McLean Hospital Launches the National Eating Disorders Brain Bank

The Foundation for Research and Education in Eating Disorders (FREED) and the Harvard Brain Tissue Resource Center (HBTRC) at McLean Hospital today announced the establishment of the first and only national brain bank dedicated to research in eating disorders.

The National Eating Disorders Brain Bank is a resource to the community to help advance studies to find the causes of eating disorders which, in turn, will drive breakthroughs in the search for treatments that are desperately lacking for these neuropsychiatric illnesses. The brain bank will also provide researchers with the opportunity to examine the impact of altered nutrition on the brain.

More than 30 million Americans are impacted by eating disorders, including anorexia nervosa, bulimia nervosa and binge eating disorder. These complex conditions can have a profoundly negative impact on those who are affected as well as their families. They are increasingly being recognized as public health concerns. “Eating disorders are associated with the highest rates of health problems, death and suicide among all mental illnesses, but it remains unclear as to what causes these conditions and who are at risk,” notes Dr. Kevin St. P. McNaught, executive director of FREED. “The brain bank will allow researchers to explore the central nervous system to gain a better understanding of the biology of eating disorders.”

“Currently, only one drug is specifically approved by the Food and Drug Administration to treat individuals with binge eating disorder, and none are FDA-approved for the other eating disorders diagnoses,” said Dr. Stuart Koman, co-founder of FREED and chief executive officer of Walden Behavioral Care, a full system of specialized care for individuals and families impacted by all types of eating disorders. “I expect that the national brain bank will help to evaluate and identify structural brain tissue changes and other underlying mechanisms that can be targeted to develop much needed treatments for the millions of people impacted by eating disorders.”

The HBTRC is internationally renowned as a brain tissue repository for neurological and psychiatric brain disorders, including several focused brain collections. “We have long recognized the need to develop similar resources to support research into eating disorders, and are delighted to establish this partnership with FREED to launch this program,” said Dr. Sabina Berretta, scientific director of the HBTRC. Dr. Wilson Woo, medical director of the HBTRC, added, “The National Eating Disorders Brain Collection will represent an invaluable asset to a growing research community focused on eating disorders.”

The national brain bank is in its early developmental stage and in the months and years ahead will drive innovations as have occurred in other neuropsychiatric and neurological disorders. “This incredible resource is a vital priority for the eating disorders community and will require broad support to help alleviate the suffering that millions of children, adolescents and adults with these conditions experience,” said William Mosakowski, chief executive officer of Public Partnerships, LLC and a founding sponsor of FREED and the brain bank program.

(This article was adapted from a press release issued by McLean and FREED)

Best Post of September 2015 -- Guest Post: How to make your own Mercado Brain Cutting Device

The next in our Best of the Month Series comes from September 22, 2015:

Today I am fortunate to host a guest blogger, Dr. Juan Mercado, who is a neuropathology fellow at the University of Alabama at Birmingham under the guidance of Drs. Robert Hackney and Kenneth Fallon. Dr. Mercado studied music from a young age and went to a specialized school of music in San Juan, Puerto Rico; but during college he decided to exchange music for medicine and attend the University of Puerto Rico School of Medicine. He has not, however, abandoned his creative approach to the subject matter at hand; in this case, cutting autopsy brains. His guest post follows:

Juan J. Mercado, MD (neuropathology fellow at UAB 2015-17)

A while ago, as a pathology resident, I was temporarily in charge of organizing the weekly brain cutting activity. During this event I always felt a little bothered by the unpredictability and irregularity that occurred with each cut and the variability of results with each different person trying to pursue the same goal.  I decided to do some research trying to find more information about how braingrossing examination was done in different places. To my amazement, I found out about a brain tissue bank in the United Kingdom that performed their coronal sections with the help of a tool. This tool enabled them to create perfect fine cuts every time to perform a complete meticulous evaluation. After knowing about this, I was highly motivated to perform a DIY project. As I optimistically anticipated, the results were excellent. I made the tool using materials that I could easily find in any hardware store. This new and improved tool could now be made by anyone interested in having the same results.  

