Wednesday, December 5, 2012

Are brain tumours on the rise?

The causes of brain tumours benign or malignant  are mostly unknown, and despite singer Sheryl Crow's belief that her benign brain tumour was caused by excessive use of her cellphone, there is no scientific evidence to support this.
sheryl crow reuters Johannesburg - Tumours in the brain and nervous system are increasing, show the cancer registries of many Western countries. 

Some specialists say rising statistics could be due to better diagnosis of conditions previously attributed to, say, strokes or dementia

Others say that patients with cancer in other parts of the body are surviving longer due to better treatment, and that cancer cells are spreading to the brain or nervous system

No one is saying there is an epidemic, and the prevalence of brain tumours in the general population is still low. 

But, even taking into account better diagnosis and survivability of cancer patients, the extent of the rise is worrying, even for the experts, published reports say. 

The prevalence of brain tumours in South Africa is not known, because in the National Cancer Registry of 2004 (the last one available), brain cancers are combined with cancers of the central nervous system

At that time, it was estimated that the lifetime risk of developing a central nervous system tumour was one in 849 for men, and one in 1 611 for women

However, according to oncologist Dr Andre Dreyer of the GVI Oncology group, “95 percent of nervous system tumours are in the brain”. 

Brain cancers are quite common, and they affect all communities, in all age groups all over the world,” he says. 

In children, he adds, although the incidence of brain tumours is low, they are the second most common cancer after leukaemia

More adults have brain tumours, and are more prone to it the older they get. 

“In the young, the most common brain cancer is embryonal (it begins in foetal tissue), and in the adults, it is the glioblastoma (aggressively malignant tumours arising from the cells that make up the supportive tissue of the brain),” says Dreyer. 

Brain tumours are graded from one to four, with grade one and two being benign or slow developing, and grades three and four more rapidly progressing, with grade four being the most aggressive. 

The specialists who remove brain tumours are neurosurgeons, and over many years of clinical practice, Tshwane neurosurgeon Dr Edward Gurnell has seen an increase in malignant brain tumours in the patients referred to him. 

“This applies to both primary brain tumours, those that originate within the brain, and secondary or metastatic tumours, which are tumours that have spread to the brain from elsewhere, such as the lung or breast,” he says. 

“It’s important to note in the case of secondary brain tumours, however, that cancer patients are surviving longer with modern day chemotherapy treatment, and therefore a greater number of patients develop secondary brain deposits (of cancerous cells),” he adds. 

The causes of brain tumours – benign or malignant – are mostly unknown, and despite a contentious Roman court finding recently that there is a “causal link” between cellphone use and brain tumours, and singer Sheryl Crow’s belief that her benign brain tumour was caused by excessive use of her cellphone, there is no scientific evidence to support this. 

The symptoms of these tumours are also myriad, depending on where the tumour is located, and can mimic another malaise like a stroke

The most common symptoms are headache, nausea, vomiting, epileptic seizures or neurological deficits, like partial paralysis of the face, says Gurnell. 

Loss of hearing in one ear, or sight in one eye, is common if the tumour is located in or near the cranial nerves, or weakness in a limb might occur if it is in or near the primary motor cortex. 

Cape Town neurosurgeon Dr Roger Melvill says the “insidious nature” of brain tumour symptoms means the correct diagnoses is often delayed, and a slow growing tumour like a meningeoma (forms on the brain’s surface membrane and not in the brain itself), can go undetected for years. 

But whatever the nature of the tumour, once it is found the neurosurgeon has to weigh up whether it can be safely removed and what the risks are of causing more harm. 

“The tumour may be in an area where the risk of loss of sight or speech ability, say, is too high. So the surgeon’s call might be to leave it,” he explains. Ideally, however, as much of the tumour as possible is removed. 

Surgical removal is also the mainstay treatment of benign tumours, as they may be causing pressure inside the brain, disturbance of brain function (loss of vision, hearing or movement) or abnormal brain activity like epilepsy

Dave Chambers, a Cape-based editor who was diagnosed with a table tennis ball-sized meningeoma in 2003, says his first symptom was an “seizure in my sleep”. 

“I was having convulsions and biting my tongue,” he recalls. 

His wife called an ambulance and a tumour was soon found in an MRI scan

After it was successfully removed, Chambers went on epilepsy treatment for a year and must undergo an MRI scan every five years to check that the tumour hasn’t grown back. 

In the case of tumours affecting brain function, neurosurgeons sometimes rely on a technique called “awake cortical mapping”, which allows the surgeon to “wake” the patient during the surgery to test, say, language function using delicate electrical stimulation. 

“The brain doesn’t feel pain, so this is a very useful technique,” says Melvill. 

