Editorial
A Shifting Paradigm: Central Nervous System Diseases and Metabolic Health Concerns
Nicholas Van Halm-Lutterodt1,2 and Yu Lun Xu2*
1Department Orthopaedic Surgery and Neurosurgery, Keck Medical Center of USC, USA
2Department of Neurosurgery, Beijing Tiantan Hospital, China
*Corresponding author: Yu Lun Xu, Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 6 Xili Street, Dongcheng District, 100050, Beijing- China
Published: 18 May, 2018
Cite this article as: Van Halm-Lutterodt N, Xu YL. A
Shifting Paradigm: Central Nervous
System Diseases and Metabolic Health
Concerns. Clin Surg. 2018; 3: 1967.
Editorial
This letter stems from an important clinical observation of patients with Central Nervous System
(CNS) disorders including tumors and we project this piece of documentation would shed an insight
towards the approach of these defined subsets of patients. In general medical practice, the clinical
evaluation of metabolic profiles and states as well as its outcomes in patients have been very much
appreciated in patients with cerebrovascular, cardiopulmonary, Hepatobiliary, gastrointestinal,
endocrine and nutritional disorders. Nevertheless, remnant episode(s) sometimes remain even
after offering proposed treatment regimens and most often undulate patients with severe refractory
metabolic concerns towards a mortality sequel. The concept and recognition of metabolic disorders
in neuro-medical and neuro-surgical patients continue to provocatively lambaste medical experts
with evolving phenotypic challenges, some of which are complicated with neuroendocrine and/or
neuropsychiatric elements, often narrowing our opinion options and more importantly, making
choice of treatment quite skeptical for an increasing number of patients in recent years. For
instance, taking into account spinal neoplasms or tumors, it is undoubtedly true that spinal tumors
diagnosed as either malignant or benign, all stem from either primarily or secondarily induced
aberrations in the genetic architecture that result in mutations and consequently, neoplasms. Most
finale determinants of neoplasms development require progressive internal environmental adaptive
changes over time depending on the specific presentations of patients; such as long-standing
exposure to inflammatory response, metaplasia, anaplasia with concomitant recruitment of the
immune cells, cytokines and cell-cycle checkpoints factors predisposed to worse outcomes when
biochemical flaw(s) maturely establish in vivo. Firsthand experience shows that the mechanisms
involved are proven to be very complex, however, it is essential to highlight on and project forward
two-dimensional theories that carry the potentials for unlocking the chains of these conundrums
genetic and environmental factors.
Genome-Wide Association Studies (GWAS) indicate that the concept of genetics alone cannot
fully explain and provide satisfactory account of disease onset, progression and final outcomes in
studied patients and populations. This red-flags the importance of exploring potential external
factors originating from our environment that impact health and disease outcomes. Deduced
theories of the interplay between our inherited genes (susceptible or resistant) and the surrounding
environment (external factors such as dietary patterns, nutritional status, lifestyle, social habits,
educational level, etc…) and how these entities interact to promote health or disease have become a
groundbreaking facet of research focus. Interestingly, emerging number of researchers and studies
in the literature are directing more focus on the importance of metabolic health as an entity of
the environmental aspect, the part that has a direct role in disease and health status. This model
shift apparently appears to hammer more on the conceptual theory of the effects of metabolically
induced oxidative stress. We encounter many patients with this phenotype presentation who have
not been optimized by other consulted physicians. It is therefore essential to emphasize on the
need that necessitates careful re-evaluation of patients with metabolic disarrays. Oxidative stress
most often involves mechanisms that release of oxygen-free radicals in vivo. It has been reported in
countless number of studies that oxidative stress and the release of these harmful redox elements
result in unhealthy ‘internal environment’ modifications that negatively impact the normal function
of cells and tissues; with undesired prognostic outcomes occurring when adaptive mechanisms are
diminished or lost.
Variations still exist in the local approach and management of patients with CNS disorders, most
often centered on medical and surgical interventions. Little is offered by physicians and surgeons
regarding nutritional, endocrine and/or metabolic concerns. For
instance, say, a patient is randomly diagnosed with CNS tumor in a
cardiovascular center. First of all, what is conventional is to stabilize
and optimize the patient within the cardio-center and re-schedule
an appointment for neurological consultation, not a dietitian,
nutritionist or endocrinologist. However, the potential or greater
cause of this CNS pathology may most likely be stemming from a
cause other than neurological. It is pragmatically recommended that
neurologists, including all physicians and surgeons re-visit their
knowledge background on nutritional, metabolic, endocrine as well
as psycho-social aspects to enhance the efficiency of their overall
armamentaria in practice. These are the pitfall areas encountered in
current medical practice because we often get accustomed to or too
comfortable in our specialty areas of practice and with time, wane
away from necessary integrative skills required by other relevant
areas in practice that evaluates our armamentaria on critical bases.
It comes with no doubt to document that, despite all currently
existing challenges in practice, disease management and treatment
outcomes have significantly improved over the decades with
advancing technology against a backdrop of patient factors and
clinical presentations.
It is therefore pertinent to highlight the importance of necessitating
and laying emphases on this issue associated with comprehensive
patient-specific approach that essentially lacks incorporated aspects
of nutritional patterns, metabolic profile and status, life style and
habits, physical activity status, epigenetic as well as neuropsychiatric
and psychosocial concerns effectively in our mundane practice.
It is with these pearls of invested evaluation efforts that experts
in specific disciplines can properly understand and address with
comprehensive approach, the daily encountered disease icons
with complex interactions of cerebrovascular disorders and/or
cardiovascular disorders and/or cardiopulmonary disorders and/
or disorders neoplasms and/or neuroendocrine disorders and/or
metabolomics as well as other acute disorders and/or chronic comorbidities.
On 26th April, 2018, a typical illustration of an intriguing potential
translational science study published by the New England Journal of
Medicine (NEJM) shows an emerging clinical inference of the role of
diet quality in health and neoplasm outcomes. In this study, it was
discovered by Chen. that two-key tumor suppressor genes; PTEN and
PML, known to be associated with prostate cancer were functionally
limited by obesity induced by high-fat diet and it was found that the
status of high fat diet predisposed the studied species to enhanced
cancer metastases. This outcome further demonstrates how essential
environmental factors play role in pathological progression and
outcomes of disease and the crucial step(s) needed to identify and
intervene in this advanced age of medical praxis.