Some MRI contrast agents might be dangerous

What’s in YOUR MRI contrast agent?

This just in from BrainBlogger – as it turns out, my hunch about gadolinium-based contrast agents not being all that great for you, is not far wrong.

Thank you, science, for backing me up. Bold emphasis is mine below.

Some MRI contrast agents might be dangerous

With millions of patients getting MRI scans every year, the technique rapidly becomes one of the most commonly used diagnostic tools in the developed countries. However, new data published this month cast the shadow on the safety of the contrast agents used for the data acquisition – so-called linear-type gadolinium-based contrast agents.

It appears that repeated use of these agents in the MRI scans lead to accumulation of toxic heavy metal gadolinium in the patients’ brains. The safety concerns may have serious implication on the whole MRI industry and likely to result in substituting linear-type agents with safer and more stable macrocyclic gadolinium-based agents. The use of the latter does not lead to accumulation of gadolinium in the brain.

Ref: Robert, P., Lehericy, S., Grand, S., Violas, X., Fretellier, N., Idée, J., Ballet, S., & Corot, C. (2015). T1-Weighted Hypersignal in the Deep Cerebellar Nuclei After Repeated Administrations of Gadolinium-Based Contrast Agents in Healthy Rats Investigative Radiology, 50 (8), 473-480 DOI: 10.1097/RLI.0000000000000181

Bottom line is, pick your poison. Heavy metal contrast agents aren’t particularly good for you, to begin with, but some may be lesser evils than others.

Check with your doctor/neurologist before you have your next MRI.

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TBI Alert: Rehab Program Improves Memory and Mood, Even Years After Injury

Work it!

From Neurology Now

Tuesday, June 09, 2015

TBI Alert: Rehab Program Improves Memory and Mood, Even Years after Injury

BY REBECCA HISCOTT

Depression and difficulty concentrating are some of the potential long-term symptoms of a traumatic brain injury (TBI), but a specially designed cognitive training program may help improve these and other symptoms—even 10 years after the injury. That’s the finding from a new study from the University of Texas at Dallas’s Center for BrainHealth, published in the journal Neuropsychological Rehabilitation.

The researchers developed and tested an eight-week, 18-hour cognitive training program called SMART (for “Strategic Memory Advanced Reasoning Training”) in a group of TBI patients, many of whom had sustained the initial injury more than 10 years earlier.

The SMART Approach to Rehab

For the study, 31 TBI patients between the ages of 19 and 65 participated in the SMART program; 13 were veterans. All had experienced TBI more than six months earlier, with two-thirds experiencing the injury more than 10 years earlier. They all had chronic cognitive or psychological symptoms, including difficulty carrying out daily tasks, grasping complex concepts, or problem-solving, which affected their ability to work full-time or find employment.

During the program, the patients learned strategies for improving their attention, reasoning, and innovative thinking skills. For example, the researchers explained, patients with TBI have trouble multitasking, which can tax the injured brain. In order to improve concentration, investigators taught the patients to identify and block out distractions in order to better focus on a single task. In turn, honing these attention skills helped the patients read complex articles and tease out the core ideas and messages. The participants were also asked to apply these strategies in their daily lives, for instance by reading the newspaper and identifying the most important parts of a news story.

The researchers compared the effects of the SMART program to those of a brain health workshop, in which 29 people with TBI learned basic facts about brain health and brain injury, but did not learn any specific strategies for dealing with the symptoms of TBI.

SMART Improves Memory, Thinking, and Mood

After eight weeks, people in the SMART program had improved their ability to grasp abstract concepts, as measured by a reading test, by 20 percent and improved their scores on memory tests by more than 30 percent, the researchers reported. The patients also reported a 60 percent decline in symptoms of depression and stress, and a 40 percent reduction in symptoms of post-traumatic stress disorder (PTSD).

These cognitive and psychological improvements could also “have a positive impact on one’s confidence, cognitive control, sense of well-being, and self-worth,” the researchers wrote.

Brain Imaging Shows Signs of Improvement

As part of the study, the researchers also administered magnetic resonance imaging (MRI) scans to all of the participants, looking at blood flow in areas of the brain linked with stress and depressive symptoms, such as the frontal lobe, the anterior cingulate, and the precuneus. In people with TBI, blood flow to these regions is decreased, which is considered a marker of injury severity and is linked to worse performance on cognitive tests and symptoms of PTSD, the researchers explained.

