Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

This transcript has been edited for clarity.

Mark J. Alberts, MD: Hello, and welcome to this Medscape update. My name is Dr Mark Alberts. I'm chief of neurology at Hartford Hospital and I'm a vascular neurologist.

Today I'm joined by my friend and colleague, Dr Jesse Weinberger. I'm going to let Dr Weinberger introduce himself now. Jesse?

Jesse Weinberger, MD: Thanks. I'm Jesse Weinberger. I'm a stroke neurologist at Mount Sinai and I'm coming to you from the neurovascular lab. I'm the director of the neurovascular laboratory at Mount Sinai.

Alberts: What we're going to be talking about for the next little while is something that I'm sure many of our colleagues on the Medscape platform are interested in, which is the association between COVID-19 infections and cerebrovascular disease.

Here at Hartford, we have seen our fair share of COVID-19 folks with strokes. I'm sure that Jesse, being at Mount Sinai, at sort of ground zero in New York, has also seen his fair share. So let's talk about the overall landscape of COVID-19associated strokes.

Jesse, what have you seen, and [can you speak to] the epidemiology and some of the numbers?

Weinberger: Mount Sinai has affiliates all over Manhattan and in Queens. And it was our Queens affiliates, Elmhurst and Mount Sinai Queens, that were in the epicenter of stroke in New York. If you recall from the news, Elmhurst was the hospital that got flooded over and we got a lot of their transfers.

We have one interventional team that services all the hospitals and moves [to the patients] to avoid the patients having to be moved. That makes it much faster to get a fast thrombectomy time.

Our group has probably seen the most stroke COVID-19 patients because we've had the most COVID-19 patients. In terms of epidemiology, one of the papers that our interventional group is putting together compares the number of interventions we do in a given month prior to COVID to how many we're doing now. They found that we're doing twice as many interventions for large vessel thromboses than usual, over 50% of which were on COVID-19 patients.

These were mainly young patients who were forming clots in the arteries, and with no evidence of dissection or a cardiac source. [These were] spontaneous thrombi affecting large cerebral vessels, like the middle cerebral artery.

Alberts: One of the things that we've seen here at Hartfordand I want to see if your experience in New York has been the sameis that in general, we have seen a decline in terms of routine stroke patients and routine interventions, like use of TPA and endovascular therapy.

I think our colleagues around the country have also seen a general decline in stroke patients overall, even though as I've seen and as you just pointed out, in those COVID-19 patients, certainly there seems to be some coagulation and ischemic issues. Have you see an overall decline in the nonCOVID-19 stroke population?

Weinberger: Not so much a decline as that they're coming in a day or two after. They're not coming in for the acute intervention, which is unfortunate because some of them might have been candidates for TPA or thrombectomy, and instead they come in too late.

Alberts: COVID-19 is attacking people in different age groups and [results in] very high mortality with older folks and those in nursing homes. But what about this younger population we're seeing?

Weinberger: These are patients primarily under 50. They're young patients that are getting this, for some reason.

Alberts: As we both know, there have been several reports about COVID-19 causing somewhat of a hypercoagulable state. We've certainly seen many folks with high D-dimers, DVTs, PEs, as well as ischemic stroke. Has that been your experience in New York, Jesse?

Weinberger: Well, we see a lot with elevated D-dimers. We had four patients with acute thrombi in the carotid bifurcation and two of them had normal D-dimers, so we weren't sure exactly why that happened. Some of the patients have had anticardiolipin antibody.

My rheumatology colleagues say that they're seeing many rheumatologic disease mimics from the COVID-19 infection that turn into Kawasaki syndrome. It may be that they're having an immune response that mimics a lupus anticoagulant or anticardiolipin antibody that contributes to the thrombosis.

Alberts: Very interesting. As we talk about specific stroke syndromes, we have seen two varieties. Number one are folks with MRIs showing a bunch of small strokes all over the place, like you could see in somebody hypercoagulable with cancer or with a central embolic source.

We're also seeing the same thing that you describe, which is large vessel strokes like M1 inclusions, in folks who don't have a good reason for it. There's no atrial fibrillation and they're not really atheropathic, per se. They're just having in situ clots. Are you seeing the same variety?

Weinberger: Oh, yeah. In addition to the ones that I mentioned with the large vessel thromboses, we're seeing many with multiple small infarcts, but we don't find anything in the heart causing it. We think it's probably multiple angiopathy due to COVID-19 thromboses.

Alberts: In the vascular studies that we've done here in the folks with strokes all over the place, I don't think we've seen many with an underlying vasculopathy. The vessels, as near we can tell, look normal. They're just having clots all over the place, producing this shotgun image of small strokes in different vascular territories.

Weinberger: Right. We're seeing the same thing, but it does seem to us that it was direct thromboses in these vessels rather than a shower of emboli.

Alberts: And it could be both. It's hard to tell. But I agree: We're not seeing any obvious central embolic source like clots in the left ventricle or left atrium, or myxomas or anything like that.

Weinberger: Our echocardiographers didn't want to do echos on the COVID-19 patients. Fortunately, the first one we sent to them actually had an atrial septal defect. After that, they acquiesced to doing all of our studies, and no one else had any positive [cardiac] findings.

Alberts: We and others are seeing folks with DVTs and PEs, which speaks to a hypercoagulable state, obviously.

Weinberger: Right. The people I'm thinking of that had the multiple infarcts also had PEs. They had both, so it wasn't a paradoxical embolus.

Alberts: Right. Again, when you have D-dimers in the thousands, it's not too surprising that we would see that.

How about your approach to treatment in terms of IV lytic therapy versus endovascular therapy? I know some of this is dictated by the underlying CTA results, but are most of your patients being treated with TPA, endovascular therapy, or both?

Weinberger: We approach it the same way as with any other stroke patient. If they're in the window for TPA, we'll give it and then proceed to the thrombectomy if they need it. We've had a couple of patients that actually got better right after the TPA, which was nice.

Alberts: Yes, very gratifying. How about the response to endovascular therapy? Are you able to do a thrombectomy or otherwise open up these vessels, or do some of them look like the clot is old and it's like a brick?

Weinberger: No, they mainly open with thrombectomy, but the results are a little bit mixed. I don't think we see the same percentage of recoveries with these patients as we do under normal circumstances.

Alberts: Yeah, we're tending to see that most of these clots are removable or otherwise treatable. To me, this speaks to the fact that they are probably acute, not like an old clot that's been sitting in the heart for months, which then embolizes and it's hard as a rock and you have a hard time getting it out.

Weinberger: That's probably why they responded to TPA as well.

Alberts: Right. Fresh clots. Now, you did mention that the overall recovery was not as good as you were hoping for. Can you shed some light on this?

Weinberger: I can't really. It's just an observation from a few patients, but it seems like they don't do as well.

Alberts: If your patients are like my patients, most of them are not on the primary neurology or stroke service. We're seeing them as consults because they're in the MICU or another ICU service due to their underlying COVID-19 infection. Is that your experience also?

Weinberger: No. We're admitting them to the neurology ICU or to the stroke service floor. We're taking care of the COVID-19 patients for primary care as well.

Alberts: Do you think COVID-19 patients with stroke as a complication differ from those coming in with a stroke, but in whom you then find have COVID-19?

Weinberger: Interestingly, when many patients go for CT angiography, they're not diagnosed with COVID-19. We pick it up as having a ground-glass appearance in the lungs and then we get to swab them. Once we see that, we assign them to the COVID-19 floor until proven otherwise.

Alberts: My rule of thumb nowadays is that anybody who comes in with a stroke has COVID-19 until proven otherwise.

Weinberger: Right.

Alberts: On the back end, are you having luck sending these folks to rehab or a nursing home? What is the paradigm like in the New York City area?

Weinberger: Actually, there are several nursing homes that take them for subacute rehabilitation. Our acute rehab service isn't taking them, but they're going to subacute centers.

Alberts: Got it. I think we're fortunate because we've had a number of these patients who actually made a good recovery and the nursing homes and rehab center were willing to take them. So we were able to offload some of the patients from the hospital to make room for the next round.

Weinberger: Actually, in the past couple of weeks that I've been on, it's really been slowing down. We haven't had a COVID-19 stroke patient in a couple of weeks now.

Alberts: Wow!

Weinberger: Mitigation.

Alberts: Mitigation is good.

Weinberger: The overall number of COVID-19 patients admitted to the Sinai system is going down and so are the strokes. The other thing is that as soon as somebody is diagnosed with COVID-19, they're being anticoagulated with Lovenox (enoxaparin) because of the known thrombosis risk.

Alberts: That's a great point. We also have a hospital policy that anybody admitted with COVID-19 gets at least prophylactic doses of an anticoagulant. Obviously, if they have ongoing thromboses, then they will get therapeutic doses.

