Demetrius Demetri Maraganore, MD, is the recently appointed Herbert J. Harvey, Jr. Chair in Neurosciences and Chair of the Department of Neurology at Tulane University School of Medicine, where he runs the Healthy Brain Aging Initiative that helps patients prevent cognitive decline and dementia, including Alzheimers disease. (Photo by Paula Burch-Celentano)

More than 5 million Americans of all ages have Alzheimers. While deaths from heart disease and cancer have been declining due to treatment advances, deaths from Alzheimer's have grown significantly in the last two decades as more people live longer.

The costs are staggering. Alzheimers and other dementias will cost the nation $305 billion this year and more than triple by 2050, according to the Alzheimers Association.

This isnt inevitable and Americans must do more to protect themselves from dementia as they age, said Demetrius Demetri Maraganore, MD, the recently appointed Herbert J. Harvey, Jr. Chair in Neurosciences and Chair of the Department of Neurology at Tulane University School of Medicine.

We can prevent Alzheimers disease. There are about 20 well-defined risk factors for dementiaeach at least doubling the likelihood of Alzheimers disease.

Demetrius Demetri Maraganore, MD

We can prevent Alzheimers disease. There are about 20 well-defined risk factors for dementiaeach at least doubling the likelihood of Alzheimers disease, Maraganore said. Yet little effort is being made by health agencies or doctors to create awareness of these modifiable risks, or to identify and address related health disparities. When a disease has modifiable risk factors, it can be prevented by reducing those medical risks. There are also several protective lifestyle and behavioral interventions that can reduce the risk for Alzheimers by 50% or more. These include regular aerobic fitness, adherence to the Mediterranean diet, cognitive training and good sleep habits.

Maraganore, who joined the School of Medicine this summer, is also co-director of the Tulane Center for Clinical Neurosciences and a professor of neurology. He has launched the Tulane Healthy Brain Aging Initiative to help patients prevent cognitive decline and dementia (including Alzheimers disease) and to reduce the burden of Alzheimers disease and related disorders. The program will lead population health initiatives to identify people at greater risk for cognitive decline as well as serve as a self-referral and physician-referral destination for the evaluation and management of brain health.

Typical patients may include those with a family history of dementia or Alzheimers or a known genetic risk for late-onset Alzheimers disease. It will also serve those looking to age free of cognitive decline or dementia.

Our outpatient office evaluations include an inventory of possible modifiable risk factors for dementia, a comprehensive neurological examination to rule out cognitive impairment and the delivery of evidence-based interventions to reduce the risk for dementia, Maraganore said. We will order diagnostic studies when indicated. We will also offer genetic testing for late-onset Alzheimers disease and provide annual followup evaluations to refine our preventive care plans as needed to early detect and manage cognitive impairment.

The programs multidisciplinary team will include not only neurologists, but also physical therapy (for instruction in aerobic exercise), nutrition therapy (for instruction in the Mediterranean diet), speech therapy (for cognitive training), occupational therapy (for instruction in sleep hygiene), and also the opportunity to work with a licensed clinical social worker or health psychologist (for lifestyle coaching). Patients can opt in or out of these services as they consult with their neurologist.

Before joining Tulane, Maraganore was the BJ and Eve Wilder Professor of Alzheimers Disease at the University of Florida, and the founder and director of the University of Florida Brain Health Program. He has published more than 180 peer-reviewed studies and was the principal investigator or co-investigator for research grants totaling in excess of $20 million. His research projects have included using electronic medical record (EMR) data to predict Alzheimers and dementia risks and studying super agers who live beyond 90 years old to better understand healthy aging. Using an electronic medical records registry, he was part of a team that identified 45,000 Floridians over the age of 90 who were living independently and free of dementia-related diagnoses.

Using the EMR we computed a successful aging status in the over-90-year-olds. We are in the process of contacting those persons to confirm that the medical records estimations of successful aging are accurate, and to invite the successfully aged over-90-year-olds to mail in a saliva sample for DNA studies, he said. We hope to find in these persons genome the fountain of youth. We anticipate similar studies in the state of Louisiana, using a similar electronic medical registry that is available, and similar population health screening approaches.

A Chicago native, Maraganore received his Bachelor of Science and medical degree at Northwestern University. He then completed his internship and residency at the Mayo Clinic in Rochester, Minnesota. He was then the Honorary Clinical and Research Fellow to Professor C. David Marsden at the National Hospital for Neurology and Neurosurgery in London, England.

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Neurology chair dedicated to dementia prevention and brain health - News from Tulane

Oliver Sacks (1933-2015) had a highly unusual career. The titles of some of the neurologists books tell you how unusual. Awakenings (1973), The Man Who Mistook His Wife for a Hat (1985), An Anthropologist on Mars (1995), Uncle Tungsten: Memories of a Chemical Boyhood (2001), Hallucinations (2012). Awakenings was later made into a movie (1990), with Robin Williams playing Sacks.

Those titles combine the personal and scientific, the humanistic and clinical, and that combination made Sacks famous. Or as he says in Ric Burnss Oliver Sacks: His Own Life, Im asked are you a doctor first and then a writer? The answer is I think Im equally both; and in important ways they blend together. The documentarys chief virtue, after the very considerable pleasure of getting to spend time in Sackss company, is learning how much his personal life rivaled his career in remarkableness.

Starting Sept. 25, its available for streaming via the Coolidge Corner Theatres Virtual Screening Room, at coolidge.org/films/oliver-sacks-his-own-life. In addition, the Coolidge will present a virtual Q&A with Burns and Atul Gawande, an author-physician very much in the Sacks tradition, on Sept. 30, at 8 p.m. Gawande is among the films interviewees.

The documentary was shot in 2015, shortly after Sacks learned he had terminal cancer. The diagnosis has done nothing to affect his gusto. The Falstaffian beard that readers know from Sackss author photos is matched by an equally outsize personality. He was immoderate in all possible directions, his friend the Italian writer Roberto Calasso says in the film. Nothing we see suggests otherwise.

The son of doctors, he grew up in a cultivated Jewish household in London. The most shocking moment in the documentary comes when Sacks describes his much-beloved mothers response to learning her 18-year-old son was gay. You are an abomination, she told him. The shock worsens when Sacks later says she remained the person he was closest to.

Early on, Sacks acquired passions for swimming, the periodic table of elements, mineralogy, motorcycles, and weightlifting. He came to the United States to do his medical internship in San Francisco, then residency in Los Angeles. Possessed of a serious amphetamine habit, he thought nothing of going on 36-hour rides on his bike, stopping only for gas.

In New York, Sacks began the work that would make him famous, treating patients whod been severely debilitated by encephalitis for more than four decades. Giving them the amino acid L-DOPA, Sacks helped them awaken from their near-vegetative state. We see before-and-after footage of the patients from 1969. Its both wondrous, the transformations wrought, and disturbing, the severity of the patients previous condition and seeing how some returned to it.

The documentary also includes talking-head interviews intense shyness did not keep Sacks from having many devoted friends as well as period photographs and archival films from throughout his life. These are welcome and offer a nice counterpoint to the 2015 footage. Sackss marvelous speaking voice provides a kind of voice-over throughout. Its a tribute to how articulate he was that its hard to tell when hes speaking extemporaneously and when hes reading from his just-completed memoir, On the Move.

What isnt welcome is an intrusive score and recurring bits of quite-unnecessary filmmaking flashiness: reenactments and weird, semi-abstract shots meant to represent . . . the nervous system? Sackss descriptions of neurological disorders are so compelling that trying to offer visual equivalents is superfluous as well as distracting. The movie opens with Sacks saying, Could you repeat your question more shortly? I only have an attention span of about 12 seconds. Clearly, thats not true. The filmmakers seem to think its true of the audience, though.

OLIVER SACKS: HIS OWN LIFE

Directed by Ric Burns. Available via Coolidge Corner Virtual Screening Room. 114 minutes. Unrated (as PG-13: the occasional cheerful obscenity; disturbing archival footage of neurological patients)

Mark Feeney can be reached at mark.feeney@globe.com.

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Oliver Sacks: His Own Life gives the celebrated neurologist and author his own documentary - The Boston Globe

Karen White Tong first came to our EMG labs as a college sophomore, soon becoming fascinated with the neurological processes behind nerve conduction studies and with her interactions with patients. Now as a clinical research coordinator, shes running a large clinical trial for patients with Parkinsons disease and recruiting patients with spinocerebellar ataxia. For this weeks Spotlight interview, White Tong talks to us about developing long-term relationships with her patients, juggling work and parenting during the age of COVID-19, and her lifelong enjoyment of Duke football and basketball and the outdoors of North Carolina.

What are your current responsibilities within the Department? What does a typical day look like for you?I am a CRC II (clinical research coordinator), and I am currently running a big Parkinsons research trial with early Parkinsons patients that have monthly infusions. I also have a spinocerebellar ataxia trial going on right now that I am still recruiting for. Recruiting for these studies involves a lot of phone calls, looking through medical records and going through extensive screening/consent processes. Typically my studies run 2 years, if not more.

Since I typically see my patients monthly for greater than 2 years, I feel like the patients and I get to know each other really well and we develop friendships that last far beyond when the studies have concluded. Each day for me starts with seeing my first patient of the day, usually starting at 8 am. My study visits can last anywhere from 1 hour to 4 hours so afternoons are usually spent going through all my data and entering it for sponsor perusal. I typically prepare for my study visits in advance and have appointments, paperwork, lab kits, etc all ready to go on visit days.

How has the COVID-19 epidemic affected your job and personal life? Whats one positive strategy or resource youve found that helps you cope?So far, COVID-19 has not affected my job as my studies are considered essential and I have had every single patient come in for their visits since March. Personally, COVID has affected me much more on the home. In March, my daughters school went virtual and I had to juggle coming into work every day and staying home with her to make sure she did her virtual classes. We also didnt go out to eat anymore or go to the movies. My daughter played soccer and that was canceled as well as spring/summer swim team. Luckily, I live in the country and can take walks in the woods with our yellow lab Kula or fish on our pond in order to get fresh air.

How and when did you first come to the Neurology Department? I came to the Neurology Department when I was a sophomore in college here at Duke. I worked part time in the EMG Lab and eventually full time. I started working with Drs. Donald Sanders and Janice Massey. I was an EMG/NCS technologist and performed nerve conduction studies on patients. Doing this helped me learn about the various neurological disease processes and fascinated me.

Whats the biggest change in your work and at Duke in general since you first came here?One of the biggest changes in my work since I came to Neurology is the number of patients I see on a daily/weekly basis. In the EMG Lab I saw up to 8 patients a day and now I see 1 to maybe 2 patients a day. I still know and work with a number of neurologists that I knew when I first started here at Duke.

What other passions or hobbies do you have outside of the Department?I love going to see/watch Duke football and basketball games. I have been doing that since I was a child. I also love watching my daughter play soccer, which is mostly year long and I love watching her swim for her swim team in the spring and summer. I enjoy taking walks/hiking on our property in Hillsborough, we have miles of trails in the woods and a stream to wade in. We can also fish in the pond behind our house.

Above, White Tong enjoys a day out with her husband; below, she enjoys a (pre-COVID) night out with friends.

