Ask the Doctor: Omega-3 Alzheimer’s; Surgery for Epilepsy; Alcohol Dependence Drug

Q: At age 62, I am beginning to experience memory difficulties. Would taking omega-3 supplements help protect me from developing Alzheimer’s disease?

A: Some recent research suggests that taking regular doses of omega-3 may help preserve brain-power, and especially memory, in aging individuals. Omega-3 fatty acids—which contain do-cosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)—help stabilize the membranes of brain cells and make them more elastic and responsive to signals from other cells. These polyunsaturated fats are also thought to improve glucose delivery and metabolism in the brain, suppress inflammation, and promote the elimination of the toxic beta-amyloid plaque that is a hallmark of Alzheimer’s disease (AD).

A study involving more than 1,000 older women published online Jan. 22, 2014 in Neurology linked higher blood levels of omega-3 fatty acids with reduced loss of brain cells associated with aging. Brain scans taken over a period of eight years found that compared to study participants with low levels of omega-3, those who had the highest levels had greater brain volume in the hippocampus, a memory region vulnerable to the earliest symptoms of AD. Earlier research revealed that in older adults who took omega-3 in supplement form, the fatty acids were able to pass through the blood-brain barrier and enter the brain and led to higher levels of DHA and EPA in the spinal fluid. The amount of DHA in the spinal fluid was directly related to positive changes in AD symptoms and reduction in markers of inflammation, which promote disease progression.

I would advise you to see your medical care provider for a thorough assessment of your memory problems and a discussion about the benefits of omega-3 supplementation. If you do not regularly eat cold-water fish—a major source of omega-3 fatty acids—and there are no contrain-dications to supplement use in your case, it makes sense to take a fish-oil or algal supplement for additional omega-3. A supplement with about 1,000 mg of a mixture of EPA and DHA should be suf-ficient.

Q: I have epilepsy that is worsening with age (I’m 67). Are there effective surgical solutions for epilepsy?

A: Surgical intervention appears to have a good track record in helping people with treatment-resistant epilepsy. Research presented at the American Epilepsy Society meeting in December 2013 found that 92 percent of 250 epilepsy patients who had brain surgery between 1993 and 2011 reported that they considered their surgery worthwhile. In this group, 75 percent of individuals who had undergone surgery on the most common site—the temporal lobe—reported rarely or never having seizures following their surgery. The researchers said that surgery should be considered sooner rather than later in order to prevent the side effects of continued seizures and medications from compromising a patient’s quality of life.

Q: I heard there’s a new drug for treating alcohol dependence. Please tell me more.

A: You are probably referring to gabapentin, a generic anticonvulsant drug used in the treatment of epilepsy. In a study published Nov. 4, 2013 in JAMA Internal Medicine, gabapentin was shown to be safe and effective in the treatment of alcohol dependence. Participants who took gabapentin avoided heavy drinking twice as often, and abstained from alcohol altogether four times as often, as participants who took placebo, and reported a significant reduction in cravings and the number of drinks they consumed. Gabapentin’s effect on drinking outcomes was at least as large or greater than those of other FDA-approved treaatments currently in use, and also helped re-duce symptoms of depression, anxiety, and sleeplessness, which the other drugs did not.

—Dr. Maurizio Fava, M.D.

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