Alberts: What about the lack of taste and smell? Are you seeing that in many of your patients?

Weinberger: I haven't noticed that. Frankly, I probably didn't ask about it.

Alberts: Yeah. Obviously, if they're really sick with a stroke or if they're intubated [it would be difficult]. But it's been reported by CDC that it's one of the cardinal signs to ask about. It would imply cranial nerve involvement, right?

Weinberger: Right. Going up the olfactory nerve into the brain.

Alberts: I think here in Connecticut, we're a few weeks behind you in terms of the curveor maybe in front of you, depending on how you look at itbut like you, we have a number of different hospitals throughout the state [with varying rates]. St. Vincent's, which is in the western part of Connecticut in Fairfield County, is still seeing high volumes. But in general they are all coming down, which is very encouraging.

Weinberger: The question is whether it will stay coming down when we start trying to open up the city again.

Alberts: Right. The other interesting thingand I don't have any answers or insightsis to see if there might be some sort of postCOVID-19 syndrome, like pulmonary fibrosis or some other systemic manifestations, after the infection.

You mentioned the autoimmune component. Like many autoimmune diseases, they do have the potential to fluctuate, and it's just going to be very interesting to have these patients followed long-term for 3 months, 6 months, a year, just to see if there are any long-term sequelae, either autoimmune or postinfectious or something in that realm.

I don't have any answers or insights, but that's why they call it "novel." This is a new disease that we don't have much experience with.

Weinberger: Correct.

Alberts: I think we've touched on a lot of the points about epidemiology, acute treatment, and long-term outcomes.

Thank you to our Medscape audience for joining us. I wish that all of our colleagues be well and that their patients have a rapid recovery.

Follow Medscape on Facebook, Twitter, Instagram, and YouTube

Originally posted here:
Explaining the Association Between COVID-19 and Stroke - Medscape

Article In Brief

Most therapies for multiple sclerosis and neuromyelitis optica spectrum disorder should be continued and not stopped during the COVID-19 pandemic, MS experts agree. But there are also pros and cons of starting certain B-cell depleting and other therapies.

For most patients with multiple sclerosis (MS), the benefits of staying on therapy will outweigh the risks of stopping due to concerns over COVID-19, according to new guidelines for treating MS during the pandemic.

Even in those with a documented mild case of COVID-19, continued treatment with most MS medications may be reasonable, the guidelines recommend. However, they emphasize: Neurologists should have a lower threshold for stopping treatment in people taking therapies with greater immunosuppressive effects and those with risk factors for a more severe disease (older age, comorbidities), or if COVID-19 symptoms are deteriorating.

Published online in Neurology on April 2 by a team of MS neurologists from the United States, Australia, The Netherlands, and the United Kingdom, the new guidelines cover both MS and neuromyelitis optica (NMO) spectrum disorder. The guidelines differ only slightly from guidelines previously released by the National Multiple Sclerosis Society, the Italian Society of Neurology, and other groups.

Even so, MS neurologists not involved in preparing the recommendations welcomed their publication.

Kudos to the authors for taking the time to do this when we're all under so much pressure, said Annette Langer-Gould, MD, PhD, the regional lead for clinical and translational neuroscience for the Southern California Permanente Medical Group/Kaiser Permanente.

Based on prior experience with other viral infections in people with MS, the recommendations will likely need to be updated as data emerges from actual cases of patients who develop COVID-19.

New data are emerging quickly from clinical experience and from registries that have been established for MS patients with COVID-19, said the first author of the paper, Wallace Brownlee, MD, PhD, a neurologist with the Queen Square MS Centre and the National Hospital for Neurology and Neurosurgery in London.

Indeed, one recommendation in the paper is already out of date. Face masks are only recommended for people who are coughing or sneezing, or for those caring for a patient with suspected COVID-19 infection, the guidelines stated. By now, of course, most public health recommendations call for wearing face masks whenever people are in public and are unable to stay at least six feet away from others.

Otherwise, MS neurologists told Neurology Today that they had few if any disagreements with the guidelines as published. In particular, they all agreed that IV treatments with drugs known to cause significant declines in immune function should be avoided or delayed as long as possible.

Dr. Brownlee and other MS neurologists urged any neurologist treating a patient with MS who develops a COVID-19 infection to submit data to one of the patient registries that have been established. In North America, the National MS Society and the Consortium of MS Centers have established the Coronavirus and MS Reporting Database at http://www.covims.org.

For MS patients who are just beginning treatment, Dr. Brownlee said, We recommend that neurologists take a cautious approach to initiating patients on treatments that can be associated with periods of significant immune suppression, including autologous hematopoietic stem cell transplantation, alemtuzumab and cladribine.

Although acute MS relapses are often treated with a short course of high-dose IV methylprednisolone, such treatments should be avoided during the pandemic, the guidelines stated. High-dose steroids hasten the recovery from MS relapses, but do not influence the final degree of recovery, the paper noted. Because steroids can increase the risk of infection, neurologists should have a higher threshold for offering them during the COVID-19 pandemic, according to the guidelines.

A few disease-modifying therapies (DMTs), including interferon-beta and glatiramer acetate, do not increase the risk of systemic infections. Other DMTs, however, do have immunosuppressive effects with alterations in lymphocyte number, trafficking, proliferation and function, with an increased risk of infections, including viral infections and respiratory infections, the guidelines stated.

People with MS who are profoundly lymphopenic, for example, after treatment with alemtuzumab or less commonly during treatment with cladribine, fingolimod or dimethyl fumarate, may be at higher risk.

As reasonable as such concerns appear to be at this time, the paper noted that no data specific to MS patients with COVID-19 has yet emerged supporting them.

For patients scheduled for routine treatment with alemtuzumab or cladribine, We recommend delaying treatment with these therapies, the paper stated. Likewise, standard every six-month dosing with ocrelizumab or rituximab can also be delayed in most cases.

B-cell depletion frequently lasts much longer than the scheduled dosing interval, the recommendations noted. Extended interval dosing should be considered, especially in patients who are B-cell depleted...or [in] those with low levels of immunoglobulin-G. Extended interval dosing is already widely used in patients treated with natalizumab because of observational data showing a reduced risk of progressive multifocal leukoencephalopathy. Whether this approach reduces the risk of other infections is unknown but should be considered during the COVID-19 pandemic to reduce hospital visits.

For MS patients who are hospitalized with a severe COVID-19 infection, consideration should be given to stopping treatment, the guidelines state. Treatment can be restarted after four weeks, or when symptoms have fully resolved, keeping in mind the risk of rebound MS activity with S1P modulators and natalizumab. Neurologists should alert intensive care physicians to the importance of fever management in people with MS.

Patients with neuromyelitis optica spectrum disorder who do not have a COVID-19 infection should be encouraged to continue attack-prevention therapies, because relapses of NMOSD can be devastating. If the need to stop or delay treatment in such patients arises, then moderate dose corticosteroids (e.g. prednisolone 20mg) can be used to prevent relapses in the short to medium term, the guidelines recommended.

Dr. Langer-Gould echoed the guidelines' concern about MS drugs associated with lymphopenia.

With COVID-19, we're seeing something very unusualthat in the people who do poorly, almost all of them have lymphopenia when they're admitted, she said. Any drug you're on that is causing T-cell lymphopenia is more likely to increase your risk of getting a severe case of COVID. So they have correctly identified the ones to stay away from, including alemtuzumab and cladribine, but I would add fingolimod, dimethyl fumarate and other S1P modulators to that list.

Starting in early March, she said, We actively reached out to patients on dimethyl fumarate and S1P inhibitors and are switching them, depending on their disease severity, either to interferon and glatiramer acetate, or if they had active disease, then we switched them to either rituximab or natalizumab.

But for all her patients other than those on interferon-beta or glatiramer acetate, she said, We're telling them to consider themselves immune-suppressed. They should immediately get themselves tested for COVID-19 if they develop fever or shortness of breath.

Her practice recently had an MS patient who had been stable on natalizumab until suddenly developing a high titer positive antibodies against JC Virus. The patient is now at increased risk of progressive multifocal leukoencephalopathy, Dr. Langer-Gould said.

Our plan had been to switch them to rituximab, but then they developed a COVID-19 infection and are mildly symptomatic. That's a big problem, because you need to pre-treat for rituximab with steroids, potentially increasing the risk of a more severe case of COVID-19, and the infusion is long, which raises the risk of infecting the nursing staff at the infusion center. We've decided to give her another dose of natalizumab eight weeks after her last dose. It's a short infusion, and we don't have to pre-treat with steroids. But what's the right decision?

Timothy L. Vollmer, MD, FAAN, professor of neurology at the University of Colorado Health Sciences Center and medical director of the Rocky Mountain MS Center, said that most of his group's patients are on ocrelizumab.

