This week, Drs. Daniel Correa and Audrey Nath hear from three podcast listeners as part of a recurring 'Listener Questions’ series that delves into the questions that you, our listeners, want to learn more about. In this episode, Drs. Correa and Nath answer questions about neurologic conditions like restless legs syndrome and potential treatment options to relieve symptoms, the connection between traumatic brain injury and dementia, and more.
Do you have a question you would like to be answered by the Brain & Life podcast hosts? Email blpodcast@brainandlife.org or call in and leave a question at 612-928-6206 for a chance to have it included in future episodes.
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Additional Resources
- Restless Leg Syndrome Overview
- Traumatic Brain Injury Overview
- Dementia Overview
- Epilepsy Overview
- How Sleep Protects the Brain
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Episode Transcript
Dr. Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa.
Dr. Nath:
And I'm Dr. Audrey Nath.
Dr. Correa:
This is the Brain & Life podcast.
Dr. Nath:
Welcome back to the Brain & Life podcast by the American Academy of Neurology. This week it's all about answering questions from you, the listener. We really wanted to hear what sorts of neurological questions y'all have on your minds. I love it. I could do this every day.
Dr. Correa:
You guys had some great questions for us. Everything from restless leg syndrome, to traumatic brain injury, dementia, and even the tongue twister amygdalohippocampectomies.
Dr. Nath:
That's right. Even as an epileptologist who does deal with a lot of amygdalohippocampectomies, it is still a tongue twister. It's like one of those theater exercises.
Dr. Correa:
Oh, it is so much fun and now, let's open up the mailbag.
Dr. Nath:
So fun. Okay, first question. This is from the mail, from Stanley. Stanley wrote, "I have restless leg syndrome. I can never let my legs get cold or feel any vibration, or I would never get any sleep. Do you think that acupuncture would help?" Stanley, thank you for writing in about this topic, which as neurologists, Daniel, we hear about this a lot and let's talk about it. Let's talk about restless legs.
Dr. Correa:
We had that previous episode, where we talked about the importance of sleep, really trying to work towards getting better sleep is so important.
Dr. Nath:
Oh, yes.
Dr. Correa:
But I think the first part of this, Audrey, is we have to understand what is restless legs syndrome.
Dr. Nath:
Absolutely. Basically, what Stan Lee is referring to, and maybe there's a lot of our listeners that are like, "Oh yeah, this is me too," but many of our listeners may relate to this, but it's right as you're falling asleep and then you feel this zap like little zing feeling in your leg and you just have to move your leg in order to get that feeling away, which then wakes you up and is pretty annoying. We refer to this as being part of restless leg syndrome.
In the neurologist office, when this gets brought up, one of the things that we do is we test for something called ferritin. We get a lot of questions about this. Ferritin, that's iron, what does that have to do with anything? But it turns out that iron is a co-factor in this chemical process in your body that converts tyrosine eventually to dopamine. Dopamine is very important in motor control in the brain, essentially. It's a super scientific thing.
Dr. Correa:
It's just one of the things that needs to be looked at when you're being tested for causes for restless leg.
Dr. Nath:
That is treatable and we can prescribe iron. Just so y'all know why we keep ordering that.
Dr. Correa:
Now, Stanley also asked about acupuncture, Audrey.
Dr. Nath:
Oh, it's so interesting. My mom is Chinese, she drives to Austin to see her particular acupuncturist. We talk about this a lot in our household. There's a lot of really great uses for acupuncture and there's also a lot of conditions where acupuncture isn't so well studied. I think both of those things are true with restless leg. I just did a little search and it looks like there have been some studies to investigate if acupuncture can help specifically with restless leg syndrome and there's some evidence that it kind of does, but there are some limitations to the studies that are out there, mostly that these haven't been randomized controlled studies with a real control arm.
Dr. Correa:
What would that mean? Okay, they studied it, why does it matter that it wasn't randomized or controlled?