For malignant tumours, radiotherapy – sometimes combined with chemotherapy – is the standard follow-up treatment after surgery, but the recovery rate depends entirely on the unique nature of the tumour and how rapidly it grows back. 

“For malignant tumours, there is no cure, only control of tumour growth and delaying a recurrence of the tumour,” points out Gurnell. 

The tumours with the poorest prognosis for survival are the glioblastomas, adds Melvill. 

That said, many people survive and live a long life after being diagnosed with a brain tumour, thanks to advancements in medical science.

Many people who had benign tumours have been cured, their only reminder being the need for an MRI scan every few years. 

Andrew Lanham, who had resigned himself to an early death more than once during the trauma he experienced, says: “It’s not necessarily a death sentence. In fact, surviving one makes you appreciate your life more.” 

The first sign that something was wrong with Sandi Slabber, 46, a lighting consultant and married mother-of-two in Cape Town, was the onset of “small epileptic-like fits”. 

“They felt like panic attacks, and my left eye would veer off to the right,” she recalls. The fit wouldn’t last long and her eye would soon return to its normal position. 

“I’d just had my baby girl, so I thought it might be a symptom of hormonal imbalance,” she says. 

That was in March 2006. Three months later, after the fits kept recurring, Slabber was referred for an MRI (magnetic resonance imaging) scan, then booked immediately for surgery

She had oligodendroglioma, a brain tumour that develops from the cells that produce the fatty covering of nerve cells in the cerebrum

It was located on the right motor cortex, the area of the brain which controls muscle movement. 

It was a low grade tumour (not aggressively malignant), but it was causing pressure on the brain and had to be removed so Slabber could reclaim her life

By then, Slabber was unable to drive in case of a fit, and when she felt her eye twitching to the side, she’d cover her face with her hands until it had passed. “It was very distressing and disabling,” she says. 

That August, Slabber underwent surgery, but a crescent-shaped sliver of the tumour was left behind, as to attempt to remove it all would probably have left her blind. 

Unfortunately, in 2010, the tumour had grown back, and was more malignant this time. Again Slabber was operated on, and had a follow-up programme of radiation, which she says has stunted its growth. 

For now that is. A six-monthly MRI scan has to ensure this remains the case, as if not, she’ll have to go back on radiation or chemotherapy treatment

The fallout on Slabber’s family life was much more devastating than the procedures, however. 

“After the first op I looked like conehead with all the bandages. I couldn’t hold my baby for the first six months of her life. My mother paid for a carer,” says Slabber. 

Her marriage has since deteriorated to the point that she is filing for divorce. 

But typical of many other cancer survivors, she is surprisingly upbeat. “I feel lucky, and I’m just grateful the tumour wasn’t highly cancerous,” she says. 

The first symptom felt by Andrew Lanham, 65, a Midrand mining writer, was his right cheek going numb and getting steadily worse over a year. 

In his case, a tumour ran along his trigeminal nerve, the cranial nerve responsible for facial sensations.
After 14-hour surgery to attempt to remove the tumour, Lanham returned to consciousness to discover his face was not only numb on the right side, but he’d lost hearing in the right ear, a side effect his surgeon had warned him about. 

“For the first three days afterwards I wasn’t sure if I was going to live or die,” he says. “I couldn’t move, and I had tubes coming out of the top of my head. It was painful and very frightening.” 

So two years later, when Lanham learned that the tumour had grown back as a more malignant one, he was terrified. 

By then the tumour had “eaten away a golfball-sized hole in my forehead and gone off in strands into the orbits of the eyes”. 

Lanham found a new neurosurgeon for the second operation, who he says did a much finer job of removing the tumour, and also had a prosthetic forehead made for him. 

Five months of chemotherapy followed and today, two years later, Lanham is still married and working, living an almost normal life

“My face on the right is paralysed and I have to remember to blink my right eye otherwise it gets dry and red. And I have no hearing in the right ear. 

“But I’m still functioning well. I just have to be careful to maintain a healthy diet and get enough sleep and, above all, avoid flu because I have no sinuses left, so my head just swells up,” he says. 

A diagnosis of a brain tumour can be devastating, not only for the sufferer, but also for their friends and relatives, says oncology social worker Linda Greeff, who co-founded the support group People Living with Cancer

This is regardless of whether or not the financial cost of treating someone is borne by a medical aid, which ideally should be coupled with dread disease insurance cover. 

“It is heartbreaking especially for parents of children with brain tumours, as sometimes the surgery leaves them without mobility, or they lose sight or hearing,” she says. 

State patients and their families are especially vulnerable, as they don’t have the resources to undergo proper rehabilitation including counselling for family members. 

“It can be very traumatic if a loved one is seriously affected, say, in their physical, personality or psycho-social behaviour,” says Greeff. “Professional counselling is important in these cases.” 