We probably didn't need to be dosing patients every six months, he said. As a result of COVID-19, we're reevaluating the dosing strategy. We're checking their B cells and antibody levels, and if they are still depleted, we wait another two months. It will take some patients a year or more before they begin to normalize their B cells. Dosing less frequently will also decrease costs substantially and make the drug more attractive for patients to use.

One clear effect of the COVID-19 pandemic is that many MS patients are reaching out to their neurologists about what it means for them.

My colleagues and I have been receiving many phone calls and messages about our recommendations, said Bardia Nourbakhsh, MD, assistant professor of neurology at Johns Hopkins. We try to extrapolate the information that we have from other viral infections.

Dr. Nourbakhsh said he had been contacted the week of April 13 by a community neurologist whose patient had developed a severe, disabling, demyelinating relapse that did not improve after IV steroids.

My recommendation was for the neurologist to set up a plasma exchange, he said. I would not delay the treatment of a serious relapse that could affect the mobility or vision of the patient. Treating an actual condition takes precedence over the possibility of coming into contact with coronavirus.

Bianca Weinstock-Guttman, MD, director of the Jacobs MC Center at the University of Buffalo and director of its Pediatric MS Center of Excellence, said she recommends that all MS patients should be reminded, now more than ever, to follow basic daily health recommendations.

Supportive recommendations for patients include keeping interactions with friends and relatives through video, exercising via YouTube, maintaining a healthy diet, and vitamin supplementation, especially vitamin D, she said.

Joseph Berger, MD, FAAN, professor and associate chief of the Multiple Sclerosis Division at the University of Pennsylvania School of Medicine, noted that the very same tendency of some MS drugs to suppress immune function could in fact benefit COVID-19 patients who develop acute respiratory distress syndrome (ARDS).

Individuals who end up developing ARDS are not dying because of unsuppressed viral replication, Dr. Berger said. Rather, it's an overly robust immune response, a cytokine storm, that appears to give rise to the ARDS. Many of the drugs we use may actually have a beneficial effect on the phase of the illness that results in high morbidity and mortality.

He pointed out that a non-randomized, open-label trial is underway in China to test the effect of giving fingolimod to 30 patients with COVID-19 in order to prevent ARDS.

Dr. Weinstock-Guttman said another drug that might block the cytokine storm is tocilizumab, approved to treat moderate to severe rheumatoid arthritis.

IL-6 blockade was shown beneficial recently also for NMO patients, so it will be interesting to see COVID-19 patients' outcome when treated with antiIL-6 products for a previous underlying disease, Dr. Weinstock-Guttman said.

Dr. Langer-Gould expressed caution about the approach. There's a big difference between using a drug like fingolimod for a few days to reduce a cytokine storm versus having someone on it as a long-term therapy, which results in chronic T-cell suppression and, in rare instances, fatal viral infections, she said.

If your T-cells are markedly diminished and you are infected with COVID-19, your body would have a hard time clearing that virus and you would potentially be at higher risk of developing pneumonia, ARDS, and, potentially, multisystem organ failure.

She added that none of the immunologists she works with are recommending a T-cell-depleting therapy for COVID-19. Most of the patients we're seeing already have low lymphocytes, she said. The virus is taking down the CD4 and CD8 cells. I don't think anyone would feel comfortable giving a drug that further suppresses CD4 and CD8.

Dr. Brownlee agreed that while the potential benefit of fingolimod as an acute treatment to prevent ARDS is interesting, we need to be careful about being too quick to translate hypotheses into treatment. It's not enough to inform patient care at the moment.

Ultimately, such questions can only be answered as more experience is gained in treating MS patients who develop a COVID-19 infection, Dr. Berger said. Time will tell, he said. It's going to be important to get real-world data from the registries to see whether or not what we think is correct. Is there a signal for any of these MS drugs? We'll know when the registries reveal their data. It's going to take the participation of neurologists around the world to distill out the treatments with one or another drug.

Dr. Brownlee has accepted speaker honoraria and/or participated in advisory boards for Biogen, Merck, Mylan, Novartis, Roche and Sanofi-Genzyme. Dr. Vollmer has received compensation for lectures and consultancy with Biogen IDEC, Genentech/Roche, Siranax, Celgene, EMD Serono, and Novartis. He has received research support from Rocky Mountain MS Center, Biogen,Actelion, Roche/Genentech;, F. Hoffman-La Roche, Ltd., and TG Therapeutics, Inc. Dr. Berger has received honoraria and an institutional grant from Biogen, and Genentech/Roche. He has received honoraria as a consultant for Celegene, Millennium/Takeda, Novartis, Inhibikase, Excision Biom Amgen, Shire, Dr. Reddy, Serono, Morphic, Encycle, Merck, and MAPI. Dr. Nourbarkhsh served on the advisory board for Jazz Pharmaceutical. Dr. Langer-Gould had no disclosures.

Excerpt from:
COVID-19: Recommendations for Treating MS and Related... : Neurology Today - LWW Journals

UAB researchers say lack of financial resources and health insurance, as well as living in the South, are keys to disparities in epilepsy care.

UAB researchers say lack of financial resources and health insurance, as well as living in the South, are keys to disparities in epilepsy care.Treatment of epilepsy in America varies depending on several social factors, including income, insurance and region, according to new research from the University of Alabama at Birmingham published online on April 12 in Epilepsy and Behavior.

Using data from the 2013, 2015 and 2017 National Health Interview Survey administered by the Centers for Disease Control and Prevention, the researchers found that poverty is associated with a lower likelihood of anti-seizure medication use and the uninsured are less likely to visit a neurology provider, while people in the Northeast are more likely to see a neurologist. They also found that epilepsy treatment did not vary by race/ethnicity or immigrant status.

According to the United States Institute of Medicine, there are significant social barriers to optimal care and health outcomes for people/persons with epilepsy (PWE), said Magdalena Szaflarski, Ph.D., associate professor in the UAB Department of Sociology in the College of Arts and Sciences and the studys first author. This study examined those barriers, as this knowledge is essential and identifies potential points of intervention at the policy, public health and health care system levels. Social factors, not only clinical, need to be addressed in order to improve care and outcomes in this patient population.

Szaflarski says insurance was a key social predictor of seeing a specialist, while poverty was a key barrier in medication use.

Magdalena Szaflarski, Ph.D, says that poverty is associated with a lower likelihood of anti-seizure medication use.The association between anti-seizure treatment and poverty extended over and beyond insurance status, indicating that not only access to care but also poverty effects more broadly (e.g., distance and transportation barriers) restrict opportunities for quality care and treatment among PWE, she said.

The study documented several disparities in visits to an epilepsy provider and anti-seizure medication use in the U.S. sample of adult PWE and indicated that a large proportion of PWE continue to experience recurring seizures, an alarming trend, according to the authors, due to the broad array of advanced treatment options currently available.

In our study, uninsured and people residing outside of the Northeast were less likely to visit an epilepsy provider in the past year compared with their insured and Northeast-based counterparts, said Jerzy Szaflarski, M.D., Ph.D., director of the UAB Epilepsy Center in the School of Medicine and a study co-author. Notably, the U.S. South has high burden of disease including epilepsy and has recently been referred to as the Epilepsy Belt. In this study, the South had the highest proportion of epilepsy cases, but much lower rates of neurology visits than in the Northeast.

In particular, Szaflarski says, the findings are consistent with previous analysis of supply and demand for neurologists nationally and state-by-state.

At the national level, over 1,800 more neurologists are needed to meet the demand, and this is reflected in previously published state-by-state estimates: The demand for neurologists in the majority of the states was estimated at 20 percent or higher than supply, he said. Only a few states, all but one in the Northeast region and the District of Columbia, had a supply of neurologists greater than the demand.

Magdalena Szaflarski says the study contributes to better describing socially based variations in two aspects of epilepsy treatment: use of epilepsy specialized services and anti-seizure medication use.

Jerzy Szaflarski, M.D., Ph.D., says there is a shortage of 1,800 neurologists in the United StatesInformation from this study can guide health and disability policies, public health programs and health care delivery systems to strengthen resources and access to care/treatment for PWE, especially for people with treatment-resistant seizures, she said. Engaging patients/families in policy and program development, as well as research, is also essential for further understanding of the needs of this population and opportunities for improvements.

Co-authors on the study are Joseph D. Wolfe, Ph.D., associate professor of sociology, Joshua Gabriel S. Tobias, graduate assistant in sociology, and Ismail Mohamed, M.D., associate professor of pediatric neurology.

This study was supported by the Interdisciplinary Innovation Team Award from theUAB College of Arts and Sciences, with a contribution by theUAB Center for Clinical and Translational Science(CCTS;National Institutes of Health grantUL1TR003096).

