Monthly Archives: March 2014

brain injuries, brain training, Family, family life, father son moment, fear, frustration, human brain, kids' imagination, kids' perspective, parenting

Surogate Amygdala Reporting For Duty

I was at a conference over the weekend where the presenter used a term I find fantastic to describe parenting.  She said parents are the young child’s “surrogate amygdala” while we attempt to teach our kids emotional control and how to make good decisions.  Children do not have the capacity to apply what they know about right and wrong to their decision making at the time.
The amigdala is an almond shaped part of the brain in the middle of our temporal lobes, and it plays a central role in our emotional learning.  The amigdala is the part of the brain which determines the prominence of memories which invokes fear and shame or pride and joy.  Not surprisingly, it takes until around the age of 25 for the amigdala to fully develop.
Until then parents must continue to watch their children do crazy things.    I noted she said men typically have larger amygdalae than women.  I know O is the most emotional of our kids by a wide margin which supports this assertion, and J chimed in confirming little boys cry more than little girls.  I guess society teaches us to choke down our emotions and “be a man.”  Still, I can not help but wonder if O’s brain damage as an infant will always leave him more susceptible to the often harshest of his emotions.
J and I will just have to live up to the surrogate roll.  I just hope we can do so teaching him we don’t pee on the carpet at the top of the stairs because it makes our parents angry even if our sister thinks it would be funny.  If we can stop such madness while still allowing the creative freedom of expression and comedy to think of dressing in a wedding dress and a Spiderman mask in order to save the day, then I will judge our surrogacy a success.
Spiderman's wedding dress provides the confusion needed for him to swoop in and save the day.
Spiderman’s wedding dress provides the confusion needed for him to swoop in and save the day.
Still sometimes, I find myself going back to my father-in-law’s words on the hardest part of parenting being “remembering to not get angry with a kid for acting their age.”  Perspective is difficult to maintain when a boy sprays a heating lamp with water and then describes how cool it was to have the light bulb explode.  Of all the dunderheaded things done by our children this week, this was the one I understood the best.  Curiosity can lead to unfortunate results, but at least it’s not malicious.  We all have to learn.  It’s just some things are better learned through logic, asking and stories than personal experimentation.
“Paging Surrogate Amygdala!  You are needed to instill proper fear of eye damage and burned down houses.”
Words of wisdom for patients and parents alike.
Words of wisdom for patients and parents alike.
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MS, MS cognitive function, MS outcomes, MS progression, MS research

What Numbers Matter?

Sometimes numbers make me seem a little crazy like my daughters wonderful hair.
Sometimes numbers make me seem a little crazy like my daughters wonderful hair.
I asked for a long time why we cared so much about dots on an MRI if they don’t correlate well with symptoms.  As an MS patient for more than 8 years, I don’t care much about the dots on my MRI.  Still, I can appreciate the goal when we use MRI’s to determine whether our MS is “active” or whether a drug is effective.  We need a measurable, and so we pick a variable we feel gives us the most accurate way to model reality.  Is that not the reason man uses numbers for anything, to describe reality in the way which feels most accurate?
When attempting to solve a problem, one must first define exactly what the problem is.  For us patients, the temptation is to think problem begins and ends with our symptoms.  I think this has been my biggest problem with MRI’s as a measure of MS activity.  Even with a stable MRI, my symptoms progress.  This doesn’t mean MRI’s are not a valid way to measure MS.  It just means MRI’s are not accurate enough to paint the picture I am looking to use.
Over the past few years, I have come to appreciate the inherent logic in dealing with complex systems.  Complex systems are different from complicated systems in that, one can never accurately predict the impact of damage to any one place in the system. They are different from the a->b->c…->z complicated systems where one knows the impact of breaking the chain.  A complex system is more akin to a road system.  Interestingly enough, the complex system theory was designed to replicate the brain, but is more commonly used today for other system models like roads.
One of the studies I found interesting was a recent one showing brain atrophy predicted long term cognitive issues were correlated with brain shrinkage and physical issues were better correlated with flares. http://jnnp.bmj.com/content/83/3/282.long Interesting to me is that neither flares nor shrinkage accurately predicted both.
Brain shrinkage would seem to imply a less able system simply by reducing the size of the system.  Even if we can not identify the specific area of deficit, the sum of all the paths now reaches less than it once did.  If the brain shrinks, the number of alternate paths for signals to take likely shrinks too.  The alternate routes for traffic disappear and the fragility of the system increases, even if it appears traffic is moving at the time.  Shrinkage would seem likely to predict future problems.  This study seems to be validating this assumption at least in terms of cognition.  In doing so, it redefines the problem and measurement of MS.  It is no longer enough to simply look for a flare (think car crash).  One must also look to see if the map still needs folding to carry.
I owe thanks once more to http://multiple-sclerosis-research.blogspot.com for publishing multiple posts about brain atrophy in MS patients.
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On a side very cool note, after my interview last week, I was asked to participate on the American Board of Internal Medicine as a patient advocate.  I’m amazed and incredibly honored.  I can hardly wait to find out how I can help.
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