SYRACUSE, N.Y. (WSYR-TV) Central New York has the highest population of patients with Multiple Sclerosis (MS) in the nation. Doctors have been speculating why for years, and it may be getting worse.

A neurologist at St. Josephs Health is concerned about the trend hes seen throughout the pandemic.

Dr. Fahed Saada recently treated a 24-year-old man. His brain and spine were riddled with lesions. Hes in the early stages of MS and joins a growing list of Saadas patients, adding to a trend no neurologist wants to see.

Ive never seen so many acute Multiple Sclerosis cases over the years compared to this past year and I dont know why.

Saada says other viruses can increase our risk, but it will be years before we learn COVID-19s contributions, if any. In the meantime, more people are getting sick.

Early treatment can give patients some improvement, but over time, MS progresses.

The disease disrupts the brains ability to send messages to the rest of the body. Theres no cure, and eventually, it causes permanent damage to the nerves.

These lesions, if theyre not treated appropriately and quickly, they become what we call black holes in the brain.

Its hard to stop an uptick in cases when doctors dont know whats causing it.

However, neurologists do know that places north of the equator are at a higher risk because patients with MS have low vitamin D levels.

Doctors also know we here in Central New York dont get a lot of sunlight in the winter.

For now, though, Saada says its a medical mystery doctors desperately want to solve.

Saada says a vitamin D supplement may help boost your prevention, but you should always talk to your doctor before making any changes to your medication and supplements.

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Wellness Wednesday: neurologist concerned about Multiple Sclerosis trend hes seen throughout the pandemic - WSYR

Whether stress-induced or genetic, headaches are a common condition that can affect anyone. This includes neurologists AKA the specialists who treat headache disorders.

Headache is any pain affecting the head, upper face or upper neck. Headaches are called primary when they arise from biological changes within the brain itself, Robert Kaniecki, the director of the UPMC Headache Center in Pittsburgh, told HuffPost. These include migraine headaches, tension-type headaches, and cluster headaches.

Migraine-induced headaches cause additional symptoms such as nausea, sensitivity to light and noise, fatigue, visual disturbances and more. People may also experience secondary headaches if there is another underlying illness or cause for the headache, Kaniecki said.

Worldwide, headache disorders are considered one of the most common yet under-treated disorders of the nervous system. Additionally, a 2018 study found that one in six people in the U.S. reported having a migraine or severe headache over a three-month period.

HuffPost spoke to neurologists about the things they personally do when experiencing a headache, and why these go-to strategies work.

Find a calming space.

Creating a quiet and relaxing environment is often the first step some neurologists take to alleviate headache pain.

If I have a headache, I rest or lie down for as long as I can, and it doesnt depend on the time of day, said Faye Begeti, a neurology doctor and neuroscientist in the U.K. With migraines in particular, people usually find that they have to lie down in a quiet, dark room.

Distract your mind.

With busy schedules and responsibilities, taking a quick siesta isnt always feasible. Rami Burstein, a professor of anesthesia and neuroscience at Harvard Medical School, explained that he tends to utilize relaxing distractions when he cant power nap in the workplace.

As contrary as it may sound, walking can be helpful and reading, Burstein said.

Figure out your triggers.

Understanding your headache triggers can serve as both a preventative and in-the-moment approach to address pain.

Most of my migraine attacks are visually triggered or are triggered when I am ambivalent or worried about a decision or situation. The latter is a bit harder to control, but its fascinating to recognize, said Jan Lewis Brandes, the director and founder of the Nashville Neuroscience Group. Red wine can be a trigger for me, so I am careful about not having more than a few ounces.

Additionally, a common headache trigger is sleep disturbances. Theres a misconception that headaches are primarily caused by sleep deprivation, but Begeti explained that sticking to a consistent sleep schedule may be more important than the amount of sleep you get every night.

This is something that I didnt know when I was at university, so I would reliably have a headache every single Saturday after staying up late the day before, and sleeping in on the weekend, Begeti said.

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Get hydrated ASAP.

Many neurologists pay closer attention to what they drink when experiencing headache pain. As simple as it sounds, water is your best friend when you have a headache or migraine.

Kristina Lopez, an assistant professor at the West Virginia University Rockefeller Neuroscience Institute and headache specialist, said that her headaches are typically a signifier that she needs to up her hydration. While Lopez explained that researchers arent quite sure why drinking water eases headache pain (there are a number of theories), its a cheap and safe preventative and as-needed treatment strategy.

I finally took my own advice and started getting a consistent eight hours of sleep and drinking more water, Lopez said. Its wild how much better I feel.

