EMBARGOED FOR RELEASE UNTIL 4 P.M. ET, WEDNESDAY, APRIL 20, 2022

MINNEAPOLIS Cardiovascular disease risk factors, like high blood pressure, diabetes, obesity and smoking, are believed to play key roles in the likelihood of developing cognitive decline, dementia, and Alzheimers disease. A new study suggests that people who accumulate these risk factors over time, at a faster pace, have an increased risk of developing Alzheimers disease dementia or vascular dementia, compared to people whose risk factors remain stable throughout life. The research is published in the April 20, 2022, online issue of Neurology, the medical journal of the American Academy of Neurology.

Our study suggests that having an accelerated risk of cardiovascular disease, quickly accumulating more risk factors like high blood pressure and obesity, is predictive of dementia risk and associated with the emergence of memory decline, said study author Bryn Farnsworth von Cederwald, PhD, of Ume University in Sweden. As a result, earlier interventions with people who have accelerated cardiovascular risks could be an effective way to help prevent further memory decline in the future.

The study looked at 1,244 people with an average age of 55 who were considered healthy in terms of cardiovascular health and memory skills at the start of the study. Participants were given memory tests, health examinations, and completed lifestyle questionnaires every five years for up to 25 years.

Of all participants, 78 people, or 6%, developed Alzheimers disease dementia during the study and 39 people, or 3%, developed dementia from vascular disease.

Cardiovascular disease risk was determined by using the Framingham Risk Score which predicts the 10-year risk of a cardiovascular event. It looks at factors including a persons age, sex, body mass index (BMI), blood pressure and whether they smoke or have diabetes. Participants started the study with an average 10-year risk between 17% and 23%.

Researchers determined who had an accelerated cardiovascular disease risk by comparing participants to the average progression of cardiovascular disease risk.

Researchers found that cardiovascular disease risk remained stable in 22% of participants, increased moderately over time in 60%, and rose at an accelerated pace in 18% of people.

People in the study with stable cardiovascular disease risk had an average 20% risk of a cardiovascular event over 10 years throughout the study, while those with a moderate increased risk went from 17% to 38% over the course of the study and those with an accelerated risk went from a 23% to 62% increased risk by the end of the study.

Researchers determined that when compared to people with a stable cardiovascular disease risk, people with an accelerated cardiovascular disease risk had a three to six times greater chance of developing Alzheimers disease dementia and a three to four times greater risk of developing vascular dementia. They also had up to a 1.4 times greater risk of memory decline in middle age.

Several risk factors were elevated in people with an accelerated risk, indicating that such acceleration may come from an accumulation of damage from a combination of risk factors over time, said Farnsworth von Cederwald. Therefore, it is important to determine and address all risk factors in each person, such as reducing high blood pressure, stopping smoking and lowering BMI, rather than just address individual risk factors in an effort to prevent or slow dementia.

A limitation of the study was the inability to determine whether the decline leading to dementia is initiated by an accelerated cardiovascular disease risk. Farnsworth von Cederwald said it cannot be ruled out that other factors may also contribute, so more research is needed.

The study was funded by the Swedish Brain Foundation, Knut and Alice Wallenberg Foundation, and Swedish Foundation for Humanities and Social Sciences.

Learn more about dementia at BrainandLife.org, home of the American Academy of Neurologys free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life on Facebook, Twitter and Instagram.

When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.

The American Academy of Neurology is the worlds largest association of neurologists and neuroscience professionals, with over 38,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimers disease, stroke, migraine, multiple sclerosis, concussion, Parkinsons disease and epilepsy.

For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

See the article here:
Faster accumulation of cardiovascular risk factors linked to increased dementia risk - EurekAlert

Robert K. Shin, MD: Actually, it's more than a quarter-century as I think about it, right? We're approaching 30 years3 decadesof having approved therapies for multiple sclerosis. And some of the medications that were approved in the early 1990s are still being used today, which is kind of amazing. However, I think that with some of the data that that's been presented now, we're doing more and more head-to-head studies with active comparators. I think we can say that certainly for patients with active MS, we can see that there's a difference. That some MS therapies are more effective than other therapies, I think we should just be honest about that. They're not all created equal. And it doesn't really matter whether we focus on relapse rate or MRI parameters, disability progression, or combining them together into a metric like No Evidence of Disease Activity, whether it's NEDA-3 or, if you incorporate other components, NEDA-4. For the first time, we can say, Oh, if I use drug X over drug Y, I'm going to have a greater chance of seeing no evidence of disease activity.

I think that MS might be not totally unique, but unlike in some other fields of medicine, we have not agreed upon a firstline therapy. We don't have a consensus that when somebody is diagnosed with MS, we should start with drug X, and then if that's not tolerated. That kind of thing, which is common in other disease spaces. We just haven't come to a consensus in this space. But I think that if we look at studies that we're seeing reported out today, and what I think you can really see is that we should be honest and say that there are therapies that are more effective than others, there are strategies that will be more likely to result in shutting down of the disease process than others. Again, in our field, we're still debating sort of the timing of that optimization of our strategy.

But I do think that maybe there's an increasing shift, a recognition, that with the advent of therapies with greater efficacy, at least that option exists. I think more and more people are looking at using them earlier in the disease course rather than waiting until disability is apparent. And so to me, this is a positive shift. One thing I think that's kind of changed even how we think about MS, in terms of its clinical course, is the different disease processes. Because I do think in the past, we really thought in a very binary way. We thought that people would present with a relapsing form of the disease, and you know, heaven forbid that you transition into phase 2, like a progressive form of the disease. As if there's sort of this wide gulf between the two. Hopefully, you would never cross over in that regard. As we've seen at AAN and other meetings, data using different biomarkers, whether it's optical coherence tomography, serum neurofilament light, other biological markers, volumetric MRI, other more investigational MRI markerswhat's the common theme? We're seeing that neurodegeneration occurs from the beginning of the disease process, if not probably before the patient's even aware or the providers are even aware of the diagnosis. I would say, rather than two different stages, we now see them almost as overlapping. We see that there is a progressive neurodegenerative component that is occurring, as best we can tell, probably from the beginning of the disease process that is punctuated by relapses.

My opinion of why we were, I guess, misled is because of the existence of reserve, right? The ability of a young healthy person to compensate for the early stage means that it created the illusion that everything was fine until reserve runs out, and then the progression is more obvious. So to me, this has been the biggest shift in our understanding of the disease process because what this means is that we are developing a heightened sensitivity to any signs of progression. In other words, rather than waiting until somebody suddenly needs to use a cane or walker, what's the focus? Everyone's interested in things like cognition and biomarkers and different things to recognize this component as early as possible, really setting the stage for theoretically, hopefully, another class of therapies that will be to be particularly helpful for that. So there's been this shift, I would say, in sort of our thinking about MS, which I find very exciting because I think this maybe bodes well for the future. But as we discussed earlier, there are still some important steps that are necessary before we'll know how to best address that.

Transcript edited for clarity.

Original post:
Progress in MS Therapeutic Development and Shifts in the Landscape - Neurology Live

Article In Brief

Neurology practices, hospitals, and academic institutions across the country are experiencing severe workflow disruptions as a result of hiring and recruitment challenges post-COVID-19.

Over the past 20 months, many sectors of the health care workforce have suffered extraordinary levels of stress and exhaustion due to the COVID-19 pandemic. This has resulted in massive departures of physicians, advanced practice providers (APPs), nurses1, technicians, medical assistants (MAs), research assistants, administrative assistants, and other employees.

According to a survey by Morning Consult, which polled 1,000 U.S. health care workers in early September, nearly one in five had quit their jobs during the pandemic, and one in five of those remaining had considered leaving. The exodus has placed downstream pressure on the remaining staff, who are often asked to bear an increased workload, creating a domino effect on the outflow of employees.

The causes for these departures are complex and multifactorial. They have been attributed to the effect of vaccine mandates on those unwilling to get vaccinated, illness related to COVID-19 or its sequelae, and severe burnout and other psychological consequences triggered by the pandemic. More broadly, COVID-19 has caused health care professionals to reevaluate what they find meaningful in life, to examine whether they feel sufficiently valued in their workplaces, and to consider alternative positions or even professions. Many ultimately end up leaving for higher pay and better opportunities.

As a result, neurology practices, hospitals, and academic institutions across the country are experiencing severe workflow disruptions. So ubiquitous is this crisis that one might ask who in our profession has not been impacted, rather than who has.

Neurology Today spoke to several neurologists and business administrators who provided examples of how the employment shortages have affected their departments and practices across the country.

Randolph W. Evans, MD, FAAN, a solo practitioner in Houston, who has practiced general neurology and headache medicine for the past 39 years was unable to find an MA after two left in April 2021. Prior to the pandemic, a listing in Indeed by his practice would have elicited a robust response of qualified assistants, but in April he received responses from 73 unqualified applicants, despite posting a two-year experience requirement. (Candidates included a canine coach, bus driver, waitress, sales associate, babysitter, school volunteer, housekeeper, security officer, music school coordinator, and a preschool teacher.)

Five people worked in the office for less than two weeks each and did not work out, said Dr. Evans, who tried to do the best he could by hiring nursing students who proved to be unreliable or left the position for better pay. Another new hire resigned due to the vaccine mandate and one person never showed up at all.

After I lost an MA due to illness and another due to a family relocation, it created big problems for me, but it was nothing compared to our regional hospitals, which have been very short-staffed and overwhelmed during waves of COVID over the last few months, he added.

Recruiting for nurses, APPs, and MAs is somewhat similar to the post-COVID housing marketa seller's marketwith owners receiving multiple offers that end up increasing the selling price, said Bryan Soronson, MPA, FACMPE, CRA, senior administrator in the department of neurology at the University of Maryland School of Medicine- in Baltimore, who has not previously witnessed such market forces in his 36 years of work in the department.

These job searchers are offered additional salary, benefits and other goodies, and usually take the highest offer.

Recently we had two vacancies for MAs; on two consecutive occasions, candidates accepted the position, gave notice, and two to three days before the start date contacted our clinic director stating that they decided to take another position that paid a higher salary, he said. We then went to a temporary agency that was supposed to send two new MAs but only one showed up, noting that the lack of consistent MA staffing is an ongoing challenge which is negatively impacting clinic operations and efficiency as well as patient satisfaction.

Many large medical systems are behind in providing competitive salaries and this is becoming an ongoing spiral, Soronson said. Once a market adjustment is made, other medical groups further increase their salaries, a treadmill that continues to be pushed faster.

There have been workplace shortages throughout the pandemic and our clinic and hospital, like many others, have been working very hard to cope, said neuromuscular specialist, Anne Louise Oaklander, MD, PhD, FAAN, director of the Massachusetts General Hospital Nerve Unit & Neuropathology Skin Biopsy Service in Boston, Massachusetts. But I hadn't expected to lose one of two histotechnologists in my neurodiagnostic skin biopsy lab with two weeks' notice, particularly with the workload becoming so heavy in 2021, explaining that the sudden resignation was a result of a hospital-wide vaccine mandate.

Clinical diagnostic labs still have specimens arriving even if the lab is short-staffed. My one remaining technologist has been working sometimes seven days a week and until midnight to try and catch up, Dr. Oaklander said. Clinical testing labs are disproportionately affected by loss of technologists as there isn't a pool of trained EEG, EMG, histotechnologists, and intra-operative monitoring techs looking for jobs..

Dr. Oaklander said the loss of their team members affected the remaining staff emotionally, herself included, because they worried about how departed staff members would support their families, given that mandated resignation makes employees ineligible for unemployment benefits.

We have not experienced this degree of personnel loss in any given year in my 14-year tenure, said Vinny Kaur, MPH, senior clinical department administrator in the department of Neurology at the Texas Tech University Health Sciences Center in El Paso. In Texas, no entity has allowed state-based institutions to mandate vaccines to date (although this may change on January 5) so we have not lost neurology personnel for this reason so far..

Kaur, who performed exit interviews on all departed staff, said, After a campus-wide restructuring in January 2021, a new centralized billing department lost more than half its billers and coders within ten months, including five of six neurology personnel.

One chose retirement, another with childcare issues decided to be a stay-at-home mother, and three changed their line of work and transferred to other departments. The clinic structure was also reorganized leading to the departures of a manager who decided to pursue an RN degree and a cashier and authorization personnel who left for jobs in the community. (MAs also left due to a variety of reasons.)

We used a combination of strategies to fill the positions, including utilizing interns and temporary agencies, outsourcing coding and billing, and turning to internal hires and promotions, said Kaur. But we experienced no shows for interviews and also ended up reopening positions for a long period of time, since we did not have a robust pool of candidates applying.

While staff had a multitude of other reasons for leaving, Kaur explained that the duration of unfilled positions has been compounded by a very lengthy hiring process at her institution.