Dr. Nath:
Exactly. People can have progression for the better or for worse with their conditions for all kinds of reasons while a study is happening. When we have a control arm, it's so helpful, because then we know like, "Oh, was there really a change because of this treatment or was it just kind of a coincidence?" To do a real control study for acupuncture... When we do control studies for medications, we might take a sugar pill or a pill that looks like a pill, but nothing's in it. But acupuncture is not a pill. They can do what we call sham acupuncture, where they put needles in the body, so you still think you're getting acupuncture, but they're basically put in the wrong spots and then can compare and see if the people who got the acupuncture in the right spots did better, than the people who got them in the wrong spot.
Dr. Correa:
More information is needed about it. Now, with all of these things, supplements and other alternative or supportive therapies, you have to think about it for yourself. What is your own benefit that you feel from it? How much does it cost for you? If there's not necessarily set research, if you do it and you find a benefit for it and it doesn't outweigh the amount of cost and the time it takes you, then that's something for you to consider. But it doesn't seem right now that we have enough evidence to know that it definitely helps and that it should be your regular therapy for restless leg.
Dr. Nath:
But if you're doing it anyways, go for it. I know my mom's going to have another treatment soon and that's cool too.
Dr. Correa:
Well, thank you guys so much for sharing that question.
Dr. Nath:
Good luck, Stanley. We hope your sleep gets better.
Dr. Correa:
Okay. We have another question we received by email.
Dr. Nath:
Yay.
Dr. Correa:
Bernadette wrote, I've heard that if one had a traumatic brain injury, chances are they will acquire dementia. Is that true about all people with traumatic brain injury?
Dr. Nath:
Oh, good question, Bernadette.
Dr. Correa:
Yeah. No, that's a very good question.
Dr. Nath:
This comes up a lot.
Dr. Correa:
I think that's something that we're all talking about in our community and in society, whether it's related to sporting injuries, professional athletes, and even our children and athletes growing up. When I was in the military, I worked at a traumatic brain injury rehab center in Georgia and during my time training at Walter Reed. The reality is right now, we're still at a stage that it does seem, when you take a look back at many of the people who've had different types of brain injuries, whether they're mild traumatic brain injuries or what can sometimes also be described as concussion, we get into that a little bit more if we go back and check out the episode that we did with dancers on performance mentality.
But what we know is, when you look back at populations who've had concussions and traumatic brain injuries, that there can be a greater likelihood for types of dementias. But we don't necessarily yet know if some of those people were already at greater risk. Is it more related to the fact that they had that concussion and those traumatic brain injuries? Is it more related to multiple that need to occur over time?
Dr. Nath:
That's something we're looking into now, people who have repeated head injury, because it's not so much that one plus one equals two with this, there can be kind of a cumulative effect of having multiple traumatic brain injuries over time. Exactly.
Dr. Correa:
We've talked some before in other episodes how we need more evidence in certain ways. One of the best ways that we'll know about this and studies that are actually going on right now around the country and in many places is looking at athletes, regular community members, people with all kinds of different types of risk factors, looking forward and following them both before they ever have any head injury and then after they have types of head injuries, whether those are mild TBIs or traumatic brain injuries and concussions or more severe ones and then, following with time.
Dr. Nath:
There's so many factors that could affect which exact person is going to go on to have dementia, which Bernadette basically we don't know right now, is the long way of saying that. We're all doing our best to protect our brains, protect our brains from injuries, to be wearing helmets, to be taking precautions during contact sports amongst ourselves and for our patients.
Dr. Correa:
Those are all great points, yeah, that we need to make sure people are taking the precautions that we know about. Everyone needs to focus on the things that help support our brain health, especially if you're prone to or have had traumatic brain injuries or concussions in the past
Dr. Nath:
Here in Texas, I did a couple of years of pediatrics here before neurology residency and we saw a number of kids in our urgent care clinic who had concussions in the context of football. We would go through with them the concussion protocol, which basically involves some degree of brain rest for a good seven days after the injury, which would even mean limiting the amount of schoolwork or the amount of time paying attention, really taking it easy on screen time and letting the brain just chill for a little bit for a number of days, until they kind of got back to their baseline. This is something that, yeah, Daniel, you were mentioning that we're talking about with kids these days in addition to adults, because these concussions are happening in children as well and we got to take precautions and we got to help these kids.
