Overview

Neurological disorders are the leading cause of disability globally and access to essential medicines for neurological disorders remains a critical global health challenge.

The Improving access to medicines for neurological disorders report comprehensively describes the status of access to medicines for neurological disorders worldwide. Using epilepsy and Parkinson disease as tracer conditions, it highlights the wide unavailability and unaffordability of these medicines, explores the different health system barriers affecting access, and showcases special scenarios where some of the challenges can be exacerbated. The report offers a framework for multi-level, multi-sectoral actions, and serves as a call to action for all stakeholders to commit to tangible, sustainable improvements in the accessibility of medicines for neurological disorders.

The report is intended for use by policy-makers, public health professionals, health programme managers and planners, healthcare insurance authorities, health-care providers, researchers, the pharmaceutical industry, and prescribers working in national health ministries, in subnational health offices, or at the district level, as well as health initiatives led by nongovernmental organizations.

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Improving access to medicines for neurological disorders - World Health Organization (WHO)

The Neuro Care Network, a new joint operating agreement between MSU Health Care and University of Michigan Health-Sparrow, will offer more convenient local neurological services for an improved patient experience. Effective immediately, the collaborative effort will include inpatient and outpatient neurology, neurosurgery, electrodiagnostic and infusion service lines from both institutions.

MSU Health Care provides neurology services to thousands of local patients each year and we expect that number to continue to grow, said Seth Ciabotti, chief executive officer of MSU Health Care, the academic health system of Michigan State University. The Neuro Care Network enables patients to receive this high level of care as well as additional services. As MSU Health Care continues to build a health system of the future, partnerships like this will help us design experiences that revolve around the needs of patients.

MSU Health Care and University of Michigan Health have a history of working together to provide neurology care to the mid-Michigan community. MSU Health Care providers have supported patients at the MSU Clinical Center and University of Michigan Health-Sparrow, contributing to its designation as a comprehensive stroke center.

The agreement will formalize and advance having University of Michigan Health and Michigan State University neurological specialty providers work collaboratively on a variety of clinical advancements and research potential, said Margaret Dimond, president of UM Health Regional Network, which includes UM Health-Sparrow and UM Health-West. This collaboration will provide access to a more comprehensive and coordinated experience for patients in Michigan who require specialized care for any neurologic condition. Its a unique and progressive partnership that will set an example for multi-university collaboration on key diagnostic and treatment breakthroughs.

According to the National Center for Health Workforce Analysis, Michigans supply of neurology specialists will fulfill just 88% of the demand by 2031, which is below national projections for the same period. The Neuro Care Network will work to identify future community needs and collaboratively recruit specialists so that mid-Michigan residents have convenient access to inpatient and outpatient neurology services.

As our population ages and the rates of neurological diseases such as Parkinsons, stroke and dementia increase, the demand for neurology specialists will continue to outpace the supply, said John Goudreau, neurologist and interim chair of the MSU Department of Neurology and Ophthalmology. Working collaboratively strengthens our position to recruit top neurological talent and care for our patients.

MSU Health Care and UM Health-Sparrow will be partnering to provide outstanding new services, thus expanding access for our mid-Michigan patients to advanced specialty care without needing to leave the region, added Aditya Pandey, chair of the UM Health Department of Neurosurgery.

New service lines are also anticipated as a result of this collaboration and will be announced as they are ready for patients. To learn more, visit the MSU Health Care website.

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MSU Health Care, UM Health unite to provide expanded neurology services for mid-Michigan residents - MSUToday

Despite the significant progress made in developing effective, safe, and cost-effective medicines that enhance the quality of life of individuals with neurological disorders, these medicines remain largely inaccessible.

A new WHO report, Improving Access to Medicines for Neurological Disorders, sets out the barriers that prevent access to these essential medicines, and presents a framework for action to address these challenges.

