Basic and Clinical Research

Epilepsy: scientific and medical advances

Research into epilepsy falls into two main categories, basic and clinical. However, the vast majority of the technology required to carry out this research and the benefits which accrue from the research are available in developed countries.

Basic Research

This focuses on the fundamental mechanisms which underlie the development of epilepsy, the cause of spontaneous seizures, their different manifestations, their timing and duration and the consequences of repeated seizures on brain function.

Understanding the cellular (neuronal) and brain processes responsible for individual seizure types and epileptic disorders will lead to new approaches to prevention, treatment and care.

* Recent work has traced specific types of seizure to distinct disturbances in neuronal connections in the brain and the chemical transmission of information between neurones.

* Neuropharmacologists have subsequently identified or designed compounds which selectively interfere with these abnormal brian functions, leading to the development of new anti-epileptic drugs which are able to treat specific types of epilepsy with less impairment of normal brain function.

This is because they are less sedative and have fewer cognitive side-effects.

* In the past few years, there have also been advances in research on the genetic basis of some epileptic syndromes, mainly in childhood and adolescence, with the identification of specific chromosomal linkages which increase the probability that an epileptic disorder will appear, usually in association with other acquired or environmental factors.

* Identification of some of the genes responsible for a predisposition to epilepsy may reveal the basic neurochemical or physiological defects which need to be prevented or corrected.

This, in turn, may help scientists to develop new anti-epileptic treatments.

* It is quite possible that research over the next decade on molecular genetics of human epilepsy will result in an entirely new classification of epileptic disorders and a better understanding of the fundamental causes of the many forms of epilepsy.

Clinical Research

This research is primarily concerned with the application of new diagnostic technologies and therapeutic interventions.

It also includes understanding regional differences in the various types of epilepsy and their cause, studying the provision of health services for people with epilepsy and the cost-effectiveness of treatments. Further research, in the fields of psychology and sociology, and which is not detailed here, has improved the understanding of the impact of the disease on people with epilepsy and enabled the formulation of rehabilitation programs.

WHO

Being overweight

Risks associated with being overweight or obese

Ischaemic heart disease

Cerebrovascular disease

Non-insulin - dependent diabetes

Cancer of the uterus, cervix, ovary and breast

Hypertension

Hypercholestrolaemia

Gall - bladder disease

Osteoarthritis

Gout

Ovulatory failure

Menstrual irregularities

Polycystic ovarian disease

Complications after surgical operations

Complications in labour and delivery

Dietary advice for obese patients.

* Eat three times a day food which are low in fat and sugar and high in fibre.

* Eat complex carbohydrates (bread, potatoes, rice, paste and cereals) regularly, though not in excess.

* Increase your intake of fibre.

Eat wholemeal granary bread, high fibre breakfast, cereals, brown rice and all fruit and vegetables including potatoes.

* Reduce fat intake. Avoid fried foods, grill or bake instead.

* Limit the quantity of crisps, biscuits and pastry you eat.

* Use low-fat milk, spreads and cheese.

* Reduce your sugar intake. Avoid added sugar, confectionary, sweet, biscuits and cakes.

* Use ‘diet’ or sugar - free soft drinks.

* Regular aerobic exercises should be undertaken, increasing the amount of exercises as necessary to balance the food intake and energy expenditure.

Sent by Dr. Viraj Peramuna

Chocolate and heart disease...

Continued from last week

Flavonoids: Many thousands of poly-phenolics in the plant world contribute to human food supply. Probably the most abundant are flavonoids which comprise the isoflavins in soya bean, the flavonoid (catechins) and (epicatechins) in grapes and tea, quercetin in onions and apples, naringer in citrus and others.

Thus, we get Japanese paradox based on Soya and green tea, the French paradox based on red wine and the benefits of Mediterranean diet based on olive oil. In each instance single polyphenols such as (genistein, epicatechines and revertrol) have been claimed to have powerful antioxidant activity.

Joining the lengthening list of flavonoids are the (procyanidins) found in grape-seeds, tea, coffee and cocoa.

(Procyanidins) are complete molecules in which (catechins, epicatechins) and other (gallic esters) are linked. Like all other (polyphenols, procyanidins) display strong antioxidant activity and are believed to have cardiovascular protection.