Dr. Correa:
If you're in those situations where you're maybe at risk, maybe they'll go ahead and participate with one of those concussion or TBI clinics and make sure they're going through a protocol of rest and recovery and then reintroduction into the activities. But thank you so much Bernadette for that question and we look forward to more excellent questions.
Dr. Nath:
This is from David. Hi, David. He says, "I had an amygdalohippocampectomy. I was experiencing so many seizures every day. My surgeons told me I would experience intense emotions at times, because they removed one half of my emotions from my brain. Anger, fear and joy can be very intense for me. I can also be very forgetful. This is good, because I can easily forget why I was so angry with someone or something very quickly. That's amazing. I can also laugh for the smallest reason." David, I want to go meet you somewhere. This is amazing. "I stay mentally active and try to learn everything I can to exercise my brain the best way I know how, but I wonder if there's something specific I can do to improve?"
Dr. Correa:
Wow. David is taking us deep into the brain.
Dr. Nath:
I love it.
Dr. Correa:
Making us remember all the great things that why we went into epilepsy and into neurology. But Audrey-
Dr. Nath:
He's so positive. He's turning it all into a positive. I love this guy.
Dr. Correa:
Totally. I love it. Now, Audrey, stop for a moment. Tell us and tell our listeners what is an amygdalohippocampectomy, because we're starting at a big point right there.
Dr. Nath:
That is a long word with a lot of syllables I realize, and you and I are both epileptologists. For us, we feel like this is just a word we use every day. It's a long way of saying, "Removal of the amygdala and hippocampus," and the amygdala and hippocampus are right next to each other. Many seizures can start from this part of the brain and it's deep in the middle of the brain. What it looks like, is David was describing that he had refractory epilepsy is what it sounds like. That he had many, many seizures despite medication, I'm guessing. That it was an option for him, that it looked like the seizures were starting from one side of his brain in this region and that this region could be removed to help him stop his seizures.
From his letter, he doesn't tell us if his seizures got better, but I'm guessing they did, since he talked about his seizures being in the past tense. I'm hoping that the seizure control got better and that is great. Then there's the emotions side effects that he talks about that, Daniel, patients definitely tell us about after some of these surgeries, because of what these parts of the brain do.
Dr. Correa:
Each of the emotions or side effects, potentials of different surgeries can be different, because it's important for everyone to know this is not necessarily the same surgery that everyone would get for epilepsy.
Dr. Nath:
Absolutely. Absolutely.
Dr. Correa:
If you have a type of epilepsy that's not well controlled with medications or what we call refractory epilepsy, then you may be a candidate. If you are working with doctors, they can identify where in the brain your seizures come from, and then they can have a conversation with you. "Okay, that area where the seizures come from, what does it do if we take that area out to help stop the seizures? What kinds of side effects or symptoms might you have?" For each person, the risks and side effects could be very different.
Some of the types of surgeries can be very safe with very minimal side effects. One of them in the most common in about 2-5% of people is some mild memory loss. David described that for us, but also because his surgery required taking out that amygdala area, that's one of those areas that regulates emotions. That's why he gets so much fluctuation in his emotional regulation and it's great that he's aware of it and he's able to also be conscious of it and adapt to it. Audrey, how do we know about different causes or what these different areas in the brain, what they do? Were there examples that we started with?
Dr. Nath:
That's a great question. Just like in general, there's all these parts of the brain and how do we know what they do? Way back before we had fancy imaging devices like MRI scans and CT scans, people figured out what parts of the brain did based on what we call lesion studies, where somebody would have an injury to the part of the brain and then you looked and would see what happened to the patient and what they had trouble with.