Patients who participated in the SMART program had a more than 25 percent increase in blood flow to these brain regions, suggesting a healthier and less-stressed brain, which could also explain the improvements on psychological health, the researchers said.

Effects Last for Several Months

The benefits of the SMART training program persisted when the researchers administered another set of cognitive tests and MRI scans three to four months after the program ended, noted lead investigator Sandra Bond Chapman, PhD, founder and chief director of the Center for BrainHealth, in a news release.

Need for Further Study

The results are promising but preliminary, and will need to be verified in rigorous future studies, said Dr. Chapman and her colleagues. If future research confirms the results, SMART could be added to the growing arsenal of cognitive training programs that have shown promise for treating the long-term effects of TBI, the researchers said, with the ultimate goal of helping people with TBI lessen their symptoms, rejoin the workforce, and lead happier, healthier, and more productive lives.

To learn more about traumatic brain injury and how it’s treated, see and browse our archives here.

 

Diving Into My MRI

I spent time yesterday studying my MRI, comparing my brain with pictures of normal MRI’s I found online at Google images. What a treasure trove Google is! Just being able to find pictures of what “normal” looks like has been a great boon to me.

Looking at MRIs can be very trippy, and looking at my own brain is kind of spooky. From looking at it, the untrained eye could easily become very disoriented and alarmed. But knowing what other normal MRIs look like is very helpful. How else would I know that I’m not a freak of nature? The brain is just so fascinating!

It’s so great to find descriptions of the normal brain MRIs, since it can be hard to figure out what you’re looking at. I’ve got a used textbook on neuroscience I picked up, as well as a copy of Netter’s Atlas of Human Anatomy, which is a hefty tome of highly detailed drawings (done by Dr. Netter) of virtually every part of the human body, which also have every little piece clearly marked and labelled. I look at my MRI, then I consult my Netter’s book, then I Google the part of my brain that I think I’m looking at and read about it, and then consult my neuroscience textbook, to read more in-depth information that’s at a student level. Fascinating.

But I’m surprised to be having such a hard time finding information on reading MRIs. Maybe I’m not looking in the right places. Maybe that type of information is too advanced to be safe to release into the public, lest we all fire our radiologists, start reading our own MRIs, and jump to conclusions about ourselves. I’ve already had people look askance at me, when I told them I was going to be studying my MRI. They clearly seemed to think that I’m not qualified to do it, but I figure, why let that stop me? I’m not getting paid by anyone to ply that trade, and I’m only interested in my own situation, and it’s really just for my own gratification, so I’m not letting their skepticism stop me. It’s my body. I’ll study it to my heart’s content.

I know there’s no substitute for a qualified neurologist or radiologist, but I really need to understand what’s going on with me, and nobody seems to have the time to spend with me to make sure I’m clear on what’s going on. It’s very discouraging to have this level of testing done, only to not be able to find someone to help me understand it. The neuro I saw a week ago wouldn’t give me any more information, other than that my tests read as normal. I asked if they could show me the film, but they brushed me off. Maybe they thought I’d be looking for something that doesn’t exist… malingering and all that. I’m not malingering. I’m curious! And honestly, I don’t want to milk this and make myself out to be sicker than I am. I just want to know why my life experience is so different from what I hear everyone else describing. I want to know why I have the many, many issues I’ve got. I want to know what makes my brain unique — and treat that uniqueness as a strength, not a weakness. And having MRI images to help me gain just a little more insight into my situation seems like a great opportunity to learn more… even/especially if what I learn is that my variations on experience are “within normal range” and not the sort of thing I need to be concerned about.

I did find some pictures of my brain that I have questions about. Places where there are asymmetries and/or dark/light spots that might be old injuries or some abnormality. The part of me that’s been on high alert — or hovering around there — is eager to run off to a neuro to get the spots and dots and bright places explained… to explain how the asymmetries in my brain might translate to some irregularities in how my mind works. I know I need to calm down, get some rest, let it all sink in. There’s no tremendous hurry, now that I know that I’m not in imminent danger from a brain tumor or MS or some other terrible neurological condition. I can relax, now. And I need to make more of an effort at doing that.

In the meantime, while I recover from my over-excitabilities, I’ll think about my next steps. Study normal MRIs online, look around, just do the whole visual image thing, getting my eyes used to the sight of MRIs, so when I do get a chance to talk to a neuro about my results, I can sound at least moderately intelligent. I’m thinking about contacting that last neuro I went to see — the one who treated me like I was looking for drugs, who has since apparently recanted their attitude towards me and offered to help me “in any way” they can. I may give them another chance — but next time, take someone I trust with me, and ask the neuro to just walk me through the high-level points of my MRI. There are some things that are grabbing my attention, and I would like a little bit of an explanation.

