Article In Brief

Cognitively normal older adults who experienced falls also had markers of neurodegeneration, such as amyloid uptake and smaller hippocampal volume on imaging measures. The research suggest falls in cognitively normal older adults may serve as a behavioral biomarker of preclinical Alzheimer's disease.

Falls in cognitively normal older adults could potentially serve as a behavioral marker of preclinical Alzheimer's disease (AD), researchers suggested in a paper published September 15 in the Journal of Alzheimer's Disease.

The findings were based on a cross-sectional analysis of structural and functional MRI and PET measures of amyloid uptake, brain volumetrics, and global resting state-functional connectivity (rs-fc) intra-network signature on MRI in cognitively normal adults who kept a calendar of falls over a one-year period. (The global rs-fc intra-network signature measures connectivity between brain networks when subjects are in a resting state.) The researchers compared imaging data with similar measures from preclinical AD participants who had not recorded falls.

Falls in cognitively normal older adults correlated with markers of neurodegeneration, such as amyloid uptake and smaller hippocampal volume (p=0.004). Amyloid-positivity alone did not lead to more falls, however. Rather those who had increased amyloid and more disrupted connectivity (on rs-fc MRI), particularly in the somatomotor and primary sensory networks, had a greater risk of more falls.

Not everyone who has a fall is going to develop AD, but it is something that you should be asking about among patients; we can't just think about memory complaints alone, said study author Beau M. Ances, MD, PhD, MS. FAAN, the Daniel J. Brennan, MD professor of neurology at Washington University in St. Louis, MO.

Clinicians should inquire about other physical changes that individuals are experiencing. This information can help clinicians address the individual's needs, Dr. Ances said.

We work with a great team of occupational therapists, and if individuals are having repeated falls, if they are having difficulties getting in and out of the bathroom or the tub, we can assess their home environment. We can do certain kinds of things so that individuals can stay in their homes and be comfortable and be safe, and that can make a huge difference for the family as well as the individual who may be developing AD, he added

To look closely at the association between neurodegeneration and falls, the study team evaluated 83 cognitively normal individuals who had been assessed by the Clinical Dementia Rating scale. The research used tailored calendar journals to collect data on falls on these individuals over a one-year period.

We verified falls both with the individual as well as other caregivers who could report and be a collateral source for helping us evaluate that, Dr. Ances explained.

Within two years of falls, the participants underwent structural functional MRI and amyloid PET. Using standard cutoffs, cognitively normal participants were dichotomized by amyloid PET status.

The team compared the relationship between the global rs-fc intra-network signature and amyloid accumulation among those who did and did not fall among amyloid-positive participants. In addition to having a smaller hippocampal volume, those who fell had a negative correlation between global rs-fc intra-network signature and amyloid uptake (R = -0.75, p=0.012).

This means that within those individuals who had falls a loss of connections within the brain was associated with increased amyloid uptake, Dr. Ances told Neurology Today.

The researchers also found a trend toward a positive correlation between global rs-fc intra-network signature and amyloid uptake among preclinical AD participants who didn't fall (R = 0.70, p=0.081).

It's really the presence of amyloid and tau that is really starting to lead to changes in the brain, which are then reflected in those functional connections in the brain, Dr. Ances said. Because those functional connections are no longer as strong between these various brain networks, individuals may be more susceptible to having falls. This tells us that falls could be an important evaluation tool for individuals, he added.

More research is underway in which the investigators are going into homes to evaluate these patients, noted Dr. Ances. We are looking at these falls and the trajectories of these patients longitudinally, he said. We will continue to use these biomarkers, and other markers at home, to report on how they are doing in the home setting. That's where our next efforts are focused.

This is a very useful and important cross-sectional study connecting neurodegeneration to factors other than cognition, said Sudha Seshadri, MD, FAAN, a professor of neurology and founding director of the Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases at the University of Texas Health Science Center in San Antonio.

Obviously, we have achieved an understanding of amyloid-related neurodegeneration in the brain. And the most obvious and distressing part of AD is the loss of memory and thinking, but when the brain has changes, it affects more than just cognition, she added.