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Staff Spotlight: Karen White Tong | Duke Department of Neurology - Duke Department of Neurology

Newswise Background: Coronavirus disease 19 (COVID-19) is the most globally impactful pandemic of the past century. The causative pathogen, SARS-CoV-2, infects ACE2-expressing cells and leads to pulmonary disease and a systemic immune response. In patients with severe COVID-19, a dysregulated immune response is associated with secondary extrapulmonary dysfunction, including neurological symptoms. Neurologic complications of SARS-CoV-2 infection are increasingly recognized, yet it is unknown to what degree humoral autoimmunity is a feature of neurological impairment in COVID-19.

Objectives: To perform an unbiased survey of peripheral and central humoral autoimmunity in COVID-19 patients with neurologic dysfunction.

Methods: Paired cerebrospinal fluid (CSF) and plasma biospecimens were collected from nasopharyngeal (NP) SARS-CoV-2 PCR positive patients with comorbid neurologic impairment (n = 5). Additional unpaired CSF biospecimens were collected from neurologically impaired NP PCR positive patients (n = 3). All COVID-19 patients were PCR negative for SARS-CoV-2 in the CSF. CSF and plasma were also collected from SARS-CoV-2 uninfected healthy control volunteers. Neurologic syndromes were diverse and included myositis, seizures, and encephalopathy. Biospecimens were screened in replicate by mouse brain immunostaining, immunoprecipitation mass spectrometry (IP-MS), and human peptidome phage display immunoprecipitation sequencing (PhIP-Seq). IP-MS spectra were analyzed by both spectral counting and MS1 peak area. For PhIP-Seq, proteins with overlapping peptides that were enriched at least 10-fold above control samples, or single peptides enriched 100-fold above controls were considered candidate autoantigens. Candidate autoantigens identified by at least two of three methods (PhIP-Seq, spectral counting, and peak area) were carried forward for validation.

Results: Unexpectedly, seven of eight COVID-19 CSF samples had evidence of humoral autoimmunity by tissue staining (n = 7), and IP-MS (n = 6), PhIP-Seq (n = 7), or both (n = 6). By IP-MS, significantly more candidate autoantigens were identified in COVID-19 biospecimens than in uninfected controls. PhIP-Seq identified twice as many candidate autoantigens in COVID-19 biospecimens than in controls. Notably, COVID-19 biospecimens were enriched for clinically relevant candidate autoantigens including those associated with dermatomyositis, and myasthenia gravis (none known to be pre-existing comorbidities). Additionally, COVID-19 biospecimens were enriched for candidate autoantigens with prima facie clinical relevance as they targeted proteins enriched in skeletal muscle, endothelial cells, and at the synapse. One candidate autoantibody targeted a ciliary protein implicated in syndromic anosmia.

Conclusions: We identified evidence of an increased burden of humoral autoimmunity in COVID-19 patients with comorbid neurologic dysfunction.

Presenter:M.D., Ph.D. Christopher Bartley, University of California San Francisco, Department of Psychiatry and Behavioral Sciences, 401 Parnassus Avenue, Room LP-263, 94143, San Francisco, US

Originally posted here:
Evidence of an Increased Burden of Humoral Autoimmunity in the CSF and plasma of COVID-19 Patients with Comorbid Neurologic Dysfunction - Newswise

A deadly combination of two mosquito-borne viruses may be a trigger for stroke, new research published in theThe Lancet Neurologyhas found.

University of Liverpool researchers and Brazilian collaborators have been investigating the link between neurological disease and infection with the viruses Zika and chikungunya. These viruses, which mostly circulate in the tropics, cause large outbreaks of rash and fever in places like Brazil and India. Zika is widely known to cause brain damage in babies following infection in pregnancy, but the new research shows it can also cause nervous system disease in adults.

The study of 201 adults with new onset neurological disease, treated in Brazil during the 2015Zika and 2016 chikungunya epidemics, is the largest of its kind to describe the neurological features of infection for several arboviruses circulating at the same time.

The new research shows that each virus can cause a range of neurological problems. Zika was especially likely to cause Guillain-Barre syndrome, in which the nerves in the arms and legs are damaged. Chikungunya was more likely to cause inflammation and swelling in the brain (encephalitis) and spinal cord (myelitis). However, stroke, which could be caused by either virus alone, was more likely to occur in patients infected with the two viruses together.

Stroke occurs when one of the arteries supplying blood to the brain becomes blocked. The risk of stroke is known to be increased after some types of viral infection, like varicella zoster virus, which causes chickenpox and shingles, and HIV. Stroke is also being recognised increasingly as a complication of COVID-19. This has important implications for the investigation and management of patients with viral infection, as well as for understanding the mechanisms of disease.

In total 1410 patients were screened and 201 recruited over a two-year period at Hospital da Restaurao in Recife, Brazil. Comprehensive PCR and antibody testing for viruses was carried out in Fiocruz laboratories.

Aedes aegypti mosquito

Of the 201 patients admitted with suspected neurological disease linked to Zika, chikungunya or both, 148 had confirmation of infection on laboratory testing, around a third of whom had infection with more than one virus.

The median age of patients was 48, and just over half the patients were female. Only around 10% patients had fully recovered at discharge, with many having ongoing issues like weakness, seizures, and problems in brain function.

Of the stroke patients, who were aged 67 on average, around two thirds had infection with more than one virus. Many of the people who had a stroke had other stroke risk factors, such as high blood pressure, indicating that stroke following Zika and chikungunya viral infection may most often be seen in those who are already high risk.

Dr Maria Lcia Brito Ferreira, neurologist and head of department at Hospital da Restaurao, leading the Brazilian team said: Zika infection most often causes a syndrome of rash and fever without many long-term consequences, but these neurological complications although rare can require intensive care support in hospital, often result in disability, and may cause death.

Dr Suzannah Lant, a Clinical Research Fellow at the University of Liverpool, who worked on the study explained: Our study highlights the potential effects of viral infection on the brain, with complications like stroke. This is relevant to Zika and chikungunya, but also to our understanding of other viruses, such as COVID-19, which is increasingly being linked to neurological complications.

Senior author Professor Tom Solomon, Director of the National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections at the University of Liverpool said: Although the worlds attention is currently focused on COVID-19, other viruses that recently emerged, such as Zika and chikungunya, are continuing to circulate and cause problems. We need to understand more about why some viruses trigger stroke, so that we can try and prevent this happening in the future.

The rest is here:
Zika-Chikungunya dual infection linked to stroke: Research - Outbreak News Today

Article In Brief

Using a three-dimensional model of engineered human tissue, researchers replicated the pathological effects of the blood-brain barrier under ischemic conditions and used drugs to prevent or lessen the damage. The lab model will be used to test new therapies, their potential neurotoxicity, and make it easier to understand how the blood brain barrier works, experts say.

Using a three-dimensional model of engineered human tissue with six different cell types, researchers at Wake Forest School of Medicine replicated the pathological effects of the blood-brain barrier (BBB) under ischemic conditions and used drugs to prevent or reduce the damage.

The spheroids have all the qualities of human BBB functionwith expression of tight junctions, adherens junctions, adherens junction-associated proteins, and cell-specific markers. They also have the same proportion of human microvascular endothelial cells, neurons, astrocytes, microglia, pericytes, and oligodendrocytes.

The lab model will be used to test new drugs in the pipeline and their potential for neurotoxicity. The model will also make it easier to understand how the BBB works to protect the brain and to model human brain diseases, experts told Neurology Today.

We developed a much-needed model of an entirely natural BBB and show that we can reverse many of the problems that occur in acute stroke, said senior author Anthony J. Atala, MD, director of the Wake Forest Institute for Regenerative Medicine.

In our three-dimensional model, every cell contributes. The development of tissue-engineered three-dimensional brain tissue equivalents can help advance the science toward better treatments and improve patients' lives. The study was published online on June 17 in Nature Scientific Reports.

Much of the day-to-day work on these studies was carried out by the paper's first author, Goodwell Nzou, PhD, who created the model during his doctoral studies at Wake Forest.

To study the model, the scientists decided to test what goes wrong with the BBB during stroke. They depleted the organoids of oxygen and observed an inflammatory cascade set in motion to stop the damaging chain of events that occurs during stroke.

By knowing at the cellular level what is going on, we can start thinking about therapies to stop this process, explained Dr. Atala.

Not surprisingly, the more oxygen removed from the cellular environment, the more damage there wasincluding an increase in proinflammatory and oxidative stress molecules. The investigators looked closely at the neuroinflammatory cascade and observed that the length of exposure, not just the amount of oxygen reduction, seemed to play a role.

The cytokines that were released disrupted the integrity of the BBB, and over time the cells began to lose their capacity to function normally. The scientists were able to measure the chemicals during the cytokine storm: chemokines and cytokines, heat shock proteins, transport proteins, tight junctions, and basement membrane protein expression.

Next, they used anti-inflammatory agentssecoisolariciresinol diglucoside and 2-arachidonoyl glycerolto reduce the effects of inflammation and the other pathological processes underway.

The treatment was effective at ameliorating the damage and improved tight junction distribution, said Dr. Atala.

The investigators also tested a free radical scavenger and anti-inflammatory endocannabinoid that have been shown to model inflammation and cell death. Again, it worked to alleviate the response to the hypoxic environment.

Dr. Atala, a regenerative medicine specialist, believes that this disruption of the BBB may be used as a crack in the door to get targeted treatments through. When we used these agents we were able to manage the response and observed positive effects, said Dr. Atala. By using this model that replicates in many ways the human physiological response to hypoxia we can now look at agents that can impact things in a positive way.

The critical role played by the BBB in maintaining homeostasis within the central nervous system makes it clear why BBB breakdown is evident in many neurological disorders, they wrote in the paper. During ischemic stroke, in particular BBB breakdown leads to edema and hemorrhage.

These pathologic consequences worsen secondary brain injury and significantly contribute to cognitive impairment. Hence pathological effects of hypoxia on BBB function may be critical in understanding strategic therapeutic targets for BBB maintenance and recovery during and after neurologic injury, the scientists wrote.

The scientists are now designing studies of other pathological conditions, including Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, and Huntington's disease. Dr. Atala said that neuroimaging studies have shown BBB breakdown and inflammatory processes underway in many neurodegenerative conditions.

The development of three-dimensional organoid models of the neurovascular unit offers a unique opportunity to study the effectiveness of novel therapeutics for neurological diseases in a cell-based system that takes into account intercellular communication, said Patrick Ronaldson, PhD, an associate professor of pharmacology, physiological sciences, and neuroscience at the University of Arizona College of Medicine.

Intercellular communication between endothelial cells, glial cells, mural cells, and neurons is a property that is often lacking in many of the in vitro model systems that are routinely used for CNS drug discovery and development.

Dr. Ronaldson added that three-dimensional neurovascular unit organoid models can also enable the identification of novel compounds that can protect the vasculature from further injury. Such utility may facilitate critical breakthroughs in treatment of neurological diseases where blood-brain barrier dysfunction and neurovascular injury are known pathological characteristics, such as ischemic stroke, traumatic brain injury, and Alzheimer's disease.

Despite this advance, however, he said there are many unanswered questions regarding the application of this three dimensional organoid model to drug discovery and development. These questions specifically relate to the magnitude of blood-brain barrier leak observed in the organoids and the ability to study drug transport at the neurovascular unit in a multi-transporter environment.

