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Longevity and compression of morbidity from a neuroscience perspective: Do we have a duty to die by a certain age?
Date of publication: 30-Mar-2015
Abstract
The search for longevity, if not for immortality itself, has been as old as recorded history. The great strides made in the standard of living and the advances in scientific medicine, have resulted in unprecedented increases in longevity, concomitant with improved quality of life. Thanks to medical progress senior citizens, particularly octogenarians, have become the fastest growing segment of the population and the number of centenarians is increasing, even though in the last two decades, spurred by the bioethics movement, the priority assigned to the prolongation of lifespan has taken a back seat to the containment of health care costs. This article describes what individuals can do to lead healthy lifestyles and increase longevity, concomitant with preservation of quality of life until the very end of life—as postulated by Dr. James F. Fries’ hypothesis of the compression of morbidity. This review article investigates the contention of bioethicist Dr. Ezekiel Emanuel that Fries’ theory is a “fantasy” and not a realistic possibility. In this context recent advances in neurobiology, epigenetics, and aging are described, and the hypothesis of the compression of morbidity re-examined. We find that people are not only living longer but are remaining healthier. Recent studies suggest that brain plasticity develops and potential neurogenesis occurs in those individuals who continue to be mentally and physically active allowing them to thrive well into old age. Controlled studies as well as Medicare spending data strongly corroborate Fries’ predictions and support my conclusion that compression of morbidity should be upgraded from a hypothesis to a theory. Lastly, leisure in association with or without retirement is discussed and suggestions are made as to how to use this time to remain intellectually sharp and physically vigorous until the very end of life.
Sequential pathological changes during malignant transformation of a craniopharyngioma: A case report and review of the literature
Date of publication: 30-Mar-2015
Background:Malignant transformation of craniopharyngiomas is quite rare, and the etiology of transformation remains unclear. The prognosis of malignantly transformed craniopharyngiomas is very poor.
Herpes simplex reactivation or postinfectious inflammatory response after epilepsy surgery: Case report and review of the literature
Date of publication: 25-Mar-2015
Background:Herpes simplex virus encephalitis (HSVE) is the most morbid clinical syndrome associated with the human herpes virus. Despite treatment with appropriate dosages of acyclovir, neurologic relapse of HSV infection have been reported after cranial surgery. Rarely, neurological deterioration due to postinfectious inflammatory response without demonstrable HSV reactivation may recur following cranial surgery.
Should routine MRI of the lumbar spine be required prior to lumbar epidural steroid injection for sciatica pain?
Date of publication: 25-Mar-2015
Background:We describe three patients who received lumbar epidural steroid injections (LESI) for lumbosacral radicular pain that resulted in worsening of their symptoms. The procedures were performed following a review of remote diagnostic imaging studies. These cases demonstrate the lack of consensus in pain management domains for how to approach the workup and treatment of persistent/chronic low back pain, with a noted fragmentation in pain management strategies and applied therapies.
Cortico-cortical activity between the primary and supplementary motor cortex: An intraoperative near-infrared spectroscopy study
Date of publication: 24-Mar-2015
Background:The supplementary motor area (SMA) makes multiple reciprocal connections to many areas of the cerebral cortices, such as the primary motor cortex (PMC), anterior cingulate cortex, and various regions in the parietal somatosensory cortex. In patients with SMA seizures, epileptic discharges from the SMA rapidly propagate to the PMC. We sought to determine whether near-infrared spectroscopy (NIRS) is able to intraoperatively display hemodynamic changes in epileptic network activities between the SMA and the PMC.
Glyphosate, pathways to modern diseases III: Manganese, neurological diseases, and associated pathologies
Date of publication: 24-Mar-2015
Abstract
Manganese (Mn) is an often overlooked but important nutrient, required in small amounts for multiple essential functions in the body. A recent study on cows fed genetically modified Roundup®-Ready feed revealed a severe depletion of serum Mn. Glyphosate, the active ingredient in Roundup®, has also been shown to severely deplete Mn levels in plants. Here, we investigate the impact of Mn on physiology, and its association with gut dysbiosis as well as neuropathologies such as autism, Alzheimer's disease (AD), depression, anxiety syndrome, Parkinson's disease (PD), and prion diseases. Glutamate overexpression in the brain in association with autism, AD, and other neurological diseases can be explained by Mn deficiency. Mn superoxide dismutase protects mitochondria from oxidative damage, and mitochondrial dysfunction is a key feature of autism and Alzheimer’s. Chondroitin sulfate synthesis depends on Mn, and its deficiency leads to osteoporosis and osteomalacia. Lactobacillus, depleted in autism, depend critically on Mn for antioxidant protection. Lactobacillus probiotics can treat anxiety, which is a comorbidity of autism and chronic fatigue syndrome. Reduced gut Lactobacillus leads to overgrowth of the pathogen, Salmonella, which is resistant to glyphosate toxicity, and Mn plays a role here as well. Sperm motility depends on Mn, and this may partially explain increased rates of infertility and birth defects. We further reason that, under conditions of adequate Mn in the diet, glyphosate, through its disruption of bile acid homeostasis, ironically promotes toxic accumulation of Mn in the brainstem, leading to conditions such as PD and prion diseases.
Pupil sparing oculomotor nerve paresis after anterior communicating artery aneurysm rupture: False localizing sign or acute microvascular ischemia?
Date of publication: 24-Mar-2015
Background:We describe a rare case of solitary pupil sparing oculomotor nerve paresis following rupture of anterior communicating artery (ACom) aneurysm and discuss the pertinent literature. Oculomotor nerve paresis caused by an ACom aneurysm rupture is an uncommon occurrence. Also, partial paresis affecting only fibers of superior division of oculomotor nerve is never reported before.
Spinal cord compression due to primary intramedullary tuberculoma of the spinal cord presenting as paraplegia: A case report and literature review
Date of publication: 23-Mar-2015
Background:Spinal cord compression can be due to various causes but spinal intramedullary tuberculoma is a rare cause. We report a case that had an intramedullary spinal cord tuberculomas in which the diagnosis was made histologically, without evidence of symptoms of systemic tuberculosis. This lesion, located in the thoracic region, mimicked as an intramedullary tumor radiologically.
Management of intracranial pathology during pregnancy: Case example and review of management strategies
Date of publication: 23-Mar-2015
Background:Intracranial tumors during pregnancy are uncommon, and they present an interesting challenge to both the neurosurgeon and the obstetrician. Special considerations must be made in every aspect of care. The authors use the rare case of a 27-year-old pregnant female with suspected pineal region tumor eventually diagnosed as a thalamic region ganglioglioma to review the current literature on management of pathology in this unique patient population.
Surgical management of a transosseous meningioma with invasion of torcula, superior sagittal sinus, transverse sinus, calvaria, and scalp
Date of publication: 20-Mar-2015
Background:Meningiomas involving both intradural and extradural structures are rare tumors. We report the complete resection of a massive complex transosseous meningioma that had invaded the torcula, superior sagittal sinus, occipital bone, and scalp.