Greeff advises people living with cancer, or those affected by it, to contact Cancer Buddies for free counselling and assistance. 

Cancer Buddies carefully matches a newly diagnosed person with someone who has fought and survived the same type of cancer

Cancer caregivers – spouses, parents, siblings, children and other family and friends – also receive one-on-one connections with other caregivers and survivors, says Greeff, as it’s crucial families get support..

Sleep Apnea May Cause More Brain Damage in Women

Women suffering from sleep apnea have more severe brain damage than men with the disorder, a new study suggests.

Researchers at the University of California in Los Angeles looked at patients diagnosed with obstructive sleep apnea and compared the nerve fibers, or white matter, in the patients' brains to fibers of individuals without sleep disorders.
If left untreated, sleep apnea can lead to high blood pressure, stroke, heart failure, diabetes, depression, and other serious health problems. Sleep apnea may cause more brain damage in women.

 Researchers also focused on understanding the difference in brain damage between men and women with sleep apnea, according to the study published in the journal Sleep.

Chief investigator Paul Macey, an assistant professor and associate dean of information technology and innovations at the UCLA School of Nursing, said that while researchers have known that obstructive sleep apnea affects women "very differently" than men, previous brain studies done on sleep apnea and the impact on an individual's health have mostly focused on men or combined groups of men and women.

"This study revealed that, in fact, women are more affected by sleep apnea than are men and that women with obstructive sleep apnea have more severe brain damage than men suffering from a similar condition," Macey said in a statement.

Researchers found that the sleep disorder particularly affects the cingulum bundle and the anterior cingulate cortex, frontal regions responsible for decision-making and mood regulation, in women with the condition. Women with sleep apnea also showed significantly higher levels of depression and anxiety symptoms compared to men with the disorder.

"This tells us that doctors should consider that the sleep disorder may be more problematic and therefore need earlier treatment in women than men," Macey said.

Researchers said that the latest findings serve as a foundation for future research on untangling the timing of brain changes as well as revealing whether treating sleep apnea can help the brain.

"What we don't yet know is, did sleep apnea cause the brain damage, did the brain damage lead to the sleep disorders, or do the common comorbidities, such as depression, dementia or cardiovascular issues, cause the brain damage, which in turn leads to sleep apnea," he concluded.

Obstructive sleep apnea is a disorder than occurs when a person's breathing is repeatedly interrupted during sleep. Every time breathing is interrupted, the oxygen level in the blood drops, which could eventually lead to damage to many cells in the body.

Experts say if the condition is left untreated, it can lead to a host of serious health problems including high blood pressure, stroke, heart failure and diabetes.

Woman's running nose revealed to be leaking brain fluid

For four months, doctors believed one Arizona woman's running nose was allergies.  The truth turned out to be a much more horrifying scenario – brain fluid was leaking out of her nose.
According to the University of Arizona department of surgery, whenever Aundrea Aragon bent over, clear liquid would run out of her nose.

"I was scared to death and desperate,'' Aragon said. "I knew it could not be allergies. The fluid would come out like a puddle.''

After she visited several doctors', UA surgeons finally discovered two small cracks in the back of Aragon's sphenoid sinus, which were caused by cerebral pressure.  The crack ultimately allowed cerebral spinal fluid (CSF) to stream through her nose.

Although the human brain replaces brain fluid, the leak put Aragon at risk of developing meningitis, in which bacteria crawls through the brain, causing either a coma or death.

While the typical surgery to fix this condition is invasive and often results in a painful recovery process and other dangerous side effects, UA surgeons were able to fix Aragon's condition without using any incisions.  They performed an endoscopic procedure through her nose, using image-guided neuronavigation and fluorescein dye to locate the cracks.  Then, using tissue from her nose and a small portion of belly fat, the surgeons were able to repair the cracks, stopping the leak.

The process liberated Aragon from a long, painful recovery.  She is now recovering well at home with her husband and two children.  She recently posted about her ordeal on her Facebook page.

"I am so grateful to [the UA surgeons] for everything they have done for us,'' said Aragon. "I had great care from a great staff.  I'm here, and I am grateful I can take care of my kids."

Brain’s Stress Response Differs Among Epilepsy Patients

Differences in brain activation for those believing stress is an important factor in seizure control
There is a significant difference in the brain's response to stress among patients with epilepsy who believe stress is an important factor in seizure control compared to those who do not, according to a study presented at the annual meeting of the American Epilepsy Society, held from Nov. 30 to Dec. 4 in San Diego.

There is a significant difference in the brain's response to stress among patients with epilepsy who believe stress is an important factor in seizure control compared to those who do not, according to a study presented at the annual meeting of the American Epilepsy Society, held from Nov. 30 to Dec. 4 in San Diego.