The range of staff issues, which have impacted clinic operations, has included burnout due to overtime requirements, human error due to fatigue, and a pervasive inability to catch up with daily operations, she noted. In addition to permanent staff loss, the department of neurology has been struck by temporary staff losses due to FMLA [Family and Medical Leave Act] issues and illnesses, which has made this an extraordinarily challenging time. This unfortunately has hampered the provision of effective service to our patients.

The scientific community has been hard hit over the past year due to serial obstacles serving as impediments to research which could cripple science for some time to come. A perfect storm of adversities has ensued from the pandemic, including the loss of clinical coordinators and related personnel, supply chain shortages, and barriers to patient enrollment, including prolonged travel fears and telemedicine regulatory roadblocks.

Neuro-oncologist Maciej M. Mrugala, MD, PhD, MPH, FAAN, professor of medicine and director of the Comprehensive Neuro-Oncology Program at Mayo Clinic in Phoenix, has been witnessing difficulties with retention of research coordinators. It's hard to provide exact numbers, but we have been plagued by high turnover rate with departures from the clinical research core, he said.

He suspects that many left for better opportunities within the institution or elsewhere, with improved work schedule and/or pay. I think most feel overworked and underappreciated, he said. This is a high-stress work environment that calls for excellent navigation skills and an ability to multitask and meet tight deadlines.

The departures have impacted day-to-day operations with periodic halts in enrollment into trials due short staffing. This is concerning, particularly in my field, neuro-oncology, where clinical trials are a vital part of treatment strategy, and patients don't have time to wait as prognosis is poor and disease progresses rapidly, he explained. Situations like this can lead to potential problems providing appropriate follow up of study patients and may threaten protocol compliance and data integrity.

Dr. Mrugala pointed out that this is a nationwide problem. Clinical research specialists/coordinators are vital parts of the team and scientific progress can't be achieved without their involvement, he said. They must be recognized for their work and treated and compensated appropriately, so that their retention will improve.

To compound the dearth of research assistants, the pandemic has led to a loss of study patients who are averse to travel. Until now telemedicine filled the gap, said Bruce Cohen, MD, FAAN, director of the NeuroDevelopmental Science Center at Akron Children's Hospital in Ohio. But as states rescind the waiver for telemedicine licenses, it may no longer be legal for us to practice medicine across state lines without obtaining a license in that state, Dr. Cohen explained.

We went from a time prior to COVID-19 when patients got on a plane at the expense of a pharmaceutical sponsor to take part in a clinical trial to a pandemic when we learned how to conduct research safely by telehealth with the assistance of their local doctors, laboratories, and visiting nurses, he said. And although we have patients who are still reluctant to travel, state license waivers are being rescinded removing telemedicine as a viable alternative option.

Patients will be difficult to recruit for new trials if they continue to avoid getting on planes, he said, adding that this may slow development of new therapies for some time to come.

The worst-case scenario for patients currently enrolled in trials is that they will not be able to receive the drug/device and lose the opportunity entirely. To avoid that we are scurrying around trying to identify accredited visiting nurses in their communities who are research-qualified to assist us, Dr. Cohen said. Furthermore, if we are unable to complete trials, industry stands to lose years of work and millions of dollars of their investment, an especially dire situation for smaller pharma companies who may not be able to recover and for new treatments for serious illnesses.

Finally, supply chain shortage has impacted not only consumer household goods but laboratory supplies. Research labs across the country are running low on plastic lab materials such as gloves, pipette tips, reagents, centrifuge tubes and other essential items for which they are waiting longer and paying more. Several neuroscientists cited shortages in cryotubes, commonly used for cryogenic storage of biological materials using liquid nitrogen, including the preservation of serum, blood, and cells.

This six-month long shortage is impeding an NIH-sponsored multi-institutional trial at our institution, said Dr. Cohen. Two patients this week who wanted to participate in the trial were turned away due to shortages of these containers.

Justin T. Jordan, MD, MPH, who serves as clinical director of the MGH Pappas Center for Neuro-Oncology and director of the MGH Family Center for Neurofibromatosis (NF) in Boston, said that his current administrative assistant is pulled in more directions than ever, working with more physicians and doing additional non-secretarial work to support hospital and patient needs. Indeed, she is the fourth secretary he has had this past two years due to multiple departures.

During the pandemic, telemedicine opened a unique door to see NF patients during virtual visits, he said. But now that state license waivers have been rescinded, that door has been closed again.

This regulatory roadblock acutely affects people with rare diseases, who typically must travel a significant distance for care, he explained, having studied aggregate data on patient access to care reported by patients and specialty NF clinics between 2008 and 2015.

He found that geographic access to care is particularly limited for adults, patients with rarer conditions, and patients in the Western U.S.2

Dr. Jordan is currently applying for a license in New Hampshire so that he may continue to care for patients who reside there. The process has been laborious and disruptive and even with the available secretarial assistance he has, there were many things only he could do.

For example, I had to go out to get ink fingerprinted this week, he said. The administrative burden of completing an application for a new license is so high that it leaves me with little desire to accumulate licenses from other states, he said.

Neurology Today reached out to Paul B. Ginsburg, PhD, professor of health policy at the Sol Price School of Public Policy at the University of Southern California in Los Angeles, California, who also serves as vice chair of the Medicare Payment Advisory Commission, to understand what is happening to the labor market and to ask how long the current workforce departures may last.

Dr. Ginsburg, who has spent his career studying changes in the financing and delivery of health care and the evolution of health care markets is particularly intrigued by a behavioral economics explanation for the workforce resignations, particularly those in low-wage jobs.

It suggests that that the pandemic caused many employees, typically comfortable with the status quo, to look into alternative positions, he explained.

This gets reinforced when they see others changing jobs to get higher pay and possibly more satisfying work, he added.

People often have little information about employment alternatives, but the pandemic motivated them to look more, he said. The pandemic has also caused people to do serious rethinking about where they are in their lives, often triggering a move to make a change.

Dr. Ginsburg expects that as COVID-19 gets under control and the infection rates go down, some of the precipitants of departures will recede as people get used to a new status quo. A winding down of the pandemic will also allow more individuals to work; for example, when more children get vaccinated and schools are open more consistently, some parents will be able to return to work.

Medical facilities are responding to labor shortages by reducing services delivered and likely some will affect patient health, while others will not.

It is said that about a third of medical care does not produce value, so with pressure to do less due to workforce constraints, wasteful services may be abandoned, Dr. Ginsburg explained. Over time, this will lead to even faster consolidation in health care delivery.

Many economists believe that much of the economy-wide inflation is temporarycaused by large shifts in spending away from services towards goods.

People are already starting to shift back; they are rejoining gyms and acquiring less home exercise equipment, said Dr. Ginsburg.

But the higher wages that came from greater willingness of workers to look at alternatives will stay with usand this may be a good thing, he concluded.

Excerpt from:
The Great Resignation: The Workforce Exodus Hits Neurology... : Neurology Today - LWW Journals

For a retrospective cohort study, researchers wanted to determine if there was a link between early decompressive surgery and the influence of transport time on traumatic spinal cord injury (tSCI) patients neurological outcomes. tSCI was a life-changing incident leaves a person permanently unable or unable to function. There was a lot of debate over when the best time is for surgical decompression in tSCI patients. The goal of the research was to compare the neurological results of tSCI patients who had early vs. late surgical decompression and the effect of transit time on neurological outcomes. A total of 84 patients with tSCI who required surgical decompression were studied. Time to decompression classification cutoffs was determined using regression analysis. The following subgroups of patients were identified: As a percentage of total or admitting hospital time to decompression, 0 to 12 or greater than 12 hours. It was discovered how the American Spinal Injury Association Impairment (AIS) Grade changed from admission to discharge. In addition, the influence of transport duration on AIS grade conversion was evaluated, with patients being divided into 2 groups: those who travelled for less than 6 hours and those who travelled for more than 6 hours. Confounding factors such as age, injury severity, and AIS grade had no significant differences (P>0.05) among the time to decompression subgroups. Patients who got decompression within 0 to 12 hours had considerably (P<0.0001) better average ASIA grade improvements (0.76). Patient transport periods of fewer than 6 hours were linked to a significantly larger conversion of AIS grade to less impaired states (P=0.004). According to the findings, decompression within 12 hours and short transport periods (<6 hours) are linked to significant improvements in neurological outcomes.

Link:journals.lww.com/spinejournal/Abstract/2022/01010/Early_Decompression_and_Short_Transport_Time_After.10.aspx

Go here to see the original:
Longer Decompression Time and Early Transport Time After Spinal Cord Injury Are Linked to Higher Impairment... - Physician's Weekly

Article In Brief

Neurology residency directors reflect back on the way training has shifted in the last 20 yearsfrom training and work limits for residents to new models for assessing skills.

With the understanding of a host of neurologic diseases growing at an impressive pace, neurology residency programs have plenty of new discoveries and topics to consider.

Just 20 years ago, stroke care was in its infancy and neurologists were only starting to experience the potential of tissue plasminogen activator (tPA) to limit the devastating effects of acute stroke. Now with the introduction of mechanical thrombectomy, stroke care has evolved even more, as have therapies for everything from multiple sclerosis (MS) to epilepsy.

It used to be that residency programs could teach residents the field of neurologythis is what's out there and this is what you should know is comingbut now that's impossible, said Shannon M. Kilgore, MD, FAAN, who serves as the site director of the Stanford University neurology residency program. The depth and breadth of neurology is so big at this point that there is no way to cover everything.

Exposing residents to a spectrum of neurologic diseases and degrees of illness remains at the heart of clinical rotations in neurology training, Dr. Kilgore said, but there also is a shift toward the goal of creating learners, life-long learners. It's about teaching trainees how to access information, how to recognize when they don't know something and seek out information from someone else or another resource.

Other key changes in neurology training in recent years include limitations on how many hours residents can work each week (80 is the magic number); the use of milestones to track residents' advancement through levels of mastering skill sets (such as diagnosis and management of neurologic emergencies); and more attention to broader societal issues such as diversity, inclusion, cultural awareness, inherent bias, and health care access and inequities.

A lot has changed and a lot has not changed, said Ralph Jzefowicz, MD, FAAN, who at the end of this year will step down after 25 years as program director of the neurology residency program at the University of Rochester School of Medicine and Dentistry.

On the change side, Dr. Jzefowicz said neurology is shedding its image of being a kind of laid-back specialty where there isn't much for practitioners to do besides making diagnoses and managing symptoms as best they can. When he began training residents, stroke was not considered a medical emergency, and largely involved admitting a patient to the hospital, providing physical and occupational therapy, and transferring the patient to a rehabilitation facility or a nursing home depending upon the severity of the neurologic deficit.

Dr. Jzefowicz, professor of neurology and medicine, said, What hasn't changed is the aim to turn out residents who are physicians foremost with the knowledge to care for patients with neurologic disorders, outstanding teachers, as well as leaders who are kind, compassionate, and have humanistic skills.

Pierre Fayad, MD, FAAN, FAHA, who served as neurology residency program director for more than 12 years at the University of Nebraska Medical Center and is currently a member of the neurology residency review committee for the American Council for Graduate Medical Education (ACGME), said, The key shift in neurology training, as in other specialties, has been to move away from a very structured, prescriptive approachthe prescriptive do these rotations, cover these core subjects toward assessing a training experience focused on clinical competencies and milestone achievement.

There are various milestones for what we feel are important things for a neurology resident to achieve in training, said Dr. Fayad, professor of neurological sciences and chief of vascular neurology and the stroke division of the University of Nebraska Medical Center. Assessing residents using 27 milestones, which began in 2013 and was updated this year, gives us a much bigger and better picture of the progress of residents, he said.

The 27 milestones, grouped under six major domains of physician competency, are each rated from 1 (novice) to 5 (expert). For instance, in a milestone for Interpretation of Neuroimaging, residents advance from Level 1 (identifies basic neuroanatomy on brain and vascular anatomy of the head and MRI and CT) to Level 5 (interprets advanced neuroimaging).

The specialty of neurology has grown tremendously because of the massive expansion in knowledge and therapeutics that led to subspecialization within neurology to carry forward the science and clinical practice, said Dr. Fayad, who noted there are now 10 ACGME-approved neurology subspecialties and many others that are not yet approved by the ACGME.

A big challenge for the neurology residency is parceling out the knowledge from each of the subspecialties and integrating them to a general neurologist's need, he said. An example is incorporating some of the critical content and practice from endovascular surgical neuroradiology into the neurology residency. Other subspecialties with such challenges include MS and neuro-oncology, which require a significant knowledge and comfort with managing immune therapies, or movement disorders and epilepsy, which are heavy in surgical therapies, procedures, and pharmacotherapies.

He said telehealth, which became quite common in neurology during the early months of the pandemic, will eventually need to be officially incorporated into neurology residency training.

Dr. Fayad said residency directors have a lot of balls to juggle: They need to consider the professional interests and goals of individual residents, the on-call demands of a given servicevascular and endovascular neurology require availability 24 hours a day on an urgent basiswhile other specialties do not have such needs, the impact of urgent calls on residents' well-being, and compliance to the 80-hour work requirement.