I really need someone to read it who knows how to interpret the orientation of the images. I think MRIs may give you a mirror image of a body part, so the left side of the picture is actually the right side. At least, that’s the impression I get from reading descriptions of MRIs that show clear anomalies on the left side… but the text talks about right-side issues. It gets confusing. One side of my brain is shaped a little differently than the other, and I’m not sure if my right side is lop-sided, or if it’s my left. I think it makes a difference, too, which side is varied from the “norm” — left and right sides have different functionality, or so I understand, and if I’ve got developmental issues with one side of my brain, then knowing about them might help me better understand and manage my own issues.

It could be that I’m on some wild goose chase, and that all the differences in my brain are in fact quite normal. But looking at my pictures and comparing them with other MRIs, my head is kind of lop-sided, and one side of my brain has a noticeably different angle than the other side — between the lower frontal/parietal lobes and the temporal lobe that sits beneath it. I’ve got some asymmetrical bulges, and in some places, one part of my brain looks like it’s been crowded by another part that is not shaped the same way as others’ normal pix. It is considerably wider and looks bigger than I’ve seen elsewhere, so that just makes me wonder.

I don’t think it’s a bad thing, having parts of my brain differently arranged than the norm. If anything, it’s probably an advantage. Even if my brain developed differently over the course of my life, it hasn’t completely stopped me from living my life, and no one would probably ever guess that it’s developmentally different. I’ve been far too successful in my life, far too resilient, far too capable, far too adaptable, far too effective, all across the board, for any sort of developmental differences to be a liability. If anything, my differences are a strength. And I’d never part with them. Not at all.

Looking at all these “normal MRI” pix, I have to wonder… What is normal, anyway? If you think about it, the chances of anyone turning out the same way as other people are just so slim. The human body is an amazingly intricate and sensitive system that can be impacted by unseen, invisible forces that we don’t recognize for a long time, if we recognize them at all. We’ve got billions and billions of cells constantly growing and changing and multiplying, we’ve got tons of distinct body parts, we’ve got so many different bodily functions, many of them invisible to us. And we’ve got not only our internal world but our external world to deal with and factor in. Some days, I’m amazed that the human race — or, for that matter, any living creature — makes it through a single day.

Lots can go wrong. Lots can change us. Lots can affect us and our development. But variations are what keep the human race viable. The healthiest living systems have a lot of variety in them, and I would expect that variations in brain development are critical for a healthy system, as well. Even if those variations appear to be “disabilities” or some other sort of rare deviation. The human brain is an amazing organ, and not only can it do things we cannot even begin to imagine possible, but it can also accommodate a whole lot of additional variations and bounce back from injuries, with neuroplasticity and remapping functions and other mechanisms we haven’t even begun to name. (I haven’t done a plug for The Brain That Changes Itself by Norman Doidge, in a few months, so I’ll mention it here — if you have doubts about the ability of the brain to adapt, then you should definitely check it out.)

So, even if my brain is developmentally anomalous, and even if it got broken along the way with those hits and falls and accidents, and even if it gets tired and overwhelmed and doesn’t know where it is, sometimes, it’s still mine. It’s what I have to work with. And so far, injuries and accidents notwithstanding, it’s still going strong.

Prepping for my neuro visit tomorrow

I’ve got another neuro visit tomorrow — this one is finally a substantial one, when I’ll actually be reviewing the results of my MRI and my EEG. It’s been about a month since I got my MRI, and it’s been nearly 3 weeks since my EEG, and the suspense has been really intense at times.

In my more dramatic moments, part of me thinks, “Today is the last ‘normal’ day/week of my life.” And I get all worked up, thinking that these test results might come back with terrible news or some sign of a horrible condition/disease/tumor/whatever that will sideline me permanently — or at least turn my life into one big detour.

I worry that I won’t be fully functional anymore. That I’ll have to invest all this extra time and energy in overcoming a real issue that I’ve blissfully ignored for a long time. That I’ll be officially disabled. That I’ll be “less than human” and have to live a second-rate life as a result of what the pictures of my brain show.

I also worry that they won’t find anything at all… that I’ll turn out to be crazy and people will look at me like I’m just looking for attention… making things up… malingering… defrauding professional service providers.