In vitro, (procyanidins) are powerful inhibitors of tyrosine nitration by peroxinitrate.Chocolate and preparations containing cocoa powder which are rich in bio-flavonoids commonly known as (procyanidins) are some of the most commonly consumed dietary supplements by the young in developed countries and developing countries.

Bio-flavonoids in dark chocolate and cocoa powder provide better protection against oxidative damage than other antioxidants such as vitamin E, vitamin C and (betacarotene) Bio-flavonoids in dark chocolate have been shown to decrease chemically induced DNA damage and lipid peroxidation.

By inhibiting inflammation, bio-flavonoids in dark chocolate have been shown to prevent platelet aggregation in vivo (Am J Clin Nutri, 2000, 72, 30-3) Wan et al showed that healthy individuals benefit by consumption of dark chocolate and cocoa powder by reducing LDL oxidation susceptibility and increasing serum total antioxidant capacity and HDL concentration (Am J of Clin Nurri, 2001, 74, 596-602)

In the younger age groups chocolate is preferred to tea and dark chocolate contains four times catechines as compared to tea, whereas in adults, tea contributes to most of the catechines. Therefore, chocolate can be an important dietary source of flavonoids in addition to tea, especially, in the young.

Oxidative modification was shown to play a key role in the initiation of atherogenesis and flavonoids prevent LDL oxidation in vitro by scavenging free radicals (Miller et al, Arch.Bio. Bioghys, 1995, 322, 339-46).

Extracts of cocoa powder also significantly inhibits LDL oxidation according to Kando et al (Lancet, 1996, 348, 1512). According to Waterhouse et al, cocoa phenols inhibited LDL oxidation by 75 percent whereas red wine inhibited LDL oxidation by 37 percent. (Lancet, 1996, 348, 834).

Vinson et al showed that chocolate had a higher flavonoid antioxidant quantity - quality index than it did in fruits, vegetables, red wine and black tea (J Agric food Clin, 1995, 43, 2798-9).

Wang et al reported that a dose dependant increase in plasma epicatechin was associated with an increase in antioxidant capacity and reduction in (plasma lipid peroxidation) two and six hours after consumption of procyanidin rich chocolate (Wang et al, J, Nutri 2000, 130, 2155-9).

According to Ying Wan et al, cocoa powder and dark chocolate may favourably affect cardiovascular disease risk status by modestly reducing LDL oxidation susceptibility, increasing serum total antioxidant capacity and not adversely affecting prostaglandins (Am. J of Clin Nutr, 2001, 74, 596-602).

In summary, cocoa powder and dark chocolate consumption gives rise to a decreased risk of cardiovascular disease and incorporation of dark chocolate and cocoa powder into diet is one means of effectively increasing antioxidant intake.

Furthermore, the inclusion of dark chocolate and cocoa powder in a diet that is rich in other food sources of antioxidants such as fruits, vegetables, tea and wine results in a high antioxidant intake and may consequently reduce the risk of cardiovascular disease.

An important recommendation is that chocolate be incorporated sensibly and prudently in a healthy diet and should emphasize the intake of fruits, vegetables, whole grain, skim-milk, reduced fat dairy products, lean meat, fish and poultry.

The dangers of Multiple sclerosis

Multiple Sclerosis (MS) is a chronic neurological disease that affects young adults in their 20s and 30s and lead to progressive loss of nerve function. This can lead to blindness, inability to walk, incontinence, constant pain and fatigue and impairment of cognitive functions. While there are drugs which help to delay progress of the disease there is no known cure for this disease.

In MS, the immune system, which normally targets and destroys substances foreign to the body such as bacteria, mistakenly attacks the host’s own normal tissues of the brain and spinal cord. the disease progresses relentlessly and has to be endured on a daily basis for the rest of a patient’s life. The speed at which the disease progresses varies from patient to patient and the end result is often a person who has to be confined to a wheel chair or is completely bedridden.

MS can be devastating to a young person, who is often a bread winner of the family with a young family to support.

The patient often requires round the clock nursing, expensive drugs to manage the symptoms, regular physiotherapy and rehabilitation. As these patients are young and have a normal life span, care has to be provided for many decades.

The Multiple Sclerosis Association of Lanka (MSAL) brings together persons with MS their doctors, caregivers and other well wishers with a view to promoting health and improving the lives of persons with MS. The main objective of the Association is to provide support to persons living with MS.