Falls are the other big problem with older adults, and because falls were often dealt with by other physicians and geriatricians, we have tended to think of them as a related to muscle strength and bone density, Dr. Seshadri said. It is related to those things, but there is [also] a very important neurologic component to solve. This study highlights the importance of understanding that association in terms of its biology. It may help us perhaps better prevent falls, and potentially use something like a simple gait test as a marker, Dr. Seshadri told Neurology Today.

I'm excited by this study as I think it recognizes the need to look at the physical and other aspects of amyloid-related neurodegeneration as well as other types of neurodegeneration, Dr. Seshadri said.

Douglas W. Scharre MD, CMD, FAAN, professor of clinical neurology and psychiatry in the Ohio State University Wexner Medical Center, who was not involved in the study, agreed. Common sense may tell us that the more your brain is damaged by AD, the more likely it will not work as well to prevent falls. This study looks at volume loss of the brain in particular areas and looks for loss in neural networks and connections between different parts of the brain to see if that is associated with increased falls, he said.

The findings suggests that the more advanced the preclinical disease, the more at risk they are for falling. Practically speaking, it is universally good practice to educate patients on fall prevention as eliminating any falls is worthwhile, Dr. Scharre added.

Dr. Scharre pointed out that this research team previously published work on falls in preclinical AD based on PIB amyloid PET and CSF tau-to-amyloid ratios and had previously associated increased amyloid in the brain with more falls. But this paper added functional and structural MRI to amyloid PET, he said.

The study was underpowered in proving the association between falls and AD because some of the other neurodegenerative dementias may not have been entirely captured, noted Kevin Conner, MD, a neurologist at the Texas Health Arlington Memorial Hospital and with Neurology Inpatient Physician Services, a Texas Health Physicians Group practice. Dr. Conner noted that the study duration was relatively short, and perhaps more positive findings would have been found with a longer duration.

Falls are difficult to assess because there can be many factors at play when a person falls, and just because a person falls doesn't mean they have AD, Dr. Conner noted. Falls may be related to a range of factors like peripheral neuropathies, amyotrophic lateral sclerosis, stroke, spinal cord injuries, or even vitamin deficiencies, Dr. Conner continued.

I think what this study tells me is that if you have a patient, who is having falls, and you have ruled out some of the other reasons behind the falls that you need to think about AD as a potential etiology for the fall itself. If you have a patient who is cognitively impaired and is falling, then it may be worth doing additional studies looking specifically looking for AD or for some of the other neurodegenerative dementias that can cause falls, like Lewy Body disease, frontotemporal dementia, or Parkinson's disease, Dr. Conner told Neurology Today.

Drs Ances and Conner reported no disclosures. Dr. Scharre disclosed relationships with Acadia, BrainTest, Biogen, InSightec, vTv therapeutics, Eisai, Eli Lilly, Biogen, Roche, AZTherapies, Biohaven, and Novartis. Dr. Seshadri disclosed relationships with Biogen.

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Falls Are Associated with Markers of Neurodegeneration in... : Neurology Today - LWW Journals

Article In Brief

Newly-approved epilepsy drugs and other therapies in development may be effective in treating cases that were once resistant to treatment, epileptologists say. But while experts said they appear promising, they also were not ready to skip older options for which more data are available.

New epilepsy medications and other products in the pipeline may soon start to chip away at the stubborn one-third of epilepsy cases that are resistant to treatment, epileptologists told Neurology Today in a series of telephone interviews. What's more, they said, the new therapies may also offer the possibility of seizure control with fewer side effects.

Among the recent advances in epilepsy care are a much-anticipated new drug for uncontrolled focal seizures in adults, an added indication approved for the first cannabidiol (CBD)-based medication for children with uncontrolled seizures associated with several rare conditions, and rescue medications in the form of nasal sprays.

Epilepsy researchers said the new drugs and others in development will begin to fill niches in both adult and pediatric epilepsy care and expand treatment options for some patients.

There have been dramatic changes in the past few years, and there are even more dramatic ones on the horizon, said James W. Wheless, MD, FAAP, FAAN, professor and chief of pediatric neurology at the University of Tennessee Health Science Center.

