivable that the next generation of Alzheimer’s patients will live a normal life span without experiencing symptoms of the disease.

    Researchers at Cedars-Sinai recently launched a Phase I clinical trial to study safety and tolerability of an experimental treatment for Alzheimer’s that’s based on a drug often prescribed to reduce the frequency of multiple sclerosis relapses. “Scientists used to believe that all inflammation in the brain and spinal cord was damaging and looked for ways to suppress immune activity. But recent studies have found some immune responses to be beneficial,” according to Maya Koronyo-Hamaoui, PhD, assistant professor of Neurosurgery and Biomedical Sciences and head of the Neuroimmunology and Retinal Imaging Laboratory. “The new idea is to enhance recruitment of immune cells from the blood to the brain to fight the disease, regulating harmful inflammation and supporting tissue repair and regeneration.”

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2 Responses

  1. s. freed says:

    very informative. Keep it up.

  2. Anis says:

    I love that you are debunking some of the myths that are frequently repeated in social settings. I wish you would have included some sources to quote so I can make a more credible argument the next time someone tells me, for example, aluminum causes Alzheimer’s. Just telling me it is “dismissed” hardly gives me the ammunition I need. Of course many of those believers will not be swayed, but I know some who parrot the myths who may still be open to new information when it is well substantiated. A few citations would be appreciated.

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