Activities of the association include providing moral support to patients and caregivers through home visits, organizing talks by experts to help patient understand and cope with their disease and providing financial assistance for wheelchairs, physiotherapy, purchase of drugs and disposable, for travel to MS meetings and for daily living especially in cases where the bread winner has been affected.

The association serves as a support group for patients and their families where they can share their day to day problems and solutions.

MS meetings are held every other month in Colombo with regional meetings in Kandy from time to time as well.

These meetings provide an opportunity for MS patients to share their experiences and coping mechanisms with other patients and are open to anyone interested in MS. The MSAL was started in 2006 and is now a registered company affiliated to the Multiple Sclerosis International Federation. The MSAL is a voluntary organization and is funded by donations and fundraising activities.

The first ever ‘World MS day’ declared by the Multipel Sclerosis International Federation (MSIF) was celebrated on May 27 World MS Day hopes to raise awareness about MS and build global solidarity for the MS movement around 47 MS organisations across the globe have already declared events for this day.

In Sri Lanka, the MSAL has planned a week of events including a MS day for patients, TV publicity and MS awareness program that will be conducted simultaneously in Colombo and Kandy.

Appointment of new SLMC president

Professor Lalitha Mendis MBBS (Cey), MD (Cbo), PhD (Lond), Dp Bact (Manch), F.Nat.Acad.Sc(SL), Hon.F. CGP-SL, was recently appointed President of the Sri Lanka Medical Council (SLMC) by Minister of Healthcare and Nutrition Nimal Siripala de Silva.

She is the first woman to hold this post and replaces Dr. H.H.R. Samarasinghe who served as president SLMC for ten years. She is an Emeritus Professor of the University of Colombo. She was President of the Sri Lanka Medical Association in 2008, the first woman Director of the Postgraduate Institute of Medicine, University of Colombo (2002-2005) and Dean Faculty of Medicine Colombo from 1996-2002.

Previously she served on the University Grants Commission. and was President of the College of Microbiologists, President of Section A of the Sri Lanka Association for the Advancement of Science, and was on the Board of Directors of IVIMEDS Ltd (International Virtual Medical School).

She has on several occasions served as a consultant to WHO and is currently a member of SAGE (Strategic Advisory Group of Experts) on immunization to the WHO Geneva. The Ad Hoc Committee on HIN1, Geneva, and Chairperson of the Technical Consultative Group on immunization to WHO SEARO, New Delhi..

She has over 112 publications and presentations to her credit and conducted the first ever studies in Sri Lanka on rotaviruses, genital herpes, rubella and human papilloma viruses. She has supervised several research students.

Ways to control blood sugar

Type 1 patients need insulin for survival and must be on insulin injections lifelong.

Type 2 patients should very strictly follow the prescribed diet, medication and regular exercises. The knowledge about diabetes is essential for them.

They may need insulin for the control of diabetes as duration of Diabetes increases.

How Complications should be treated

In early stages eyes need to be examined regularly. Some individuals may need to be evaluated with a fundus fluorescein angiogram where defects of the Blood vessels in the eyes may be studied by injecting a dye and photographing the eye. This will help the doctor to decide if the patient requires laser therapy.

Early stages of kidney diseases need good control of sugar and blood pressure to prevent the progress. However, patients with advanced kidney failure will need lifelong, dialysis or kidney transplantation.

Diabetics who have suffered a heart attack will have to undergo a coronary angiogram and by pass surgery if needed.

Foot infection in diabetics is the toughest complication to treat and requires prolonged hospitalisation in order to clean the wound and achieve tight sugar control, which is essential for wound healing.

Sexual dysfunction due to diabetes is a complication sensitive to discuss as it is embarrassing.

However, if properly assessed, it can be treated successfully.

Permanent cure

There is no permanent cure for Diabetes. But it can be kept under control by diet, lifestyle modification, regular exercise and medication.

Alternative medication systems

There is no scientifically proven cure for diabetes in any system of medication on date.

Latest formulations are available in Allopathy to control diabetes. Regulated food habits, regular exercise with regular monitoring of blood sugar and sincere following of doctor’s advice only will help in controlling diabetes.

Lead a normal life

By a very strict adherence to food schedule, regular exercise, proper monitoring of blood glucose tests and adjustment of medications, a diabetic can definitely lead a very normal life.

Sent by Meenakshi Mission, Hospital Medura