But Dr. Wheless said that in spite of the progress achieved in recent years in developing new treatments, seizure freedom rates haven't improved dramatically. We haven't found the Holy Grail yet.

Researchers anticipate that some genetic-based therapies will likely be in the next wave of epilepsy treatments. The general approach is to target underlying genetic causes of epilepsy rather than treating the symptomseizures.

We have come to understand that epilepsy has many causes, said Dr. Wheless, who is working with companies that are developing therapies that would target the SCN1A gene, which is implicated in Dravet syndrome.

The goal is to modify the one good copy of the gene that these patients' have, which will correct the channel defect, he said. This should restore normal brain function and dramatically improve the symptoms, one of which is uncontrolled seizures.

Some of the newer treatment options include cenobamate (Xcopri), which was approved by the US Food and Drug Administration (FDA) in November 2019 as an adjuvant therapy for treatment-resistant partial-onset seizures in adults. The experts said the drug is a noteworthy addition, but it is too soon to say whether it will be a game changer for many patients.

Gregory L. Krauss, MD, professor of neurology at Johns Hopkins University who was a co-investigator for the drug's clinical trials, said that in two placebo-controlled regulatory trials, about 60 percent had marked seizure reduction (greater than 50 percent) and 20 percent became seizure free, despite having highly treatment-resistant epilepsy.

Dr. Krauss said that two-thirds of his 49 patients have continued cenobamate treatment for up to eight years, and 12 achieved long-term seizure freedom. The drug's mechanism of action is not fully understood, though its strong efficacy may relate to its activity as a selective sodium channel blocker, preferentially inhibiting a persistent sodium current, Dr. Krauss said. It also may enhance release of the gamma aminobutyric acid inhibitory neurotransmitter.

Several patients in clinical trials developed serious allergic reactions with DRESS syndrome (drug reaction with eosinophilia and systemic symptoms). In a subsequent open-label safety study, more than 1,300 patients started treatment using very low, slowly titrated initial doses and they did not develop the syndrome.

Dr. Krauss said the while cenobamate was approved for patients with intractable epilepsy, it may have broader potential.

The question is how patients with less refractory epilepsy than those enrolled in the placebo-controlled trials will do and so far, based on the large safety study results and our initial clinical use, cenobamate looks pretty effective, he said.

A CBD therapy (Epidiolex), the first FDA-approved medication derived from marijuanawas approved in July for a new indicationseizures associated with tuberous sclerosis complex. The therapy was approved in 2018 to treat seizures related to two other rare conditions, Lennox-Gastaut syndrome and Dravet syndrome.

While there have been dramatic stories in the media of young patients whose relentless seizures were helped by the therapy, clinical experience with cannabidiol is still new.

I've had some real success with a handful of patients who have drug-resistant epilepsy, said Shawniqua Williams Roberson, MD, assistant professor of neurology at Vanderbilt University Medical Center. Her enthusiasm, however, has been tempered by the drug's side effects, including significant diarrhea and somnolence, that her patients have experienced.

Dr. Williams Roberson said that in general, and not just with cannabidiol, she tends to adopt new medications into her practice slowly because she wants to wait for post-approval reports that may provide a fuller picture of side effects and efficacy.

In general, I don't see the new drugs as first-line agents because we have a number of agents that are quite reliable and likely to work, she said. Why expose the patient to the unknown potential for side effects of a new drug when it does not offer a substantially better chance of seizure freedom than others I have yet to try?

But some newer therapies are worth trying for certain patients, some neurologists said. Diazepam nasal spray (Valtoco) and midazolam nasal spray (Nayzikam) are rescue medications approved for the acute treatment of seizure clusters. They are considered a welcome alternative to rectally-administered diazepam.

Dr. Wheless said the rescue nasal sprays can be life-changing for families who fear venturing very far from home because their child might have seizures and not be near a hospital.

It really empowers the families and can change the quality of life for the entire family, he said.

Fenfluramine (Fintepla) was approved by the FDA in June for the treatment of seizures associated with Dravet syndrome. The drug comes with a warning that it can cause valvular heart disease and pulmonary arterial hypertension.

