Thursday, May 18, 2017

University of Arizona Neurology Grand Rounds Podcasts

University of Arizona Neuroscience Department has an excellent podcast series of their Neurology Grand Rounds which I have accessed through iTunes U on my iPhone 6s.  I’ve been listening to these driving to and from work for the last couple of years.  They have always been most informative and extremely well presented.   The presentations have visuals  which I cannot access given I’m driving but I’ve gone back and reviewed some later.  However the presenters seem to appreciate that a lot of us aren’t watching them so make a point of explaining the most relevant information.
I’ve just listened to Sheena Aurora MD presenting on Migraine Pathophysiology and it’s been a real treat. She’s an amazing researchers with obviously well deserved awards and credits. Much to my surprise she explained that the MRI and fMRI angioplastic imaging blow the old idea of vascular migraines right out of the water. I’d heard this was being challenged as a theory a few years back but now it’s clear that the old idea of vascular constriction and ischemia just doesn’t occur.  What does occur is a hyper perfusion of the brain with a cortical depression. It appears that there is an increase in blood flow but that the brain is unresponsive .
The genetic predisposition for migraine phenomena has been found in variations on Chromosome 19.    80% of migraine sufferers have first degree relatives with migraine also.  There appears to be an channelopathy abnormality , the very area of neurology Dr. Robert Stowe studies here at UBC.  It appears that the presynaptic channel gate allows greater flow of potassium causing changes in the sensitivity of the tissue.  The techniques with various perfusion and scanning approaches used first in animals and later in less invasive forms in humans has been a long hard struggle to delineate the actual problem areas.
The generation of pain appears to be in the brain stem but the actual location is uncertain, though the research focus now is the hypothalamus.
The attempt too is to sort out why the variety of medications used in treatment of migraines appear to work with some not all.  Tryptans, topiramate, Coenzyme Q-10, possibly magnesium, etc.  The issue of inflammation exists too because the standard anti inflammatory medications like ASA, and NSAids (ibuprofen, and naproxen) continue to be beneficial.
There was much more that Sheena Aurora MD covered but those were the points that mattered most to me clinically. I certainly will be trying Coenzyme Q - 10 and watching for newer medications to come along shortly given the advances that are really coming along quickly.
I really did enjoy my commute to work thanks again to the University of Arizona and Sheena Aurora.

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