Carlo S. Tornatore, MD, professor and chair of neurology at Georgetown University Medical Center, was residency director from 1998 to 2015. He believes the decision to limit residents' hours has led to mostly positive results, though he said there needs to be extra attention on good communication when handing a patient off from one doctor to the next. The adoption of electronic medical records helps.

There is no question that work hours are more humane and respectful of our learners, and the whole purpose of residency is to learn, he said.

Dr. Tornatore said that with advances in stroke care, spending time on stroke service is all the more critical for residents, but he said inpatient, acute-care experience shouldn't be emphasized at the expense of outpatient services because that is where most neurologic care is delivered.

Our goal is to train somebody who is highly competent as a general neurologist and who can easily pass the boards, he said, though most residents do go on to specialty training.

I think a general trend (in training) has been to have residents spend more time in the outpatient setting, he said, which helps connect residents with the everyday practice of neurology and the dynamics outside the walls of the hospital.

Dr. Tornatore, who specializes in MS, said the COVID-19 pandemic brought front and center to his residents the pressing issue of health disparities and inequities in health care access in low income and minority communities.

What we learned during the pandemic is that lack of access to care and the incredible inequities in care absolutely had an impact on patients' risk of developing COVID-19 or being hospitalized and dying from COVID, he said. He said part of medical education and training has to focus on what doctors can do within their institutions and communities to address health inequities and disparities, including being cognizant of the inherent biases they may bring into patient encounters.

It's getting at the idea that when you see a person don't immediately jump to the conclusion, I know this person and what they are about, he said.

He said Georgetown University Medical Center has undertaken multiple initiatives to address issues of diversity, inclusion, and equity, including the establishment of the Racial Justice Committee for Change, which consists of attending staff, fellows, residents, medical students, patients, and staff. Dr. Tornatore said the committee has been tasked to make tangible and meaningful changes over the next year to address diversity, inclusion, and equity concerns.

Wendy Peltier, MD, associate professor of neurology and medicine at the Medical College of Wisconsin, said she wonders whether the holistic side of being a doctor is being shortchanged amid the need to teach all sorts of new developments in neurology while still keeping training hours in check.

I think it is important for medicine as a whole to have a broader approach for doctors in training, to focus on not just what they learn but how they grow as humans, she said.

Dr. Peltier, who was neurology residency director for a decade and now specializes in palliative care, said she's not advocating a return to the days when she once worked 100 days in a row as an intern during the HIV/AIDS epidemic, but said today's trainees may be perhaps missing a little of that lived and shared experience with a patient.

I can look back and say my (training) experiences brought me so close to patients and families and made me the doctor I am today, she said. The joy I got from the patientdoctor relationship empowered me to stay active in neurology.

Dr. Peltier said that one trend in neurologic care that she finds particularly exciting is the growth in using multidisciplinary care teams in field such as amyotrophic lateral sclerosis, MS and memory care, so there needs to be an emphasis on residents learning how to be a leader of a team.

Stanford's Dr. Kilgore, who has served on the ACGME's Review Committee for Neurology, said neurology training of the future needs to be organized in such a way to help address the unmet need for neurologists in many communities, including rural America, which contributes to inequities in care.

Training is inherently tied to hospital care [due to Medicare funding of GME], but we have historically woefully undertrained in the outpatient clinics, she said. Residents are really uncomfortable going into practice where they are going to see patients mostly in a clinic because that's not what they've been doing for four years.

Read the original:
20 Years Later, Neurology Training Transitions with New... : Neurology Today - LWW Journals

The chronic and short-term complications of coronavirus have remained in sharp focus throughout the pandemic. But as research advances, its becoming increasingly apparent that certain patients find their brains continue to bear out the scars of their COVID-19 battles. Data released last year raised the alarm over the cases of three young COVID-19 patients who developed Parkinson's within weeks of contracting the virus. An expert has now warned that many more could be at the perils of the neurodegenerative condition in the coming years.

Kevin Barnham from Florey Institute of Neuroscience and Mental Health warned that a wave of neurological illness is set to follow the pandemic.

Parkinsons disease is a complex illness, but one of the causes is inflammation, and the virus helps to drive that inflammation," explained Miss Barnham.

Once the inflammation gets into the brain, it starts a cascade of events which can ultimately lead to Parkinsons disease.

Evidence is already suggesting the triggers for Parkinsons disease are there with this virus. I believe the risk is real.

READ MORE: Parkinson's: Exactly how much water you should drink to avoid Parkinson's symptoms

We cant put a number on it, but with 30 million people worldwide affected by this virus, even a small shift in the risk of getting Parkinsons would lead to many more people getting diagnosed.

We know COVID-19 has short-term effects, but we are releasing more about the potential long-term effects.

Data published in November of 2020 were the first to raise the alarm over potential neurological implications of infection with COVID-19.

The data drew on three separate case reports on relatively young COVID-19 patients who developed Parkinsons within two to five weeks of contracting the disease.

DONT MISS:

The lead author of the article, Patrik Brundin, warned at the time: If this link is real, we might be in for an epidemic of Parkinsons disease in the future."

The three patients, aged 35, 45 and 58-years-old respectively, all incurred a severe respiratory infection from Covid, which led to their hospitalisation.

Brain imaging later revealed classic signs of Parkinsons disease in all three patients.

These cases of acute Parkinsons in patients with COVID-19 are truly remarkable," noted Mr Brundin.

They occurred in relatively young people - much younger than the average age of developing Parkinsons - and none had a family history of early signs of Parkinsons prodrome. That is quite a stunning observation.

Parkinsons is normally a very slowly developing disease, but in these cases, something happened quickly.

The doctor suggested the virus might make patients susceptible to Parkinsons by plaguing them with neurological symptoms after infection.

These typically include brain fog and depressions, which are consistent with damage to the brain and could lead to Parkinsons.

Parkinson's disease is characterised by a gradual shortfall of dopamine in the brain, the hormone responsible for movement in the body.

This causes problems with body movement, including involuntary tremors and rigidity, both of which can severely compromise quality of life.

In light of the alarming findings, researchers have suggested patients undergo early tests to pick up symptoms.

Parkinsons patients can experience loss of smell up to a decade before the onset of symptoms, so a smell-test screening could open up the window opportunity for early medical intervention, explained doctor Lyndsea Collins-Praino, Head of cognition ageing laboratory at the University of Adelaide.

Doctor Collins-Praino, added: The earlier we can detect [the damage] the better our chances of really effective and meaningful therapeutics for individuals.

Read the rest here:
Experts stark warning over wave of neurological illness to follow Covid infections - Express

When Luc LeBlanc received a phone call from his family doctor in March 2021 telling him he had a neurological illness and it was terminal his world crumbled.

"I knew I had something wrong cognitively," said LeBlanc, 41, of Dieppe, N.B. "I was falling, I was having multiple episodes of passing out and cracked three ribs. I reached out to my family doctor to say, 'We need to push neurologists any way possible because I can't live like this.' "

LeBlancbecame part of a cluster of 48 New Brunswick residents diagnosed with a neurological condition of unknown cause, a medical enigma dubbed a "mystery illness."

He kept pushing, however, for a second opinion and last week travelled to Toronto for an appointment at the University Health Network's Krembil Brain Institute.

After about 16 hours of assessments over three days with neurologists and neuropsychologists, he had some answers.

"The good news for Luc is that we can say that he doesn't have this rapidly progressive neurodegenerative disease," said Dr. Lorraine Kalia, a neurologist and scientist specializing in Parkinson's disease and movement-related disorders.

WATCH| A patientdescribes his symptoms:

Kalia is quick to caution that "all we can speak to is Luc," noting he is the only person from those in the cluster whom they've assessed. There's no doubt LeBlanc has a lot of neurological difficulties, she said, but they are likely related to a concussion he suffered in 2018, as well as anxiety he has been dealing with throughout his life.

While last week's diagnosis gave LeBlanc some understanding of his own condition, questions remain about whether the cluster actually exists.

Those questions also come as concerns heighten inside and outside the provincial government over longstanding shortcomings many see in New Brunswick's health-care system.

"We need more recruitment. We need better retention of physicians, but we also need the dollars put in place to enhance the health-care system," said Mark MacMillan, president of the New Brunswick Medical Society, the professional association for doctors in the province.

"Access could certainly be improved. Wait times are too long for many appointments that need to be seen by a specialist, but that's not just a problem in New Brunswick," he said, noting it's a problem across Canada that needs to be addressed by increasing health transfer dollars from the federal government to the provinces.

From late 2019 onward, LeBlanc and 47 other New Brunswick residents were identified as being part of a cluster of patients with a "progressive neurological syndrome of unknown etiology." That cluster was first identified by Moncton neurologistDr. Alier Marrero. The people range in age from 18 to 85. They are men and women, with the majority living in Moncton.Others arein the Acadian Peninsula and on the north shore, close to the Quebec border.

The first case was retroactively discovered by Marreroin 2015. By 2019, there were 11 cases displaying similar symptoms. By the following year, the count doubled to 24. By June 2021, 48 people were identified, the vast majority by Marrero. Six of the cluster had died.

In March 2021, news of the cluster made headlines after a memo from the province's chief medical officer of health to physicians and other health-care professionals was leaked to the media.

"If you have patients who you feel may meet the case definition for this novel neurological syndrome, please send a clinical referral to Dr. Alier Marrero at the Mind Clinic," the memo said. The clinic is run out of The Moncton Hospital.

The symptoms were similar to Creutzfeld-Jacob disease (CJD), a rare and fatal brain wasting disorder, and included visual hallucinations, muscle twitching and aggression.

An interim reportreleased last week by the New Brunswick government revealed the number of deaths had risen from six to nine and that there were no known factors such as food, place of home or work that could be linked between the cases.

Autopsies for those who died revealed findings including Alzheimer's, Lewy body dementia and cancer, and, according to Health Minister Dorothy Shephard, represent a group of "misclassified diagnoses."

Shephard told The Fifth Estateprovincial health officials reporting that there was an unknown neurological illness "was really a little premature." In her opinion, she said, she does not believe there is a cluster.

More clinical review is necessary, she said, and another report will be released in January.

As LeBlanc watched Shephard speaking last week, he said the province needs to be open-minded to a new disease.

"They don't want to create panic, but they create panic."

At the centre of the unknown illness is Marrero, a neurologist in Moncton. Born in Cuba, he received a medical degree from Universidad Nacional Pedro Henrquez Urea in the Dominican Republic in 2000. He completed his residency in neurology at Laval University in Quebec in 2010.

That same year, Marrero moved to Moncton, where he helped identify the province as having some of the highest rates of multiple sclerosis in Canada. Marrero had concerns about how New Brunswick was relatively underserviced in terms of MS research and the difficulty sufferers had in gaining access to care.

His work led him to cross paths with scientists at the Creutzfeldt-Jakob Disease Surveillance System an arm of the Public Health Agency of Canada. With their input, dating back to 2019, he began developing a case definition for a "progressive neurological syndrome of unknown etiology" theunknown illness he was diagnosing in patients.

While Marrero accepts he could be wrong, he says he is convinced there is a cluster and that the diagnoses from the autopsy findings should not rule that out.

Watch |N.B. neurologist wants patients to feel hopeful:

"Complex problems don't have easy solutions," he said in an interview with The Fifth Estate. "I am confident we will find the cause and we will find a way of dealing with it, hopefully a treatment, hopefully a way of avoiding it."

Jill Beatty, who was told her father was part of the cluster, describes Marrero as an empathetic and calm presence in their storm. Her trust in Marrero has not wavered.

"We were so scared, and we had no idea what we were dealing with."

Marrero has diagnosed 48 people, but said he is treating more than 100 patients with symptoms at the Moncton clinic.

"As a physician, I try to open to them a door of hope that is meaningful hope. And as a scientist, I'm interested in discovering what is causing this problem."

Like many people in the cluster, LeBlanc has had difficulty navigating the health-care system.

Three years ago, he was in a car accident and suffered a concussion. He began experiencing mobility and balance issues, muscle spasms and brain fog. His world spiralled downwards, and he hasn't worked since. He had to wait two years to see a neurologist.

"I think that demonstrates a lack of access to neurology that we all experience across the country," Kalia said after LeBlanc's assessment in Toronto.

As part of LeBlanc's earlier treatment, he did physiotherapy for at least seven months, but saw no improvement. A visit to his physician landed him in Nova Scotia to see an eye doctor specializing in head trauma. He was given prism glasses and told to go to a specialized physiotherapy facility in Amherst, N.S.He had one appointment and then COVID-19 hit. His remaining appointments were virtual.

"It just wasn't the same."

In interviews with The Fifth Estate, several people within the cluster and those who wonder if they have the unknown syndromedescribe long waits to see specialists. Often, they feel they are dismissed by practitioners and left with nowhere to turn.