Jacqueline A. French, MD, FAAN, professor of neurology at NYU Langone Health, said the excitement around new and emerging treatments for epilepsy was evident during a conference in August that focused on new therapies in the research and development pipeline.

The pipeline for epilepsy therapies is just exploding, which is a wonderful thing to see, said Dr. French, who is chief medical officer for the Epilepsy Foundation, which sponsored the conference. There is a renewed enthusiasm for tackling the unmet needs in epilepsy.

She said emerging therapies are likely to include disease-modifying drugs that target genetic underpinnings of disease.

Most therapies up to now have been symptomatic treatments. They can stop seizures, but they leave the disease unchanged, she said.

Dr. French coauthored an article published in Epilepsy Currents in March that advocated for changing the name used to describe drugs from antiepileptic drugs (AEDs) to antiseizure medicines (ASMs).

Using the term antiepileptic to describe these compounds is misleading because it suggests an action on the epilepsy itself, she wrote along with Emilio Peruca, MD, PhD, of the University of Pavia in Italy.

Using appropriate terminology is especially important at a time when innovative treatments targeting the development of epilepsy and its comorbidities are being actively pursued, the article said.

The International League Against Epilepsy is considering the issue, Dr. French said.

For now, much of the attention in epilepsy care is expected to be on cenobamate. Dr. French, who participated in a randomized phase 2 trial and the open-label testing of the drug conducted primarily to look at safety concerns, said it is too soon to make any firm conclusions about the drug's potential, noting that it will take time for more data on efficacy, safety and tolerability to emerge from clinical use.

Sheryl R. Haut, MD, professor of neurology at Albert Einstein College of Medicine and director of the Adult Epilepsy Program at Montefiore Medical Center, said that in addition to pharmacological interventions for epilepsy, surgical treatments such as thermal ablation have also expanded. Surgery is still seen as the ideal option for many patients with intractable seizures. She said there is also an important role in epilepsy care for alternative approaches, such as using meditation or mindfulness to reduce stress.

Dr. Haut, who participated in clinical testing of both cenobamate and cannabidiol, said she and her colleagues who work in epilepsy centers continue to have a healthy respect for the efficacy and experience with the older drugs. Insurance coverage also influences prescribing decisions, she added, particularly since many older drugs are available in cheaper generic forms.

Changing someone who is seizure-free to another medicine ends up being a big decision, she said, even if the person has some milder side effects. Some drug changes, involving switching from a potentially teratogenic drug, are necessitated by a female patient's desire to become pregnant.

Dr. Haut said that while seizure freedom is the goal for which we aim, in tailoring a patient's treatment, there is a long list of positive outcomes that have to also be our goals.

The impact of epilepsy is far-reaching, she said, noting that improvements in quality of life are a measure that doesn't necessarily get enough attention.

Dr. Haut has received consulting fees from Alden Health. Dr. Williams Roberson has received fees for an in-kind gift of a dinner from LivaNova. Dr. French receives NYU salary support from the Epilepsy Foundation and for consulting work and/or attending scientific advisory boards on behalf of the Epilepsy Study Consortium for Aeonian/Aeovian, Anavex, Arvelle Therapeutics, Inc., Athenen Therapeutics/Carnot Pharma, Axovant, Biogen, BioXcel Therapeutics, Blackfynn, Cerebral Therapeutics, Cerevel, Crossject, CuroNZ, Eisai, Encoded Therapeutics, Engage Therapeutics, Epiminder, Epitel, Fortress Biotech, Greenwich Biosciences, GW Pharma, Ionis, Janssen Pharmaceutica, Knopp Biosciences, Lundbeck, Marinus, Merck, NeuCyte, Inc., Neurocrine, Otsuka Pharmaceutical Development, Ovid Therapeutics Inc., Passage Bio, Pfizer, Praxis, Redpin, Sage, SK Life Sciences, Stoke, Sunovion, Supernus, Takeda, UCB Inc., Xenon, Xeris, Zogenix. She has also received research grants from Biogen, Cavion, Eisai, Engage, GW Pharma, Lundbeck, Neurelis, Ovid, Pfizer, SK Life Sciences, Sunovion, UCB, Xenon and Zogenix as well as grants from the Epilepsy Research Foundation, Epilepsy Study Consortium, and NINDS. She is on the editorial board of Lancet Neurology and Neurology Today. She has received travel reimbursement related to research, advisory meetings, or presentation of results at scientific meetings from the Epilepsy Study Consortium, the Epilepsy Foundation, Arvelle Therapeutics, Inc., Biogen, Cerevel, Engage, Lundbeck, NeuCyte, Inc., Otsuka, Sage, UCB, Xenon, Zogenix.

