First Choice Neurology

Lumbar Puncture for Cerebrospinal Fluid is a Vital Tool to Assess Amyloid Build Up in Alzheimer’s

In recent years, research has shown that tests of cerebrospinal fluid (CSF) can be a valuable tool for the detection of hallmark proteins that are involved in diseases that cause dementia. For example, amyloid and tau proteins build up in Alzheimer’s disease, and their levels can be measured in CSF.

These abnormalities contribute to the disabling signs and symptoms of dementia:
Alzheimer's Amyloid Build Up• Loss of memory that affects daily life—forgetting information that was recently learned. This can occur with normal aging, but the information is usually remembered later. This includes forgetting important dates or events, having to rely on memory aids, and asking for the same information again and again.
• Difficulty planning or problem-solving, such as keeping track of bills and payments
• Problems completing usual tasks, such as forgetting how to get to a familiar location
• Confusion about place or time—losing track of time, forgetting where you are or how you got there
• Increasing difficulty reading or judging distances
• Problems speaking or writing—forgetting words, repeating the same thing, struggling with vocabulary
• Losing things more frequently and not being able to logically retrace steps to find them
• Impaired judgment, such as giving away unusually large amounts of money
• Increasing withdrawal from activities, including social, work, or family events
• Changes in mood and personality, such as increased anxiety, fear, suspicion, and depression

Getting a sample of cerebrospinal fluid is a bit like getting a sample of blood for a blood test in that a needle is used to access the fluid and a sample is taken. The process is called a Lumbar Puncture — a procedure easily performed on an out-patient basis.

Dr. Jeff Gelblum, Senior Neurologist with First Choice Neurology, asserts, “the new ABC’s of Alzheimer’s treatment are: Assessment of clinical status; Beta-amyloid in the CSF; Consider infusion of Aduhelm (Aducanumab)”.

Lumbar Puncture Process

A needle is inserted in a specific place between two of the bones in the lower back. The doctor will ask you to be in a position that allows the space between these bones (or vertebrae) to be as wide as possible. This may be curled up on your side or sitting up and leaning forward over a pillow.

After the area is numbed using a local anesthetic, a needle is put through the skin and a protective membrane called the dural sac. After this, it enters the space containing the CSF. When the needle is in place the fluid will gradually flow out and be collected using a syringe. Only half of a teaspoon of fluid is required for analysis.

The process takes around 30 minutes in total. When the collection is complete, you will typically lie down and rest for an hour or so. During this time nurses will check that you’re feeling okay.

Are there Side Effects from Lumbar Punctures?

Lumbar punctures are a standard medical procedure used for a wide range of medical purposes. It is not common to experience side effects after a well-conducted lumbar puncture. When there are side effects, these are generally limited to headaches that can last for several days. Despite this, there are some common myths and misconceptions about the procedure that prevent some people from having one done.

Is Lumbar Puncture Painful?

People believe that lumbar punctures are painful. In fact, most people report that the painful or uncomfortable part of the procedure is the sting they feel when the anesthetic is injected. Discomfort associated with a lumbar puncture seems to vary from person to person and the doctor will make sure that you are feeling comfortable throughout the procedure.

Does Lumbar Puncture Cause Infections?

There is a misconception that people can develop meningitis from a lumbar puncture. This myth may have come about because bacterial meningitis, where bacteria makes its way into the spinal canal, is diagnosed by using a lumbar puncture to collect spinal fluid for testing. There is virtually no risk of meningitis from a lumbar puncture.

Can Lumbar Puncture Cause Paralysis?

Some people we speak to are reluctant to get a lumbar puncture because they have heard it can cause paralysis. Paralysis can be caused by spinal cord injury. The spinal cord ends about five inches above the spot where the lumbar puncture needle is inserted, so is not affected by the procedure. This means that there is almost no chance of paralysis. Nerves do branch from the spinal cord and dangle down through the lower part of the spine. Sometimes the needle may brush against one of these nerves. This can feel like an electric shock or a twinge down one of the legs. The feeling usually goes away very quickly, but if it does not the doctor will re-adjust the needle before proceeding any further. The nerves are surrounded by spinal fluid so will be pushed aside by the needle, which is blunt to prevent any damage.

New FDA approved Aduhelm (Aducanumab) Infusion Drug for Alzheimer’saduhelm Alzheimer's drug

Biogen’s Aduhelm (Aducanumab) was recently FDA approved as a promising infusion treatment for Alzheimer’s patients. Aduhelm is the first new treatment approved for Alzheimer’s since 2003 and is the first therapy that targets the fundamental pathophysiology of the disease.
Researchers evaluated Aduhelm’s efficacy in three separate studies. Patients receiving the treatment had a significant reduction of amyloid-beta plaque, while patients in the control arm of the studies had no reduction of amyloid-beta plaque.
These results support the accelerated approval of Aduhelm, which is based on the surrogate endpoint of reduction of amyloid-beta plaque in the brain—a hallmark of Alzheimer’s disease.

 

 

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