Materials:

·        White durable cutting board: the bigger the better (Fig. 1)

Figure 1

·        Straight cabinet handles: they come in different diameters, meaning a different brain slice thickness can be created depending on this diameter. Also they come in different lengths. Choose a length proportionate to the size of the cutting board you select. These bars always come with the screws included. (Fig. 2)

Figure 2

·        Drill: to make four holes 

·        Rubber O-ring washers: not necessary, but I use them just for the preservation of the tool, preventing liquids or tissue to enter in the drilled holes (Fig. 3)

Figure 3

·        Rubber chair legs (to elevate the board from a surface and to hold its placement) (Fig. 4)

Figure 4

With the above materials you can create the basic version that will permit you to create cuts of only one predetermined thickness based on the diameter of the bar you select. You can also have an add-on to be able to do thinner cuts with the same board, but it is not necessary. 

How it works:

After detaching the brainstem via an axial cut through the midbrain and then making the first brain coronal section cut through the middle of the mammillary bodies, proceed as usual making coronal sections but with the help of the tool

The bars aligned in the way pictured (Fig. 5) serve to hold in place any brain size firmly while cutting. Use a rigid knife sliding it above the bars as a guide. In this way the thickness of the brain sections will be the same as the diameter of the bars 

Figure 5


Advantages

·        Always the same results, not relying on the experience of the person cutting the brain -- meaning standardization.

·        Homogeneous leveled slices. Option of creating thin slices help in a more meticulous evaluation.

·        When a pathologic finding is present, such as a big intraparenchymal hemorrhage that normally disintegrates the brain slice if performed by normal technique; it does not happen with this tool.

·        Better pictures.

·        It is a lot faster and the cuts are perfect. Less time cutting, more learning and teaching.

See for yourself…

        Add-on(s): Optional (need a saw)

A thinner cutting board cut to fit within the two bars. The diameter of the bar minus the thickness of this board will be your new brain slice thickness, making the same board practical for two different thicknesses.

Thanks, Dr. Mercado. I have often thought about how nice it would be to have a tool that could simplify and standardize braincutting. I am hoping he builds a limited-edition series of these devices and sells them at the next AANP meeting. Since I am not particularly mechanically inclined, I would be the first in line to purchase what I am hereby dubbing "The Mercado Brain Cutting Device"!

Guest Post: How to make your own brain cutting board

Today I am fortunate to host a guest blogger, Dr. Juan Mercado, who is a neuropathology fellow at the University of Alabama at Birmingham under the guidance of Drs. Robert Hackney and Kenneth Fallon. Dr. Mercado studied music from a young age and went to a specialized school of music in San Juan, Puerto Rico; but during college he decided to exchange music for medicine and attend the University of Puerto Rico School of Medicine. He has not, however, abandoned his creative approach to the subject matter at hand; in this case, cutting autopsy brains. His guest post follows:

Juan J. Mercado, MD (neuropathology fellow at UAB 2015-17)

A while ago, as a pathology resident, I was temporarily in charge of organizing the weekly brain cutting activity. During this event I always felt a little bothered by the unpredictability and irregularity that occurred with each cut and the variability of results with each different person trying to pursue the same goal.  I decided to do some research trying to find more information about how brain grossing examination was done in different places. To my amazement, I found out about a brain tissue bank in the United Kingdom that performed their coronal sections with the help of a tool. This tool enabled them to create perfect fine cuts every time to perform a complete meticulous evaluation. After knowing about this, I was highly motivated to perform a DIY project. As I optimistically anticipated, the results were excellent. I made the tool using materials that I could easily find in any hardware store. This new and improved tool could now be made by anyone interested in having the same results.  

Materials:

·        White durable cutting board: the bigger the better (Fig. 1)

Figure 1

·        Straight cabinet handles: they come in different diameters, meaning a different brain slice thickness can be created depending on this diameter. Also they come in different lengths. Choose a length proportionate to the size of the cutting board you select. These bars always come with the screws included. (Fig. 2)

Figure 2

·        Drill: to make four holes

·        Rubber O-ring washers: not necessary, but I use them just for the preservation of the tool, preventing liquids or tissue to enter in the drilled holes (Fig. 3)

Figure 3

·        Rubber chair legs (to elevate the board from a surface and to hold its placement) (Fig. 4)

Figure 4

With the above materials you can create the basic version that will permit you to create cuts of only one predetermined thickness based on the diameter of the bar you select. You can also have an add-on to be able to do thinner cuts with the same board, but it is not necessary. 