Link:
New Epilepsy Drugs, Expanded Therapy Options: How the... : Neurology Today - LWW Journals

Courtesy of Yale Medicine

For some COVID-19 patients, recovery does not mean the end of their suffering. Effects from the illness could linger in the brain and manifest through symptoms including persistent headaches, brain fog and cognitive difficulties.

To address these long-term neurological effects, doctors at the Yale New Haven Hospital have started a new neuroCOVID clinic one of the first of its kind in the United States. Led by a team of physicians at YNHH, the clinic started offering telehealth consults on Oct. 12 and will likely transition into a physical setting in the coming months.

In normal circumstances, starting a new clinic takes a while, but patients need help now so everybody was supportive in getting it off the ground, said Lindsay McAlpine, a neurology resident at YNHH and one of the clinics leaders.

Neuroinfectious disease specialist and assistant professor at the School of Medicine Shelli Farhadian said that the pulmonary division at YNHH swiftly established an outpatient clinic for post-COVID patients who were experiencing long-term respiratory difficulties. Some of these patients were never even hospitalized but still contended with lasting symptoms months after diagnosis. Pulmonologists running this service would often come across patients with neurological complaints, who they would refer to YNHH neurologists.

The volume of patients in need of special neurological attention was part of what inspired the creation of a specialized neuroCOVID clinic. Specific neurological symptoms could be addressed through the clinic while unloading some of the obligations from the hospitals primary neurology service. According to Farhadian, this dedicated service could really [help] us begin to understand just the basics of the spectrum of disease thats associated with COVID-19.

Because neurological manifestations have a wide range of variability, the clinic will harness the expertise of neuroinfectious disease doctors, clinical neurologists, neuropsychiatrists and other specialists to help patients.

According to behavioral neurologist Arman Fesharaki-Zadeh, this decision to coalesce forces should lead to a more conclusive understanding of elusive neurological symptoms.

I think we have a synergistic picture moving forward and hopefully a complementary set of expertise, Fesharaki-Zadeh said.

McAlpine said that, from her experience with inpatient consults, not only do patients often want to learn more about what is happening to them, but they also want to help others by participating in research.

Although the clinics primary mission is to help patients feel better, the doctors hope to work with those who wish to voluntarily enroll in studies to paint a clearer picture of how COVID-19 can affect the brain, Farhadian said.

We have an obligation, I think, and also an important opportunity here, to understand how and why these symptoms are happening, she said.

Fesharaki-Zadeh said that one of the first post-COVID patients he saw was a YNHH technician who had contracted the virus from a patient. Despite having no prior medical issues, he suffered a complicated infection course and was hospitalized for almost a month.

According to him, this patient not only struggled with respiratory difficulties, but also grappled with neurological and psychiatric manifestations, including anxiety, memory issues and difficulties organizing his thoughts. These observations, coupled with imaging that evidenced oxygen deprivation in his brain, struck Fesharaki-Zadeh.

I was really taken back by what I saw, he said. He didnt have any of the risk factors that I would associate with that type of presentation.

The brain is a three-pound organ that nevertheless expends 20 percent of the bodys oxygen supply, Fesharaki-Zadeh said. Because of that, the neurovascular effects of the coronavirus can be devastating. Fatal coronavirus-related strokes, for example, have been documented in the medical literature.

But, according to Fesharaki-Zadeh, not all phenomena affecting the brain have easily identifiable anatomical indications. Sometimes, patients experiencing psychiatric symptoms can have perfectly normal brain scans.