This is how we identify it, a number of different parts of the brain and what they did. Along the lines of what parts of the brain are involved in emotion, we know that the amygdala is heavily involved in emotion and we know that the connections between the amygdala and some of the more prefrontal or front parts of the brain, are a whole network that's involved in emotion. One of the early lesion studies that taught us about those more frontal parts of the brain being involved in emotion are a historical case of a man named Phineas Gage, who Daniel, I know amongst neurologists, we love talking about Phineas Gage, because it-
Dr. Correa:
Many people who took psychology classes or maybe have heard about him in college, in short, you maybe not remember the name, but you heard of the guy who had a railroad rod through his nose and eye into his brain and that's-
Dr. Nath:
And he lived.
Dr. Correa:
He lived.
Dr. Nath:
Which is incredible and he was able to still walk and talk after that. But he did have a big emotional change and the people around him said, "Gage isn't Gage," because his personality had changed and he would have emotional outbursts and things like that. But what I find to be interesting is reading more about this case later, because this is what we do as neurologists, we read about Phineas Gage, is it looks like actually in his later life he did achieve some degree of rehabilitation for his issues.
He started driving a stagecoach is my best understanding of it, which was just a very regimented job where he had a very, very regimented schedule and he would do his job and he would go to bed every night. It's thought that maybe in having that regimented schedule and a clear idea of what he is going to do every day and doing the same thing every day, that he might have actually improved a little over time. The outbursts may have gotten better depending on which accounts that you read, and so for-
Dr. Correa:
I think that gives a good idea to David, because David was wondering what can he do?
Dr. Nath:
Yeah. Other than drive a stagecoach.
Dr. Correa:
Yeah, I mean that I want to see David actually driving a stagecoach, but one thing is that having a sense of regularity in his schedule, it already is great and already you can tell in David's question that he's developed an awareness about these things.
Dr. Nath:
Absolutely.
Dr. Correa:
Being able to develop that self-awareness and sometimes now what we call often is mindfulness, can help him pay attention. If he's following a regular schedule of exercise and activities-
Dr. Nath:
And sleep.
Dr. Correa:
May help him find the triggers and plan ahead to help adapt and manage some of these triggers or help in his response and recovery from any of the changes in his emotions, his fluctuations, or even the things that might trigger more of his memory loss. Then, that way he can help with maintaining notes and a calendar and those kinds of skills. There's also some similar memory skills and ideas. If you take a look at our episode that we did with Marilu Henner.
Dr. Nath:
Yes.
Dr. Correa:
And with a neuroscientist who's a memory expert, he talks about also memory enhancement skills and we hope actually to have him and more experts back, to talk about skill development in Season Two. Make sure to stay tuned. Thank you, again, for joining us on the Brain & Life podcast. Follow and subscribe to this podcast so that you don't miss our weekly episodes. You can also sign up to receive the Brain & Life Magazine for free at brainandlife.org.
Dr. Nath:
Also, for each episode, you can find out how to connect with us and our guests along with great resources in our show notes. You can also reach out by email at blpodcast@brainand life.org. You can call in any time and record a question at 612-928-6206.
Dr. Correa:
You can also follow the Brain & Life Magazine, Audrey and me on any of your preferred social media channels.
Dr. Nath:
A special thanks to the Brain & Life team, including-
Dr. Correa:
Andrea Weiss, executive editor for education and news publications.
Dr. Nath:
Nicole Lussier, Public Engagement Program Manager.
Dr. Correa:
Rachel Coleman, our Public Engagement Coordinator.
Dr. Nath:
Twin Cities Sound, our audio editing partner. We are your hosts.
Dr. Correa:
Daniel Correa, I'm joining you from New York City and online @NeuroDrCorrea.
Dr. Nath:
And Audrey Nath, beaming in from Texas and on Twitter @AudreyNathMDPhD.
Dr. Correa:
Thank you to our community members that trust us with their health and everyone with neurologic conditions. We hope together we can take steps to better brain health and each thrive with our own abilities every day.
Dr. Nath:
Follow and subscribe, wherever you get podcasts.
Dr. Correa:
We really appreciate it. If you could give us five stars and leave a review,
Dr. Nath:
Thank you.
Dr. Correa:
This helps others find the Brain & Life podcast. Thanks again, see you next week.