See the original post:
Poverty, location and insurance status play major role in epilepsy care - UAB News

To get ahead of the possible long-term neurological problems from infection, multiple labs in The Picower Institute for Learning and Memory at MIT have begun pursuing research to determine whether and how it affects the brain, either directly or via the bodys heightened immune response. If it indeed does, that would be consistent with a history of reports that infections and immune system activity elsewhere in the body may have long-term impacts on mental health.

While some scientists, for instance, suspect a role for infectious diseases in neurodegenerative disorders such as Parkinsons disease or dementias, Picower Institute Member Gloria Choi and Harvard University immunologist Jun Huh have meticulously traced the pathway by which infection in a pregnant mother can lead to autism-like symptoms in her child and how, counterintuitively, infection in people with some autism spectrum disorders can temporarily mitigate behavioral symptoms. With deep expertise in neuro-immune interactions, as well as in the neural systems underlying the sense of smell, which is reported to be lost in some Covid-19 patients, Choi is planning several collaborative coronavirus studies.

With these various suspected neurological symptoms, if we can determine the underlying mechanisms by which the immune system affects the nervous system upon the infection with SARS-CoV-2 or related viruses, then the next time the pandemic comes we can be prepared to intervene, says Choi, Samuel A. Goldblith Career Development Assistant Professor of Applied Biology in the Department of Brain and Cognitive Sciences.

Like Choi, Picower Professor Li-Huei Tsai is also planning studies of the neurological impact of Covid-19. Tsais studies of Alzheimers disease include investigation of the blood-brain barrier, which tightly gates what goes into and out of the brain through the circulatory system. Technologies that her lab is developing with collaborators including MIT Institute Professor Robert Langer put the team in a unique position to assess whether and how coronavirus infection might overrun or evade that safeguard.

It is critical to know how the coronavirus might affect the brain, Tsai says. We are eager to bring our technology to bear on that question.

Neuro-immune interactions

Choi is considering three lines of coronavirus research. Together with Picower Institute colleagues Newton Professor Mriganka Sur and Assistant Professor Kwanghun Chung, she hopes to tackle the question of anosmia, the loss of smell. Choi has studied the olfactory system in mice since her graduate and postdoc days. Moreover, a key finding of her neuroimmunology research is that because neurons express receptors for some of the signaling molecules, called cytokines, emitted by immune system cells, those interactions can directly affect neural development and activity. Working in mouse models, the team plans to ask whether such an impact, amid the immune systems heightened response to Covid-19, is occurring in the olfactory system.

Based on her and Huhs studies of how maternal infection leads to autism-like symptoms in their offspring, they are concerned about two other aspects of coronavirus infection. One builds on the finding that the risk of offspring developing neurological problems depended strongly on the composition of the pregnant mothers gut microbiome, the populations of bacteria that everyone harbors within their body. Given the wide range of outcomes seen among coronavirus patients, Choi and Huh wonder whether microbiome composition may play a role in addition to factors such as age or underlying health conditions. If that turns out to be the case, then tweaking the microbiome, perhaps with diet or probiotics, could improve outcomes. Working with colleagues in Korea and Japan, they are embarking on studies that will correlate microbiome composition in patients with their coronavirus outcomes.

Over the longer term, Choi and Huh also hope to study whether Covid-19 infection among pregnant mothers presents an elevated risk of their offspring developing neurodevelopmental disorders like autism. In their research in mice, they have showed that given a particular maternal microbiome composition, immune cells in pregnant mice expressed elevated levels of the cytokine IL-17a. The molecule directly influenced fetal brain development, causing neural circuits governing autism-like behavioral symptoms to develop improperly. The pair aim to assess whether that could happen with coronavirus.

Covid-19 access to the brain

A major question is whether and how the SARS-CoV-2 virus can reach the central nervous system. Tsais lab may be able to find out using an advanced laboratory model of the blood-brain barrier (BBB), whose development has been led by postdoc Joel Blanchard. In a study in press, he has shown that the model made of human astrocytes, brain endothelial cells, and pericytes cultured from induced pluripotent stem cells closely mirrors properties of the natural BBB, such as permeability. In collaboration with Langer, the team is integrating the model with induced pluripotent stem cell-derived cultures of neurons and other crucial brain support cells, like microglia and oligodendrocytes, on a chip (called a miBrain chip) to provide a sophisticated and integrated testbed of brain cell and cerebral vascular interaction.

With the miBrain chip platform Tsais lab plans several experiments to better understand how the virus may put the brain at risk. In one, they can culture miBrain chips from a variety of individuals to see whether the virus is able to permeate the BBB equally or differently in those personalized models. They can also test another means of viral entry into the brain whether the bodys immune system response (a so-called cytokine storm) increases the BBBs permeability by using blood serum from Covid-19 patients in the miBrainChip model.

Yet another way the virus might spread in the nervous system is from neuron to neuron via their connections called synapses. With cultures of thousands of neurons, the miBrain chip platform could help them determine whether thats the case, and whether specific kinds of neurons are more susceptible to becoming such conduits.

Finally, there may be genetic differences that increase susceptibility to viral entry to the brain. Using technologies like CRISPR/Cas9, the team can engineer such candidate risk genes into the BBBs to test whether permeability varies. In their Alzheimers disease research, for example, they study whether variations in a gene called ApoE causes different degrees of amyloid proteins plaque buildup in the BBB model.

The potential interactions among the virus, the microbiome, the immune system, and the central nervous system are likely to be highly complex, but with the expertise, the tools, and strong collaborations, Picower Institute researchers see ways to help illuminate the possible neurological effects of coronavirus infection.

Go here to read the rest:
How could Covid-19 and the body's immune response affect the brain? - MIT News

ROCKLAND, Mass., May 23, 2020 /PRNewswire/ --EMD Serono, the biopharmaceutical business of Merck KGaA, Darmstadt, Germany, in the U.S. and Canada, today announced data on the long-term efficacy and safety profile of evobrutinib, an investigational, oral, highly selective Bruton's Tyrosine Kinase (BTK) inhibitor in adult patients with relapsing multiple sclerosis (RMS). The results from the Phase II open-label extension (OLE) study will be presented as a late-breaker at the European Academy of Neurology (EAN) 2020 Virtual Congress.

"These data demonstrate evobrutinib has a sustained and high impact on annualized relapse rate over 108 weeks," said Luciano Rossetti, Head of Global Research & Development for EMD Serono. "Greatest efficacy was clearly associated with BTK occupancy, and this further validates our choice of dose for the Phase III program. We are also encouraged by evobrutinib's breadth of consistent safety data, including no increase of serious infections in more than 1,200 patients up to two years."

Annual relapse rate (ARR) results in the double-blind phase of the study were maintained over the open-label extension, with patients receiving evobrutinib 75mg BID (twice a day) in the double-blind phase showing an ARR of 0.11 (95% CI 0.040.25) at week 48, and of 0.12 (0.060.22) for the 108-week period.

The data from the Phase II study continues to demonstrate that BID dosing can achieve higher efficacy than QD dosing on clinical outcomes, as demonstrated by reduced ARR. Modelling data show that greater than 95% BTK occupancy at trough is necessary in nearly all patients to achieve highest efficacy and this can be best achieved with BID dosing.

Data previously published in the New England Journal of Medicine reported the findings of the Phase II study where at 24 weeks, evobrutinib significantly reduced the cumulative number of T1 Gd-enhancing lesions compared to placebo, meeting its primary endpoint. At week 48, all patients could enter the OLE which assessed the long-term efficacy and safety of evobrutinib.

"The 108-week efficacy and safety data for evobrutinib through the double-blind and the OLE period are very robust," noted Dr. Xavier Montalban, Chairman & Director Neurology-Neuroimmunology Department & Neurorehabilitation Unit, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron University Hospital, Barcelona, Spain. "This, combined with the high selectivity of evobrutinib, suggests that evobrutinib may offer a promising approach to MS treatment."

Of 267 randomized patients, 213 completed 108 weeks of treatment (48 weeks in main study and 60 weeks in OLE). Evobrutinib was generally well-tolerated, with the safety profile maintained during the OLE including no increase in infections and overall no new safety signals identified. Consistent with evobrutinib's high selectivity, patients participating in the trial experienced no systemic side effects, such as gastrointestinal disturbances. In the Phase II trial, the most commonly observed adverse events of any grade associated with evobrutinib included nasopharyngitis and increases in levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and lipase.

The transient elevated liver aminotransferases were restricted to the first 24 weeks following evobrutinib treatment initiation and were not observed in the OLE in patients continuing treatment with evobrutinib.