How it works:

After detaching the brainstem via an axial cut through the midbrain and then making the first brain coronal section cut through the middle of the mammillary bodies, proceed as usual making coronal sections but with the help of the tool

The bars aligned in the way pictured (Fig. 5) serve to hold in place any brain size firmly while cutting. Use a rigid knife sliding it above the bars as a guide. In this way the thickness of the brain sections will be the same as the diameter of the bars 

Figure 5


Advantages

·        Always the same results, not relying on the experience of the person cutting the brain -- meaning standardization.

·        Homogeneous leveled slices. Option of creating thin slices help in a more meticulous evaluation.

·        When a pathologic finding is present, such as a big intraparenchymal hemorrhage that normally disintegrates the brain slice if performed by normal technique; it does not happen with this tool.

·        Better pictures.

·        It is a lot faster and the cuts are perfect. Less time cutting, more learning and teaching.

See for yourself…

        Add-on(s): Optional (need a saw)

A thinner cutting board cut to fit within the two bars. The diameter of the bar minus the thickness of this board will be your new brain slice thickness, making the same board practical for two different thicknesses.

Thanks, Dr. Mercado. I have often thought about how nice it would be to have a tool that could simplify and standardize braincutting. I am hoping he builds a limited-edition series of these devices and sells them at the next AANP meeting. Since I am not particularly mechanically inclined, I would be the first in line to purchase what I am hereby dubbing "The Mercado Brain Cutting Device"!

Treatable Neurological Disorders Misdiagnosed as Creutzfeldt-Jakob Disease

A case of primary CNS angiitis thought to be sCJD

Dr. Mark Cohen and a team of workers at Case Medical Center in Cleveland, Ohio have published an important article in the Annals of Neurology entitled Treatable Neurological Disorders Misdiagnosed as Creutzfeldt-Jakob Disease (Ann Neurol 2011;70:437–444). Why is this article important? Well, because mistaking a survivable, treatable disorder for a fatal, non-treatable disorder is not optimal. Cohen's team reviewed the pathologic diagnoses of 1,106 patients who were referred for potential prion disease to the National Prion Disease Pathology Surveillance Center (NPDPSC) at Case Western Reserve University from 2006 to 2009. About one-third of the cases did not have prion disease, with Alzheimer disease and vascular disease being the most common conditions accounting for dementia. Further, about one-quarter of the non-prion cases had treatable diseases, including immune-mediated disorders, neoplastic disorders such as lymphoma, as well as infectious and metabolic disorders. The immune-mediated disorders included primary angiitis of the CNS, acute disseminated encephalomyelitis, limbic encephalitis, neurosarcoidosis, paraneoplastic cerebellar degeneration, and one case of Wegener granulomatosis. Of note, more than half of patients with a treatable dementia had a positive CSF 14-3-3 protein test, highlighting the danger of relying too heavily on this test in making a diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD). It turns out that the most specific test for distinguishing CJD from other diseases was magnetic resonance imaging. Drs. David Perry and Michael Geschwind, in a review of this study in the September 2011 issue of Nature Reviews Neurology, (Perry, D. C. & Geschwind, M. D. Nat. Rev. Neurol. 2011:7, 479–480) write: "The fact that many of the non-prion diagnoses in the present study were potentially treatable RPDs [rapidly progressive dementias] should prompt thorough diagnostic testing in patients who are suspected of having sCJD, in order to rule out mimics. The use of CSF testing, contrast-enhanced MRI, and autoimmune antibody screening is supported by this study."

American Brain Banking Network renamed the International Brain Banking Network, with new website

Piotr B. Kozlowski, MD, PhD

From Dr. Piotr B. Kozlowski, Touro College of Osteopathic Medicine, New York City:

"The website of the brain banking network formerly known as the American Brain Banking Network (ABBN), is now renamed as the International Brain Banking Network and its website can be found at http://www.intbbn.org/ 

 "Please have a look at this website, still in a nascent state, and if the information regarding your brain/tissue bank needs to be updated, please let me know."

Dr. Kozlowski's email address is piotr.kozlowski@touro.edu