The impact of neurological disorders can be significantly decreased and quality of life improved, if people living with these disorders are provided access to the essential medicines they need, says Dvora Kestel, Director or WHOs Department of Mental Health, Brain Health and Substance Use. However, most people with neurological disorders struggle to access the treatment they need for their conditions because these medicines do not reach them or are too expensive.

Neurological disorders are the leading cause of disability and over 80% of neurological deaths and health loss occur in low- and middle-income countries. The treatment gap (the difference between the number of people with a condition and those receiving appropriate treatment) for neurological disorders is extremely high, exceeding 75% in most low-income countries and 50% in most middle-income countries.

Evidence shows that the treatment gap for epilepsy, for example, can reach 90% in low-income countries that means that 9 out of 10 people living with epilepsy do not receive the care and treatment they need.

Barriers to accessing medicines for neurological disorders

Using epilepsy and Parkinson disease as tracer conditions, WHO published a report that sets out the complex and inter-linking challenges that prevent access to treatment for neurological disorders, including:

These challenges are further compounded by existing health inequities, disproportionately affecting populations in low- and middle-income countries, individuals living in poverty, rural areas, and other vulnerable groups, creating a fundamental obstacle to achieving universal health coverage.

WHO report provides a framework for action

The report offers a framework for stakeholders to step up multi-level, multi-sectoral action and address the many barriers impeding sustained access to essential medicines for neurological disorders. The proposed actions address multiple areas across the health system, including policy and regulatory environments, health infrastructure and education systems. The report also emphasizes the importance of engaging with individuals with lived experience and the power of collaboration at country, regional and global levels, as well as among stakeholder groups.

Actions proposed in this report have clear synergies with the WHO Roadmap for access to medicines, vaccines and other health products. With the proposed approach for neurological medicines, we have a robust set of actions and a clear way forward to improve access to these essential medicines, says Christophe Rerat, Senior Technical Officer in the Medicines and Health Products Division, WHO.

Supporting countries to improve access to medicines for neurological disorders

This report is an important tool in the implementation of the Intersectoral global action plan on epilepsy and other neurological disorders (IGAP) 20222031, which is supporting countries to scale up access to the essential medicines and technologies needed to manage neurological disorders by 2031.

Some countries are already taking significant steps to address these challenges. In Ghana, neurological disorders such as epilepsy and Parkinson disease have been prioritized. The recent update of the national essential medicines list and standard treatment guidelines included several medicines and clinical guidance for treatment of neurological disorders.

In the United Republic of Tanzania, a national coordination committee for epilepsy and other neurological disorders is being established to provide technical support to policymakers. The countrys Medical Stores Department is conducting special procurements of medicines for neurological disorders in order to address the lack of access. Significantly, the United Republic of Tanzanias National Health Insurance Fund package 2024, now includes several medicines for neurological disorders, including epilepsy and Parkinson disease. These actions represent a major step towards ensuring more people living with these disorders can access the treatment they need.

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WHO calls for better access to medicines to reduce vast treatment gap for neurological disorders - World Health Organization (WHO)

University of Michigan Health and Michigan State University Health Care plan to expand neurological care in the Lansing area and mid-Michigan through a new joint venture.

The two formed the Neuro Care Network to partner on inpatient and outpatient care for patients with neurological diseases such as Parkinsons and dementia or who have suffered a stroke. The partnership includes inpatient and outpatient neurology, neurosurgery, electrodiagnostic and infusion services.

The partnership took effect immediately and marks an unprecedented collaboration between the states two leading academic institutions, University of Michigan President Santa Ono told the Board of Regents, which approved formation of the joint venture Thursday afternoon.

The Neuro Care Network will include practitioners from both institutions to enhance care in the region, Ono said.

Under this new agreement, a dedicated team of neurosurgeons and neurologists will provide world-class care at University of Michigan Health-Sparrow in Lansing and MSU Health Care in East Lansing, Ono said. Together, they will care for more patients, help recruit more neurology specialists to mid-Michigan and, most importantly, transform more lives.