Worst of all, I think, would be getting inconclusive results that will waylay my energy and keep me pre-occupied trying to track down the root cause of stuff that’s been getting in my way for a long time, but I’ve been able to brush off and minimize until the past year or so.

I’d almost rather get no results than inconclusive ones. But whatever happens, happens. And I’ll just deal with whatever comes up. I always do.

This waiting around for test results is really exhausting. Especially since I never got any medical attention for any of my multiple TBI’s, and I don’t have a lot of reliable medical records describing my symptoms and issues in medical jargon-y detail. I’ve never been able to articulate my issues to doctors with any level of accuracy, and most of the time, I’ve just given up and said, “Oh, forget it — it’s not that bad, really…” and went off to lick my wounds where I was safe and warm and able to tend to myself and my problems on my own terms.

I swear, this cognitive-challenge/communication-difficulty stuff just makes me nuts. I have a hell of a time articulating my issues out loud to doctors, who are all too often looking for medical data and/or some Latin-based vocabulary in order to properly assess my situation. I don’t know Latin, and I don’t have medical records that show evidence of my injuries. All I have is my life experience and a muddled, garbled mish-mash of out-loud observations that don’t come across right, when I’m talking to someone who doesn’t know me personally (and even if they do, can’t for the life of them imagine that I’ve actually been injured). Absent concrete data, I’m out of luck… so, I’ve been largely resigned over the years to just being out of luck.

Oh, well… what’s next? Life is waiting…

But tomorrow, I will actually be having a discussion with a doctor about real, honest-to-goodness medical test results. Imagine that. I am really looking forward to it. I’m looking forward to it so much that I’ve been studying up on MRI’s and EEG’s and learning to recognize what they show.

I found a couple of great sites for learning about them — with plenty of pictures, which I desperately need.

There’s the section on Electroencephalography and Evoked Potentials followed by their Electroencephalography Atlas over at Medline. I have been studying the page on Normal Awake EEG
so I know what I’m looking at, when the doctor shows me what’s going on with me. I’m studying the normal EEG, as well as other types, so I can tell the difference — if there is any — between what my EEG looks like and what a normal one would look like.

Normal Awake EEG - A 10-second segment showing a well-formed and well-regulated alpha rhythm at 9 Hz.

Normal Awake EEG : A 10-second segment showing a well-formed and well-regulated alpha rhythm at 9 Hz.

I’ve also been studying MRI’s over at Harvard’s Whole Brain Atlas, which shows what a normal MRI looks like — with the different slices — so that when I look at my own MRI, I can see if/how it differs from how it “should” look.

The Whole Brain Atlas

They have MRI slices from different scenarios —

  • Normal Brain
  • Cerebrovascular Disease (stroke or “brain attack”)
  • Neoplastic Disease (brain tumor)
  • Degenerative Disease
  • Inflammatory or Infectious Disease

And you can look at the slices from different angles, which is way cool!

I’ve been studying the normal brain MRI slices, so I am better able to understand what — if anything — is wrong with my gourd.

Now, on a wireless or dialup connection, the images load a little slowly, but on broadband/cable modem, they’re speedy.

Okay, so I know I’m a bit of a nerd/geek, but this just fascinates me. I’m also studying EEG electrode placement patterns, so when I look at my own EEG, if there is any abnormal activity, I can see what area of my brain it takes place in.

Electrodes are placed on 10-20 different areas of the scalp, and they’re lettered/numbered by position. F means Frontal Lobe, T means Temporal Lobe, O means Occipital Lobe, P means Parietal Lobe, and combinations of them mean the electrodes are getting data from more than one lobe. The numbers are odd on the left side of the head and are even on the right side. Here’s an image I’ve been studying:

eeg electrode placement - click to enlarge

I think it’s fascinating. And I have a lot to learn. I think I’ll get myself a balloon and blow it up, then write all the electrode numbers on the balloon with a permanent marker, so I have a 3D version of the placement to take with me to the doctor. I’ll let the air out of the balloon, so I can take it with me easily and then blow it up at the doctor’s office so I can see what’s up, when they start talking about the different readings of my brain.

Of course, this may be moot, if my EEG comes back perfectly normal, but in case it doesn’t, I would like to understand where/how/why things are ‘off’ with me… what it means… and if/how any of my prior TBIs have specifically impacted certain parts of my brain.

This stuff just fascinates me. It’s a lot to take in, and it can actually be pretty serious, but for now I’m going to entertain myself… not to mention distract myself from all the different scenarios my broken brain is coming up with.

Sometimes the inside of my head is a scary place to be.