Try drinking a little coffee, too.

Though it may seem counterintuitive, caffeine can actually be a remedy for headaches. Brandes said that drinking a cup of coffee is the first step she takes when combatting a migraine attack, followed by drinking a glass of water and taking medication.

Caffeine causes blood vessels to narrow and restricts blood flow around the brain, which can relieve pain. However, moderation is key: Consuming caffeine on the regular may have the opposite effect, leading to withdrawal headaches if you suddenly stop drinking your morning espresso or green tea.

Eat smaller meals throughout the day.

Interestingly, another personal tip from Kanieki is to break snacks and meals into five to six portions throughout the day.

This is because low blood sugar may exacerbate headache pain, along with migraine symptoms. Try swapping up your meal times or breaking down bigger meals into smaller parts that you eat intermittently and see if it helps.

Take pain relievers when necessary.

Depending on the severity of her headache, Begeti will take over-the-counter pain medication such as non-steroidal anti-inflammatory drugs (aka NSAIDs) or acetaminophen. However, be sure to keep track of the amount of pain relievers you take: Begeti noted that she limits her monthly intake of over-the-counter pain medication to under 10 days a month to avoid medication-overuse headaches.

If you are experiencing more severe pain or symptoms, it may be worth a trip to the neurologist to see if you could benefit from prescription medication.

I get migraine attacks and will take a triptan an as-needed migraine pain medication and a nausea medication when I feel an episode coming on, Lopez said.

Remember that some factors are outside of your control.

While some things can help you prevent headache pain, its important to note that not every headache can be linked to lifestyle or environmental factors.

Sometimes there are no notable triggers to headaches, Begeti said. A big part of why people get headaches is due to genetics, and I see headaches that run in families.

Headache pain can range from mild to debilitating. Trying neurologist-approved strategies until you find what specifically works for you may help to alleviate your pain in the long run. Establishing a unique, at-home routine is vital to treating these conditions effectively.

Its important to listen to your body. I find that a headache may resolve if I do that and it certainly prevents it from getting worse, Begeti said.

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8 Things Neurologists Do When They Have A Headache - HuffPost

Our search found 37 bedside clinical tests or groups of tests for motor FND (functional weakness and functional movement disorder) that had some formal validation (table 2). Sample size varied between 8 and 107 patients with FND. Most investigations of positive signs were conducted in a single study or a small number of studies (maximum five for the Hoover sign), allowing for the calculation of pooled specificity and sensitivity by merging data from different studies. Five studies reported on the inter-rater reliability of positive signs.

Overall, the specificities of validated signs are high, ranging from 64% to 100%; however, the sensitivities are lower, ranging from 9% to 100%. Inter-rater reliability of these signs is overall good to excellent (defined as values: <0.2 poor/0.21-0.4 fair/0.41-0.6 moderate/0.61-0.8 good/>0.8 excellent).

General signs common to all FND presentations are: variability of the symptom, which can be observed during history taking and examination, and effortful or grimacing expression while following the examiners instructions during examination. If suspecting a functional movement disorder, test oculomotor function to show abnormal eye movements and in particular convergence spasm,100 even if the patient did not endorse this as a concern during history taking.

When assessing gait, look for typical positive signs such as monoplegic leg dragging, excessive visible effort (huffing and puffing sign),50 falling toward support (chair nearby, table, wall), excessive slowness, hesitation or caution, non-economic posture (for example knee flexed), and knee buckling (sudden loss of tone at each step).101 Asking a patient with severe gait disorder to propel a chair while sitting on it will show improvement in FND.51

When assessing hemifacial spasm, look for typical signs such as long contraction of more than three seconds, lip pulling (tonic deviation of the lip, often the lower one) sometimes with platysma contraction, and lack of other Babinski sign for hemifacial spasm (other Babinski sign=eyebrow elevation on the side of the spasm).102 Positive signs for functional orofacial movements in comparison with tardive dyskinesia are: lack of chewing movements, lack of self-biting, lingual movements without mouth movements, and abnormal speech.45 A large case series (61 patients) that focused on facial functional movement103 reported involvement of the lip as the most frequent (60.7%, with the lip pulling feature).

When assessing movements of the trunk, look for the typical positive sign of asymmetry in strength of the sterno-cleido-mastoid muscle.53 A functional Romberg sign is described as large movements of imbalance with sudden steps and no falls and improvement with cognitive distraction or numbers drawn on the back.48

When assessing episodes of cataplexy (brief, symmetrical loss of muscle tone with retained consciousness precipitated by strong emotions) look for positive signs54 such as lack of sudden facial expression change, facial jerks or grimaces, postural dyscontrol (head drop, trunk fall), in addition to preserved tendon reflexes (which typically disappear during cataplexy associated with narcolepsy).