Fesharaki-Zadeh told the News that he hopes more nuanced ways of looking into brain function will be developed in the near future, possibly by measuring other biological footprints including molecules in synapses, the points of connection between neurons.

We have a few barriers to surpass, he said. But I think once those barriers are at least partially resolved it will be a new renaissance, a new era of clinical care.

Serena Spudich division chief of neurological infections and global neurology and one of the leaders of the new neuroCOVID clinic and her colleagues published a paper in The Lancet which details lessons learned from consults with neuroCOVID patients prior to opening the clinic.

Upon reviewing 100 post-COVID cases at YNHH spanning from Apr. 6 to May 29, they observed that, among patients requiring neurological consults, 25 percent were Hispanic and 25 percent were Black. In Connecticut as a whole, 17 percent of residents are Hispanic and 12 percent are Black.

The authors wrote that this discrepancy reflects the racial and ethnic disparities observed throughout the pandemic in the United States and in Europe, and that further action is required to understand and target the roots of this phenomenon.

These observations are important to highlight and guide future research on how we can, one, figure out why this disparity is happening, and two, create policies to address it, McAlpine said. Its definitely one piece of the puzzle, and its an important one that we want to figure out.

Farhadian also emphasized that doctors are currently open to what the spectrum of disease for COVID-19 could be.

She pointed out that it is possible that these long-term symptoms could be common to other extended conditions but have never been studied under the same level of scrutiny as now.

We dont know if the symptoms that people are reporting now are specific to COVID-19 or if these are symptoms that people may experience after any kind of critical illness really, and that were paying attention to them in a different way because of COVID-19, Farhadian said.

According to the New York Times, at the time of this writing, over 64,000 coronavirus cases have been reported in the state of Connecticut.

Maria Fernanda Pacheco | maria.pacheco@yale.edu

Link:
YNHH opens neuroCOVID clinic to treat long-term neurological symptoms associated with COVID-19 - Yale Daily News

From sleep to neurologic conditions, to better food allergy care and worse respiratory outcomes, coronavirus 2019 (COVID-19) has been more impactful to every field of medicine this year than any disease in recent memory.

Courtesy of sister publicationHCPLive, here is some new research from this last week which illuminates COVID-19s effect on patients across non-infectious disease specialties.

COPD Linked to Three-Fold Greater Mortality Risk in Severe COVID-19 Patients

The prevalence of comorbid chronic obstructive pulmonary disease (COPD) among patients hospitalized with COVID-19 is actually lower than its presence in the general population, according to a new observational cohort analysis presented at the CHEST 2020 Annual Meeting this weekend.

A pair of investigators reported that just 5% of observed patients hospitalized with COVID-19 suffered from COPDversus significantly greater rates of cardiometabolic disease among the most severely ill patients.

Their analyses included 22 studies from 8 countries including 11,000-plus patients hospitalized with COVID-19.

Patients with COPD faced a three-fold greater risk of mortality (odds ratio [OR], 3.23; 95% CI, 1.59 6.57;P<.05) than those without.

Investigators also found that smoking was present in 37% of COVID-19 patientsyet patients who smoked faced only a 52% worsened risk of disease severity (OR, 1.52; 95% CI, 0.81 2.87;P= .20).

Virtually Supported Home Peanut Introduction is Viable Option

A new report detailed the first known use of a virtually-supported home peanut introduction in infant patients at risk of developing peanut allergy. The program, conducted in April, could provide means to continue crucial, timely peanut allergy care during the pandemic.

Investigators noted that no reactions were reported during the assessed virtual food introduction process, which they considered to be consistent with the current evidence that anaphylaxis is rare and non-threatening with first ingestion in infancy.

Thus, they emphasized that mild reactions can generally be managed with antihistamine and/or observation.

Even before COVID-19, lack of allergist resources presented significant barriers to the introduction of peanut to at-risk patients where there was hesitance, they wrote. Virtually supported introduction may represent a future option after COVID-19 to improve access for patients who live in remote areas, or otherwise have limited access to allergists, or for clinicians with overburdened clinics.

