Wednesday, 18 December 2013

Better late than never?

My apologies for not maintaining this blog over 2013, I have been out of action after being diagnosed with stage II breast cancer in January. My treatment for that is now over, and I hope to have a much better year in 2014.

I'd like to share some disparate articles that appeal to my appreciation of the late Douglas Adams's theory of the " fundamental interconnectedness of all things", as expressed through his Hitckhikers Guide to the Galaxy, and Dirk Gently Holistic Detective Agency books. Of course, he may not have invented the theory, but his books were where I first encountered and enjoyed it. 

I've encountered these articles in my year off from neuropsychology, where focussing on my personal health and family has been a priority, and which has led to wide and diverse reading on a number of topics. I'm sharing them in the hope that you'll also be encouraged by some good news about treatments for conditions that we previously thought were incurable or unstoppable.

Firstly, have a look at this story from New Scientist, which talks about links between  Type II diabetes and Alzheimer's.

If we could only prevent Alzheimer's (and other diseases) in the first place, wouldn't that be great?

This page suggests that it may be possible

If you go to the home page for the ketogenic diet resource above,  you'll see a lot more about the ketogenic diet, and how it may help with childhood epilepsy, alzheimers, cancer... Well, nearly everything (which makes us scientists rightfully skeptical). If you don't  like the above page, then this article gives an overview of what seems to be a growing trend in dietary thinking

Sounds like it could be less harmful than the "healthy food pyramid" promoted since the 1970s which has seen an enormous increase in the incidence of obesity and diabetes. And we get to enjoy butter and cream again, and ditch the polyunsaturated oils... All with a view to decreasing inflammation in our cells.

A quote from Wikipedia about ketogenic diets may be of interest to neuropsychologists:
"There is some evidence that adults with epilepsy may benefit from the diet, and that a less strict regime, such as a modified Atkins diet, is similarly effective.[1] Clinical trials and studies in animal models suggest that ketogenic diets provide neuroprotective and disease-modifying benefits for a number of adult neurodegenerative disorders.[5][6] As of 2012, there is limited clinical trial data in these areas, and, outside of paediatric epilepsy, use of the ketogenic diet remains at the research stage.[7][8][9]

Of course, you can look it up on wiki yourselves, I don't want to make it too easy for you.

Finally, if our epilepsy or alzheimer patients, or people with cancer can be helped with dietary changes, there is great news on a treatment for the most aggressive brain tumours, Grade IV gliomas, or GBMs.

A letter and an article appeared  in September, showing remarkable improvements in median survival times and long-term outcomes for GBM patients given Valcyclovir, a drug used to treat cytomegalovirus, a common virus thought to be implicated in the development of GBMs, and found in many adults. The background to the research is here

The letter to the NEJM is here

And this is the abstract of the article.

Int J Cancer. 2013 Sep 1;133(5):1204-13. doi: 10.1002/ijc.28111. Epub 2013 Mar 13.

Effects of valganciclovir as an add-on therapy in patients with cytomegalovirus-positive glioblastoma: a randomized, double-blind, hypothesis-generating study.

Department of Neurology, Karolinska University Hospital, Sweden.
Cytomegalovirus is highly prevalent in glioblastomas. In 2006, we initiated a randomized, double-blind, placebo-controlled, hypothesis-generating study to examine the safety and potential efficacy of Valganciclovir as an add-on therapy for glioblastoma. Forty-two glioblastoma patients were randomized in double-blind fashion to receive Valganciclovir or placebo in addition to standard therapy for 6 months. Magnetic resonance images were obtained before and immediately and 3 and 6 months after surgery to evaluate treatment efficacy by measuring contrast enhancing tumor volume (primary end point). Survival data were analyzed for patients and controls in explorative analyses to aid the design of future randomized trials. Trends but no significant differences were observed in tumor volumes in Valganciclovir and placebo patients at 3 (3.58 vs. 7.44 cm3, respectively, p = 0.2881) and 6 (3.31 vs. 13.75 cm3, p = 0.2120) months. Median overall survival (OS) was similar in both groups (17.9 vs. 17.4 months, p = 0.430). Patients could take Valganciclovir for compassionate use after the study phase. Explorative analyses showed an OS of 24.1 months (95% CI, 17.4-40.3) in patients receiving >6 months of Valganciclovir (Val > 6M) versus 13.1 months (95% CI, 7.9-17.7, p < 0.0001) in patients receiving Valganciclovir for 0 or <6 months, and 13.7 months (95% CI, 6.9-17.3, p = 0.0031) in contemporary controls. OS at 4 years was 27.3% in Val>6M patients versus 5.9% in controls (p = 0.0466). Prolonged OS in Val>6M patients suggest that future randomized trials are warranted and should evaluate whether continuous antiviral treatment can improve outcome in glioblastoma patients.

These are fantastic improvements in outcomes, and I hope it is borne out by further research. From reading the cancer forums, some oncologists are already prescribing Valcyte to GBM patients on the basis of this research, and the drug company may provide the drug at cost on compassionate grounds.

 I know that giving specific advice on diet is outside our area of expertise, but would it do harm to encourage our patients or their carers to be proactive in researching all lifestyle options available to them, in consultation with their doctor(s)?

If only we could also get a global consensus on halting climate change...

Wishing you all a restful and happy holiday season, and hoping to be back on deck in some capacity next year. 

Best wishes


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