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The partnership will bring a higher level of care in neurology to the mid-Michigan market at a time when incidence rates are rising. The Neuro Care Network will examine future community needs in the market and recruit specialists to mid-Michigan residents, alleviating the need for patients with complex conditions to travel elsewhere for the care they need.

Neurological care and neuroscience care, these are two areas where the diseases and the growth will only be higher, and there will only be more disease rates over time, MSU Health Care CEO Seth Ciabotti said. For us to come together and offer really world-class neurological care, neurological and neurosurgery care for mid-Michigan, and really the state, is something were really excited about. Its something that was lacking, frankly, within mid-Michigan.

On top of the clinical improvements, the partnership can increase clinical research in the region for neurological disease, said Margaret Dimond, president of the University of Michigan Health Regional Network.

Our top research institutions are aligned on expanding our clinical work and seeking more opportunities for research in the neuroscience area, Dimond said. This is a unique and progressive partnership that will set an example for multi-university collaboration on key diagnostic and treatment breakthroughs. It is just the best thing for mid-Michigan in terms of clinical and research for neurological conditions.

MSU Health Care and University of Michigan Health have collaborated for 40 years in a variety of different ways within the neurologic sciences, said Dr. David Kaufman, a professor of neurology and assistant vice president for clinical affairs for the Office of Health Sciences at MSU and medical director of neurology at UM Health-Sparrow.

Weve done this at clinical level research education, but never at this level, Kaufman said. This joint operating agreement helps unite this states top two research intensive universities for the clinical benefit of people within mid-Michigan.

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With nine clinical specialties ranked in the top five nationally, NYU Langone is also No. 1 in New York for cardiology

NEW YORK, July 16, 2024 /PRNewswire/ -- NYU Langone Health has reaffirmed its position as the nation's top hospital for neurology and neurosurgery, securing the No. 1 ranking for the third straight year in U.S. News & World Report'sannual assessment of leading hospitals. NYU Langone also climbed two spots to secure the No. 1 ranking in pulmonology and lung surgery.

Additionally, NYU Langone was recognized as the top hospital in New York for cardiology, heart surgery, and vascular surgery, ranking second nationally.

While U.S. News no longer numerically ranks hospitals, it named NYU Langone to its honor roll of the top 20 hospitals in the nation. The accolades extend across NYU Langone inpatient locations, including Tisch Hospital, Kimmel Pavilion, and NYU Langone Orthopedic Hospital in Manhattan; NYU Langone HospitalLong Island; and NYU Langone HospitalBrooklyn.

"At NYU Langone Health, our culture of exceptionalism continues to deliver the best outcomes for our patients with one consistently high standard of care across all of our locations," saidRobert I. Grossman, MD, CEO of NYU Langone and dean of NYU Grossman School of Medicine. "Not only is our overall ranking one of the highest in the United States, but nine of our specialties are among the top five in the nation. We are unique in that exceptional patient outcomes come from all of our hospitals, with each of these contributing to our ranking.I am so proud of each and every one of our employees for helping deliver these fantastic results."

All 13 of NYU Langone's ranked clinical specialties placed in the top 20 nationally, with nine of those ranking in the top five.

NYU Langone's full clinical rankings:

Also of note, NYU Langone received High Performing ratings for all 20 procedures and conditions included in the Common Adult Procedure and Condition Ratings, underscoring its comprehensive capabilities across various medical specialties. Among them are kidney failure, diabetes, cardiac care, cancer surgery, chronic obstructive pulmonary disease (COPD), leukemia, lymphoma and myeloma, orthopedic surgery, pneumonia, and stroke.

Beyond its recognition by U.S. News & World Report, NYU Langone has consistently earned top marks for quality and safety from other healthcare evaluators. Vizient Inc. named NYU Langone the top inpatient and outpatient network nationwide, the Leapfrog Group awarded an "A" safety rating to every NYU Langone inpatient facility, and the U.S. Centers for Medicare and Medicaid Services bestowed a 5-star rating for safety, quality, and patient experience.