COVID-19 Linked to Several Neurological Disorders

Data from a prospective study conducted by investigators from the NYU Langone Grossman School of Medicine showed patients with COVID-19 may be at risk for developing new neurologic disorders.

The study observed that 13.5% of patients hospitalized with COVID-19 during the study timeframe developed a new neurologic disorder in a median of 2 days from COVID-19 symptom onset.

Among those newly diagnosed, the most commonly observed neurologic disorders were toxic/metabolic encephalopathy (6.8%), seizure (1.6%), stroke (1.9%), and hypoxic/ischemic injury (1.4%). Among patients with seizure, 34 of 74 (46%) had no prior history of seizure or epilepsy.

No patients reported with meningitis/encephalitis or myelopathy/myelitis referable to SARS-CoV-2 infection and 18 of 18 patients that underwent cerebrospinal fluid analyses were reverse transcription polymerase chain reaction negative for SARS-CoV-2.

In contrast to prior retrospective studies that focused on the conglomerate prevalence of non-specific neurologic symptoms (agitation, dysexecutive function, myalgia, dizziness, headache) along with neurologic diagnoses (e.g. stroke, seizures, Guillian-Barre syndrome etc.), we applied rigorous, standardized diagnostic criteria to identify the prevalence of specific neurologic diagnoses in a prospective fashion, the authors wrote.

Patients who were diagnosed with neurologic disorders after admission were significantly older, and more severely ill based on Sequential Organ Failure Assessment scores, intubation rates and acute renal failure rates. Additionally, patients who had neurologic disorders post-admission were more often diagnosed with stroke, hypoxic/ischemic brain injury, seizure, neuropathy, and myopathy.

New Study Shows Connection Between COVID-19 and Sleep Issues

Investigators from a web-based study conducted 4 weeks into national lockdowns in Israel found a high frequency of maternal clinical insomnia in recent months: 23% during the pandemic, compared to 11% in the 1-2 months prior to the pandemic.

They also found approximately 80% of mothers reported no change in their childs sleep quality, duration, and sleeping arrangement during the COVID-19 pandemic.

On the other hand, approximately 30% of these mothers reported a negative change in their childs sleep quality, as well as a decrease in sleep duration. There were also mothers who reported a positive change.

These findings suggest that the changes in sleep patterns during the COVID19 pandemic are varied and that no unified change for the worse should be expected, the authors wrote. Further consideration of changes in sleep within the family context during this ongoing crisis is needed.

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How COVID-19 Influences Allergies, Neurology, and Sleep - Contagionlive.com

TechWomen/TechGirls honor recognizes her work in epilepsy treatment

D-H neurologist Barbara Jobst was named 2020 Tech Professional of the Year by the NH Tech Alliance.

Dartmouth-Hitchcock neurologist Dr. Barbara Jobst has been named the 2020 Tech Professional of the Year at the NH Tech Alliances fifth annual TechWomen/TechGirls awards luncheon, which was held virtually earlier this month.

The annual award acknowledges the accomplishments of New Hampshire women who contribute to help advance STEM education and professional STEM advancements for women throughout the state.

Jobst, co-director of the Dartmouth-Hitchcock Epilepsy Center at Dartmouth-Hitchcock Medical Center in Lebanon, is the section chief for adult neurology and vice chair of the Neurology Department at DHMC. She is also the Louis and Ruth Frank Endowed Professor of Neurosciences at the Geisel School of Medicine at Dartmouth.

Jobst is a clinician-investigator who applies advanced technology to benefit patients and has trained many students, residents, fellows and junior faculty in using technology to advance medicine. She and her team have participated in multiple multicenter trials involving brain stimulation and she has studied the interaction of memory and epilepsy.

Her work has included improving memory with deep brain stimulation as well as developing and implementing a cognitive-behavioral program for memory problems in epilepsy.

I am honored to be recognized by the NH Tech Alliance, and applaud their efforts to illuminate the work of women in STEM fields and in promoting STEM opportunities to girls and young women throughout the state, Jobst said.