Evobrutinib is entering Phase III trials following the results of the Phase II clinical trial, which met its primary endpoint over 24 weeks of treatment. The two new trials, EVOLUTION RMS 1 and 2 are multi-center, randomised, parallel group, double-blind, double dummy, active-controlled studies of evobrutinib with teriflunomide, in participants with RMS. Each trial's primary endpoint is patients' ARR after 96 weeks of treatment. Secondary endpoints include the appearance of new or enlarging T2 lesions assessed by MRI scans and progressing disability as measured by the Expanded Disability Status Scale (EDSS).

About EvobrutinibEvobrutinib (M2951) is in clinical development to investigate its potential as a treatment for multiple sclerosis (MS). It is an oral, highly selective inhibitor of Bruton's Tyrosine Kinase (BTK) which is important in the development and functioning of various immune cells including B lymphocytes and macrophages.Evobrutinib is designed to inhibit primary B cell responses such as proliferation and antibody and cytokine release, without directly affecting T cells. BTK inhibition is thought to suppress autoantibody-producing cells, which preclinical research suggests may be therapeutically useful in certain autoimmune diseases. The global Phase III clinical development programme evaluating evobrutinib in MS includes two pivotal studies, EVOLUTION RMS 1 and 2. Evobrutinib is currently under clinical investigation and not approved for any use anywhere in the world.

About Multiple SclerosisMultiple sclerosis (MS) is a chronic, inflammatory condition of the central nervous system and is the most common non-traumatic, disabling neurological disease in young adults. It is estimated that approximately 2.3 million people have MS worldwide. While symptoms can vary, the most common symptoms of MS include blurred vision, numbness or tingling in the limbs and problems with strength and coordination. The relapsing forms of MS are the most common.

EMD Serono, Inc. and Multiple SclerosisFor more than 20 years, EMD Serono has been relentlessly focused on understanding the journey people living with MS face in order to create a meaningful, positive experience for them and the broader MS community. However, there is still much that is unknown about this complex and unpredictable disease. EMD Serono is digging deeper to advance the science.

About EMD Serono, Inc. EMD Serono - the biopharmaceutical business of Merck KGaA, Darmstadt,Germany, in the U.S. andCanada- is engaged in the discovery, research and development of medicines for patients with difficult to treat diseases. The business is committed to transforming lives by developing and delivering meaningful solutions that help address the therapeutic and support needs of individual patients. Building on a proven legacy and deep expertise in neurology, fertility and endocrinology, EMD Serono is developing potential new oncology and immuno-oncology medicines while continuing to explore potential therapeutic options for diseases such as psoriasis, lupus and MS. Today, the business has approximately 1,500 employees around the country with commercial, clinical and research operations based in the company's home state ofMassachusetts.www.emdserono.com.

Your Contact Alice McGrail 1-781-738-8791

View original content:http://www.prnewswire.com/news-releases/new-late-breaking-data-at-ean-indicate-evobrutinib-is-the-first-btk-inhibitor-to-report-efficacy-and-safety-in-ms-over-108-weeks-301064619.html

SOURCE EMD Serono

Follow this link:
New Late-Breaking Data at EAN Indicate Evobrutinib is the First BTK Inhibitor to Report Efficacy and - PharmiWeb.com

Neurologists at the University of Alberta are monitoring Edmonton patients diagnosed with COVID-19 for signs that the virus, which can cause deadly respiratory illness, may also attack the brain.

Several manuscripts have been published that suggest patients with severe COVID-19 symptoms also display neurological problems such as confusion, stroke-like attacks, even a hemorrhage in the brain or less severe symptoms such as a loss of the sense of smell, said Christopher Power, professor of neurology and principal investigator of the Brain Power Lab.

Many of the patients who have been found to have neurologic symptoms in the academic reports from Italy, China and the U.S. appear to be the sicker patients, said Jennifer McCombe, associate clinical professor of neurology, who is leading the initiative to look at patients locally.

Power and McCombe, who are both members of theNeuroscience and Mental Health Institute, normally treat patients with multiple sclerosis, HIV and brain infections. Neither is surprised that the novel coronavirus is attacking the brainit is known that other coronaviruses have done sobut they said it is not common and the mechanism is not well understood.

One major question that remains uncertain is to what extent does the virus gets into the brain to cause damage, or are the neurologic symptoms merely a consequence of the systemic effects of overactivation of the immune system? said Power.

Some virusesand were suspicious it is the case with COVID-19infect the lining of the blood vessels and then use that as an entrance into the brain, he said.

Other viruses like HIV actually use a Trojan horse strategy. They infect blood cells and then those blood cells transport the virus into the brain.

Power reported that approximately one per cent of patients with severe acute respiratory syndrome (SARS), caused by another coronavirus that broke out in 2003, also faced neurologic disabilities. They experienced stroke-like events, muscle weakness and peripheral nerve damage. The virus was later detected in brain tissue of some deceased SARS patients.

McCombe plans to examine electroencephalogram and MRI images of COVID-19 patients to understand their neurologic symptoms. A cerebral spinal fluid test has not yet been developed for COVID-19 but would also be very helpful as a window into the brain. Post-mortem analyses can be done to look for signs of the virus in the brain tissue and blood vessels.

McCombe said it is key to understand whether neurologic impairments are caused directly by the virus or whether they are secondary symptoms due to systemic inflammation.

That will really help us decide on potential therapies that could prevent some of these neurologic problems, she said. Do we need to focus on prevention therapies that relate to the issues that are happening elsewhere in the body, or is there viral invasion into the brain and therefore we need to continue to try to find therapies to treat the virus itself?

Power said that anosmia, a loss of the senses of smell and taste, has presented in some otherwise asymptomatic COVID-19 patients. He said anyone who develops this symptom should monitor themselves for other symptoms such as a fever or cough.

McCombe said more dramatic changes in a persons cognitive functioning are a definite cause for concern, because there can be so many potential causes besides COVID-19.

For an isolated change in smell, I would direct people to continue to maintain self-isolation measures, she said. Someone exhibiting confusion or stroke-like symptoms should seek medical attention immediately.

Power said he is speaking daily with other members of the International Society for NeuroVirology so they can work together to track neurologic symptoms in COVID-19 patients.

What we learn from COVID-19, we can apply to the next viral pandemic. The idea is to develop diagnostics and new treatments as soon as possible.

Follow this link:
University of Alberta neurologists watch for signs that COVID-19 can attack the brain - Folio - University of Alberta

Strokes, seizures, loss of smell and taste and other neurological deficits are showing up in patients critically ill with the coronavirus.

Although the virus is classified as a respiratory disorder and primarily damages the lungs, clinicians are seeing patients with a wide array of symptoms, from seizures to hallucinations, brain inflammation, disorientation, delirium and loss of smell and taste.

I had a patient, a young guy, 48, who attended a party in New Rochelle two weeks before and came in with hallucinations and confusion, said Dr. Pooia Fattahi, regional chair of neurology for Trinity Health Of New England. The patient had no fever and only a slight cough. Still, aware some COVID-19 patients show up at hospitals with seizures, strokes and confusion, Fattahi suspected, correctly, that the patient had COVID-19. Three of those who attended the same New Rochelle party ultimately died of the virus.

A third of COVID-19 patients hospitalized in Wuhan, China, suffered neurological symptoms, according to a Chinese study published April 10. Moreover, many of the patients developed these symptoms early; in some cases, the brain abnormalities were their only symptom. Because of that, study authors encouraged front-line clinicians treating patients with brain deficits to consider COVID-19 to avoid delayed diagnosis or misdiagnosis and prevention of transmission.

Precisely why and how the virus attacks the brain penetrating the protective blood-brain barrier is complex and not well understood, said Dr. Jennifer Moliterno, chief of neurosurgical oncology at Yale Department of Neurosurgery and Yale School of Medicine. Other viruses can similarly affect the brain, so its not completely surprising but it is somewhat surprising, she said.

Moliterno speculates that the brain dysfunction seen in COVID-19 patients could originate in two different responses. First, the hyperactive immune system response that physicians have observed in COVID-19-positive patients known as a cytokine storm could trigger an inflammatory response that could cause widespread clotting throughout the body_ That would explain why hospitals are seeing so many patients who manifest with stroke and later test positive for COVID-19.

Second, experts believe COVID-19 infects cells through ACE2 receptors, which are also present in the specialized endothelial cells that make up a critical part of the neurological netting that comprises the blood-brain barrier.

That can allow the virus to leak into the brain, Moliterno explained.

It is also possible that COVID-19 enters the body through the olfactory system, close to the frontal lobes in the brain, which controls cognitive skills, Fattahi and Moliterno said. Inflammation of those lobes is known as encephalitis, whose symptoms include memory loss, behavioral changes, confusion and irritation.

Fattahi noted that anywhere from 5 to 24 percent of COVID-19 patients experienced a difficulty with smell. We dont know but we suspect there are ACE2 receptors that attach the olfactory nerves, which pass through those nerves into the brain, he said.