When assessing upper arm weakness, look for discordance or inconsistency in strength (at different instances during the examination), as well as a give-way/collapsing pattern, drift without pronation, and/or co-contractions of agonist and antagonist muscles preventing movement of the tested joint. As a cautionary note, give-way/collapsing pattern of weakness is common in patients with pain limited weakness (and pain limited weakness should not be mistaken for functional limb weakness).104 In cases of complete hand plegia, involuntary abduction of the fifth finger can be seen when the patient is asked to do a forced abduction against the examiners resistance on the healthy hand.58 The flex-ext sign, which is the equivalent of the Hoover sign,105 can be elicited as follows: the involuntary flexion of the arm at the elbow that occurs when the patient focuses on extending the healthy elbow against the examiners resistance is better than the voluntary flexion.59

When assessing lower limb weakness, also look for discordance/inconsistence, give-way/collapsing weakness, co-contractions, and the Hoover sign.61 The classical way to describe a positive Hoover sign is when the involuntary hip extension (when the patient focuses on flexing the healthy leg against the examiners resistance) is stronger than the voluntary hip extension. A similar pattern can be found during leg abduction60: when the patient is asked to do a forced abduction with both legs against the examiners resistance, the weak leg will have a stronger involuntary abduction than when the voluntary abduction is tested. In patients with severe unilateral leg weakness, positioning passively the leg in flexion with the soles on the bed (spinal injury test)62 shows a discordance in strength as the weak leg will not fall on the side, as expected in complete weakness.

When assessing tremor, typical signs are distractibility, entrainment, and increase in amplitude with weight load on the wrists. In addition, look for variability in amplitude, frequency, and direction of tremor.63 A whack a mole sign can be seen106: when the limb affected by tremor is immobilized by the examiner, the tremor appears in another body segment (head, trunk, other arm, or legs).

No validated clinical signs are available for assessing dystonia, but a pattern of adult sudden onset fixed dystonia (typically clenched fist sparing thumb and index finger107) or equinovarus foot is suggestive of functional dystonia.108 Associated prominent pain and other FND signs can help support the diagnosis.109

When assessing tics, no validated signs are available but clinical clues can help identify functional tics110111: lack of premonitory urge and inability to suppress the movement, female preponderance, additional FND symptoms, lack of response to anti-tic medication, and absence of family history. In functional tics, the cranial region is less affected, the type of tic is often blocking (ie, interferes with voluntary action) and pali, echo, and copro phenomenon are less common.

Overall, the evidence for rule-in motor signs shows very high specificity, which advocates for their routine use in clinical practice. A range of educational pictorial and video libraries illustrate many of these signs.2101102112113 Too much emphasis on a single sign, however, can lead to false positives. In a cohort of 190 patients diagnosed with a neurological disorder, 37 (20%) had at least one positive functional neurological sign.91 Interestingly, regression analysis showed that this 20% of the cohort had typical risk factors known in patients with FND, suggesting that the presence of positive signs in this subgroup could either be false positives or indicate the presence of an FND comorbidity. Keep in mind the possibility that the patient has both FND and another neurological disorder: recent reports describe functional neurological signs in a subset of patients with Parkinsons disease114115 or multiple sclerosis.116 Overall, data from a systematic review and a prospective study underscore that rates of misdiagnosis in FND since 1970 (once confirmed) are low, and between 1% and 4%.117118

Recently, efforts have been made to integrate additional clinical features in the process of diagnosis, such as, for example, abrupt onset, fluctuations of the motor symptom, comorbid pain, and fatigue.119 The presence of these features should raise the index of suspicion and prompt a more systematic search of signs positive for FND.

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Diagnosis and management of functional neurological disorder - The BMJ

This article was originally published here

Disabil Rehabil. 2022 Jan 27:1-32. doi: 10.1080/09638288.2022.2028911. Online ahead of print.

ABSTRACT

PURPOSE: Peer-based interventions are increasingly popular and cost-effective therapeutic opportunities to support others experiencing similar life circumstances. However, little is known about the similarities and differences among peer-based interventions and their outcomes for people with neurological conditions. This scoping review aims to describe and compare the characteristics of existing peer-based interventions for adults with common neurological conditions.