A discussion paper released by the New Brunswick government earlier this year outlines a need for better patient-centred care, including shorter wait times for surgery and faster access to appointments.

The report said while 90 per cent of New Brunswickers have a family doctor, only 55 per cent are able to get an appointment within five days.

As his cognition declined, LeBlanc said he couldn't get a clear diagnosis or a practitioner who had the time to "look at the full picture. Somebody dropped the ball somewhere."

LeBlanc met Marrero in January 2021, and by mid-March he was told he was part of the cluster.He started making end-of-life plans: extra life insurance, care for his children and lookingfor a coffin.But one thing stood out to him: he was not physically declining like others in the cluster.

He had reached out to one of the youngest, Gabrielle Cormier, 20, and could see the intensity of symptoms was different. He could drive and dress himself. His memory wasn't too bad. He could go to the gym and lift light weights.

Meanwhile, Cormier, of Dalhousie Junction, once an avid skater with dreams of becoming a pathologist, was walking with a cane and sometimes relying on a wheelchair.

The difference between his symptoms and Cormier's, coupled with his family's doubt, left him uncertain. LeBlanc asked Marrero why he was a "confirmed case."

"It's kind of hard when, you know, a lot of people are saying it's all in your head, but is it?"

When asked by Radio-Canada's Enqute about LeBlanc's case, Marrero said he could not comment.

While LeBlanc had his doubts about being part of the cluster, some neurologists, including Dr. Valerie Sim, believe a detailed review of cases of those identified with the unknown neurological illnessis paramount.

"My goal in raising skepticism is simply to balance the discussion," said Sim, a professor of neurology in the Centre for Prions and Protein Folding Disease at the University of Alberta. She said an open mind must be kept to the possibility that there isn't a syndrome.

The extreme age range of those who were diagnosed with the unknown illness and their broad symptoms make it impossible to conclude anything, she said.

"Are we doing them a disservice by assuming that they all fit into the same pocket? Or could they actually have separate things which each might require different investigations and different treatments?"

Kat Lanteinge, a Toronto-based public health advocate, has concerns that while the N.B. government focuses on the lack of links between cases, the search for a root cause will be overlooked.

"When you start drafting a narrative and you start shutting out the experts, so no science can happen, those are massive ethical boundaries that are being crossed."

Marrero, however, still believes a cluster exists.

"I'm ringing a bell," he said, quoting his favourite musician, Leonard Cohen. "He said there is a crack in everything, that's how the light gets in. It's a truth for anything new in science. And I hope [the light] will."

While LeBlanc may have another diagnosis, that doesn't eliminate so many questions that exist around the mystery illness.

"It's hard for us to make conclusions about what we weren't a part of," said Kalia, the Toronto neurologist. "We didn't see Luc as a team two years ago. And so it's hard to know what kind of pieces to the puzzle his physicians had at that point in time to make that conclusion."

As for LeBlanc, he describes a weight lifting off his shoulders. He has gone from believing his life was ending to imagining possibilities. "It's a big shock."

He also vows to continue supporting people he has met through a social media support group for those who have received a diagnosis of the unknown illness, for their friends and family and others who believe they may have it.

"I'm lucky. I was dying. Now I'm not. But I want to help and support people if they want to talk."

See the original post:
He was told he had the N.B. 'mystery illness.' But a 2nd opinion says no as doubts swirl about diagnoses - CBC.ca

Article In Brief

Many of the state policies and regulations that enabled greater flexibility about access to telehealth across state lines have been retracted as COVID-19 rules and mandates relax. The patchwork of varying policies regarding telemedicine has prompted a call for more streamlined pathways to interstate credentialing for physicians who see patients in other states.

Neurologists at Wake Forest Baptist Health in Winston-Salem, NC, never used to get this kind of call, but it's happening more and more these days. A patient from a town like Blacksburg, VA, nearly two-and-a-half-hour's drive away will travel just over the border into North Carolina, seek out a parking lot with good cell reception or Wi-Fi, and connect via the health system's electronic medical record patient portal to their Wake Forest stroke specialist or epileptologist.

Our catchment area includes southern Virginia and West Virginia, said vascular neurologist Amy K. Guzik, MD, an associate professor of neurology at Wake Forest. Many of our patients have mobility and transportation limitations and may require a care partner or other person to drive them to the clinic. When telehealth limitations were lifted during the height of the COVID-19 pandemic in 2020, that was really beneficial for these patients, especially for follow-up appointments, and we were hoping that would continue. Now we have to ask each patient what state they are in before we are able to see them.

States of emergency issued by state and local governments in 2020 have gradually been lifted over the past year, and with them, temporary waivers allowing doctors licensed in one state to provide care to patients in other states via telemedicine.

As of October 6, 2021, the Federation of State Medical Boards (FSMB) reported that 18 states still had such waivers in place, while 32 states plus the District of Columbia no longer have waivers. Virginia's waiver, for example, expired in June 2021, but West Virginia's is still in place.

The geographic boundaries are so arbitrary, said Dr. Guzik. If a patient is 10 miles in one direction, I can't see them, but if they're 10 miles in another direction, I can.

The patchwork of emergency orders has created confusion for providers and health systems around the country, said Lisa Robin, FSMB's chief advocacy officer.

A few states have made their waivers permanent, while others have allowed them to expire. A lot of bills are being introduced surrounding telehealth in state legislatures, with licensure and credentialing being a key piece, but also credentialing of facilities and broadband and infrastructure resources to support telehealth. We expect a busy state legislative session. (Federal waivers that allow Medicare billing for both video and audio-only telehealth services remain in place at press time.)

For some neurologists and their patients, the end of the licensure waivers in some states has not proven particularly burdensome.

Here at NYU, for example, our out-of-state patients are frequently in Florida, because a lot of people go from New York to Florida for the winter, said Neil A. Busis, MD, FAAN, clinical professor of neurology at the NYU Grossman School of Medicine, associate chair for technology and innovation in the department of neurology, and clinical director of the telehealth program.

Florida makes it extremely easy to get a pure telehealth license; the process literally takes like half an hour. We also have many patients from Connecticut, which has the relaxed requirements for telehealth in place until June 2023, and New Jersey, which has made it fairly easy to get a temporary telehealth-only license with policies that are in place through the middle of January 2022.

But in neurology deserts like the Mountain West comprising Wyoming, Utah, New Mexico, Nevada, Montana, Idaho, Colorado, and Arizona, and for patients with rare conditions for whom there are only a handful of centers of excellence across the country, the waivers had provided access to expert neurologic care that would otherwise have been all but inaccessible. This was true, particularly given that travel can be burdensome for people with conditions such as epilepsy, Parkinson's, and Alzheimer's disease; post-stroke patients; and children with rare neurologic conditions.

The Child Neurology Foundation has had a series of strategic discussions this year on the role of telehealth in child neurology, said Dr. Busis. Imagine that you're at home with a child who has frequent seizures and may be on a ventilator and require frequent suctioning. You have a lot of supportive equipment that has to be with you at all times. It can take hours to pack up a medically fragile child for a visit to a specialized center an hour or more away, and if you're halfway there and the child has a seizure, what do you do? In the cases of these children, and other people who may be on home ventilation or other significant supportive care, it's not just I can't miss work today, it's life-altering. It's a quality of care issue.

As a stroke specialist, Dr. Guzik said she has found that telehealth is particularly beneficial for transitions of care as patients are discharged from the hospital to home and are adjusting to a new set of limitations.

After they're home for a couple of weeks, we want to check in and see how they're doing, she said. Maybe they do need that physical therapist they didn't think they needed at discharge, or the occupational therapist to help them modify their home. But it's difficult when you've just gotten home to turn around and go back to the medical center with your caregiver, especially if you're in a different state.

One potential solution to the licensure challenge is the Interstate Medical Licensure Compact (IMLC), which offers a voluntary, expedited pathway to licensure for physicians who wish to practice in multiple states. First launched in 2017, the Compact now has 33 member states and two member jurisdictions; Ohio became the 33rd state in July 2021.

Eligible physicians can qualify to practice medicine in multiple states by completing just one application within the Compact, receiving separate licenses from each state in which they intend to practice, according to the IMLC's website. These licenses are still issued by the individual statesjust as they would be using the standard licensing processbut because the application for licensure in these states is routed through the Compact, the overall process of gaining a license is significantly streamlined. Physicians receive their licenses much faster and with fewer burdens.

The FSMB strongly supports the IMLC, said Robin. We had expected that the number of licenses issued would fall off as the pandemic began to wane, but it has not. More states are joining the Compact and going live. With Texas and Ohio having joined the Compact this year, that's a lot of additional eligible physicians. We are going to work hard to try to get additional states to join.

The FSMB is also working on a new telemedicine policy to replace the one originally issued in 2014. The draft is expected to be released by the end of 2021, and will be voted on at the Federation's 2022 Annual Meeting in April. We are hoping to come to consensus on a very much expanded policy that addresses questions about licensure, modalities, continuity of care, and many other areas, Robin said.

In a telehealth position statement published in Neurology in August, the AAN called for a number of steps to make telehealth more accessible and equitable for all patients. Licensing, prescribing, and related policies should be simplified, the authors noted. A desirable solution could include blanket reciprocity and an expedited licensing process that would require one unrestricted state license, a new background check for each state in which telemedicine is practiced, and reduced annual fees for limited practices. This would ensure protection of patients' rights to receive telehealth services as they require.

Telehealth should be here to stay, said Riley Bove, MD, associate professor of neurology at the UCSF Weill Institute for Neurosciences in San Francisco and a co-author of the AAN telehealth statement. It reduces the barriers to care, reduces patient costs for a visit, and decreases the burden of specialty visits for patients who are navigating multiple conditions. And during the pandemic, we have learned that this is broadly doable.

Before COVID-19, we had many colleagues who said that you can't provide good neurologic care via video. Through the past year and a half, however, we have become experts in examining patients via video and learned what is more and less beneficial, and what are the use cases where we need the patients to come in versus where we can spare them that trip and expense.

Lobbying for more streamlined pathways to interstate credentialing can be challenging, however. When I talk to our state legislators, they're mostly concerned about the patients in their own state and their constituents there, so they could say, Well, we want our own doctors in our own state to see the patients here, Dr. Guzik said.

Of course we do want the best, closest neurologist to see these patients, but there are situations with certain conditions or subspecialties or locations where it just makes more sense to see an expert in another state. Telehealth allows us to meet our patients where they are, let them live their lives and also get good medical care.

Certain cases are definitely not appropriate for telehealth, Dr. Bove acknowledged. And in others, it's just about patient preference. I have some patients who have said, Please, I just want to see you in person again. But there are others who never want to come back in person because they find telehealth so convenient. The reason most medical care happens in the clinic is not because that's where it's always best provided, but because it's most convenient for the clinician.

The patchwork of state policies and regulations regarding licensure, and variable payment reimbursements for telehealth reflects so much that is difficult about health care in America, Dr. Bove said. It underscores the major flaws in our health care system. And it needs to be changed.

Read this article:
The Challenges of Maintaining Telehealth Access in a... : Neurology Today - LWW Journals

DUBLIN, Nov. 2, 2021 /PRNewswire/ -- The "Neurology Clinical Trials Market Size, Share & Trends Analysis Report By Phase (Phase I, Phase II, Phase III, Phase IV), By Study Design (Interventional, Observational, Expanded Access), By Indication, By Region, and Segment Forecasts, 2021-2028" report has been added to ResearchAndMarkets.com's offering.

Research and Markets Logo

The global neurology clinical trials market size is expected to reach USD 7.4 billion by 2028. The market is expected to expand at a CAGR of 5.5% from 2021 to 2028.

This is largely attributed to big pharma companies conducting innovative trials in neurology, increased government funding from the National Institute of Neurological Disorders and Stroke (NINDS), and stringent regulatory requirements pertaining to clinical trials.

Neuroscience continues to receive a healthy level of early investment. It received USD 1.5 billion in venture capital funding in 2018, second only to cancer, indicating that investors expect a large pharma acquisition to pay off in the near future. As the industry strives to move past the many late-stage clinical failures of recent years, early diagnosis of diseases is attracting investment and driving deal-making in the complex neuroscience sector, particularly for pain and Alzheimer's disease.

In terms of deal volume, no other therapy area comes close to matching oncology, but neuroscience is among the nearest contenders. Despite a drop in total expected value in 2017, the number of neuroscience-related licensing deals has gradually climbed over the last decade.

The vast majority of neuroscience agreements ~90%have a primary neurological focus, which corresponds to the level of R&D activity in the two disciplines.

Many experimental therapeutics require dosage by on-site administration and carefully scheduled outcome measure evaluations hence, the COVID-19 pandemic has significantly harmed the implementation of the precise procedures required to establish proof of safety and efficacy.