This study evaluated BBB permeability using only large molecular weight tracers such as immunoglobulins, albumin, and fluorescently-labeled dextrans, he explained.

This is a missed opportunity because permeability to smaller molecules could still persist. Such a leak of small molecules can occur even if large molecular permeability is restricted and can contribute to exacerbation of neurovascular pathology or neurotoxicity. Understanding whether therapeutics can protect against small molecule paracellular permeability is critical in the advancement of these compounds to the clinic.

Additionally, the researchers only evaluated organoid expression of one therapeutically relevant transporter (that is, P-glycoprotein, also known as MDR1), Dr. Ronaldson said.

There are many other transporters such as breast cancer resistance protein and organic anion transporting polypeptides that are critical determinants of drug disposition at the neurovascular unit, he continued. For this three-dimensional organoid model to be truly applicable to neurological drug discovery and development, it is important to evaluate the expression and function of the many other transporters that are known to be clinically relevant.

Costantino Iadecola, MD, the Anne Parrish Titzell professor of neurology and director and chair of the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine, said: The findings are anticipated based on previous stroke studies: the impact of hypoxia on BBB constituents, cytokine production, oxidative stress, etc., and the protective effects of free radical scavengers, anti-inflammatory cannabinoids. All these events and protective approaches were already known and validated in animal models but failed in humans.

There is little mechanistic novelty and therapeutic advance [with this paper], he said, but the positive aspect is that the model could be used for higher throughput screens for new drugs.

But, Dr. Iadecola added, one caveat with the current study is that only a particular segment of the cerebral vasculature was examined (capillaries and related cells) and that only hypoxia was tested. This is not the same as ischemia produced by an arterial occlusion in vivo, which is associated with intravascular clotting, distal microembolism, infiltration of inflammatory cells, no-reflow phenomenon, and more, he said.

Drs. Atala, Ronaldson, and Iadecola had no relevant disclosures.

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A Model of the Human Blood-Brain Barrier Shows the Effects... : Neurology Today - LWW Journals

The Interventional Neurology Device industry research report is improved with the current effect realized through COVID-19 on the business. The report has been scrupulously studied and the data has been speculated in view with the present pandemic shock that the world has witnessed- market brief, dynamics, trends, and upcoming profit openings.

The report details future forecasts for the industry for the year 2020, for example, CAGR, market share, size, demand and consumption rate, and manufacturing competence of the voluminous key contenders. Moving forth, Interventional Neurology Device research investigation provides market data, entailing trends, consumer behavior, and combative landscape in a way that permits individuals and businesses to classify potential growth throughout the worldwide markets.

Market Major Companies: Medtronic , Johnson and Johnson , Terumo Corporation, Penumbra, Inc., Merit Medical Systems, Inc, W.L. Gore & Associates , Microport Scientific Corporation, Medikit Co., Ltd., Stryker

Market Segment via Product type: Carotid artery angioplasty & stenting, Embolization & coiling, Neurothrombectomy Devices,

Strategic Interventional Neurology Device applications along with their consumption forecast details: Treatment of Cerebral Aneurysms, Treatment of Cerebral Vasospasm, Vertebroplasty,

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The eminent challengers incorporated in the report:

Interventional Neurology Device Market research report contributes extensive knowledge with the specialized investigation for the timeline 2020-2024. The report shares details of upstream raw materials, downstream requirements, and production value through some significant elements subject to market growth.

The timeline considered to evaluate the market size of the Interventional Neurology Device is as follows:

History Year: 2015-2019|Base Year: 2019|Estimated Year: 2020|Forecast Year 2020 to 2024

Market Segmentation:

The global Interventional Neurology Device industry is separated into the fundamentals of the product, application, and region. Our prominent publisher preparing the report performs a precise and intrinsic evaluation of all segments included in the report. The necessary conserving the market share, revenue, market growth rate, and other integrated into the report. The segments are studied conscientious evaluation of all the segments model of product, application, and region. The global Interventional Neurology Device markets are segmented on the study recognizes high-growth divisions of the global industry and comprehend how the principal segments can thrive during the forecast period.

Primary Objectives of Interventional Neurology Device market Report:

The report comprises an overview of the vital geographies, market grounds in line with the production and consumption qualitative analysis, supply and demand chain, cost and revenue analysis, principal contenders, and their manufacturing plants following future estimation. The report uses SWOT and PESTLE analysis to collate market investment feasibility and return analysis.

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Table of Content

Chapter 1 About the Interventional Neurology Device Industry1.1 Industry Definition and Types1.1.1 Carotid artery angioplasty & stenting1.1.2 Embolization & coiling1.1.3 Neurothrombectomy Devices1.2 Main Market Activities1.3 Similar Industries1.4 Industry at a Glance

Chapter 2 World Market Competition Landscape2.1 Interventional Neurology Device Markets by Regions2.1.1 USAMarket Revenue (M USD) and Growth Rate 2015-2025Sales and Growth Rate 2015-2025Major Players Revenue (M USD) in 20192.1.2 EuropeMarket Revenue (M USD) and Growth Rate 2015-2025Sales and Growth Rate 2015-2025Major Players Revenue (M USD) in 20192.1.3 ChinaMarket Revenue (M USD) and Growth Rate 2015-2025Sales and Growth Rate 2015-2025Major Players Revenue (M USD) in 20192.1.4 IndiaMarket Revenue (M USD) and Growth Rate 2015-2025Sales and Growth Rate 2015-2025Major Players Revenue (M USD) in 20192.1.5 JapanMarket Revenue (M USD) and Growth Rate 2015-2025Sales and Growth Rate 2015-2025Major Players Revenue (M USD) in 20192.1.6 South East AsiaMarket Revenue (M USD) and Growth Rate 2015-2025Sales and Growth Rate 2015-2025Major Players Revenue (M USD) in 20192.2 World Interventional Neurology Device Market by TypesCarotid artery angioplasty & stentingEmbolization & coilingNeurothrombectomy Devices2.3 World Interventional Neurology Device Market by ApplicationsTreatment of Cerebral AneurysmsTreatment of Cerebral VasospasmVertebroplasty2.4 World Interventional Neurology Device Market Analysis2.4.1 World Interventional Neurology Device Market Revenue and Growth Rate 2015-20192.4.2 World Interventional Neurology Device Market Consumption and Growth rate 2015-20192.4.3 World Interventional Neurology Device Market Price Analysis 2015-2019

Chapter 3 World Interventional Neurology Device Market share3.1 Major Production Market share by Players3.2 Major Revenue (M USD) Market share by Players3.3 Major Production Market share by Regions in 2019, Through 20253.4 Major Revenue (M USD) Market share By Regions in 2019, Through 2025

Chapter 4 Supply Chain Analysis4.1 Industry Supply chain Analysis4.2 Raw material Market Analysis4.2.1 Raw material Prices Analysis 2015-20194.2.2 Raw material Supply Market Analysis4.2 Manufacturing Equipment Suppliers Analysis4.3 Production Process Analysis4.4 Production Cost Structure Benchmarks4.5 End users Market Analysis

Chapter 5 Company Profiles5.1 Medtronic5.1.1 Company Details (Foundation Year, Employee Strength and etc)5.1.2 Product Information (Picture, Specifications and Applications)5.1.3 Revenue (M USD), Price and Operating Profits5.2 Johnson and Johnson5.2.1 Company Details (Foundation Year, Employee Strength and etc)5.2.2 Product Information (Picture, Specifications and Applications)5.2.3 Revenue (M USD), Price and Operating Profits5.3 Terumo Corporation5.3.1 Company Details (Foundation Year, Employee Strength and etc)5.3.2 Product Information (Picture, Specifications and Applications)5.3.3 Revenue (M USD), Price and Operating Profits5.4 Penumbra, Inc.5.4.1 Company Details (Foundation Year, Employee Strength and etc)5.4.2 Product Information (Picture, Specifications and Applications)5.4.3 Revenue (M USD), Price and Operating Profits5.5 Merit Medical Systems, Inc5.5.1 Company Details (Foundation Year, Employee Strength and etc)5.5.2 Product Information (Picture, Specifications and Applications)5.5.3 Revenue (M USD), Price and Operating Profits5.6 W.L. Gore & Associates5.6.1 Company Details (Foundation Year, Employee Strength and etc)5.6.2 Product Information (Picture, Specifications and Applications)5.6.3 Revenue (M USD), Price and Operating Profits5.7 Microport Scientific Corporation5.7.1 Company Details (Foundation Year, Employee Strength and etc)5.7.2 Product Information (Picture, Specifications and Applications)5.7.3 Revenue (M USD), Price and Operating Profits5.8 Medikit Co., Ltd.5.8.1 Company Details (Foundation Year, Employee Strength and etc)5.8.2 Product Information (Picture, Specifications and Applications)5.8.3 Revenue (M USD), Price and Operating Profits5.10 Stryker5.10.1 Company Details (Foundation Year, Employee Strength and etc)5.10.2 Product Information (Picture, Specifications and Applications)5.10.3 Revenue (M USD), Price and Operating Profits

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Interventional Neurology Device Market Technological Improvements Steering Growth during 2020-2025 | TOP Players- Medtronic , Johnson and Johnson ,...

ASPEN It isnt noticeable at first. It starts with changes for which the brain can compensate, meaning no real impact on day-to-day functions or cognition.

But as time passes, the brain can no longer compensate for the damage its experiencing. Subtle problems with memory and thinking begin to pop up. Subtle turns to noticeable. Noticeable turns to difficulty carrying out everyday activities. Eventually, around-the-clock care is required.

This is the broad view progression from preclinical to severe Alzheimers disease, a degenerative brain disease that becomes worse with time and age, and is the most common cause of dementia, according to the Alzheimers Association.

In Colorado, an estimated 76,000 people are living with Alzheimers dementia, and that number is expected to increase 21% to 92,000 by 2025, a 2020 Alzheimers Association report states. As of July 2019, 14.6% of Coloradans, or about 840,000 people, were 65 or older, U.S. Census Bureau data shows.

While its been shown that living in higher elevation communities can lead to a more active, healthier lifestyle and even prolonged life, its less clear how living at high elevation correlates with degenerative brain diseases.

In short, the answer is complicated and not well researched.

As far as I know, there isnt a lot of evidence one way or another about high altitudes versus low altitudes for Alzheimers disease risk, said Dr. Huntington Potter, director of the Alzheimers and Cognition Center at the University of Colorado Anschutz Medical Campus. We cant say one way or another whether high altitude is a risk factor for Alzheimers.

At the Alzheimers and Cognition Center, which is part of the CU Anschutz Medical Campus and School of Medicine, clinicians and researchers are dedicated to discovering effective early diagnostics, preventions, treatments and ultimately cures for Alzheimers disease and related neurodegenerative disorders, according to its website.

For Potter, that means looking at biomarkers or diagnostic proteins in the blood that can help clinicians predict the disease earlier, conducting projects that look at the lifespan of people with Alzheimers disease, and other research that can quickly be translated to better care, treatment and hopefully a cure.

Right now, the center is studying a drug called Leukine, which preliminary data shows might improve Alzheimers disease in the short term, Potter explained. The center also is studying other drugs that attack the disease.

Leukine may be the first one we found that looks promising, but we have several coming up that look promising, as well, Potter said.

When it comes to looking at the potential correlation between living at high elevation and the risk for dementia-inducing diseases, Potter and Dr. Peter Pressman of the Alzheimers and Cognition Center said it would take great effort, time and funding to research.