Using functional magnetic resonance imaging, Jane B. Allendorfer, Ph.D., from the University of Alabama at Birmingham, and colleagues assessed the neural response to psychosocial stress in 23 patients with left temporal lobe epilepsy. Participants included 16 patients who believed that stress impacts their seizure control (+S) and seven who did not (−S). The Montreal Imaging Stress Task was used as the stress paradigm, whereby participants performed a simple (control) and difficult (stress) task, with positive and negative feedback provided in the simple and difficult tasks, respectively.

The researchers found that, in the +S group, there was increased activation bilaterally in the superior temporal gyrus (STG) in response to the difficult versus simple math problems. In response to negative versus positive feedback, in the +S group, there was increased activation in the left insula and bilaterally in the STG, Brodmann area 39, and posterior cingulate. Increased activation was not seen in stressful conditions in the −S group.

"We also hypothesize that the difference in brain activation patterns may be related to why some epilepsy patients have seizures more frequently than do other patients," Allendorfer said in a statement.

The Smartest Virtual Brain Yet

With 2.5 million virtual neurons, researchers have created a brain model that can perform complex tasks.

The Digital Brain Health Market to Reach $1 Billion by end of 2012 According to New SharpBrains Report

In-Depth Industry Report Tracks Growing Brain Health ; Brain Fitness Applications of Web-based ; Mobile Platforms and Biometrics.

SharpBrains, the leading market research firm tracking brain health innovation, announced today the release of an in-depth industry report titled The State of the Digital Brain Health Market 2012-2020 – Transforming Health with Digital Tools to Assess, Monitor, and Enhance Cognition across the Lifespan. The biennial report provides readers with key insights into the digital revolution transforming brain health and heath overall, with trend analysis and detailed revenue growth forecasts.

"We want to provide the most comprehensive analysis and forecast of the substantial transformation underway within the brain health field," said Alvaro Fernandez, CEO of SharpBrains, recently named a Young Global Leader by the World Economic Forum. "Despite the economic downturn this market has still grown from $600 million in annual revenues in 2009 to more than $1 billion by the end of 2012. With more than two billion people worldwide currently suffering from brain-based health and productivity challenges, it is rewarding to see a new generation of technologies and methodologies being developed and implemented to confront this challenge in efficient and scalable ways."

SharpBrains forecasts the market for digital brain health to grow exponentially to between $4 and $10 billion by 2020, with $6 billion being the most likely scenario. It also predicts the Asia Pacific region to likely surpass North America and Europe by 2017. The report analyzes data and trends in four key customer segments--led by consumers increasingly looking to proactively manage and improve their brain health and performance outside clinical settings—and in two types of digital technology that are already going mainstream:
  • Software including fully computerized Web-based and mobile cognitive assessments, cognitive training and cognitive behavioral therapies
  • Biometrics-based monitoring and brain training solutions that measure physiological responses such as heart rate variability and electroencephalography.  
As part of the report, SharpBrains conducted in-depth analysis of more than 200 companies in the space—identifying 5 Market Leaders and 10 Companies to Watch in 2013/2014--, asked more than prominent scientists to identify the most important innovation opportunities from their published research, updated 10 innovation case studies, and surveyed over 3,000 experts and early-adopters. Summarized survey highlights include:
  • 94% Agree/Strongly Agree with "Addressing cognitive and brain health should be a healthcare priority"
  • 83% Agree/Strongly Agree with "I would personally take a brief assessment every year as an annual mental check-up'"
  • 83% Agree/Strongly Agree with "Adults of all ages should take charge of their own 'brain fitness,' without waiting for their doctors to tell them to"
  • 73% Agree/Strongly Agree with "Digital technologies can significantly complement other behavioral and drug-based interventions"
To purchase the full report as a single or enterprise license, visit The single-user license is $995.00 and the enterprise license is $2,995.00. Customers that purchase the report will also gain access to more than 30 hours of recorded panels and workshops from the 2012 SharpBrains Virtual Summit: Optimizing Health through Neuroplasticity, Innovation and Data, a four-day event that convened two hundred industry and science leaders in June of 2012.  The recordings feature discussions among CEOs, technologists, and key scientists working to advance the field.

About SharpBrains:
Sharp­Brains is an inde­pen­dent mar­ket research firm and think tank tracking health and productivity applications of cognitive and affective neu­ro­science, with special emphasis on non-invasive neurotechnology and the growing needs of an aging population.

The company maintains a biannual state-of-the market report series, produces an annual global and virtual professional conference, and maintains a consumer-facing guide, The SharpBrains Guide to Brain Fitness., the company's edu­ca­tional blog, is one of the most pop­u­lar brain ; innovation blogs with 100,000+ monthly read­ers and 45,000+ eNewsletter subscribers. To learn more about SharpBrains' work, visit