Originally from Germany, Jobst attended Dartmouth Medical School (now known as the Geisel School of Medicine) for four months in 1992 as a medical exchange student. She returned to the United States in 1996 as a medical resident at DHMC after earning her medical degree, and has been with D-H ever since.

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Dartmouth-Hitchcock neurologist named Tech Professional of Year - New Hampshire Business Review

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St. Clair Hospital welcomes new chief of neurology

St. Clair Hospital has appointed noted neurologist Maxim D. Hammer, M.D., MBA, as its new chief of neurology.

Hammer joins St. Clair from UPMC, where he held numerous titles, including vice chairman, clinical affairs, Department of Neurology; clinical director of neurology; and director of stroke Services at UPMC Mercy Hospital, where he helped develop the Stroke Clinic. Hammer founded and directed the Neurosonology lab, which provides outpatient and inpatient services, using carotid duplex and transcranial ultrasonography.

He earned his medical degree at Albany Medical College, Albany, N.Y., and completed his neurology residency at Cleveland Clinic, where he was elected chief resident. He also completed a Vascular Neurology Fellowship at UPMC. Hammer holds an executive healthcare masters degree in business administration from the University of Pittsburgh Katz School of Business. He is an associate professor, Department of Neurology, at University of Pittsburgh School of Medicine. Hammer is board-certified in neurology, as well as in vascular neurology.

Covid-19 relief funding

Fire and EMS companies in the South Hills will share more than $200,000 in state grants awarded to offset operational expenses related to covid-19.

State Rep. Harry Readshaw (D-Allegheny) said the grants awarded by the Office of State Fire Commissioner are necessary to help first responders continue operating as they face additional expenses and a loss of fundraising.

The awards are as follows:

Baldwin Emergency Medical Services Inc.: $23,973

Baldwin Independent Fire Co. No 1: $24,520

Baldwin Emergency Medical Services Inc.: $24,238

Brentwood Volunteer Fire Company: $20,752

Brentwood Emergency Medical Services: $15,048

Mount Oliver Hook and Ladder Company: $23,288

Pleasant Hills Volunteer Fire Co.: $25,068

South Baldwin Volunteer Fire Co.: $22,094

Whitehall Fire Co.: $25,342

Readshaw said the funding may be used for operational expenses such as apparatus repair, fuel, personal protective equipment, utilities, insurance and lost revenue related to pandemic restrictions. It may also be used for cleaning, sanitizing and disinfecting equipment and property or other expenses needed to prevent the spread of disease.

The funds must be used for expenses initiated on or after March 6 and completed on or before Dec. 30 to be eligible for the grant program.

Virtual Turkey Trot 5K

Bethel Park Recreations 2020 Thanksgiving Turkey Trot 5K Run & Walk is offering individuals of all ages the chance to participate in the fun annual event being held virtually this year.

Those registered can run their race between Nov. 8-30.

Registration cost is $40 for adults and $20 for children 12 and under.

Each participant will receive a bib number, finisher certificate, finisher medal and T-shirt. Shirts and medals will be shipped the week of Nov. 30.

To register, stop by the Bethel Park Community Center, 5151 Park Ave., Bethel Park, 15102, or visit runsignup.com/Race/PA/BethelPark/ThanksgivingDayBethelParkRecreationTurkeyTrot5KRunWalk.

For questions or more information, call Bethel Park Recreation at 412-831-1328.

Womens Business Network

Part networking group, part mastermind group, Womens Business Network provides members with the tools to be successful while expanding her circle of influence and marketplace.

All professional women are welcome to attend a meeting as a guest at no charge. Many meetings are being held virtually, so check with a local chapter representative for more information.

The Mt. Lebanon Chapter meets on the second and fourth Tuesdays of the month at 8:30 a.m. The next meeting is Oct. 27. To find out more, contact chapter representative Marlene Will-Knapp at 412-833-9279.

The South Hills Chapter meets on the first and third Thursdays of the month at 8 a.m. To find out more, contact chapter representative Katie Martin at 724-288-1819.

The All Virtual Chapter meets on the first and third Wednesdays of the month at 7:30 p.m. Guests are welcome to attend at no cost. For more information, contact Jennifer at 412-908-1663.

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