Assistant professor for the Department of Neurology, Dr. Peter S. Pressman works in his office at the University of Colorados Anschutz Medical Campus in Aurora on Thursday, Sept. 10. Photo by Liz Copan / Studio Copan

Assistant professor for the Department of Neurology, Dr. Peter S. Pressman is pictured outside his office building at the University of Colorados Anschutz Medical Campus in Aurora on Thursday, Sept. 10.Photo by Liz Copan / Studio Copan

Assistant professor for the Department of Neurology, Dr. Peter S. Pressman works in his office at the University of Colorados Anschutz Medical Campus in Aurora on Thursday, Sept. 10. Photo by Liz Copan / Studio Copan

Assistant professor for the Department of Neurology, Dr. Peter S. Pressman works in his office at the University of Colorados Anschutz Medical Campus in Aurora on Thursday, Sept. 10. Photo by Liz Copan / Studio Copan

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Pressman, who is a behavioral neurologist and researcher with the center, said on top of securing and carefully selecting a large group of people living at elevation to participate in a study, researchers also would have to follow that group for about a decade to get meaningful results.

Its easy to fund a study for a few years, Pressman said. People give you money to do something for two to three years, but two to three years is not enough time for a process as slow as Alzheimers and dementia to really even pick up. Im not saying thats not possible. Its doable, but it would take some effort.

Dr. Brooke Allen, neurologist, founder of Roaring Fork Neurology in Basalt and medical director at Renew Roaring Fork, an assisted living and memory care center in Glenwood Springs, expressed similar thoughts.

As a part of any mild cognitive impairment or dementia evaluation, Allen said her team checks the oxygen level a patient has and considers the elevation at which that person spends most of their time.

Lower oxygen levels can contribute to people experiencing confusion, dizziness and mild short-term memory issues. But outside of looking at oxygen levels and how they could be contributing to symptoms, Allen said she doesnt consider elevation a higher risk situation.

Allen said she feels High Country residents 65 and older tend to be much younger than their age in terms of their lifestyle, which is a positive in terms of dementia prevention.

About four years ago, Allen and her team conducted a long-term preclinical Alzheimers trial as part of the Alzheimers Prevention Initiatives Generation Program, a study that looked at the effectiveness of preventative treatments for individuals between 65 and 75 who had no symptoms of dementia.

Allen said more than 250 people came in to participate in the study and all generally led healthy, active lifestyles.

I think in our valley, Ive experienced meeting those kinds of people and not thinking of altitude as a risk factor but as a lifestyle opportunity in a rural area like ours, Allen said about the people who participated in the study.

Looking at the potential correlation between living at high elevation and risk of degenerative brain diseases is not just a difficult feat for Colorado researchers. Little research with concrete findings exists nationally or globally.

One study published in 2015 by Dr. Stephen Thielke in JAMA Psychiatry looked at deaths attributed to Alzheimers dementia reported in 58 counties in California to try to determine whether rates of dementia were associated with average elevation of residence. The study found that the counties at higher elevation generally had lower rates of dementia mortality.

Additional work is needed to determine whether this relationship holds in other populations, the study notes.

But beyond this study, there isnt much conclusive evidence for or against a correlation, as emphasized by Dr. Brent Kious, a psychiatrist, assistant professor and researcher with University of Utah Health and the schools Department of Psychiatry.

Kious has studied the link between living at high elevations and major depressive disorder, anxiety and suicide, and he said he and his research team have been interested in the impact of elevation on the incidence and median age of onset of Parkinsons disease.

However, Kious said decrements in cognitive performance due to chronic exposure to moderately high elevation might not necessarily translate into an increased risk of dementia.

It is not clear whether altitude would affect those neurodegenerative processes or not, though there is some reason to think that they involve oxidative damage so relative hypoxia might slow them, Kious wrote in an email. He went on to note that relative and prolonged hypoxia, or a lack of oxygen, has been associated with dementia risk. In any case, a good epidemiological study of the association between altitude and dementia should control for things that might be associated with both.

Karen Eck, 60, of Silverthorne, picks tomatoes at the Timberline Adult Day Program garden in Frisco on Thursday, Sept. 10. Eck, who was diagnosed with early onset Alzheimers, attends programs three to four times a week at the center.Photo by Jason Connolly / Jason Connolly Photography

Karen Eck, 60, of Silverthorne, waters tomatoes at the Timberline Adult Day Program garden in Frisco on Thursday, Sept. 10. Eck, who was diagnosed with early onset Alzheimers, attends programs three to four times a week at the center.Photo by Jason Connolly / Jason Connolly Photography

Karen Eck, 60, of Silverthorne, poses for a portrait at the Timberline Adult Day Program garden in Frisco on Thursday, Sept. 10. Eck, who was diagnosed with early onset Alzheimers, attends programs three to four times a week at the center.Photo by Jason Connolly / Jason Connolly Photography

Karen Eck, 60, of Silverthorne, enters the Timberline Adult Day Program in Frisco on Thursday, Sept. 10. Eck has early onset Alzheimers.Photo by Jason Connolly / Jason Connolly Photography

Karen Eck, 60, of Silverthorne, leaves the Timberline Adult Day Program garden in Frisco after watering tomatoes on Thursday, Sept. 10. Jason ConnollyPhoto by Jason Connolly / Jason Connolly Photography

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While theres not good data for or against high elevation as a risk factor for degenerative brain diseases, there is evidence that people living in more rural communities do not have the same access to dementia care and treatment as those living in urban areas.

According to the 2020 Snapshot of Rural Health in Colorado, produced by the Colorado Rural Health Center, 721,500 people are living in rural Colorado and 19% of the rural population is age 65 or older. Rural is defined as a nonmetropolitan county with no cities over 50,000 residents.

Chad Federwitz a gerontologist, or specialist in the study of aging, and manager of Pitkin County senior services said he hasnt seen any correlation between living at high elevation and dementia risk. Anecdotally, he does know that people move to Grand Junction or the Front Range if they have dementia because of a lack of care resources in the High Country.

Given the nature of our rural-ish community, we dont have the same resources, Federwitz said, referring to things like long-term assisted living and memory care options. You can go to Grand Junction or the Front Range and have pages and pages of resources as opposed to here.

While there are some dementia care resources in more rural Colorado communities, the Alzheimers and Cognition Center is working to do more to develop meaningful relationships with health care providers and dementia patients in the states mountain communities as part of its mission.

According to Pressman, who is heading this charge on behalf of the CU center, a lot of projects are in the planning stages but include virtually educating medical providers, nurse practitioners and primary care doctors on Alzheimers and general healthy brain aging as well as mutual, participatory research with rural Colorado communities and communities of color.

Pressman explained that a lot of research related to Alzheimers overwhelmingly is based on middle-class, well-educated, white participants. And so while researchers think they know a lot about the disease in general, they really only know about the disease related to this demographic group.

Through the centers outreach and efforts to better connect with underrepresented communities, Pressman hopes to conduct better science and better serve the larger Colorado community.

What motivates me is trying to do good work, trying to do good science and to make sure our results actually represent real life, Pressman said. We want to make sure were helping everybody, not just a niche group, and that our services are available equitably to as many people as possible.

Editors note: This is Part 2 of a four-part series on longevity in the High Country. The series is being produced in partnership with The Aspen Times, Glenwood Springs Post Independent, Steamboat Pilot & Today and Vail Daily. Read more at SummitDaily.com/longevity.

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The aging brain: Exploring the connection between neurology and elevation - Summit Daily News

By Dr. Paul Wright, Senior Vice President and System Chair of Neurosciences, Nuvance Health

Summary:

At Nuvance Health, we're seeing patients who are thankful because they recovered from COVID-19, but are now worried because they have lingering neurological symptoms. Nationwide, a small number of people who recovered from COVID-19 are reporting neurological concerns such as headache, dizziness, lingering loss of smell or taste, muscle weakness, nerve damage, and trouble thinking or concentrating sometimes called "COVID fog" or "brain fog".

There's still much to learn about COVID-19 because it's a new virus, including possible long-term neurological complications. What we do know is that it's important to talk with your healthcare clinician if you have any health concerns after recovering from the virus.

Here's what you can do if you or a loved one experiences lingering neurological concerns after COVID-19 infection.

Neurological concerns after recovering from COVID-19

Patients of all ages are reporting lingering neurological symptoms after COVID-19 infection. At Nuvance Health, most of the patients we're seeing with these symptoms are between the ages of 30 and 60. It's important to stress that only a small number of patients are experiencing these neurological after-effects and although neurological symptoms are certainly possible, they aren't common.

In most cases, patients with neurological symptoms report brain fog or feeling as if they aren't quite back to normal weeks or months after recovering from COVID-19. Other lingering symptoms are headaches that affect their quality of life and ability to function, and loss of taste or smell.

The COVID-19 virus itself, as well as the symptom of fever and chills, can lead to muscle aches that usually resolve within a few days or weeks after contracting the virus. However, neurological specialists are also seeing some patients who experience increasing muscle weakness after recovering from COVID-19.

What to do about lingering neurological symptoms

If you or a loved one is experiencing lingering or unexplained neurological symptoms after recovering from COVID-19, you should make an appointment with your primary care clinician or a neurologist.

Early evidence shows that some lingering symptoms, such as brain fog, may improve over time, and lingering symptoms could be related to the virus itself. However, you could have an underlying health condition that was previously undiagnosed or an autoimmune problem that was triggered by the COVID-19 infection, which is why it's important to have a medical exam. Your healthcare clinician will take a thorough personal and family history and conduct an exam to make sure there's no other cause for your symptoms.

In some cases, you may be able to have a Virtual Visit, which is a safe and secure way to remotely connect with your healthcare clinician. If an in-person visit is required, Nuvance Health is taking precautions to reduce the risk of COVID-19 transmission in its facilities. Precautions include:

Mental health concerns

COVID-19 has affected nearly every aspect of our lives, from how we shop for food and access healthcare services to how we work and whether we send our kids to school. It's common for individuals to be afraid of the virus's unknown effects, which can cause anxiety that may manifest itself in different ways, such as inability to sleep, sadness, and feelings of dread.

It's important to be vigilant and protect yourself, your loved ones, and your fellow community members from COVID-19 infection. Still, you also need to make sure you're eating healthy, exercising, and taking care of your mental health by connecting with others and doing things you enjoy.

If you're experiencing symptoms of anxiety or depression whether you are recovering from COVID-19 or not you should seek help by reporting it to your healthcare clinician.

It may also help to remember that as we learn more about COVID-19, we're developing effective ways to prevent transmission and treat the virus. We're also learning more about possible complications and how the virus may effect individuals differently. For example, even though some initial reports stated that strokes were common among younger patients with COVID-19, the stroke rate among younger patients across the country doesn't appear to be as high as originally thought.

The bottom line: COVID-19 is still new, and experts don't fully understand the potential long-term health effects of the virus. If you're experiencing neurological symptoms or mental health concerns after COVID-19 infection, an evaluation by a healthcare clinician is your next step toward recovery.

Dr. Paul Wright has more than 18 years of experience in neurology. Board certified in psychiatry and neurology, Dr. Wright has extensive research experience including studying the effectiveness of novel therapies such as electroceuticals to treat neurological diseases.