Those who present with brain disorders, Moltinero said, have a particularly dangerous infection. These patients are really sick, she said. A lot of the patients with the neurological symptoms have the more severe COVID-19 cases.

In Italy, the neurological damage has been so severe among affected patients that a neurologist at the university of Brescia has opened an 18-bed neuro-COVID-19 unit to treat these patients exclusively. Dr. Alessandro Pezzini, associate professor of neurology at the University of Brescia, has advised U.S. doctors to consider the possibility that these brain events are another effect of the virus.

So is a pronounced loss of smell. In South Korea, China, and Italy, about a third of patients who have tested positive for COVID-19 have reported a loss of smell known as anosmia often as their only symptom. That has led some experts to speculate that those who experience a loss of smell might be unsuspecting carriers of the virus who have unwittingly transmitted it to others.

British researchers recently advised doctors to consider loss of smell among the first symptoms of the virus.

There is potential that if any adult with anosmia but no other symptoms was asked to self-isolate for seven days we might be able to reduce the number of otherwise asymptomatic individuals who continue to act as vectors, not realizing the need to self-isolate, Professor Claire Hopkins, president of British Rhinological Society, said in a joint statement released late last month with the British Association of Otorhinolaryngology. Hopkins noted that because these patients do not have the dry cough, fever or shortness of breath that are hallmarks of the virus, they may not meet criteria for testing or self-isolation, though they could be spreading Covid-19.

Dr. R. Peter Manes, a rhinologist at Yale New Haven Hospital, said it was possible that people who lost their sense of smell in the absence of anything else, it can be one of the first signs of COVID-19.

At Saint Marys, Fattahi said he was perplexed to see a seizure in a relatively young patient. I thought, This is a guy who is not a drinker, has no personal history of seizure, so why is he having seizures?' Fattahi said of his 48-year-old patient. I was worried he was maybe exposed to COVID-19 at a party. Unwilling to wait for lab results, Fattahi said he ordered a CT scan, which confirmed his COVID-19 diagnosis. The patient was treated with a battery of antibiotics, anti-seizure medications and hydroxychloroquine and released.

_______________________________________________

WATERBURY Brain malfunction is also a feature of many young, obese patients who are rapidly emerging as at high-risk to contract COVID-19, said Dr. Juan Diego Holguin of Alliance Medical Group.

Once they become infected with the virus, it seems to make their neurological effects more pronounced, Holguin said.

He points to the propensity for the obese to have abnormal pressure of the cerebral spinal fluid. He noted those with a body mass index more than 50 who contract the coronavirus also tend to deteriorate more rapidly.

The progression is unusually fast, Holguin said. We dont know why it progresses so quickly.

Because of the rapid deterioration, he recommends that those younger than 60 with a BMI over 40 should be tested as soon as they develop symptoms: You run the risk of progressing too quickly.

A 6-foot male with a BMI of 50 would weigh 370 pounds. A 54 woman with a BMI of 50 would weigh 290 pounds, Holguin said.

They already have restriction of their thorax from the excess weight. They already have problems getting air to their lungs, he said.

A series of new studies have found obesity may be among the most important predictors in severe COVID-19, particularly among young people. A study from NYU Langone study of patients under age 60 found that those with obesity were twice as likely to be hospitalized. was the second-highest reason why patients were hospitalized with COVID-19.

Tracey OShaughnessy

Related

Continue reading here:
Not just the lungs: Some COVID-19 patients show signs of neurological ailments - Waterbury Republican American

Coronavirus not only causes fever, cough and breathing problems, but also neurological problems such as headache and dizziness, a new study has found. The study was conducted by Chinese scientists on patients in Wuhan, the origin of the pandemic, and published in JAMA Neurology.

They reported that a third of the 214 patients they examined showed signs of a virus affecting the nervous system. Earlier, there were cases where patients suffering from covid-19 lost their sense of smell and taste.

These symptoms indicate that the brain was also affected in some way, commented infectious disease specialist Bernd Salzberger of the University Hospital in Regensburg. "But there are very few studies on the effects of coronavirus on patients' brains. We are still tapping in the dark," he added.

The study from Wuhan was based solely on medical history, laboratory findings and radiological examinations of 214 patients. Neurologist Ling Mao from the Huazhong Faculty of Science and Technology wrote that 78 patients (36.4 percent) had neurological problems.

Most often it was dizziness and headache. In addition, 12 of them lost their sense of taste and 11 of them smell. Six patients also suffered a stroke. But Chinese scientists are uncertain whether these symptoms are due to the disease itself or are part of the body's response to inflammatory processes.

See the original post:
A third of COVID-19 patients have neurological problems - The Dubrovnik Times

A recently published report describes the case of a 61-year-old female patient with a history of stroke that experienced an acute focal neurologic deficit due to salicylate toxicity and highlights the importance of considering this diagnosis and initiating treatment as quickly as possible.

In the emergency department (ED), the patient reported experiencing hemiparesis in her upper and lower extremities after waking up that morning. Further questioning revealed that over the past 2 weeks, the patient had been feeling generally unwell, anxious, and had experienced persistent chest pressure, which she treated with aspirin.

The patients past medical history included essential hypertension, generalized anxiety disorder, and a previous ischemic stroke with an associated seizure disorder. She stated that her seizure disorder was well controlled with diazepam and phenobarbital, however, she had not taken either medication the week prior to her ED presentation due to her illness. Additionally, the patient stated that she was not taking antiplatelet or anticoagulant drugs at the time.

After her arrival, the patient became confused and began experiencing tinnitus, shortness of breath, and blurred vision. Due to her neurologic presentation, age, and past medical history, recurrent stroke or transient ischemic attack were initially considered. After these diagnoses were excluded through further evaluation, laboratory findings revealed a mixed acid-base disorder with a wide anion gap metabolic acidosis and respiratory alkalosis.

Upon further questioning, the patient admitted to excessive use of salicylate over the previous 2 to 3 weeks. Laboratory findings revealed her initial serum salicylate level to be 78.1mg/dL (upper therapeutic limit, 19.9mg/dL).

The patient was treated with oral activated charcoal and intravenous sodium bicarbonate, potassium and dextrose. The patients symptoms completely resolved within 48 hours of her presentation to the ED.

The delay in diagnosis was a concern, considering the potentially fatal nature of salicylate toxicity and the importance of early treatment, the authors concluded, adding that physicians should maintain a high index of suspicion for salicylate toxicity in patients who present with acute neurologic symptoms, and medication history should include direct questioning for salicylate use.

Reference

Delaney TM, Helvey JT, Shiffermiller JF. A Case of Salicylate Toxicity Presenting with Acute Focal Neurologic Deficit in a 61-Year-Old Woman with a History of Stroke [published online February 15, 2020]. American Journal of Case Reports. doi: 10.12659/AJCR.920016.

Read more:
Acute Neurologic Deficit Linked to Salicylate Toxicity - MPR - Monthly Prescribing Reference

Neurologic problems are common in patients with COVID-19, and in some cases are the first symptoms seen, according to a new analysis of patient data.

Among 214 patients hospitalized for COVID-19 in early 2020, 34% had neurologic issues, investigators found. In addition, patients with the most severe illness had significantly more of these problems, including acute cerebrovascular events, impaired consciousness, and muscle injury, reported Bo Hu, M.D., Ph.D., from Huazhong University of Science and Technology, Wuhan, China.

Most neurologic symptoms came early in the illnesses course. Symptom categories included:

Impaired consciousness included change of consciousness level (somnolence, stupor, and coma) and consciousness content (confusion and delirium).

Notably, some patients with fever and headache were admitted to the neurology ward after COVID-19 was ruled out. Days later, they developed established COVID-19 symptoms (cough, throat pain, lower lymphocyte count and lung scan signs) and were transferred back to the isolation ward.

Full findings were published Friday in JAMA Neurology.

In other coronavirus news:

Pharmacists permitted to order and administer COVID-19 tests: Licensed pharmacists may now order and administer COVID-19 tests approved by the U.S. Food and Drug Administration, the Department of Health and Human Services announced last week. The directive aims to improve testing access.

CDC confirms: Elders and males account for more coronavirus hospitalizations: The COVID-19 hospitalization rate for people 65 and older was 13.8 per 100,000, compared to a rate of 4.6 per 100,000 overall, preliminary data from March shows. Males may be disproportionately affected by COVID-19 compared with females, and black populations might be disproportionately affected as well, the agency reported.

Face masks offer slight protection from flu-like illness: Surgical-grade face masks provide modest protection against flu-like illness, according to a new study. Researchers from the University of East Anglia say there is enough evidence to support their use by vulnerable people, including patients and care providers in high-risk situations such as healthcare settings.