NYU Langone comprises six inpatient locations, its Perlmutter Cancer Center, and more than 300 outpatient sites across the New York area and Florida. The system also includes two medical schools, in Manhattan and on Long Island, and a vast research enterprise.

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Lacy Scarmana Phone: 646-754-7367 [emailprotected]

SOURCE NYU Langone Health

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NYU Langone Health Ranks No. 1 in the Nation for Neurology and Neurosurgery for the Third Consecutive Year - PR Newswire

A recently published meta-analysis using more than 20 studies with nearly 1400 patients showed that subcutaneous immunoglobulin (SCIG) provides a more feasible alternative for treating chronic demyelinating polyneuropathy (CDIP) than intravenous immunoglobulin (IVIG). Overall, SCIG showed more considerable cost reductions over time, was more preferred by patients, and demonstrated comparable, and sometimes superior, health outcomes.1

Published in Neurological Sciences, the systematic review comprised 50 studies up till 2024, with 22 involved in the meta-analysis. Included studies offered clinical data on patients with CIDP, mostly from western Europe and the US, representing nearly 10% of their entire CIDP populations. Almost all studies included considered SCIG to be a maintenance therapy in their context, and thus, the primary goal of those studies was to reduce relapse rate and sustain or enhance neuromuscular functions.

Led by Mostafa Ramzi Shiha, of Cairo University, meta-analysis showed that SCIG significantly improved muscle strength and sensory function, had fewer and milder adverse events (AEs), reduced relapse rates, and received a strong preference. On muscle strength, a collection of 18 studies comprising 542 individuals with CIDP demonstrated a significant improvement in muscle strength post-SCIG treatment. Overall, the pooled standardized mean difference in Medical Research Council Scale (MRC) scores was 0.68 points (95% CI, 0.28-1.08), with statistically significant enhancement (P = .0008).

When evaluating muscle strength by dose level, results showed that the high dose subgroup showed a significant effect (SMD, 2.39; 95% CI, 0.79-3.98) and high heterogeneity (I2 = 95%), whereas there was no significant effect in the low dose subgroup (SMD, 0.05; 95% CI, 0.22 to 0.14). The medium dose subgroup showed a small but not statistically significant effect (SMD, 0.18; 95% CI, 0.04 to 0.40).

Overall, treatment with SCIG was associated with a 22% decreased risk of AEs compared with IVIG (P <.0001). An analysis of 2 studies found a significant difference in headache occurrence in the SCIG group (OR, 0.14; 95% CI, 0.07-0.30; P <.0001). Infusion site reactions, a concern for subcutaneous treatments, were not significantly more common with SCIG in 2 studies, with an OR of 1.75 (P = .50). In addition, there was no significant between-group differences in severe AEs as well (OR, 0.23; P =.19).

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As to why SCIG leads to fewer AEs relative to IVIG, investigators attributed this to the "slower absorption into the bloodstream with SCIG, which avoids the high peak levels of immunoglobulin G seen after IVIG administrations."

The Inflammatory Neuropathy Cause and Treatment (INCAT) disability score, developed in 2001, was used as an assessment for overall function and disability. Across 5 studies with available data comprising 67 patients, treatment with SCIG led to a significant improvement in sensory function as measured by INCAT Sensory Score. The pooled mean difference showed a reduction of 1.73 points (95% CI, 2.29 to 1.17), which was statistically significant (P <.00001). This improvement indicated enhanced sensory function following SCIG therapy.

On INCAT results, there was high heterogeneity (I2 = 92%) among the included studies. "For impaired functional mobility, no worsening was observed in the analysis of 9-hole peg test and timed meter walk test scores, indicating that patients preserved their functional mobility upon SCIG maintenance treatment, Shiha et al wrote.

In terms of relapse rate reduction, patients with CIDP treated with SCIG had significant reductions observed, with a risk ratio of 0.146 (95% CI, 0.090-0.202; P <.001) across 8 included studies. In comparison with conventional IVIG treatment, a previous 52-week open-label study found that IVIG administered as maintenance therapy resulted in a relapse rate of 10.5%, similar to the results of high-dose SCIG treatment in the 48-week, open-label PATH extension trial relapse rate of 10.8%. Overall, the findings from the meta-analysis indicated that both IVIG and SCIG might have comparable efficacy in terms of relapse rates.