Story continues

The COVID-19 has resulted in the shutdown of the network of centers conducting stroke clinical trials. This was followed by a phased research restart plan that took local circumstances and regulatory oversight into account. This approach was successful in a reengaging research effort to some extent in all but one of the ongoing investigations within 55 days.

Neurology Clinical Trials Market Report Highlights

The phase II segment dominated the market and accounted for a maximum revenue share of 36.7% in 2020. Between 1999 and 2020, 8,205 CNS trials were conducted, with 609 trials being conducted in 2020.

The interventional segment held the largest market revenue share of 81.1% in 2020.

The Huntington's disease segment is anticipated to register the fastest CAGR of 6.0% over the forecast period. This is largely due to the high prevalence of the disease around the world.

North America dominated the market and accounted for a revenue share of 45.8% in 2020. The rising prevalence of neurological disorders and the presence of a large number of players in clinical trials drive the market in the region.

Key Topics Covered:

Chapter 1 Methodology and Scope

Chapter 2 Executive Summary

Chapter 3 Neurology Clinical Trials Market: Variables, Trends, & Scope3.1 Market Segmentation and Scope3.2 Market Dynamics3.2.1 Market Driver Analysis3.2.1.1 Increasing neurological disease, such as dementia, stroke, and peripheral neuropathy3.2.1.2 Increasing R&D investments3.2.1.3 Stringent Regulatory Requirements3.2.2 Market Restraint Analysis3.2.2.1 High Failure Rates of Trials3.2.2.2 Rising Cost of Clinical Trials3.3 Penetration & Growth Prospect Mapping3.4 COVID-19 Impact on the Market3.5 Major Deals and Strategic Alliances Analysis3.6 Neurology Clinical Trials: Market Analysis Tools3.6.1 Industry Analysis - Porter's3.6.3 PESTEL Analysis

Chapter 4 Neurology Clinical Trials Market: Phase Segment Analysis4.1 Neurology Clinical Trials Market: Phase Market Share Analysis, 2020 & 20284.2 Phase I4.2.1 Phase I Market, 2016 - 2028 (USD Million)4.3 Phase II4.3.1 Phase II Market, 2016 - 2028 (USD Million)4.4 Phase III4.4.1 Phase III Market, 2016 - 2028 (USD Million)4.5 Phase IV4.5.1 Phase IV Market, 2016 - 2028 (USD Million)

Chapter 5 Neurology Clinical Trials Market: Study Design Segment Analysis5.1 Neurology Clinical Trials Market: Study Design Market Share Analysis, 2020 & 20285.2 Interventional5.2.1 Interventional Market, 2016 - 2028 (USD Million)5.3 Observational5.3.1 Observational Market, 2016 - 2028 (USD Million)5.4 Expanded Access5.4.1 Expanded Access Market, 2016 - 2028 (USD Million)

Chapter 6 Neurology Clinical Trials Market: Indication Segment Analysis6.1 Neurology Clinical Trials: Indication Market Share Analysis, 2020 & 20286.2 Epilepsy6.2.1 Epilepsy Market, 2016 - 2028 (USD Million)6.3 Parkinson's Disease6.3.1 Parkinson's Disease Market, 2016 - 2028 (USD Million)6.4 Huntington's Disease6.4.1 Huntington's Disease Market, 2016 - 2028 (USD Million)6.5 Stroke6.5.1 Stroke Market, 2016 - 2028 (USD Million)6.6 Traumatic Brain Injury6.6.1 Traumatic Brain Injury Market, 2016 - 2028 (USD Million)6.7 Amyotrophic Lateral Sclerosis6.7.1 Amyotrophic Lateral Sclerosis Market, 2016 - 2028 (USD Million)6.8 Muscle regeneration6.8.1 Muscle regeneration Market, 2016 - 2028 (USD Million)6.9 Others6.9.1 Others Market, 2016 - 2028 (USD Million)

Chapter 7 Neurology Clinical Trials Market: Regional Analysis

Chapter 8 Company Profiles8.1 IQVIA8.1.1 Company Overview8.1.2 Service Benchmarking8.1.3 Financial Performance8.1.4 Strategic Initiatives8.2 Novartis8.2.1 Company Overview8.2.2 Financial Performance8.2.3 Service Benchmarking8.2.4 Strategic Initiatives8.3 Covance8.3.1 Company Overview8.3.2 Service Benchmarking8.3.3 Strategic Initiatives8.4 Medpace8.4.1 Company Overview8.4.2 Financial Performance8.4.3 Service Benchmarking8.5 Charles River Laboratories8.5.1 Company Overview8.5.2 Financial Performance8.5.3 Service Benchmarking8.6 Icon Plc8.6.1 Company Overview8.6.2 Financial Performance8.6.3 Service Benchmarking8.7 GlaxoSmithKline8.7.1 Company Overview8.7.2 Financial Performance8.7.3 Service Benchmarking8.7.4 Strategic Initiatives8.8 Aurora healthcare8.8.1 Company Overview8.8.2 Financial Performance8.8.3 Service Benchmarking8.9 Charles River Laboratories8.9.1 Company Overview8.9.2 Financial Performance8.9.3 Service Benchmarking8.9.4 Strategic Initiatives8.10 Biogen8.10.1 Company Overview8.10.2 Financial Performance8.10.3 Service Benchmarking8.10.4 Strategic Initiatives

For more information about this report visit https://www.researchandmarkets.com/r/c0upuj

Media Contact:

Research and Markets Laura Wood, Senior Manager press@researchandmarkets.com

For E.S.T Office Hours Call +1-917-300-0470 For U.S./CAN Toll Free Call +1-800-526-8630 For GMT Office Hours Call +353-1-416-8900

U.S. Fax: 646-607-1907 Fax (outside U.S.): +353-1-481-1716

Cision

View original content:https://www.prnewswire.com/news-releases/outlook-on-the-neurology-clinical-trials-global-market-to-2028---size-share--trends-analysis-report-301414194.html

SOURCE Research and Markets

Here is the original post:
Outlook on the Neurology Clinical Trials Global Market to 2028 - Size, Share & Trends Analysis Report - Yahoo Finance

This article was originally published here

J Neurol. 2021 Jul 31. doi: 10.1007/s00415-021-10734-z. Online ahead of print.

ABSTRACT

INTRODUCTION: We have demonstrated in a multicenter cohort that the COVID-19 pandemic has led to a delay in intravenous thrombolysis (IVT) among stroke patients. Whether this delay contributes to meaningful short-term outcome differences in these patients warranted further exploration.

METHODS: We conducted a nested observational cohort study of adult acute ischemic stroke patients receiving IVT from 9 comprehensive stroke centers across 7 U.S states. Patients admitted prior to the COVID-19 pandemic (1/1/2019-02/29/2020) were compared to patients admitted during the early pandemic (3/1/2020-7/31/2020). Multivariable logistic regression was used to estimate the effect of IVT delay on discharge to hospice or death, with treatment delay on admission during COVID-19 included as an interaction term.

RESULTS: Of the 676 thrombolysed patients, the median age was 70 (IQR 58-81) years, 313 were female (46.3%), and the median NIHSS was 8 (IQR 4-16). Longer treatment delays were observed during COVID-19 (median 46 vs 38 min, p = 0.01) and were associated with higher in-hospital death/hospice discharge irrespective of admission period (OR per hour 1.08, 95% CI 1.01-1.17, p = 0.03). This effect was strengthened after multivariable adjustment (aOR 1.15, 95% CI 1.07-1.24, p < 0.001). There was no interaction of treatment delay on admission during COVID-19 (pinteraction = 0.65). Every one-hour delay in IVT was also associated with 7% lower odds of being discharged to home or acute inpatient rehabilitation facility (aOR 0.93, 95% CI 0.89-0.97, p < 0.001).

CONCLUSION: Treatment delays observed during the COVID-19 pandemic led to greater early mortality and hospice care, with a lower probability of discharge to home/rehabilitation facility. There was no effect modification of treatment delay on admission during the pandemic, indicating that treatment delay at any time contributes similarly to these short-term outcomes.

PMID:34333701 | DOI:10.1007/s00415-021-10734-z

Read more here:
Delays in thrombolysis during COVID-19 are associated with worse neurological outcomes: the Society of Vascular and Interventional Neurology...

Embargoed until 7 a.m. CT / 8 a.m. ET Wednesday, Nov. 3, 2021

DALLAS, Nov. 3, 2021 The American Heart Association (AHA), a global force for longer, healthier lives, will present its 2021 Basic Research Award to Costantino Iadecola, M.D., FAHA, of Weill Cornell Medicine in New York City, in recognition of his outstanding work in cerebrovascular biology, particularly in the areas of stroke and dementia. He will receive the award during the Presidential Session on Sunday, Nov. 14 during the AssociationsScientific Sessions 2021. The meeting will be fully virtual, Saturday, Nov. 13 through Monday, Nov. 15, and is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science for health care worldwide.

Dr. Iadecola is a board-certified neurologist whose research focuses on ischemic brain injury, neurodegeneration and cognitive impairment. He is the director and chair of the Feil Family Brain and Mind Research Institute and the Anne Parrish Titzell Professor of Neurology at Weill Cornell Medicine in New York City. He was selected for the Associations 2021 Basic Research Award in recognition of his research in the areas of cerebrovascular biology, stroke and dementia.

Dr. Costantino Iadecolas ground-breaking research in neurology, including developing the concept of the neurovascular unit to better understand the causes of stroke and dementia and opening more possible methods of treatment, makes him a true leader at the forefront of his field, significantly impacting how we think about prevention, diagnosis and treatment of neurovascular and neurodegenerative diseases, said Association President Donald M. Lloyd-Jones, M.D., Sc.M., FAHA. Im thrilled to honor him, his work and his commitment to neurovascular research.

Dr. Iadecola is recognized to have pioneered and validated the concept of the neurovascular unit, a widely accepted notion that neurons and cerebrovascular cells work together to maintain the health of the brain. This concept inspired new research on mechanisms that regulate cerebral perfusion and on how their failure causes brain diseases. His discovery of the cerebrovascular effects of the amyloid-beta peptide and tau established that neurovascular dysfunction is an early biomarker for Alzheimers disease. His research demonstrates a relationship between innate immunity and the deleterious effects of hypertension on neurovascular regulation and cognitive function and found that high-salt diets cause dementia through the Alzheimer protein tau, bridging the age-old gap between neurovascular and neurodegenerative diseases. Dr. Iadecolas work also details how microbiota of the gut can influence a patients susceptibility to ischemic stroke.

I am honored to receive the Basic Research Prize, which I humbly accept on behalf of my mentors, colleagues and collaborators, said Dr. Iadecola. I am grateful to the American Heart Association for the continued support I received since the very beginning of my clinician-scientist career.

Dr. Iadecola earned his medical degree from the University of Rome, Italy. He first came to the U.S. in the 1980s as a post-doctoral fellow in neurobiology at Weill Cornell Medicine, New York. After completing a neurology residency at New York-Presbyterian/Weill Cornell Medical Center in 1990, he joined the University of Minnesota Medical School as an assistant professor in Neurology before returning to New York City as a professor of neurology and neuroscience at Weill Cornell Medicine, where he has been for the past 20 years.

His work has earned accolades from the AHA, the American Academy of Neurology, the National Institutes of Health and the Alzheimers Association. He was previously recognized by the Association with its 2009 Willis Lecture Award, given in recognition of his contributions to the role of prostaglandins and nitric oxide in stroke damage and to the role of cerebral blood vessel dysfunction in Alzheimer's disease. He won the 2015 Excellence Award in Hypertension Research from the Association in recognition of his research connecting hypertension and Alzheimers disease. He was honored again by the Association with a 2019 Distinguished Scientist Award to recognize his research contributions to cardiovascular disease, stroke and dementia. Additionally, in 2011 the Alzheimers Association recognized Dr. Iadecola with the Zenith Fellow Award, which is prestigious worldwide recognition in Alzheimers research.

His research has been documented in nearly 400 papers published in peer-reviewed journals and he is listed by Clarivate Analytics as one of most highly cited researcher in the world in his field. He has been a guest editor for theHypertension,CirculationandProceeding of the National Academy of Sciencesjournals and a member of the editorial boards forCirculation Research,Journal of Cerebral Blood Flow and Metabolism,Cerebrovascular Diseases,Annals of Neurology,Cellular and Molecular Neurobiologyand theInternational Journal of Stroke.(Note:Hypertension,CirculationandCirculation Researchare published by the American Heart Association.)

Additional Resources:

The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Associations overall financial information are availablehere.

The American Heart AssociationsScientific Sessions 2021is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science for health care professionals worldwide. The three-day meeting will feature more than 500 sessions focused on breakthrough cardiovascular basic, clinical and population science updates in a fully virtual experience Saturday, Nov. 13 through Monday, Nov. 15, 2021. Thousands of leading physicians, scientists, cardiologists, advanced practice nurses and allied health care professionals from around the world will convene virtually to participate in basic, clinical and population science presentations, discussions and curricula that can shape the future of cardiovascular science and medicine, including prevention and quality improvement. During the three-day meeting, attendees receive exclusive access to more than 4,000 original research presentations and can earn Continuing Medical Education (CME), Continuing Education (CE) or Maintenance of Certification (MOC) credits for educational sessions. Engage in Scientific Sessions 2021 on social media via#AHA21.