Read more here:
COVID-19 linked to neurological symptoms, analysis finds - Clinical Daily News - McKnight's Long Term Care News

EMBARGOED FOR RELEASE UNTIL 4 P.M. ET, WEDNESDAY, APRIL 8, 2020

Newswise MINNEAPOLIS People who live in urban areas with higher levels of air pollution may score lower on thinking and memory tests and may also lose cognitive skills faster over time, or it is possible they also may not, according to a study published in the April 8, 2020, online issue of Neurology, the medical journal of the American Academy of Neurology. Researchers examined the association of air pollution levels and cognitive impairment and decline in participants in two large epidemiological studies. They found an association between the air pollution and cognitive decline in one study group but not in the other.

As people live longer lives and the aging population grows, age-related cognitive decline is a growing public health concern with profound social, economic and health effects, so finding ways to reduce the risk is important, said study author Erin R Kulick, Ph.D., M.P.H., of Brown University School of Public Health in Providence, R.I., and a member of the American Academy of Neurology. Air pollution can affect large populations of people because it has known cardiovascular risks, and previous research has found that it may also contribute to cognitive decline. However, the results of our research were mixed.

The study involved people living in the Northern Manhattan area of New York City who were enrolled in two larger long-term studies: 5,330 people with an average age of 75 enrolled in the Washington Heights-Inwood Community Aging Project; and 1,093 people with an average age of 70 enrolled in the Northern Manhattan Study. Both groups were ethnically and racially diverse with black, white and Hispanic participants.

All participants were given medical exams at the beginning of the study as well as cognitive tests to measure memory, language skills and executive function, which involves thinking skills like organizing, planning and completing tasks.

The group from the Washington-Heights-Inwood study of 5,330 participants was followed an average of seven years with six rounds of follow-up testing every 18 months to two years. The Northern Manhattan study group of 1,093 participants was followed for five years with one follow-up round of testing.

Researchers used the residential addresses of each participant to determine their exposures to three air pollutants. Those pollutants were nitrogen dioxide and two groups of particulate matter, particles of liquids or solids suspended in air that were less than 2.5 microns in diameter called fine particulate matter and particles that were less than 10 microns in diameter called respirable particulate matter. Average levels of air pollutants were similar for both groups of participants. In each group, participants were divided into four groups based on their air pollution exposure.

Researchers found that participants in the Washington-Heights Inwood study were exposed to a yearly average of 32 parts per billion of nitrogen dioxide, 13 micrograms per cubic meter (g/m3) of fine particulate matter and 21 g/m3 of respirable particulate matter The U.S. Environmental Protection Agency (EPA) considers up to 53 parts per billion to be a safe level of yearly average exposure to nitrogen dioxide, up to 12 g/m3 for fine particulate matter and up to 50 g/m3 for respirable particulate matter.

While the levels were in the range considered safe by the EPA, its possible that these results reflect higher levels from an earlier point in time. It also raises the question of whether the federal levels are low enough to protect peoples health, said Kulick.

The researchers found that in the Washington Heights-Inwood group, people with greater exposure to higher levels of air pollution had lower scores on the tests at the beginning of the study and more rapid rates of decline.

Exposure to nitrogen dioxide was linked to an accelerated rate of cognitive decline comparable to one year of aging. Results were similar for fine and respirable particulate matter.

In the Northern Manhattan group, researchers did not find an association between cognitive function and air pollution. Kulick says the difference in results may be because the second group was much smaller and only had one round of follow-up compared to six rounds for the first group.

A strength of our study was that we were able to analyze the rates of cognitive decline over time so it adds important findings to the growing body of scientific evidence about air pollution and its effects on the brain health of older adults, Kulick said. More research is needed to better understand our studys mixed results. The good news for public health is that air pollution can be reduced, and has been in some cities, through laws and regulation. But there are still millions of people living in areas of the United States where major air quality improvements are needed.

A limitation of the study was that while it included levels of air pollution near a persons residence, it did not account for levels of pollution at the workplace or elsewhere. Also, many participants grew up in other countries and may have had different exposures to air pollution at younger ages.

The study was supported by the National Heart, Lung, and Blood Institute, the National Institute of Environmental Health, the National Institute of Aging and the Environmental Protection Agency.

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.

The American Academy of Neurology is the worlds largest association of neurologists and neuroscience professionals, with over 36,000 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.

Continue reading here:
Does Long-Term Exposure to Air Pollution Lead to a Steeper Rate of Cognitive Decline? - Newswise

Selbyville, Delaware, April 14, 2020 (GLOBE NEWSWIRE) --

Global Market Insights, Inc. has recently added a new report on telemedicine market which estimates the global market valuation for telemedicine will cross US$ 175 billion by 2026. Growing cases of COVID-19 infections across the globe is one of the significant factors boosting the market growth. For instance, total active COVID-19 cases have reached about 1.4 million cases across the globe.

Maintaining social distancing and self-quarantine are of key importance in containing the spread of corona virus. This have led to few countries taking stringent measures such as partial or complete lockdown. Which supports increasing adoption of telemedicine services to avail healthcare services. Also, various stringent regulations that were imposed on practicing telemedicine have also been relaxed. Such favorable government policies and growing inclination of patients towards virtual visits will propel the telemedicine market growth.

Request for a sample of this research report @ https://www.gminsights.com/request-sample/detail/3129

Tele-monitoring services market accounted for revenue share of about 29% in 2019 and similar trend is expected during the analysis period. Tele-monitoring services can be used to monitor those patients that are suffering from flu-like symptoms but are negative for COVID-19 infection. Moreover, tele-monitoring reduces the overall burden on the medical fraternity, thereby increasing their access to those patients that are suffering from serious ailments.

Telehospital market will witness more than 19% growth during 2020 to 2026. As the medical and paramedical personnel are at higher risks of COVID-19 infections, the demand for telehospital services is expected to increase in the future. For instance, more than 60 doctors have died in Italy due to the COVID-19 pandemic. Thus, with increasing number of healthcare personnel getting infected by the corona virus, the need for telehospital services is likely to increase during the analysis timeframe.

Neurology segment was valued at around USD 5.5 billion in 2019 and is anticipated to witness significant growth through 2026. Increasing incidence of Parkinsons disease, Alzheimers disease, autism, and epilepsy will increase the application of telemedicine in neurology. Growing demand for tele-neurology services especially amongst the older patient population will drive the telemedicine market for neurology. Moreover, with few countries implementing partial or complete lockdown, patients suffering from various neurological disorders will increasingly adopt telemedicine services.

Browse key industry insights spread across 200 pages with 283 market data tables & 9 figures & charts from the report, Telemedicine Market Share & Forecast, 2020 2026 in detail along with the table of contents:

https://www.gminsights.com/industry-analysis/telemedicine-market

Call centers segment is forecasted to show steady expansion at 18.8% CAGR from 2020 to 2026. Increasing influence of home quarantine and social distancing will lead to a spike in number of calls received by various telemedicine call centers. Moreover, companies are expanding their capabilities to serve and cater the exponential increase in the virtual call volume. Aforementioned factors will drive the market growth.

China telemedicine market is projected to expand at a CAGR of more than 23% over the forecast period. The regional growth is attributed to the factors such as large number of COVID-19 infections and growing target geriatric population. Moreover, with implementation of partial lockdown in certain provinces of China, the patients are increasingly adopting telemedicine services. Factors such as increasing usage of smartphones and internet among the Chinese population will further drive the market growth.

Some major findings of the telemedicine market report include:

Some of the prominent players operating in the e-health market are Allscripts Healthcare Solutions Inc, AMD Global Telemedicine, American Well, BioTelemetry, Cisco Systems, Honeywell International Inc, Koninklijke Philips N.V., and Teladoc. These players adopt various strategies such as acquisitions, collaborations, mergers, partnerships, geographic expansion. For instance, in May 2018, Allscripts signed an agreement to acquire HealthGrid Holding Company. This acquisition will enable significant expansion of FollowMyHealth platform portfolio and spur revenue generation.