To learn more about neurology at Nuvance Health, visit our websites: Connecticut Neurology | New York Neurology

CONTACTAmy Forni, Manager, Public Relations(203) 739 7478 | Amy.Forni@nuvancehealth.org

About Nuvance HealthNuvance Health is a family of award-winning nonprofit hospitals and healthcare professionals in the Hudson Valley and western Connecticut. Nuvance Health combines highly skilled physicians, state-of-the-art facilities and technology, and compassionate caregivers dedicated to providing quality care across a variety of clinical areas, including Cardiovascular, Neurosciences, Oncology, Orthopedics, and Primary Care.

Nuvance Health has a network of convenient hospital and outpatient locations Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital and Vassar Brothers Medical Center in New York plus multiple primary and specialty care physician practice locations, including The Heart Center, a leading provider of cardiology care, and two urgent care offices. Non-acute care is offered through various affiliates, including the Thompson House for rehabilitation and skilled nursing services, and the Home Care organizations. For more information about Nuvance Health, visit our website. TTY: 1-800-421-1220

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What you need to know about neurological symptoms after COVID-19 - Patch.com

Featured Image: (L-R) Barbara Johnson, Elizabeth Matthews and Mikisha Johnson. When Elizabeth Matthews (center, pictured with daughter Barbara Johnson, left, and Mikisha Johnson, right) had a stroke, doctors discovered she also had COVID-19. From strokes to mental health, the Emory Brain Health Center is leading research on the neurological effects of the pandemic.

By Emory University

Mikisha Johnson hung up the phone. On the call, her 83-year-old grandmother, Elizabeth Matthews, had struggled to string words together and sounded disoriented.

Grandmama doesnt sound right, Mikisha told her mother, Barbara.

When Barbara Johnson arrived the following morning at her parents home in the southwest Atlanta neighborhood of Collier Heights, her mother didntlookright either.

I said Mama, youre slurring your words, your mouth is twisted and your hand is trembling, Barbara Johnson said. You are going to the hospital.

Elizabeth Matthews already had a pretty good idea what was wrong, but she didnt want to worry her daughter.

I said to my husband, I believe I had a stroke, she recalled.

She was right. But that wasnt all. At that visit in early August, doctors at Emory St. Josephs Hospital told Matthews shed also tested positive for COVID-19.

I got real emotional when they told me that, Matthews said. I was thinking, Am I going to die?

Since the COVID-19 outbreak began late last year, it has largely been understood as an assault on the respiratory system. Telltale symptoms are often a fever, hacking cough and difficulty breathing; patients in the worst shape end up on respirators.

What is still less understood, but just as alarming, is the damage the virus may be doing to the brain, from strokes like Matthews to reports of headaches, seizures and confusion. And that doesnt even take into account the staggering toll of the pandemic on our mental health.

Today, more than 300 studies from around the world have looked at links between neurological problems and COVID-19. More are underway.

We are now recognizing COVID-19 disease actually has a significant neurological implication or neurologic effect, said Byron Milton III, MD, a physiatrist, or physical medicine and rehabilitation doctor, at Emory University Hospital who has helped COVID patients cope with dementia-like symptoms and other neurological problems.

(L-R) Barbara Johnson, Elizabeth Matthews and Mikisha Johnson. Elizabeth Matthews (center, with daughter Barbara Johnson, left, and granddaughter Mikisha Johnson, right) battled back from stroke and COVID-19. Shes looking forward to a new grandchild, due in late September.

Even as they care for patients, researchers and health care providers at the Emory Brain Health Center are among those leading the way toward understanding the short- and long-term neurological implications of the pandemic on the brain and the mind.

Those efforts are featured in Season 2 of the Your Fantastic Mind television series from Georgia Public Broadcasting and Emory University, which debuted Sept. 9 and continues through Oct. 14.

One of the things that really sets Emory apart is the multi-disciplinary way the Brain Health Center works, said Jonathan Lewin, MD, Emorys executive vice president for health affairs and executive director of the Woodruff Health Sciences Center.

Emory combines neurology, psychiatry and behavioral sciences, neurosurgery, rehabilitation medicine and sleep medicine. Thats proving to have a real benefit during this pandemic, where were learning so much about the virus every day and the ways it can impact us in ways we might not expect.

Read the full story at news.emory.edu >>

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Emory investigates how COVID-19 affects the... - SaportaReport

FROM THE ACADEMY OF CONSULTATION-LIAISON PSYCHIATRY

CASE REPORT

Ms Zorn was a 45-year-old woman with no previous psychiatric history who presented with a 2-month period of feeling like I am losing myself and seeing visually distorted faces. Faces of people she was looking at would appear to be hideously elongated, with the facial components distorted, as if it was melting. Cars would also appear to be more round than usual.

She was admitted to an inpatient psychiatry unit for unspecified psychosis, but after 2 days she was transferred to a general medical unit for additional medical evaluation. She was started on 25-mg quetiapine bid, which was titrated to 200 mg bid. Lumbar puncture was completed to rule out central nervous system infection or autoimmune encephalopathy, with results pending at the time of transfer to an academic medical center for higher level of multispecialty care.

On interview, she said that she felt like she was losing herself and reported visual distortions of faces melting. Ms Zorn was able to recognize faces and colors. She reported photophobia. She had headaches, which were relieved with ketorolac. Her husband reported that she had new onset of episodes of shaking her arms in a circular motion. She would also walk around the room in circular patterns while saying to herself that she was lost.

Ms Zorn had decreased appetite, weight loss, and decreased sleep. She denied depressed mood, decreased energy, mania, trauma, or previous problems with memory. She denied auditory hallucinations and suicidal/homicidal ideation. She denied a family history of suicide and psychiatric illness. Developmental history was unremarkable. She had no history of substance abuse.

On mental status examination, she was awake, alert, oriented to person, time, place, and situation. She continued to experience visual distortions of faces melting. Ms Zorns thought process was linear and coherent. Affect was mildly anxiously perplexed, non-labile, and non-tearful. Speech was normal. Insight and judgment were marginal. Her Montreal Cognitive Assessment (MoCA) score was 10/30. Her decisional capacity was impaired, and the screening neurological examination was non-focal.

Due to the atypical presentation of psychotic disorder, the full workup included a neurology consultation; brain MRI and lumbar puncture results were normal, except for autoimmune encephalitis results that were pending. Serum HIV, syphilis, vitamin B12, lead, rapid plasma regain (RPR), anti-nuclear antibody ammonia, and thyroid stimulating hormone (TSH) levels were normal; EEG was unremarkable. Pelvic ultrasound and CT were ordered to rule out ovarian teratoma. Quetiapine regimen was changed to 100 mg in the morning and 300 mg in the evening.

Ms Zorn was seen in follow-up on hospital day 2. Neurology had started her on 1-g methylprednisolone daily for a 5-day course for presumed autoimmune encephalitis. She was placed on a continuous EEG. On exam, she reported feeling better compared with the previous day. She no longer reported any distortions of faces or objects in the room, although she did report some blue dots in her field of view. She had 3 hours of sleep the previous night. Her husband noted that the she had decreased episodes of her aimless pattern of waving her arms in a circular motion. Her MoCA score was 14/30. Due to the significant improvement in her hallucinations following the first dose of methylprednisolone, the scheduled quetiapine was held.

When seen on hospital day 3, Ms Zorn said that she could fall asleep, but had trouble staying asleep. She had an episode where she got up and walked around the room purposelessly. Her MoCA score was 13/30 and decisional capacity was impaired. Quetiapine 50 mg post merdien (PM) was started to address poor sleep. On hospital day 4, she reported that her visual phenomena had returned, with her seeing pixels (flashing punctate lights) and faces melting. She had had difficulty sleeping. MoCA was 12/30 with continued limited insight, judgment, and decisional capacity. Quetiapine was increased to 100 mg pm and mirtazapine 7.5 mg pm was started to improve sleep.

On hospital day 5, her husband reported that she had had continued visual phenomena of pixels and faces melting. Ms Zorn was only able to sleep for 1.5 hours after receiving quetiapine and mirtazapine. On exam, she reported the visual hallucinations and had a MoCA score of 12/30. Continuous EEG was reported as normal and abdomen CT was negative for ovarian teratoma. To address continued psychosis and poor sleep, quetiapine was increased to 100 mg am and 300 mg pm. Mirtazapine was increased to 15 mg pm.

Ms Zorn was seen again on hospital day 6. She reported that she had been able to sleep for 8 hours. She denied any visual melting of faces but stated that the world looked pixelated at times. MoCA score was 14/30. Subsequently, when seen on hospital day 8, she stated that she was still seeing pixels in the periphery of her visual field. MoCA score improved to 17/30. Quetiapine was consolidated to 400 mg pm.

She was next seen on hospital day 10. The cerebrospinal (CSF) encephalopathy panel came back positive for anti-NMDA receptor antibody R1, confirming a diagnosis of anti-NMDA (N-methyl-D-aspartate)-receptor encephalopathy (ANMDARE). Neurology started plasmapheresis for 7 treatments, every other day. She had no hallucinations. She reported that she was getting deep sleep. MoCA score was 16/30. A quetiapine 50 mg am dose was added.

Plasmapheresis started on hospital day 11. The patient denied any visual distortions. She said that she felt significantly better than the previous week; MoCA score was 16/30. When next seen on hospital day 15, Ms Zorn reported sleeping from 11:00 pm to 5:30 am. She denied visual distortions. MoCA score had improved to 21/30; however, decisional capacity continued to be impaired. On hospital day 18, she was doing well. She had declined her scheduled quetiapine the previous day to give it a try. She no longer saw distorted faces. She had no gait disturbance. MoCA score improved further to 25/30. Given her improved mental status, the psychiatry team decided that she had recovered her decision-making capacity. Mirtaza-pine was decreased to 7.5 mg pm and quetiapine held.

Ms Zorn was seen for the last time on day 22 of hospital admission. After her final plasmapheresis treatment, she continued to be free of psychotic symptoms. She stated that she was doing better than last week, and that she was 80% back to normal. She was sleeping well and was increasingly physically active during the day. She was excited to return home; MoCA score was 22/30. Decisional capacity continued to be intact. Mirtazapine 7.5 mg bedtime was continued.

As she was medically stable for discharge, she was referred for psychiatric follow-up near her home. She was advised that any future recurrence of psychosis should first be addressed as if it was a recurrence of delirium and/or ANMDARE.

Discussion

ANMDARE is a relatively recently described illness that may present with psychiatric symptoms, neurologic symptoms, or both (either simultaneously or sequentially).1-5 While the exact mechanism remains obscure, antibodies to the NMDA receptor (on CSF and/or serum assay) is confirmatory.2 Management includes empiric treatment of manifest symptoms and immunomodulation systemic therapies.4,5

ANMDARE is important to the consultation-liaison psychiatrist for a number of reasons. First, its presentation lies in the neuropsychiatric borderland involving collaboration between psychiatry and neurology (as in other neuropsychiatric illnesses like Parkinson disease, Huntington disease, and multiple sclerosis). Second is its importance in the often hard-to-define syndrome of atypical psychotic disorder. In comparison to the classic presentation of schizophrenia, ANMDARE features a later age of onset, female predominance, visual hallucinations, relative lack of cognitive disorganization, and a lack of an extended prodromal period.