About the American Heart Association

The American Heart Association is a leading force for a world of longer, healthier lives. With nearly a century of lifesaving work, the Dallas-based association is dedicated to ensuring equitable health for all. We are a trustworthy source empowering people to improve their heart health, brain health and well-being. We collaborate with numerous organizations and millions of volunteers to fund innovative research, advocate for stronger public health policies, and share lifesaving resources and information. Connect with us onheart.org,Facebook,Twitteror by calling 1-800-AHA-USA1.

###

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Originally posted here:
Costantino Iadecola, MD, FAHA, of Weill Cornell Medicine to be recognized with the American Heart Association's 2021 Basic Research Prize - EurekAlert

Garzon, who is a Research Fellow at the Department of Neurology at the International Hospital of ... [+] Colombia in Piedecuesta, Santander, in eastern Colombia

Colombian doctor Jenny Garzon's day-to-day work involves (under the supervision of neurologists), treating patients , who have suffered from stroke, but she is also a medical researcher helping to put a number on the financial toll of strokes and not just on the patient.

Garzon, who is a research fellow at the Department of Neurology at the International Hospital of Colombia Piedecuesta, Santander in eastern Colombia, says that relatively little research has been done in Colombia into the care burdens and additional costs caused by stroke (when the blood supply to part of the brain is cut off).

"If someone has a stroke, the costs can really add up: there can be structural changes to the home, wheelchairs and more," Garzon says, adding that in Colombia, these new costs can add up to an entire monthly minimum wage or more, as neither the public health system nor private insurers usually cover the majority of these expenses in the long-term.

Garzon, who is part of a team putting together a new, as-yet-unpublished paper on the topic of the financial impacts on stroke patients and their families and care-givers, says the impact extends far beyond these medical costs.

"With these medical costs, the loss of the income of the stroke patient and usually the need for a full-time carer, you are basically looking at the loss of two to three individual wages, depending on the patient," Garzon says, "One option to fix this could be new public policies that would allow the government to cover those costs during the time the patient is in the process of rehab."

Garzon, 24, says the other solution is prevention through education and rapid response.

"Most stroke patients have much better outcomes if they can arrive at a hospital or clinic within four and a half hours," she says, adding that "telestroke" treatment, the usage of remote technology to get stroke patients treated by neurologists, doctors who have advanced training in the field, can help reduce response times even further. It is not yet available in Colombia.

Garzon says that a significant proportion of people in Colombia are not aware of how to identify the main symptoms of stroke: They can't speak well, one side of the face is numb or limbs can't move.

If people learn about stroke first signs and symptoms, then they can ask for help quickly and potentially reduce the serious health impacts after a stroke," she says.

Garzon grew up in Santander, the same department (state) where she now works.

"I've always loved everything to do with the human body," Garzon says, adding that while studying her undergraduate medical degree, she fell in love with clinical research, particularly as it pertains to brains.

"In my early path as a researcher, I've been under the mentorship of many people who have believed in me," Garzon says, adding she especially learned from neurologists Gustavo Pradilla and Federico Silva.

Garzon says the identifying and lowering costs for stroke patients is not just key in Colombia, but for patients across the entire world.

"Something that is very lovely about research is that we can do many collaborations, because not just one region has all the answers," she says, "We can do collaborations between Colombia and any other country in the world, it will make the research stronger."

Colombian neurology researcher Jenny Garzon (fifth from the left) with students and professors ... [+] during an International Brain Research Organization event in Medellin, Colombia.

A husband and wife team of Colombian scientists are also helping to improve lives through studying brain cells.

Marlene Jimenez and Carlos Velez at the University of Antioquia in Medellin, Colombia, have observed Alzheimer's precursor molecules in cells taken from newborns.

Read the rest here:
This Colombian Researcher Helps Reveal The True Cost Of Strokes - Forbes

University of California HealthThursday, July 29, 2021

The hospitals of University of California Health (UCH) once again have been rated among the best in the state and the nation, according toU.S. News & World Reports 2021-2022 Best Hospitals rankings.

UCLA Health is recognized on the Best Hospitals Honor Roll as the third best in the nation and first in California. UCSF Health is ninth nationally and first in Northern California. All five UC academic health centers that own or operate hospitals were among the best in the state out of 416 California hospitals evaluated.

UCH hospitals further distinguished themselves by being nationally ranked in two or more specialties. Only 140 of the more than 1,800 hospitals eligible for the analysis were ranked in the top 50 in one or more specialty. The neurology and neurosurgery program at UCSF Health is ranked first in the nation.

"We have a high concentration of physician and researcher expertise within University of California Health (UCH), and they share that knowledge across the system. That spirit of collaboration keeps us at the forefront of academic medicine and improves our patients quality of care. Dr. Carrie L. Byington, executive vice president of UCH and an infectious disease expert

The rankings for each of the medical centers are:

U.S. News & World Report has been publishing its Best Hospitals report for three decades to help make hospital quality more transparent. The Honor Roll recognizes the top 20 hospitals across the nation that deliver exceptional treatment across multiple areas of care.

The rankings are based on measures such as risk-adjusted survival and discharge-to-home rates, volume and staffing of nursing, among other care-related indicators. Additionally, the report considers input from physicians across the nation who vote for the best hospitals in their specialty.

University of California Health (UCH) comprises six academic health centers, 20 health professional schools, a Global Health Institute and systemwide services that improve the health of patients and the Universitys students, faculty and employees. All of UCs hospitals are ranked among the best in California and its medical schools and health professional schools are nationally ranked in their respective areas.

Original post:
News University of California Health hospitals recognized among the best in California and the nation - University of California

For 29 years, from the time she was 12, Rashetta Higgins had been wracked by epileptic seizures as many as 10 a week in her sleep, at school and at work. She lost four jobs over 10 years. One seizure brought her down as she was climbing concrete stairs, leaving a bloody scene and a bad gash near her eye.

A seizure struck in 2005 while she was waiting at the curb for a bus. I fell down right when the bus was pulling up, she says. My friend grabbed me just in time. I fell a lot. Ive had concussions. Ive gone unconscious. It has put a lot of wear and tear on my body.

Rashetta Higgins at the UCSF Helen Diller Medical Center at Parnassus Heights after surgery to implant more than 150 electrodes to monitor her seizures. Photo courtesy ofRashetta Higgins

Then, in 2016, Higgins primary-care doctor, Mary Clark, at La Clinica North Vallejo, referred her to UC San Franciscos Department of Neurology, marking the beginning of her journey back to health and her contribution to new technology that will make it easier to locate seizure activity in the brain. Medication couldnt slow her seizures or diminish their severity, so the UCSF Epilepsy Center team recommended surgery to first record and pinpoint the location of the bad activity and then remove the brain tissue that was triggering the seizures.

In April, 2019, Higgins was admitted to UCSFs 10-bed Epilepsy Monitoring Unit at UCSF Helen Diller Medical Center at Parnassus Heights, where surgeons implanted more than 150 electrodes. EEGs tracked her brain wave activity around the clock to pinpoint the region of tissue that had triggered her brainstorms for 29 years.

In just one week, Higgins had 10 seizures, and each time, the gently undulating EEG tracings recording normal brain activity jerked suddenly into the tell-tale jagged peaks and valleys indicating a seizure.

To find the site of a seizure in a patients brain, experts currently look at brain waves by reviewing hundreds of squiggly lines on a screen, watching how high and low the peaks and valleys go (the amplitude) and how fast these patterns repeat or oscillate (the frequency). But during a seizure, electrical activity in the brain spikes so fast that the many EEG traces can be tough to read.

We look for the electrodes with the largest change, says Robert Knowlton, MD, professor of Neurology, the medical director of the UCSF Seizure Disorders Surgery Program and a member of the UCSF Weill Institute of Neurosciences. Higher frequencies are weighted more. They usually have the lowest amplitude, so we look on the EEG for a combination of the two extremes. Its visual not completely quantitative. Its complicated to put together.

Enter Jonathan Kleen, MD, PhD, assistant professor of Neurology and a member of the UCSF Weill Institute of Neurosciences. Trained as both a neuroscientist and a computer scientist, he quickly saw the potential of a software strategy to clear up the picture literally.

The field of information visualization has really matured in the last 20 years, Kleen said. Its a process of taking huge volumes of data with many details space, time, frequency, intensity and other things and distilling them into a single intuitive visualization like a colorful picture or video.

Kleen developed a program that translates the hundreds of EEG traces into a 3-D movie showing activity in all recorded locations in the brain. The result is a multicolored 3-D heat map that looks very much like a meteorologists hurricane weather map.

This video shows the OPSCEA (or "Ictal Cinema") technology developed at the UCSF Epilepsy Center. It converts the usual complex "traced-based" recordings of brain waves that doctors see (on the right) into an intuitive heat map projected on the patient's own 3D reconstructed brain (right hemisphere of brain show in main view). Each trace (line) on the right is from a single intracranial electrode (black dots in the brain view). The seizure intensity is calculated automatically from the traces (specifically from the location of the arrow) and converted into color intensity (using a "line length" algorithm), revealing how activity in a given seizure moves in space and time. The technology also applies "slice views" (example shown halfway through the video) so that activity from electrodes deep in the brain can be seen in addition to the brain surface.

The heat maps cinematic representation of seizures, projected onto a 3-D reconstruction of the patient's own brain, helps one plainly see where a seizure starts and track where, and how fast, it spreads through the brain.

The heat map closely aligns with the traditional visual analysis, but its simpler to understand and is personalized to the patients own brain.

To see it on the heat map makes it much easier to define where the seizure starts, and whether theres more than one trigger site, Knowlton said. And it is much better at seeing how the seizure spreads. With conventional methods, we have no idea where its spreading.

Researchers are using the new technology at UCSF to gauge how well it pinpoints the brains seizure trigger compared with the standard visual approach. So far, the heat maps have been used to help identify the initial seizure site and the spread of a seizure through the brain in more than 115 patients.

Kleens strategy is disarmingly simple. To distinguish seizures from normal brain activity, he added up the lengths of the lines on an EEG. Seizures show up as high peaks and low valleys that make their cumulative length quite long, while gently undulating brain waves make much shorter lines. Kleens software translated these lengths into different colors, and the visualization was born.

The technology proved pivotal in Higgins treatment.

Before her recordings, we had feared that Rashetta had multiple seizure-generating areas, Kleen said. But her video made it plainly obvious that there was a single problem area, and the bad activity was rapidly spreading from that primary hot spot.

The journal Epilepsia put Kleens and Knowltons 3-D heat map technology on the cover, and the researchers made their software open-source, so others can improve upon it.

Its been a labor of love to get this technology to come to fruition Kleen said. I feel very strongly that to make progress in the field we need to share technologies, especially things that will help patients.

Higgins has been captivated by the 3-D heat maps of her brain.

It was amazing, she said. It was like, Thats my brain. Im watching my brain function.

And the surgery has been a life-changing success. Higgins hasnt had a seizure in more than two years, feels mentally sharp, and is looking for a job.

When I wake up, Im right on it every morning, she said. I waited for this day for a long, long time.

The rest is here:
3-D 'Heat Map' Animation Shows How Seizures Spread in the Brains of Patients with Epilepsy - UCSF News Services

1. In a largemulti-centerstudy of children with hemolytic uremic syndrome, those with any acute neurologic manifestation (ANM) had increased risk of mortality.

2. Brain infarction, brain hemorrhage, anoxic brain injury, and brain edema were independently associated with mortality.

Evidence Rating Level: 2 (Good)

Study Rundown:Hemolytic uremic syndrome (HUS) is a microangiopathic hemolytic anemia characterized by anemia, thrombocytopenia, and renal dysfunction. One of the most serious complications of HUS is neurologic injury, which can lead to devastating sequelae including death. Previously, only small studies examined acute neurologic manifestations (ANMs) of HUS, with widely varying conclusions. This study characterized ANMs and their association with in-hospital mortality in nearly 4,000 children with HUS using a database containing information from over 40 childrens hospitals in North America. Overall, ANMs occurred in 10.4% of patients. Mortality was significantly higher in patients with any ANM (13.9%) compared to those without an ANM (1.8%). Furthermore, mortality was higher in patients with 2 ANMs (17.6%) than in those with 1 ANM (11.9%). Researchers also examined risk of mortality with specific ANMs and specific combinations of ANMs. One important limitation of this study was the lack of differentiation between typical and atypical HUS, which are considered to be different disease processes. Overall, this robust analysis of data obtained from a large database provides valuable information in identifying which children with HUS are at risk for worse outcomes.