MATERIALS AND METHODS: We searched MEDLINE, CINAHL, PsychInfo, and Embase for research on peer-based interventions for individuals with brain injury, Parkinsons, multiple sclerosis, spinal cord injury, and stroke up to June 2019. The search was updated in March 2021. Fifty-three of 2472 articles found were included.

RESULTS: Characteristics of peer-based intervention for this population vary significantly. They include individual and group-based formats delivered in-person, by telephone, or online. Content varied from structured education to tailored approaches. Participant outcomes included improved health, confidence, and self-management skills; however, these varied based on the intervention model.

CONCLUSION: Various peer-based interventions exist, each with its own definition of what it means to be a peer. Research using rigorous methodology is needed to determine the most effective interventions. Clear definitions of each program component are needed to better understand the outcomes and mechanism of action within each intervention.IMPLICATIONS FOR REHABILITATIONRehabilitation services can draw on various peer support interventions to add experiential knowledge and support based on shared experience to enhance outcomes.Fulfilling the role of peer mentor may be beneficial and could be encouraged as part of the rehabilitation process for people with SCI, TBI, Stroke, PD, or MS.In planning peer-based interventions for TBI, Stroke, SCI, PD, and MS populations, it is important to clearly define intervention components and evaluate outcomes to measure the impact of the intervention.

PMID:35085058 | DOI:10.1080/09638288.2022.2028911

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Characteristics of peer-based interventions for individuals with neurological conditions: a scoping review - DocWire News

EXTON, Pa., Jan. 27, 2022 /PRNewswire/ -- On January 11th, the Centers for Medicare and Medicaid Services (CMS)' proposed Medicare reimbursement of FDA-approved anti-amyloid monoclonal antibodies (mAbs) be limited to clinical trials under Coverage with Evidence Development (CED). Days later, Spherix surveyed 75 U.S. neurologists and Alzheimer's disease specialists (including five follow-up interviews) to evaluate their awareness of and opinions on this unprecedented event.

The resulting insights are part of a two-wave Special Topix: Impact of CMS Reimbursement Decision on Alzheimer's Disease Therapies service. The second wave will be fielded immediately following the publication of the final determination.

Key takeaways from the first wave of research include:

Indeed, according to an interviewed neurologist, "To pre-judge before the data is submitted on the other three products is unfair. I don't think that that's reasonable because one of them may show a significant clinical improvement."

One neurologist noted, "If Lilly had very strong data on clinical benefit [with donanemab], not just clearing of amyloid, and on the side effect profile, I hope that CMS would change its decision for that particular drug."

Positive cognitive and functional data with acceptable safety from at least one of the ongoing Phase III programs with anti-amyloid mAbs would positively impact neurologists' currently low willingness to participate in such trials.

As mentioned by one interviewed neurologist, "The FDA is very concerning. As you probably are aware, the advisory committee, which were all neurologists and memory disorder neurologists, almost unanimously recommended against it [Aduhelm's approval] and then the FDA went around and said yes, so you lose a lot of confidence right now. My confidence in CMS is much better, much improved. I think they did the right thing. I think this is necessary. Too expensive and too potentially harmful to just willy-nilly start using these medications. We need to know definitively that these are really beneficial."

While CMS' draft NCD decision is specific to anti-amyloid mAbs, the Special Topix report also captures insights on the potential impact that the proposal could have on emerging therapies for Alzheimer's disease with alternative mechanisms of action (i.e., non-amyloid-targeted).

About Special Topix

Special Topix: Impact of CMS Reimbursement Decision on Alzheimer's Disease Therapies (US)includes two waves of research, collecting feedback from U.S. neurologists and Alzheimer's disease specialists about their awareness of and opinions on CMS' draft and final National Coverage Determination (NCD) decision on FDA-approved mAbs targeting amyloid for the treatment of Alzheimer's disease. The waves of research will field immediately following the releases of the draft and final NCD decisions.

Therapies covered include:

Learn more about our services here.

About Spherix Global Insights

Spherix Global Insights is a hyper-focused market intelligence firm that leverages our own independent data and expertise to provide strategic guidance, so biopharma stakeholders make decisions with confidence. We specialize in select immunology, nephrology, and neurology markets.

All company, brand or product names in this document are trademarks of their respective holders.

For more information, contact:

Virginia Schobel, Neurology Franchise Head

info@spherixglobalinsights.com

http://www.spherixglobalinsights.com

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Neurologists React to CMS' Proposed NCD Decision on Anti-Amyloid Monoclonal Antibodies for Alzheimer's Disease in the Latest from Spherix Global...

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

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Longer Decompression Time and Early Transport Time After Spinal Cord Injury Are Linked to Higher Impairment... - Physician's Weekly