This case illustrates the atypical presentation of psychotic illness rather well. Ms Zorn was in her mid-40s, of high academic and professional achievement, adaptive social function; without a clear prodrome, she relatively promptly developed a psychotic picture with striking and disturbing visual hallucinatory phenomena. Clinical suspicion for ANMDARE was confirmed with reference laboratory (Mayo Clinic) results of + R1 antibody to NMDA receptor on CSF analysis. This was accomplished in the context of a thorough laboratory evaluation for other esoteric causes of atypical psychotic illness.

Empiric treatment of the psychiatric symptoms with mirtazapine and quetiapine, concurrent with 2 rounds of immunomodulation therapy, led to amelioration of symptoms and near complete cognitive recovery in a period of 2.5 weeks. Her cognitive status based on objective measure with the Montreal Cognitive Assessment (MoCA) was initially in the moderate to severely impaired range.6 With comprehensive treatment, Ms Zorns cognitive status improved to a level of only mild impairment. Correspondingly, her decisional capacity improved from significantly impaired to largely intact over the same period.

Psychiatrists assessing and treating patients with atypical presentation of psychotic illness should actively consider a diagnosis of ANMDARE as explanatory.3,4 In female patients with suspicion of ANMDARE, pelvic ultrasonography and/or CT scan should be ordered to rule out commonly co-occurring ovarian teratoma.1 Patients with ANMDARE who are treated with high-dose intravenous corticosteroids should be monitored (and treated for) any corticosteroid-associated psychiatric adverse effects, which can overlap with the atypical psychotic symptoms at illness onset. Empiric treatment with psychopharmacology for psychotic and/or depressive symptoms should be pursued, although such medications may not be necessary indefinitely once definitive immunomodulation therapy is completed.4

ANMDARE should be on the differential for atypical psychosis, with an expectation of a thorough search for laboratory and systemic clinical (especially neurologic) findings, empiric treatment of psychiatric symptoms, and reassessment of the patient as immunomodulation therapy is completed. Prospective study of ANMDARE illness cohorts are needed to quantify recurrence risk, need for ongoing intervention, and ultimate prognosis.

Consultation-liaison psychiatrists working in academic medical centers may be in a position to assist multispecialty teams in the identification, diagnosis, management, and ongoing follow-up of these patients. As with any illness that affects cognitive function, attention to and serial assessment of decisional capacity is a critical part of C-L psychiatry care, especially as pertains to patient consent for major immunomodulation therapies.

Dr Bourgeois is chair, Department of Psychiatry, Baylor Scott & White Health, Central Texas Division, and clinical professor for medical education, Texas A&M University Health Science Center, Temple, TX. Mr Li is a medical student, Texas A&M University Health Science Center, Temple, TX. The authors report no conflicts of interest concerning the subject matter of this article.

References

1. Tuzun E, Zhou L, Baehring JM, et al. Evidence for antibody-mediated pathogenesis in anti-NMDAR encephalitis associated with ovarian teratoma. Acta Neuropathol. 2009;118:737-743.

2. Gresa-Arribas N, Titulaer MJ, Torrents A, et al. Antibody titres at diagnosis and during follow-up of anti-NMDA receptor encephalitis: a retrospective study. Lancet Neurol. 2014;13:167-177.

3. Kayser MS, Titulaer MJ, Gresa-Arribas N, Dalmau J. Frequency and characteristics of isolated psychiatric episodes in anti-N-methyl-d-aspartate receptor encephalitis. JAMA Neurol. 2013;70:1133-1139.

4. Warren N, OGorman C, McKeon G, et al. Psychiatric management of anti-NMDAR encephalitis: a cohort analysis. Psychol Med. November 19, 2019; Epub ahead of print.

5. Titulaer MJ, McCracken L, Gabilondo I, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol. 2013;12:157-165.

6. Nasreddine Z. Montreal Cognitive Assessment (MoCA) Administration and Scoring Instructions. Montreal Cognitive Assessment. Accessed July 9, 2020. http://www.mocatest.org/wp-content/uploads/2015/tests-instructions/MoCA-Instructions-English_2010.pdf .

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Anti-NMDA Receptor Encephalitis With Visual Hallucinations and Cognitive Impairment - Psychiatric Times

Single-center prospective study evaluated feasibility of bedside MR neuroimaging in the intensive care settings for 50 critically-ill patients with COVID-19, stroke, hemorrhage, traumatic brain injury and tumors.

A recent study published in the Journal of the American Medical Association Neurology demonstrates for the first time the feasibility of Hyperfines Swoop Portable MRI System to obtain bedside neuroimaging for critically-ill patients in the intensive care unit settings. Researchers tested the feasibility and demonstrated the clinical utility of the Swoop system in 50 patients, including COVID-19 patients, to assess brain injury and detect abnormalities. These patients were critically ill and presented challenges for transport to conventional MRI suites in the Radiology Department.

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Hyperfines Swoop Portable MRI System successfully detects abnormalities at bedside of critically-ill patients in intensive care unit settings. (Photo: Business Wire)

Results from the prospective, observational single-center study, Assessment of Brain Injury Using Portable, Low Field Magnetic Resonance Imaging at the Bedside of Critically Ill Patients, were published on September 8, 2020.

Investigators used the Swoop system from October 2019 through May 2020 and successfully detected abnormal neuroimaging findings at the bedside of patients presenting with ischemic stroke, hemorrhagic stroke, subarachnoid hemorrhage, traumatic brain injury, brain tumor and COVID-19 patients with altered mental status.

According to the studys senior author, Kevin N. Sheth, MD (Yale University School of Medicine, Department of Neurology), the use of traditional MRI units presents accessibility and transportation challenges in the care of critically-ill patients. Furthermore, the highly contagious nature of COVID-19 patients makes bedside MR imaging compelling for infection control protocols.

This study the first of its kind demonstrates that deployment of portable MR imaging to patients' bedsides could fill an important gap for time-sensitive neuroimaging, a cornerstone of triage and treatment pathways.

The study authors conclude, "This experience demonstrates that low-field, portable MRI can be deployed successfully into intensive care settings. This approach may hold promise for portable assessment of neurological injury in other scenarios, including the emergency department, mobile stroke units, and resource-limited environments."

Magnetic Resonance Imaging uses a magnetic field, radio waves and a computer to produce detailed pictures of the body's internal structures that are clearer, more detailed and more likely in some instances to identify and accurately characterize disease than other imaging methods. However, fixed MRI systems can be inconvenient and inaccessible for providers and patients, particularly when time is critical. Transport to the MR suite demands complicated scheduling coordination, moving patients, and, often, 4 to 6 hour patient backlogs all which compromise the utility of MRI as a diagnostic tool in time-sensitive settings such as intensive care units and emergency rooms. Furthermore, high capital investments, electrical power needs and significant maintenance requirements present a barrier to adoption across all populations, acutely so for developing countries and rural geographies.

Story continues

About the Swoop Portable MRI System

Hyperfines Swoop system was designed to address the limitations of current imaging technologies and make MRI accessible anytime, anywhere, to any patient. Swoop wheels directly to the patients bedside, plugs into a standard electrical wall outlet, and is controlled by a wireless tablet such as Apple iPad. Images are captured at the patients bedside, with results in minutes, enabling critical decision-making capabilities across a variety of clinical settings including neuro intensive care units, emergency departments, pediatrics, ambulatory outpatient surgery centers and more. The complete Hyperfine system costs less than the annual service contract alone for most current MRI systems, and it consumes 35 times less power than those same systems. Designed as a complementary system to traditional MRIs, new users can be trained on system operation, device navigation and device safety in about 30 minutes, helping clinicians to streamline workflow.

About Hyperfine Research

Hyperfine lives to make MR imaging available to everyone. The Swoop Portable MR Imaging System is the result of a total rethink of MRs potential in the healthcare landscape. What if MR imaging didnt require a dedicated suite, extensive training or expensive upkeep? Lets use the wonders of high-field MRI for the appropriate patients, and deploy Swoop system at the point-of-care for everyone else. Hyperfine received market-ready FDA clearance for its portable MR imaging for the brain and head of patients of all ages in August 2020. Hyperfine is part of 4Catalyzer, a health technology incubator with facilities in CT, NY, CA and Taiwan. http://www.hyperfine.io.

View source version on businesswire.com: https://www.businesswire.com/news/home/20200909005243/en/

Contacts

Chris Ward, cward@hyperfine.io, (203) 905-0412

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Study Published in JAMA Neurology Confirms Low-Field MR Imaging Using Hyperfines Swoop Portable MRI Successfully Detects Abnormalities at Bedside of...

The pathophysiology of pain in neuropathy is complex and may be linked to sensory phenotypes. Quantitative sensory testing, a standardized method to evaluate sensory profiles in response to defined stimuli, assesses functional integrity of small and large nerve fiber afferents and central somatosensory pathways. It has revealed detailed insights into mechanisms of neuropathy, yet, it remains unclear if pain directly affects sensory profiles. The main objective of this study was to investigate sensory profiles in patients with various neuropathic conditions, including polyneuropathy, mononeuropathy, and lesions to the central nervous system, in relation to self-reported presence or absence of pain and pain sensitivity using the Pain Sensitivity Questionnaire.A total of 443 patients (332 painful and 111 painless) and 112 healthy participants were investigated. Overall, loss of sensation was equally prevalent in patients with and without spontaneous pain. Pain thresholds were equally lowered in both patient groups, demonstrating that hyperalgesia and allodynia is just as present in patients not reporting any pain. Remarkably, this was similar for dynamic mechanical allodynia. Hypoalgesia was more pronounced in painful polyneuropathy whereas hyperalgesia was more frequent in painful mononeuropathy (compared to painless conditions). Self-reported pain sensitivity was significantly higher in painful than in painless neuropathic conditions.Our results reveal the presence of hyperalgesia and allodynia in patients with central and peripheral lesions of the somatosensory system not reporting spontaneous pain. This shows that symptoms and signs of hypersensitivity may not necessarily coincide, and that painful and painless neuropathic conditions may mechanistically blend into one another.

PubMed

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No pain, still gain (of function): the relation between sensory profiles and the presence or absence of self-reported pain in a large multicenter...

ALISO VIEJO, Calif.--(BUSINESS WIRE)--Global Genes and the Child Neurology Foundation, as part of the Rare Access to Critical Therapies (ACT) collaboration, announced today the joint release of a report highlighting and supporting guiding principles of rare disease care and access which the groups assert are universally relevant to all patients with rare diseases. This report is based on multi-stakeholder workshops and rare disease landscape and literature evaluations led by ACT, which involves leading patient, provider, research, and industry organizations.

ACT was founded in late 2018 based on evidence of significant unmet need and care variability in patients with rare diseases, to ensure the rare disease patient perspective was fully considered as part of broader public discussions and policy formation that could impact and improve patient access to needed therapies, immediately and in the future.

Certain gaps in access to rare disease care, trials and treatment have widened, and others have been exposed during COVID-19. At the same time, weve seen an advancement in the pace and productivity of treatment discovery and drug development in response to a public health crisis, which offers hope, and perhaps a model for rare diseases. These developments and others on the policy front make the release of the report all the more timely.