Quality of life and health status also remained stable after treatment with SCIG, which was consistent with IVIG treatments. Interestingly, 2 included studies that used a more IgG treatment oriented scale like LQI that considers many items related to patients convenience, comfort, and independence, according to the IgG route of administration, showed better quality of life measures after SCIG. In addition, patients treatment preferences, when analyzed, unanimously demonstrated a preference for SCIG across all studies.

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Subcutaneous Immunoglobulin Shows Superiority Over IVIG in Treating CIDP, Meta-Analysis Shows - Neurology Live

Summary: Researchers established new criteria for Limbic-predominant Amnestic Neurodegenerative Syndrome (LANS), a memory-loss condition often mistaken for Alzheimers disease.

Unlike Alzheimers, LANS progresses more slowly and has a better prognosis. The criteria help doctors diagnose LANS in living patients using brain scans and biomarkers. This advancement aids in better management and tailored treatments for memory loss.

Key Facts:

Source: Mayo Clinic

Researchers atMayo Clinichave established new criteria for a memory-loss syndrome in older adults that specifically impacts the brains limbic system. It can often be mistaken for Alzheimers disease.

The good news: Limbic-predominant Amnestic Neurodegenerative Syndrome, or LANS, progresses more slowly and has a better prognosis, and is now more clearly defined for doctors working to find answers for memory loss patients.

Prior to the researchers developing clinical criteria published in the journalBrain Communications, the hallmarks of the syndrome could be confirmed only by examining brain tissue after a persons death.

The proposed criteria provide a framework for neurologists and other experts to classify the condition in patients living with symptoms, offering a more precise diagnosis and potential treatments. They consider factors such as age, severity of memory impairment, brain scans, and biomarkers indicating the deposits of specific proteins in the brain.

The criteria were developed and validated using data from more than 200 participants in databases for theMayo Clinic Alzheimers Disease Research Center, theMayo Clinic Study of Agingand the Alzheimers Disease Neuroimaging Initiative.

Understanding the condition will lead to better management of symptoms and more tailored therapies for patients suffering from this type of cognitive decline, distinct from Alzheimers disease, saysDavid T. Jones, M.D., a Mayo Clinic neurologist and senior author of the study.

In our clinical work, we see patients whose memory symptoms appear to mimic Alzheimers disease, but when you look at their brain imaging or biomarkers, its clear they dont have Alzheimers. Until now, there has not been a specific medical diagnosis to point to, but now we can offer them some answers, Jones says.

This research creates a precise framework that other medical professionals can use to care for their patients. It has major implications for treatment decisions, including amyloid-lowering drugs and new clinical trials, and counseling on their prognosis, genetics and other factors.

Decades of work to understand and classify different types of dementia is ongoing, says Nick Corriveau-Lecavalier, Ph.D., the papers first author. These findings build upon scientists continued efforts to untangle neurological conditions that often have similar symptoms or can occur simultaneously, but can have drastically different treatments and prognoses.

Historically, you might see someone in their 80s with memory problems and think they may have Alzheimers disease, and that is often how its being thought of today, Corriveau-Lecavalier says.

With this paper, we are describing a different syndrome that happens much later in life. Often, the symptoms are restricted to memory and will not progress to impact other cognitive domains, so the prognosis is better than with Alzheimers disease.

Without signs of Alzheimers disease, the researchers looked at the involvement of one possible culprit a buildup of a protein called TDP-43 in the limbic system that scientists have found in the autopsied brain tissue of older adults.

Researchers have classified the build-up of these protein deposits aslimbic-predominant age-related TDP-43 encephalopathy, or LATE. These protein deposits could be associated with the newly defined memory loss syndrome, but there are also other likely causes and more research is needed, the authors say.