Click to read the study in Pediatrics

Relevant Reading: Neurological involvement in children with E. coli 0104:H4-induced hemolytic uremic syndrome

In-Depth [retrospective cohort]: Data was obtained from the Pediatric Health Information System database, which contains information from over 40 tertiary childrens hospitals in North America. Overall, 3915 children (52.5% female, 75.5% white, median age 3.8 years) with HUS were included in the study. The median age of patients with ANMs was 3.3 years. In addition to increased mortality in patients with ANMs, average length of stay was also longer in those with ANMs compared to those without (27.8 vs. 13.8 days, p<0.001). The three most common ANMs were encephalopathy (60% of all patients with ANMs), seizures (26.4%), and stroke (22.5%). Mortality varied between specific ANMs encephalopathy (4.3%), seizures (8.9%), meningitis (21.7%), stroke (22.2%), intracranial hemorrhage (40%), cerebral edema (25%), and anoxic brain injury (40%). Patients < 30 days old were at increased risk of mortality, as were those who required mechanical ventilation or ECMO. ANMs independently associated with mortality were brain infarction (OR 2.64, p=0.03), brain hemorrhage (OR 3.09, p=0.005), anoxic brain injury (OR 3.92, p=0.006), and brain edema (OR 4.81, p=0.002).

Image: PD

2020 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.

Continue reading here:
Acute neurologic manifestations in children with hemolytic uremic syndrome linked to increased mortality - 2 Minute Medicine

AJMC: Hello, I'm Matthew Gavidia. Today on the MJH Life Sciences Medical World News, The American Journal of Managed Care is pleased to welcome Dr Nicki Niemann, neurologist at the Muhammad Ali Parkinson Center and an assistant professor of neurology at Barrow Neurological Institute. Dr Niemann additionally served as a co-author of a review article titled Parkinson's Disease and Skin.

Great to have you on, Nicki. Can you just introduce yourself and tell us a little bit about your work?

Dr Niemann: So, I'm a neurologist by training. I did my training at Baylor College of Medicine in Houston, Texas, and then I did my mood disorders fellowship with the same institution under the mentorship of Dr Joseph Jankovic, who's one of the co-authors on the review article that we're talking about today.

I'm originally from Denmark, where I was born and raised and where I went to medical school at the University of Copenhagen before relocating to first Texas and now here in Phoenix, Arizona, for work.

AJMC: To get us started, can you first speak on the association and nature of skin disorders in Parkinson disease

Dr Niemann: So, not to state the obvious necessarily, but PD is obviously quite a common condition. In fact, it's the second most common neurodegenerative condition after Alzheimer disease. We think of PD many times as a motor disorder because symptoms such as posture, resting tremor, and slowness are quite visible. But there's a whole array of very common and often problematic nonmotor symptoms. That includes not only depression, sleep disorders, constipation, loss of sense of smell, but also skin disorders. And the reason that PD presents with this broad range of symptoms is because it's not just a disorder of the brain itself. It's a multisystem disorder; it affects pretty much the whole body.

There are certain disorders that occur more common in PD than you would expect by chance. In terms of skin, this would be things like changes in sweating, seborrheic dermatitis, melanoma, something called bullous pemphigoid, rosacea, and other conditions. I think the main ones that seem to arise prior to PD are probably changes in sweating. We know that before someone presents with motor features of PD, they can have alterations of the autonomic nervous system, and that can lead to changes in sweat patterns.

Seborrheic dermatitis, which is another common condition that's characterized by redness, scaling, oiliness, sometimes burning pain in the seborrheic areas of the bodyso the scalp, the eyebrows, nasolabial folds, the chest sometimescan also in part be due to autonomic dysfunction, but likely also because of other things such as reduced facial expression or reduced facial movements, changes in hygiene, changes in lipid composition, and changes in the fungi that are on the skin.

Then there's another group of disorders that have perhaps more, or greater, morbidity and where the relationship is much more complex. The main one that people often think of in that regard is melanoma. We've known for several decades now that there is an increased risk of melanoma in PD. There was a recent paper that we referenced in our review article, which was a study done on North American populations in which the risk of melanoma seemed to be 2-and-a halffold greater for people with PD compared with those without.

The exact reason for the association is not completely established, but things like risk factors are shared between PD and melanoma. So, Caucasian race, fair skin, red hair, male gender, pesticide exposure, etc, all increase the risk of both PD and melanoma. There are genes that cause PD that are also found to be mutated in certain melanomasso there's that correlation. There are genes that control melanin synthesis that in parts are pigmentation that can affect your risk of melanomas, but also affect your risk of PD. And then there's also imaging features that are shared between PD and melanoma.

In particular, Im referring to the appearance of the midbrain, which is a structure that's involved in PD. When that structure is evaluated using ultrasound, a so-called hyperechogenic area can be visualized, and that can be seen in PD. It can be used as a biomarker of PD, but actually a lot of people with melanomas, even without PD, can also have similar imaging changes. So that's very interesting.

Lastly, on that note, I'll just mention that there have been reports and concerns, in the past primarily, that levodopa, which is the primary treatment for PD. might increase the risk of melanoma. The reason for that suspicion has been that levodopa is both a precursor to dopamine, which treats PD, but it's also a precursor to melanin, which is found in our skin and melanomas, etc. Several high-level studies, high-quality studies have firmly refuted that there's any association between use of levodopa and development of melanoma.

I won't go into much more detail, but there's also a couple other conditions that are a little bit less common, such as rosacea and bullous pemphigoid, that can also be seen more common in PD.

Originally posted here:
Examining the Association, Nature of Skin Disorders in Parkinson Disease - AJMC.com Managed Markets Network

BURNABY, British Columbia, Dec. 03, 2021 (GLOBE NEWSWIRE) -- Xenon Pharmaceuticals Inc. (Nasdaq:XENE), a neurology-focused biopharmaceutical company, today announced that it will provide updates on its proprietary, neurology programs at the Annual Meeting of the American Epilepsy Society (AES 2021).

Mr. Ian Mortimer, Xenons President and Chief Executive Officer stated, We continue to advance our portfolio of neurology-focused programs, and we have a number of scientific presentations scheduled at the AES 2021 meeting in Chicago. In addition, this year we are hosting a symposium focused on our XEN1101 program and the X-TOLE clinical trial results. We are also participating in a joint industry scientific exhibit related to rare genetically-defined epilepsies, with a particular focus on XEN496. We are grateful for the opportunity to meet with leading epileptologists, patient advocacy groups, and other key opinion leaders at this important meeting.

The following summarizes Xenons presentations at AES 2021 related to its proprietary, clinical stage programs as well as promising pre-clinical work:

Poster: Phase 2b Efficacy and Safety of XEN1101, a Novel Potassium Channel Modulator, in Adults with Focal Epilepsy (X-TOLE)

Poster: Electronic Seizure Diary Compliance in an Adult Focal Epilepsy Clinical Trial

Poster: XEN1101, a Differentiated Kv7 Potassium Channel Modulator, Impacts Depression and Anhedonia

Poster: Pathogenic and Likely Pathogenic Variants in KCNQ2 Underlie a Large Majority of Genetic Epilepsy in Neonates and Infants <6 Months of Age

Poster: Nav1.1 Selective Potentiators Normalize Inhibition/Excitation Imbalance and Prevent Seizures in a Mouse Model of Dravet Syndrome

On Sunday, December 5, 2021, Xenon is participating in a joint industry scientific exhibit related to rare genetically-defined epilepsies, and is presenting the following posters:

Conference Call InformationXenon will host a conference call and live webcast today at 9:00 am Eastern Time (6:00 am Pacific Time) to discuss the X-TOLE results presented at AES 2021. The webcast will be broadcast live on the Investors section of the Xenon website. To participate in the call, please dial (855) 779-9075, or (631) 485-4866 for international callers, and provide conference ID number 8639677.

About Xenon Pharmaceuticals Inc.

We are a clinical stage biopharmaceutical company committed to developing innovative therapeutics to improve the lives of patients with neurological disorders. We are advancing a novel product pipeline of neurology therapies to address areas of high unmet medical need, with a focus on epilepsy. For more information, please visit http://www.xenon-pharma.com.

Safe Harbor StatementThis press release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, and the Private Securities Litigation Reform Act of 1995 and Canadian securities laws. These forward-looking statements are not based on historical fact, and include statements regarding the timing of and results from clinical trials and pre-clinical development activities, including those related to XEN496, XEN1101, and other proprietary products; the potential efficacy, safety profile, future development plans, addressable market, regulatory success and commercial potential of XEN496, XEN1101 and other proprietary product candidates; the anticipated timing of IND, or IND-equivalent, submissions and the initiation of future clinical trials for XEN496, XEN1101, and other proprietary products; the efficacy of our clinical trial designs; our ability to successfully develop and achieve milestones in XEN496, XEN1101, and other proprietary development programs; the timing and results of our interactions with regulators; anticipated enrollment in our clinical trials and the timing thereof; and the progress and potential of our other ongoing development programs. These forward-looking statements are based on current assumptions that involve risks, uncertainties and other factors that may cause the actual results, events or developments to be materially different from those expressed or implied by such forward-looking statements. These risks and uncertainties, many of which are beyond our control, include, but are not limited to: the impact of the COVID-19 pandemic on our business, research and clinical development plans and timelines and results of operations, including impact on our clinical trial sites, collaborators, and contractors who act for or on our behalf, may be more severe and more prolonged than currently anticipated; clinical trials may not demonstrate safety and efficacy of any of our or our collaborators product candidates; promising results from pre-clinical development activities or early clinical trial results may not be replicated in later clinical trials; our assumptions regarding our planned expenditures and sufficiency of our cash to fund operations may be incorrect; any of our or our collaborators product candidates, including XEN1101 and XEN496, may fail in development, may not receive required regulatory approvals, or may be delayed to a point where they are not commercially viable; we may not achieve additional milestones in our proprietary or partnered programs; regulatory agencies may impose additional requirements or delay the initiation of clinical trials; regulatory agencies may be delayed in reviewing, commenting on or approving any of our or our collaborators clinical development plans as a result of the COVID-19 pandemic, which could further delay development timelines; the impact of competition; the impact of expanded product development and clinical activities on operating expenses; impact of new or changing laws and regulations; adverse conditions in the general domestic and global economic markets; as well as the other risks identified in our filings with the Securities and Exchange Commission and the securities commissions in British Columbia, Alberta and Ontario. These forward-looking statements speak only as of the date hereof and we assume no obligation to update these forward-looking statements, and readers are cautioned not to place undue reliance on such forward-looking statements.

Xenon and the Xenon logo are registered trademarks or trademarks of Xenon Pharmaceuticals Inc. in various jurisdictions. All other trademarks belong to their respective owner.

Media/Investors Contact:Jodi RegtsXenon Pharmaceuticals Inc.Phone: 604.484.3353Email: investors@xenon-pharma.com

More:
Xenon Pharmaceuticals Provides Updates on Proprietary Neurology Pipeline Programs at the Annual Meeting of the American Epilepsy Society (AES 2021) -...

STRASBOURG, France--(BUSINESS WIRE)--Braintale, a medtech that is deciphering white matter, spin off from the Assistance Publique-Hpitaux de Paris, showcases, with Minoryx, a biotechnology company developing a treatment for X-linked Adrenoleukodystrophy (X-ALD), the results of the multicentric ADVANCE sub study with Braintale biomarker platform on the occasion of the American Academy of Neurology (AAN). The data were presented digitally on April 24th, 2022. This has also been the occasion to deepen the collaboration between the two companies.

Long underestimated in neurosciences, white matter, which represents 80% of the human brain, plays a key role in its proper functioning, development, and aging, whether normal or pathological. Accordingly, Braintale has been developing, since its inception in 2018, non-invasive, accessible, effective and clinically validated measurement and prediction tools for physicians treating patients suffering from brain diseases.

The Braintale platform includes AI-processed CE-marked digital solutions, deployed across three modules. Brainquant enables white matter quantification, brainScore powers clinical prediction and MyelinDex, monitors myelin integrity. Beyond demyelinating conditions, the platform has also been successfully implemented to monitor patients with amyotrophic lateral sclerosis (ALS) and predict recovery for comatose patients after cardiac arrest or trauma brain injury.

X-ALD is an inherited orphan neurodegenerative disease. The most common form is adrenomyeloneuropathy (AMN), which is a highly debilitating chronic disease affecting male and female X-ALD patients reaching adulthood. There is currently no approved treatment for AMN patients. X-ALD male patients can also develop the acute cerebral form, cALD, in both pediatric age and adulthood. cALD results in aggressive brain inflammation leading to permanent disability and death within 2-4 years.

Leriglitazone, a novel brain penetrant PPAR gamma agonist, recently showed significant clinical benefit in Minoryxs ADVANCE Phase II/III clinical trial in adult male patients with AMN. A separate phase II/III study in male pediatric patients with early stage cALD is ongoing (NEXUS).