The report, entitled Guiding Principles of Rare Disease Care and Patient Access, characterizes five fundamental expectations for rare disease patient care that all health stakeholders should acknowledge and act upon. Key areas where progress has and has not been made toward achieving these Guiding Principles are highlighted, as are areas where challenges and/or additional work remains to achieve the intention of each Guiding Principle.

The aggregate impact of rare diseases is as significant as diseases considered national priorities, though individual patient impact is often more profound. As such, our approaches to achieving each Guiding Principle must consider the efficiencies of broader solutions, while not missing the variability of individual patient needs. This report shows that there remains much work to do to strike the right balance for rare disease patients, despite breakthrough areas of progress, said Eric Faulkner, vice president, precision and transformative medicine at Evidera and executive director of the Genomics, Biotech and Emerging Technology Institute of the National Association of Managed Care Physicians, who served as the lead author for this publication.

Global Genes has been dedicated to supporting rare disease patients and their families since its inception, collectively bringing forward the community as one, increasing the voice and influence of those impacted every day, said Nicole Boice, co-founder of RARE-X and visionary for this effort, on behalf of Global Genes. We believe the Guiding Principles outlined in this report are a meaningful step forward to ensure that the patient perspective is front and center and included in all decisions related to access to treatments and care.

The five Guiding Principles that the multi-stakeholder leadership group believes are the right of every rare disease patient include:

Of the 7,000 rare diseases identified, 50% of them have a neurologic component and of those, 75% originate in childhood, stated Amy Brin, executive director/CEO of the Child Neurology Foundation. This robust intersection between rare disease and the child neurology community has provided a foundational alignment for our organization to co-lead this initiative with Global Genes since 2018, and calls for patients to be seen and heard first within all conversations about access to critical therapies.

We hope readers find this manuscript to be enlightening in the clear identification of the core principles that are due all patients, while also highlighting key areas where stakeholders must come together to collectively address and solve for desperately needed care and access solutions, said Timothy M. Miller, vice president and global therapeutic area head, leader of the Rare Disease and Pediatrics Center of Excellence at Evidera/PPD and a co-author.

The full report, jointly presented by Global Genes and the Child Neurology Foundation, is available to download here: https://globalgenes.org/resources/guiding-principles-of-rare-disease-care-and-patient-access/.

About Global Genes

Global Genes is a 501(c)(3) nonprofit organization that connects, empowers, and inspires the rare disease community, with the ultimate goal of eliminating the burdens of rare disease for patients and families everywhere. We provide hope for the more than 400 million people affected by rare disease around the globe. We fulfill our mission by helping patients find and build communities, gain access to information and resources, connect to researchers, clinicians, industry, government and other stakeholders, share data and experiences, and stand up, stand out, and become effective advocates on their own behalf. If you or someone you love have a rare disease or are searching for a diagnosis, contact Global Genes at 949-248-RARE or visit the resource hub at http://www.Globalgenes.org.

About the Child Neurology Foundation

The Child Neurology Foundation serves as a collaborative center of education and support for children living with neurologic conditions and their families. We connect partners from all areas of the child neurology community so that those navigating the journey of disease diagnosis, management, and care have ongoing support from those dedicated to treatments and cures. Our expanding network of patients and caregivers, advocates, partners, researchers, and physicians is committed to helping one another along the path that leads to the best quality of care and the highest quality of life for every child. For more information, check out CNFs website!

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Patient Groups Issue Guidelines for Ensuring Access to Care and Treatment for Rare Disease Patients, Citing Critical Needs and Gaps Further Exposed...

TORONTO -- A growing number of so-called COVID-19 "long-haulers" who believe they had the disease before testing was widely available are complaining of new neurological symptoms including confusion, trouble concentrating and memory loss that persist weeks and even months after their initial sickness.

Ruth Castellanos says she has developed an unnerving tremor in her hands after a suspected COVID-19 infection in mid May

"I'm jolted out of sleep and I feel like my body just vibrates at night," Castellanos said in an interview with CTV News.

Castellanos, who lives in Troy, Ont., said she is no longer able to work as a college instructor as the tremors are just one of the troubling neurological symptoms she suffers from.

Once fit and healthy, Castellanos now describes days where she is confused and has trouble reading.

"I have been experiencing a lot of brain fog and this is what happens I sometimes stutter. I lose my train of thought. I get confused reading. Even simple instructions becomes hard and frustrating. I have to re-read things," Castellanos said.

She says doctors don't know what is causing her neurological symptoms or how to help her.

"Not only am I scared of the unknown, but I'm scared now of what my symptoms are, and there's a lot of confusion inside of me," Castellanos said.

She fears the brain fog and tremors may become her "new normal."

"It's has been very debilitating, and it has been very trying on myself as a person, let alone on my body," Castellanos said.

But Canadian long-hauler patients like Suzie Golding say getting recognition or help from doctors has been difficult.

The Oakville, Ont. resident said contracting the coronavirus has been "a life-altering experience" for her. She says she has been plagued with short-term memory deficits, brain fog and fatigue since developing what appeared to be COVID-19 in March. She is unable to work as a floral designer and the single mom is doing her best to raise her son while battling her illness.

"I'm really just living my life at a very basic level, trying to get through each day with great difficulty," Goulding said. "It's terrible."

In hopes of providing some relief to other long-haulers like herself, Goulding started an online group called COVID Long Haulers Support Group Canada. The support group has over 2,800 members and the numbers are growing.

"A lot of people are having doctors that say to them 'This is just anxiety and we can't help you. There's nothing we can do. You're just anxious,' and really dismissing the fact that [this] is something that is happening," Goulding said.

The group is also asking the federal and provincial governments to provide more help for those who develop these disabling neurological symptoms.

"We need rehabilitation. We need COVID care clinics set up for us so that we don't have to wait in emergency wards for six to eight hours to be told that there's nothing that they can do for us," Goulding said.

In two labs in Ontario, Canadian researchers are focusing on this group of patients.

Dr. Adrian Owen, a cognitive neuroscience professor at Western University in London, Ont. suspects that the issue of COVID-19 long-haulers may be greater than initially thought.

"This is something that is ongoing. If these issues are long-term or permanent, we have a very, very large societal and economical problem on our hands," Owen said in an interview with CTV News.

To help address the issue, Owen is part of a team of Canadian neuroscientists who have launched the online COVID-19 Brain Study -- the world's largest project to consider the "direct and indirect effects of the disease on the brain."

The study, launched by Western University and the University of Toronto, provide online tests to 50,000 post-COVID patients worldwide over the course of a year in an attempt to measure their brain function.

Owen explained that the tests are more like online games that last about a minute and a half and assess brain functions including memory, concentration and problem-solving abilities.

"Look at all those pieces of information together and will be able to work out how COVID-19 is affecting cognitive function and whether it's affecting some people more than others," he said.

Owen hopes to have some results from the study early this fall to better understand the effects of COVID-19 on the brain and find ways to help those suffering from neurological symptoms.

In Hamilton, McMaster University scientist Dr. John Connolly is also looking at the impact the novel coronavirus can have on brain function.

"From preliminary research being published around the world, it appears the virus is capable of passing the blood-brain barrier, attacking the brain directly," wrote Connolly in an email to CTV News. He is chair of cognitive neuroscience of language at McMaster.

"This means that many of the complications from the illness, such as lung and other organ failure, may be due to brain dysfunction as opposed to the virus directly attacking these other organs."

Connolly's lab has partnered with McMaster neurotech start-up VoxNeuro and will use electroencephalogram-based (EEG) neuroimaging to assess brain function over time.

Connolly said patient enrollment in the study is expected to begin soon.

"As we specialize in cognitive health, and COVID has been proven to have lasting neurological consequences, we are able to quantify that, and provide data that differentiates between true cognitive decline and perceived decline due to symptoms caused by situational factors, such as stress, general fatigue or mood," Connolly said.

He added that the goal of this study is to better understand what types of patients are most vulnerable to neurological symptoms and which medical interventions are most effective for treatment.

Researchers will be able to draw conclusions from the study in a year but Connolly said they will likely start to see trends in the data within three to six months. However, if more long-haulers participate in the study, then results and possible treatments may come sooner.

"The more patients we can test and the faster we can test them, the faster we can get definitive answers to these questions," Connolly said.

While these symptoms may only affect a minority of COVID-19 patients, Connolly said that reliable neurocognitive assessment procedures will be essential in accurately gauging active and post-COVID patients' cognitive abilities, and in tracking their recovery.

"With the perspective that our world will not return to normal, and that instead we will be living in a post-COVID world from here on, we must understand what we're up against," Connolly said.

"Not just in the short term of mitigating death, but ensuring that life beyond COVID is healthy and meaningful for its survivors."

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'There's a lot of confusion inside of me': COVID-19 'long-haulers' suffering from neurological symptoms months later - CTV News

The Social Neurology Software Market which explains the future and present measurements of the market as for the patterns in play. The principle reason for the investigation is to legitimize the occurrences in the market by giving reader helpful and suitable bits of knowledge on the particulars of the market for the future extent of development and accessible prospects at the current situation with the market. The statistical surveying production additionally manages features, for example, drivers, restrictions, and prospects to measure the result of the market amid the conjecture time frame specified in the report.

Top Key Vendors: Epic,Brainlab,healthfusion,Athenahealth,Practice Fusion,Nextgen,Bizmatics,Greenway Health,Allscripts,Kareo,Advanced Data Systems,NueMD

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An analysis of the major trends in the global Social Neurology Software Market in the past years, which have significantly contributed in shaping the current state of the market, and the important trends of the current times is also included in the report, allowing the reader to formulate winning strategies. The data has been gathered with the help of a number of primary and secondary research methodologies and narrowed-down with the help of industry-best analytical methods.

Segmenting the global Social Neurology Software Market on several fronts, the research report examines the strengths and weaknesses of each category and sub-category in the operating environments. The report also analyses the impact of several internal and external forces such as consumer preferences, government regulations, laws and policies, technological developments, and economic environment for each segment.

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The regions North America, Global, Asia Pacific, Middle East & Africa and Latin America have been studied in depth to gain better market penetration and assure exact analysis. Top manufacturers have been given prime importance to make sure their strategies are understood and their position in this particular market can be elucidated.

The conclusions of this report illustrate the potential of the global Social Neurology Software Market in terms of investment potential in various segments of the market and illustrate the feasibility of explaining the feasibility of a new project to be successful in the near future. The core segmentation of the global market is based on product types, SMEs and large corporations. The report also collects data for each major player in the market based on current company profiles, gross margins, sales prices, sales revenue, sales volume, photos, product specifications and up-to-date contact information.

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Key Points Covered in TOC:

Global Social Neurology Software Market Research Report

Chapter 1 Global Social Neurology Software Market Overview

Chapter 2 Global Economic Impact on Industry

Chapter 3 Global Market Competition by Manufacturers

Chapter 4 Global Productions, Revenue (Value) by Region

Chapter 5 Global Supplies (Production), Consumption, Export, Import by Regions

Chapter 6 Global Productions, Revenue (Value), Price Trend by Type

Chapter 7 Global Market Analysis by Application

Chapter 8 Manufacturing Cost Analysis

Chapter 9 Industrial Chain, Sourcing Strategy and Downstream Buyers

Chapter 10 Marketing Strategy Analysis, Distributors/Traders

Chapter 11 Market Effect Factors Analysis

Chapter 12 Global Social Neurology Software Market Forecast.