With clinical criteria established by Jones, Corriveau-Lecavalier and co-authors, practitioners could soon diagnose LANS in patients so those living with memory loss might better understand options for treatment and potential progression of the disease, opening doors for research to further illuminate the characteristics of the disease.

Funding: The research was funded in part by National Institutes of Health grants P30 AG062677, P50 AG016574, U01 AG006786, R37 AG011378 and R01 AG041851 and by the Robert Wood Johnson Foundation, the Elsie and Marvin Dekelboum Family Foundation, the Liston Family Foundation, the Edson Family, the Gerald A. and Henrietta Rauenhorst Foundation and the Foundation Dr. Corinne Schuler.

Drs. Jones and Corriveau-Lecavalier reported no conflicts of interest. A complete list of co-authors and financial disclosures is available in the manuscript.

Author: Emily DeBoom Source: Mayo Clinic Contact: Emily DeBoom Mayo Clinic Image: The image is credited to Neuroscience News

Original Research: Open access. Clinical criteria for a limbic-predominant amnestic neurodegenerative syndrome by David T. Jones et al. Brain Communications

Abstract

Clinical criteria for a limbic-predominant amnestic neurodegenerative syndrome

Predominant limbic degeneration has been associated with various underlying aetiologies and an older age, predominant impairment of episodic memory and slow clinical progression. However, the neurological syndrome associated with predominant limbic degeneration is not defined.

This endeavour is critical to distinguish such a syndrome from those originating from neocortical degeneration, which may differ in underlying aetiology, disease course and therapeutic needs.

We propose a set of clinical criteria for a limbic-predominant amnestic neurodegenerative syndrome that is highly associated with limbic-predominant age-related TDP-43 encephalopathy but also other pathologic entities.

The criteria incorporate core, standard and advanced features, including older age at evaluation, mild clinical syndrome, disproportionate hippocampal atrophy, impaired semantic memory, limbic hypometabolism, absence of neocortical degeneration and low likelihood of neocortical tau, with degrees of certainty (highest, high, moderate and low).

We operationalized this set of criteria using clinical, imaging and biomarker data to validate its associations with clinical and pathologic outcomes.

We screened autopsied patients from Mayo Clinic and Alzheimers Disease Neuroimaging Initiative cohorts and applied the criteria to those with an antemortem predominant amnestic syndrome (Mayo,n= 165; Alzheimers Disease Neuroimaging Initiative,n= 53) and who had Alzheimers disease neuropathological change, limbic-predominant age-related TDP-43 encephalopathy or both pathologies at autopsy.

These neuropathology-defined groups accounted for 35, 37 and 4% of cases in the Mayo cohort, respectively, and 30, 22 and 9% of cases in the Alzheimers Disease Neuroimaging Initiative cohort, respectively.

The criteria effectively categorized these cases, with Alzheimers disease having the lowest likelihoods, limbic-predominant age-related TDP-43 encephalopathy patients having the highest likelihoods and patients with both pathologies having intermediate likelihoods.

A logistic regression using the criteria features as predictors of TDP-43 achieved a balanced accuracy of 74.6% in the Mayo cohort, and out-of-sample predictions in an external cohort achieved a balanced accuracy of 73.3%. Patients with high likelihoods had a milder and slower clinical course and more severe temporo-limbic degeneration compared to those with low likelihoods. S

tratifying patients with both Alzheimers disease neuropathological change and limbic-predominant age-related TDP-43 encephalopathy from the Mayo cohort according to their likelihoods revealed that those with higher likelihoods had more temporo-limbic degeneration and a slower rate of decline and those with lower likelihoods had more lateral temporo-parietal degeneration and a faster rate of decline.

The implementation of criteria for a limbic-predominant amnestic neurodegenerative syndrome has implications to disambiguate the different aetiologies of progressive amnestic presentations in older age and guide diagnosis, prognosis, treatment and clinical trials.

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New Type of Age-Related Memory Loss Identified - Neuroscience News