On the occasion of the American Academy of Neurology, Braintale and Minoryx jointly presented additional results of a multicenter sub-study from the ADVANCE trial. The abstract is available online: https://index.mirasmart.com/aan2022/PDFfiles/AAN2022-002872.html

Beyond the characterization of MyelinDex as a relevant biomarker for monitoring disease progression and therapeutic efficacy, these data further support the efficacy of leriglitazone and its potential to improve myelin integrity in the brain of patients affected by AMN. These results pave the way to use of MyelinDex for disease and treatment monitoring in clinical trials as well as patient management in a hospital setting.

The collaboration between the two companies has expanded in order, notably, to implement the use of MyelinDex in additional clinical trials to further characterize beneficial impact of leriglitazone on myelin content, while contributing to a better understanding of X-ALD.

We are very excited to see the potential of Braintales technology to deliver precise and longitudinal analysis of white matter said Marc Martinell, CEO of Minoryx Therapeutics. These results are aligned with preclinical data showing the impact of leriglitazone on myelination.

Pleased with the success of our collaboration to date, Minoryx and Braintale teams have decided to extend their partnership exploring the use of biomarkers developed with the Braintale platforms. Now, together, we are contributing to better understand and improve follow-up, treatment, and stratification of patients with this devastating orphan disease, explains Julie Rachline, co-founder and CEO of Braintale through LallianSe.

About Braintale

Braintale is an innovative medtech company deciphering white matter to enable better care in neurology and intensive care with clinically validated prognostic solutions. With noninvasive, sensitive and reliable measurements of white matter microstructure alterations, Braintale offers a digital biomarkers platform to support clinical decision-making. Braintale enables the identification of patients at risk, early diagnosis and monitoring of disease progression and the effectiveness of treatments in neurology, in particular for demyelinating diseases, amyotrophic lateral sclerosis and neurodegenerative diseases. Based on more than 15 years of research and development, Braintale's products are developed to meet the medical needs and expectations of healthcare professionals for the benefit of patients.

Since its inception in 2018, the company has implemented a comprehensive quality management system and is now ISO 13485:2016 certified, with a suite of products available on the European market under the European Medical Device Regulation (MDR).

For more information, please visit http://www.braintale.eu

Continued here:
American Academy of Neurology (AAN 2022) Braintale Showcases Together with Minoryx Data From Its Biomarker Platform for Disease and Treatment...

Article In Brief

When neuromuscular specialist Zach London, MD, FAAN, is not at work, he engages in other passions like music and game board development. Here he talks about what drives these interests and why he has pursued them since his busiest days as intern in medical school.

In his professional endeavors and personal life, Zach London, MD, FAAN, relishes the opportunity to be creative. Dr. London's innovative nature has come in handy as professor and director of the neurology residency program at the University of Michigan Medical School in Ann Arborthe same institution where he completed his training and a fellowship in clinical neurophysiology.

Among the interactive educational tools he has designed is a web-based training simulator called EMG Whiz. And his efforts were instrumental in developing two mobile applicationsNerve Whiz and Neuro Localizerto teach neuroanatomic localization.

For Dr. London, the goal is to engage learners any way he can, no matter how boring or challenging the subject may be. He credits his former neuroanatomy professor John K. Harting, PhD, at the University of Wisconsin School of Medicine and Public Health in Madison with instilling this belief in him.

With textbooks, workbooks, educational handouts, flash cards, and whatever else he could devise, he would teach the same material in 20 different ways, Dr. London recalled. All that mattered was that at least one of those ways clicked with his students. That was really inspirational to me.

A neuromuscular specialist, Dr. London has published online learning modules for the AAN and other national organizations. He also has received many teaching awards, including the the Consortium of Neurology Program Directors Recognition Award in 2014, the American Neurological Association's Distinguished Teacher Award in 2017, and the American Association of Neuromuscular and Electrodiagnostic Medicine Innovation Award in 2020.

The AAN recently tapped his expertise to promote an upcoming conference in a novel way. He posted this recording on Twitter.

Neurology Today spoke with Dr. London about his musical hobby as well as his interest in developing board games. One of those inventions is The Lesion: Charcot's Tournament, a tabletop strategy board game about neuroanatomy that he co-designed and published.

I was 14 years old when I first started playing. I took one or two lessons and hated it, so I put it down for a few years. Then, when I was a senior in high school, I read a modern translation of Beowulf, and for some reason, I got in my head that I was going to write a rock opera about Beowulf for my English class. I enjoyed that so much that it got me hooked on songwriting and recording. I've never really been a performer. I like the recording process more than anything else.

It's a great instrument for people who are learning to play music. The reason it's so popular is that it's easy to become good enough to play a few songs. It's also portable. You can pick it up and take it with you.

I have a few guitars hanging up on the wall. I have five guitars, a ukulele, a banjo, a mandolin, a bass guitar, and an Irish bouzouki.

I play a little piano, bass, mandolin, and accordion at the novice to intermediate level. I like to pick up new instruments and play them well enough that I can record something once.

The real turning point was when I was an intern. Your life suddenly becomes very busy. A lot of people lose their hobbies when they get into residency. It was a now-or-never moment. I decided I'm either going to stick with it or dedicate myself only to my career. It was really important for my mental health to have a creative outlet.

I record exactly one song per month and post it online at http://www.hardtaco.org. That's a realistic goal for the rest of my life. Having this self-imposed deadline has helped me focus. Some of the songs are throwaways, and some of them are ones I'm proud of. The fact that I stuck with that schedule is something I'm most proud of.

They're mostly simple pop, rock, folk, hip hop, and electronica. I don't have a classical music background. I know some music theory, but I'm not good enough to compose classical or jazz. They're the kind of songs you could hum in your head and put music to. I try to experiment with different genres, so they don't all sound the same. If there's a common thread, half of the songs tend to be silly or clever. I'm always thinking about rhyming words while I'm in the shower or I'm in the car.

My wife, Lauren London, is a trained singer with a musical theater background. She probably is on 75 percent of the songs as a lead or background singer. Professionally, she is a lawyer and the general counsel for Eastern Michigan University, while serving as executive director of a local professional theater company in Ann Arbor.

Our kidsScarlett, 16, and Malcolm, 13occasionally do vocals on the songs. Sometimes I'll write songs that have different characters in them. A few years ago, we did a song about a court trial for a bee who had murdered an elephant. One of the kids played the judge and one played the attorney. They rapped about what happened to this particular elephant.

I've been a board game player my whole life. I got into the modern board game in the mid- or late 1990s, and since then, I've been into trying out new games, especially complex ones. There's definitely a market for more complex games. Board game sales have skyrocketed in the last 20 years.

As a family, we have been involved in making games. We are also board game reviewers. When the pandemic started last year and we were all on lockdown, we decided as a family project we would play one new board game a day. We bought some and borrowed others from friends who are board game enthusiasts. Michigan's stay-at-home order was in place. We called it the Play-At-Home Order [www.theplayathomeorder.com]. The kids and my wife and I would write reviews. By now, we have reviewed up to about 130 games. Some are ones you can play in 10 minutes. It has been a wonderful family activity. Since the kids are back in school, it's harder to convince them to play a new game.

One is a board game called The Lesion: Charcot's Tournament, named after Jean-Martin Charcot, the French physician often considered to be the father of modern neurology. I developed it about five years ago with a colleague, Jim Burke, MD, MS, associate professor of neurology, who is also a board game fanatic. It's essentially based on the concept of neurologic localization on a map of the central nervous system. With any neurologic symptom in the bodysuch as weakness in the arm or facea pathway is interrupted somewhere between the brain and peripheral nerve.

The game's strategy involves looking at a bunch of symptoms and finding where those pathways overlap and where the most likely source of the problem is, where the lesion is.

There's also a non-neurological game we just published that was invented by my son. It's called Battle Thunder Worm (three words in the game), and it's a family-friendly party game. [For more information about the game, visit http://www.battlethunderworm.com.] Players have to put together a combination of two random words to name an invention that would solve a specific problem. And then they have to do a sales pitch as to why their invention is better than everyone else's.

Another game in the works is a card game about the brachial plexus called The Plexus. I'm just putting the final touches on the graphics.

We've sold over 1,000 copies of the Lesion, which has been out for five years. I use a print-on-demand board company called The Game Crafter. People order it through their website. I posted about it on Twitter a couple of months ago, and we sold over 50 copies in a few days. A bunch of neurologists and medical students were interested. It's definitely a target market for sure, very niche. I haven't made any profit. I'm not much of a businessman. I think of this as more of a fun academic project.

At my house every year for the last 25 years, we have done the fortress party. We convert our entire house into a giant maze of sheets. You can't see the walls or the ceiling of the house because everything is covered with sheets. It's a private event and not a good pandemic party.

You have to make time. That's kind of that crossroad I was at as an intern. It's really easy to let things go that are important to you when you're busy. I don't watch as much TV as I used to. I don't read as many books as I would like to. It's important to me and my family to support it, and they've been really wonderful in helping.

Definitely. It helps keep me centered. When I finish writing a song, I record it and I upload it to the website. It's a real sense of accomplishment. In academic medicine, it's good to have several irons in the fire in life, so when one of them isn't succeeding, maybe another one is. Usually, something is going well. Whether it's a work project or a home project, it keeps me engaged and helps me through the stuff that's harder.

Making board games about neurology is fun for me, but I'm also doing it as career development tool. I have to learn the material well, which probably makes me a better doctor. It's an academic niche for me. Some people do research on Alzheimer's. It's totally at opposite ends of the spectrum of what you can do as an academic neurologist.

Read more from the original source:
This Neuromuscular Specialist Keeps Life Humming with... : Neurology Today - LWW Journals

A new study from The Neuro (Montreal Neurological Institute-Hospital) and eight collaborating international epilepsy centers has developed a simple web-based application clinicians can use to predict which patients will not benefit from an invasive diagnostic work-up, preventing unnecessary, invasive procedures, saving time for patients and the clinical team, and freeing up overburdened health resources.

Surgery is the only option to cure seizures inpatients with drug-resistant epilepsy. In evaluating patients for surgery, clinicians have to pinpoint what brain region the seizures are coming from. The way to do this in patients with more complex epilepsy is through stereo-electroencephalography (SEEG), a technique by which a surgeon implants electrodes into the brain to find the source of the seizures.

SEEG is an invasive procedure that requires a one-to-two-week hospital stay and comes with risk of infection, bleeding and stroke in 0.5-2 per cent of procedures. Furthermore, in up to 42 per cent of case series, SEEG does not result in an epilepsy surgical intervention as no focal epileptic focus can be identified. To reduce the amount of people undergoing an unnecessary SEEG, researchers studied epilepsy patients to determine if a series of non-invasive tests could predict which patients would not benefit from SEEG.

The team followed 128 patients at The Neuro who had SEEG, analyzing their demographic, clinical, electroencephalography, neuroimaging, and neuropsychological data. They developed a regression model based on different modalities, called the 5-SENSE-score, that differentiated patients whose SEEG identified a defined seizure source from those that did not. They then validated this score on a larger cohort of 207 patients from nine different tertiary epilepsy centres, finding that it reliably predicted the patients in whom SEEG was unable to identify a focal seizure onset zone.

Many epilepsy centres face the challenging decision of whether a patient should undergo implantation for identifying a focal-seizure onset zone, says Dr. Birgit Frauscher, neurologist at The Neuro and the studys senior author. The 5-SENSE-score provides an easily applicable tool to guide clinicians in predicting patients where SEEG is unlikely to identify a focal seizure onset zone. Patients unlikely to benefit from this invasive and resource-intensive procedure can then be identified earlier, avoiding unnecessary burden on patients and overutilization of hospital resources.

This study, published in the Journal of the American Medical Association on Dec. 6, 2021, was funded by the Montreal Neurological Institute, the Fonds de Recherche du Qubec Sant, and the Austrian Chapter of the International League against Epilepsy.

The Neuro

The Neuro The Montreal Neurological Institute-Hospital is a bilingual, world-leading destination for brain research and advanced patient care. Since its founding in 1934 by renowned neurosurgeon Dr. Wilder Penfield, The Neuro has grown to be the largest specialized neuroscience research and clinical center in Canada, and one of the largest in the world. The seamless integration of research, patient care, and training of the worlds top minds make The Neuro uniquely positioned to have a significant impact on the understanding and treatment of nervous system disorders. In 2016, The Neuro became the first institute in the world to fully embrace the Open Science philosophy, creating the Tanenbaum Open Science Institute. The Montreal Neurological Institute is a McGill University research and teaching institute. The Montreal Neurological Hospital is part of the Neuroscience Mission of the McGill University Health Centre. For more information, please visitwww.theneuro.ca

Data/statistical analysis

People

Development and Validation of the 5-SENSE Score to Predict Focality of the Seizure-Onset Zone as Assessed by Stereoelectroencephalography

6-Dec-2021

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Read the original here:
Saving patients an unnecessary procedure - EurekAlert