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Social Neurology Software Market Research Methodology Focuses On Exploring Major Factors Influencing the Industry Development 2025 - Galus Australis

An in-home telemedicine model implemented at the Comprehensive Epilepsy Center of Childrens Mercy Kansas City showed high rates of satisfaction among advanced practice registered nurses (APRNs) and other clinicians, according to preliminary data presented by Erin Fecske, DNP, APRN, CNRN, CPNP-PC, FAES, at AES2020.1

The telehealth model was initiated in March 2020 in response to the coronavirus 19 disease (COVID-19) pandemic. At 3 months after implementation of the intervention, Dr Fecske and colleagues sent surveys to 36 clinicians at the epilepsy center to assess satisfaction with the model. A total of 24 providers responded, including 12 attending physicians, 11 advanced practice registered nurses (APRNs), and 1 resident physician.

Nearly all respondents (96%) said that in-home telehealth provided them with an adequate evaluation of patients with epilepsy. Of the 2901 patients with epilepsy seen via in-home telehealth visits within the 3-month period, 66 patients (2%) required an in-person visit within 2 weeks of the virtual visit.

Clinicians at the Comprehensive Epilepsy Center are using telehealth in various ways and settings for epilepsy visits. The first modality is in-home telehealth for new or follow-up visits, Dr Fecske said in an interview. These visits are unfacilitated, meaning that a clinician is not at the patient location to assist with the visit. Although in-home follow-up visits typically do not involve use of ancillary devices (eg, stethoscope, handheld camera), new patient visits conducted in-home are somewhat limited as they require camera use by families to allow for a visual examination.

The second modality is facilitated telehealth at an offsite location with telehealth-trained registered nurses and ancillary equipment assisting the patient, said Dr Fecske. These visits are utilized by new and follow-up patients as we would utilize a traditional clinic visit since the examination is not limited, she noted.

Alternatively, facilitated visits may occur at one of our regional primary care partners offices, Dr Fecske explained. The telemedicine visit [using Microsoft Teams] occurs in the patients primary care office. This facilitated visit includes a staff member from the primary care office, which we hope will improve engagement of the primary care provider in the care of patients with epilepsy.

In all of these modalities, we can engage with our consult services such as dietitians and social workers to provide the same support we would provide for a traditional in-person visit, Dr Fecske said. In situations where I would have a joint visit with an epileptologist [such as presurgical planning], the epileptologist can attend the telehealth appointment with the epilepsy APRN.

We have an APRN run a multidisciplinary ketogenic diet screening clinic that preCOVID required a 2+ hour in-person clinic visit from families, Dr Fecske said. With the use of telemedicine, we created videos for families to watch ahead of time and the actual time in clinic is reduced to about an hour during an in-home telemedicine visit. During that time we are able to have an occupational therapist, dietitian, social worker, chef educator, pharmacist, and epilepsy APRN meet with the family and complete appropriate assessments for ketogenic diet readiness.

Other members of the care team also can be added at the request of the patient, Dr Fecske said. Ive had children in group home settings, and we are able to include care team members as identified by the family, which has been very beneficial.

The decision to use telehealth over an in-person visit is at the discretion of the provider, who selects the modality when placing an order for follow-up. In-person visits may be preferred for infants or patients with epileptic spasms, Dr Fecske explained. Additionally, most new patients seen via in-home telehealth for their first visit will be seen in-person for their next visit to allow for a complete neurologic examination to be conducted, she said.

Before the COVID-19 pandemic, telehealth at the epilepsy center was limited to facilitated visits where patients presented to off-site locations and ancillary devices were required. At that time, only a small number of providers were credentialed for telemedicine, according to Dr Fecske.

With the original stay-at-home orders for our states we had to pivot to a more inclusive telemedicine model quickly, Dr Fecske explained. Now all of our neurology providers are credentialed to provide telemedicine. As we work to provide more in-person visits, we also are monitoring spacing in the clinic to ensure that we can follow Centers for Disease Control and Prevention recommendations. Therefore, weve continued to utilize our telemedicine offerings to ensure that patients continue to be seen regularly and monitored appropriately.

Technology limitations were one of the most commonly cited issues by the survey respondents. Families may not have a camera with a high enough resolution, may have poor internet connectivity or no internet access, or may have difficulties using video applications, Dr. Fecske noted. Additionally, while some caregivers may be able to assist in obtaining portions of the examination, other components such as reflexes are difficult to obtain.

Thus, although we may consider telemedicine a great way to improve access, we also need to consider how it can be another barrier to access for our patients and families, Dr Fecske said.

One of the biggest benefits of shifting to this telemedicine model is that it allowed us to continue to provide care to patients in a safe manner during an unusual situation, Dr Fecske said. I have patients that continue to request in-home visits as they feel that is the safest option for them at this time. In addition, epilepsy involves so much history taking that much of our visits are spent talking to families and patients and getting accurate descriptions, all of which we can accomplish during an in-home telemedicine model.

Additionally, telehealth for epilepsy may reduce the number of missed work hours for adult patients and parents as well as missed school time for children with epilepsy, Dr Feckse noted. She advised clinicians who practice telehealth for epilepsy visits to recognize what aspects of care they are and are not comfortable using the technology for.

If you need an in-person visit to get a better assessment, advocate for what you feel is going to be safest for your patient, Dr Feckse said.

1. Fecske E, Le Pichon JB, Wellman C, Waller M, Abdelmoity A. Transition to telemedicine: being nimble during COVID-19. Poster presented at: AES2020; December 4-8, 2020.

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In-Home Telehealth Model for Epilepsy Is Highly Rated by NPs and MDs - Clinical Advisor

Global Enteral Feeding Device Used for Neurology Market 2020 by Manufacturers, Type and Application, Forecast to 2025 released by MarketsandResearch.biz is the most important research for those who look for complete and authenticate information on the Enteral Feeding Device Used for Neurology market. The report compiles data on market size, market growth trends that will help its buyer to capture opportunities, to know and minimize probable risks, as well as to analyze the strategies of key companies in the market. The report offers a detailed assessment of the market to understand the current trend of the market and figure outs the expected market trend for the market for the forecast period from 2020 to 2025. Then, an in-depth competitive landscape, defined growth opportunities, market share coupled with product type and applications, key companies responsible for the production have been highlighted in the report.

Competitive Landscape:

The in-depth analysis of the industrial chain supporting the Enteral Feeding Device Used for Neurology market in the globe incorporates factual information about every aspect of the market such as information about manufacturers profiles, sales volume, price, gross margin, the contribution to the global industry in terms of revenue. The degree of competition among leading global companies has been elaborated by examining various leading key players operating across the global regions. The leading manufacturers have been analyzed by using research methodologies for getting insight views on global competition. The data related to each of the companies has been presented from historic years and is projected forecast period.

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In the global Enteral Feeding Device Used for Neurology market, the following companies are covered: Fresenius Kabi, Moog, Nestle, Danone, Abbott, Cardinal Health, Cook Medical, B. Braun, Avanos Medical, Applied Medical Technology, Alcor Scientific, Boston Scientific, BARD, Vygon, ConMed

On the basis of product types, the market report offers insight into major adoption trends for the following segments: , Enteral Feeding Pumps, Enteral Feeding Tubes, Consumables

Market segment by applications considering consumption growth rate and market share: , Hospitals, Home Care

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Global Enteral Feeding Device Used for Neurology Market 2020 Top Manufactures, Growth Opportunities and Investment Feasibility 2025 - The Daily...

Repeated remote ischemic post-conditioning (RIPC) combined with intravenous thrombolysis (IVT) can promote nerve function recovery and improve prognosis in patients with acute ischemic stroke, according to study results published in Neurology.

RIPC has recently been suggested for stroke treatment, and has been well tolerated and safe in patients when administered in a single episode following acute stroke. Study researchers sought to evaluate the impact of RIPC on patients with acute ischemic stroke undergoing IVT.

To achieve this, they conducted a single-center study which included patients with acute ischemic stroke who were receiving IVT at a hospital in China (ClinicalTrials.gov Identifier: NCT03218293). Patients were randomly assigned to an RIPC treatment group (n=34) or a non-RIPC control group (n=34).

The studys primary outcome was the percentage of patients with a favorable outcome (a score of 0 or 1 on the modified Rankin scale [mRS]) at 90 days. Each patient had received IVT within approximately 4.5 hours of symptom onset. The study researchers also assessed the safety and tolerability of RIPC and examined the neuroprotection biomarkers associated with this approach.

The mean duration of RIPC was 11.2 days (range, 8-14 days). At admission, there were no significant differences between the RIPC and control groups in terms of the National Institute of Health stroke scale score (6.5 vs 4.5, respectively; P =.364) or time to treatment (181.2 vs 179.2 minutes; P =.889).

A significantly greater proportion of patients in the RIPC arm experienced an excellent recovery at 3 months, defined as an mRS of 0 to 1, compared with the control group (71.9% vs 50.0%, respectively; adjusted risk ratio, 9.85; 95% CI, 1.54-63.16; P =.016). Compared to patients in the control group, those randomly assigned to RIPC also had lower plasma S100- (P =.007) and higher vascular endothelial growth factor (P =.003) levels.

Limitations of this study included its single-center design, the relatively small number of patients included, and the lack of assessment of infarct size and its relation to RIPC.

Ultimately, study researchers concluded that this novel treatment of combined IV tPA and RIPC mayimprove the prognosis of patients with AIS [acute ischemic stroke].

Reference

An JQ, Cheng YW, Guo YC, et al. Safety and efficacy of remote ischemic postconditioning after thrombolysis in patients with stroke. Published online October 7, 2020. Neurology. doi:10.1212/WNL.0000000000010884

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Remote Ischemic Post-Conditioning With IVT May Improve Acute Ischemic Stroke Recovery - Neurology Advisor

By: PTI | Kolkata | Updated: October 25, 2020 9:08:54 amSoumitra Chatterjee is undergoing treatment at a private hospital in Kolkata for the past 18 days after he tested COVID-19 positive. (Photo: Express archive)

Doctors are contemplating whether plasma therapy can be useful to improve the neurological condition of legendary actor Soumitra Chatterjee who is undergoing treatment at a private hospital in the city for past 18 days after he tested COVID-19 positive.

Dr Arindam Kar, who is leading the team of doctors in treating the veteran actor said in a statement on Friday evening, that the other organ functions like liver, kidney and heart conditions of Chatterjee are okay but he is barely arousable.

As he has responded briefly for steroids our neurology panel is contemplating whether plasma therapy can be useful and we are mulling future plan of action, Kar said.

The doctor said since Chatterjee has been in ICU for three weeks, it is always challenging to prevent secondary complications.

The present neurological condition of the octogenarian was due to Covid encephalopathy extended for a while, he said. It will be huge effort to get him out of this situation with other therapies for neurological complications. We hope he should recover, Kar said.

Also Read | Soumitra Chatterjees health a cause of concern, says doctor

The doctors are also administering anti-convulsants and stimulants to get him up and to rule out any auto immune disorder, post covid, he said.

The critically acclaimed actor, who has worked with renowned filmmakers like Satyajit Ray, Mrinal Sen, Tapan Sinha and Tarun Mazumdar, was admitted to the hospital on October 6 after he tested COVID-19 positive.

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Doctors contemplating plasma therapy to improve neurological condition of Soumitra Chatterjee - The Indian Express