Make an inquiry for purchasing this report @ https://www.gminsights.com/inquiry-before-buying/3129

Partial chapters of report table of contents (TOC):

Chapter 2. Executive Summary

2.1. Telemedicine industry 360synopsis, 2015 - 2026

2.1.1. Business trends

2.1.2. Service trends

2.1.3. Type trends

2.1.4. Specialty trends

2.1.5. Delivery mode trends

2.1.6. Regional trends

Chapter 3. Telemedicine Industry Insights

3.1. Industry segmentation

3.2. Industry landscape, 2015 2026

3.3. Industry impact forces

3.3.1. Growth drivers

3.3.1.1. Rising cases of COVID-19 infections across the globe

3.3.1.2. Increasing prevalence of chronic diseases

3.3.1.3. Growing number of smartphone users

3.3.1.4. Technological advancements related to mobile phones and internet

3.3.1.5. Greater need for cost-saving in healthcare delivery

3.3.1.6. Long waiting time in hospitals for disease treatment

3.3.1.7. Favorable government initiatives

3.3.2. Industry pitfalls & challenges

3.3.2.1. Security and privacy concerns

3.3.2.2. Lack of knowledge and trust in developing countries

3.4. Growth potential analysis

3.4.1. By service

3.4.2. By type

3.4.3. By specialty

3.4.4. By delivery mode

3.5. COVID-19 impact analysis

3.5.1. Impact of COVID-19 on major markets

3.5.1.1. Overview

3.5.1.2. U.S.

3.5.1.3. Canada

3.5.1.4. Germany

3.5.1.5. UK

3.5.1.6. France

3.5.1.7. Spain

3.5.1.8. Italy

3.5.1.9. Switzerland

3.5.1.10. China

3.5.1.11. Japan

3.5.1.12. Saudi Arabia

3.5.2. Impact of COVID-19 on industry segments, by 10 major markets (2020)

3.5.2.1. Teleconsultation

3.5.2.2. Tele-monitoring

3.5.2.3. Telehome

3.5.2.4. Mental Health

3.5.2.5. Respiratory illness

3.5.3. Impact of COVID-19 on industry competition

3.5.3.1. Strategy

3.5.3.2. Product portfolio

3.5.3.3. Business growth

3.6. Reimbursement scenario

3.6.1. U.S.

3.6.2. Europe

3.7. Telemedicine modalities

3.8. Telemedicine projects

3.9. Government initiatives

3.10. Telemedicine future trends

3.11. Analyst recommendations

3.12. Porters analysis

3.13. Competitive landscape, 2019

3.13.1. Strategy dashboard

3.14. PESTEL analysis

Browse reports complete table of contents (ToC):https://www.gminsights.com/toc/detail/telemedicine-market

About Global Market Insights

Global Market Insights, Inc., headquartered in Delaware, U.S., is a global market research and consulting service provider, offering syndicated and custom research reports along with growth consulting services. Our business intelligence and industry research reports offer clients with penetrative insights and actionable market data specially designed and presented to aid strategic decision-making. These exhaustive reports are designed via a proprietary research methodology and are available for key industries such as chemicals, advanced materials, technology, renewable energy and biotechnology.

Go here to read the rest:
Telemedicine Market demand to reach USD 175 Bn by 2026: Global Market Insights, Inc. - GlobeNewswire

byRyan J. Degan

A doctor from Alamo is at risk of having her medical license revoked after the California Medical Board alleged that she attempted to assist with childbirth surgery at San Ramon Regional Medical Center while under the influence of alcohol.

Filed on March 26 by the state board, the complaint alleges that Dr. Michele Louise Riopelle, an obstetrician and gynecologist (OB/GYN) with San Ramon Regional at the time, was called in to assist in a caesarean section and reported to the hospital for the operation despite having a blood alcohol level of 0.30%.

The complaint alleges the doctor entered the operating room in an intoxicated state but did not take part in the C-section that night.

It was not immediately clear whether Riopelle was represented by an attorney. There is no written response to the complaint, nor any other documentation provided by Riopelle's side, in the California Medical Board online public document database.

Krista Deans, a spokesperson for San Ramon Regional, told DanvilleSanRamon.com on Tuesday, "Dr. Michele Riopelle is not practicing at San Ramon Regional Medical Center."

The incident occurred at approximately midnight on the night of July 31 to Aug. 1, when Riopelle was the on-call obstetrician for the San Ramon Regional labor and delivery department.

According to the Medical Board's complaint, after receiving the call that she was needed to assist in an operation, Riopelle arrived to the hospital within 40 minutes -- even though San Ramon Regional bylaws require a 30-minute response time for C-section assistance -- during which time nursing staff noticed she was "unsteady on her feet, slurring her speech, confused and incoherent."

According to the complaint, Riopelle denied taking any medication and claimed she was fine, but she was observed having difficulty washing her hands and was unable to tie her shoes or apply her mask correctly.

While nursing staff tried to prevent her from doing so, Riopelle allegedly insisted on entering the operating room where, in the presence of the patient's husband, she attempted to put on her gown and gloves. Eventually Riopelle had to be escorted out of the operating room after attempting to approach the patient, according to the complaint.

The complaint added that the attending OB/GYN was able to complete the C-section with assistance from a pediatrician prior to Riopelle entering the operating room.

Riopelle was taken to the hospital's emergency room, where she was noted to have "altered speech and poor coordination," according to the complaint. After claiming to have taken a muscle relaxant the previous day, Riopelle denied having consumed any alcohol.

Fearing a "neurological event" the emergency room physician performed a full neurological evaluation that included a CT scan, before a blood test revealed a 0.30% blood alcohol level, according to the complaint. Riopelle was then released to the care of her husband with a diagnosis of acute alcohol intoxication.

After charging Riopelle with inappropriate conduct, the Medical Board of California can revoke her license to practice, have it suspended or place her on probation.

Originally posted here:
State accuses Alamo doctor of attempting to assist in C-section while drunk - danvillesanramon.com

Global Pediatric Neurology Devices Market was valued US$ XX Bn in 2019 and is expected to reach US$ XX Bn by 2027, at a nearby CAGR of 8.7 % during a forecast period.

Market Definition

Pediatric neurology is a branch of science raising to neurological disorders in children like frequent headaches and insomnia. The prevalence of neurological disorders in children is mounting rapidly. Neurological disorders are diseases of brain, spine, and nerves that connect them.

Market Dynamics

The report contains a detailed list of factors that will drive and restrain the growth of the pediatric neurology devices market. Government of developing economies are looking forward to accepting advanced technology from the developed regions to improve the quality of life of their citizen and also support the launch of medical devices for treating and aiding children with neurological disorders. Environmental factors could provoke genetic and epigenetic mutations as well as disease-related inflammatory events such as Alzheimers disease. However, the high cost related to diagnosis and monitoring of neurological diseases may hinder market growth.

REQUEST FOR FREE SAMPLE REPORT: https://www.maximizemarketresearch.com/request-sample/53953

Global Pediatric Neurology Devices Segment analysis:

The report covers the segments in the pediatric neurology devices market such as product, services, neurological subspecialties, and application. Based on service, the electroencephalography segment is expected to grow at the highest X.6 % CAGR during the forecast period. Electroencephalography (EEG) Measures electrical potentials at scalp generated by underlying neurons particularly useful at diagnosing epilepsy and coma and also it monitors record of the electrical activity of the brain. Therapists highly rely on EEG procedures and video EEG to diagnose neonatal seizures and paroxysmal events and psychogenic nonepileptic seizures (PNES) respectively.

Global Pediatric Neurology Devices Market Regional analysis

North America dominates the pediatric neurology devices market share of XX % during the forecast period because of the rising incidence of diseases such as depression, epilepsy, and migraine, high healthcare spending, and cumulative government support for research & development. The 3rd International Conference on Neurology and Brain Disorders were organized on 19-10, June 2019 at the Crowne Plaza Dublin Hotel, Dublin- Ireland helps for regional growth. Migraine is an extraordinarily prevalent neurological disease, affecting 39 million men, women and children in the U.S. and 1 billion worldwide in 2019.

According to the Neurological Alliance, estimated that there are 14.7 million neurological cases in 2019. According to a report published by UMKC School of Medicine, about 2.7 million people in the U.S are suffering by epilepsy and more than 45,000 new cases are diagnosed every year. Increasing the incidence of neurological disorders in the region, which increases the market potential for neurology drugs.

Country-wise Analysis:

Emerging economies, such as India and China, contribute to the growth of the market in APAC which will grow at a CAGR of XX%, because of increasing incidents of neurological disorders. The prevalence of neurological disorders is representing huge economic and social burden mainly in low income and developing regions where there is increased life expectancy and elevated aging populations, as well as neurological services and resources, which are rare and limited. Furthermore, factors such as the increasing demand for quality devices in the healthcare and flourishing healthcare technology is estimated to provide the drive to the market growth, which boosts the uptake of advanced equipment.

Key Development

The reports cover key developments in the pediatric neurology devices market as organic and inorganic growth strategies.

On January 2020: Abbotts has developed low dose neurostimulation for chronic pain. The Proclaim XR spinal cord stimulator can run for ten years using its internal battery, and patients can control its function using a paired iPhone. For chronic pain patients who may be helped by such therapy, it may result in a huge lifestyle improvement over many of their previous options. January 2020, The infinity Parkinsons by delivering deep brain stimulation(DBS) system, originally developed by St. Jude Medical that became part of Abbott, already has approval to stimulate the subthalamic nucleus (STN) and ventral intermediate nucleus (VIM) for the he treatment of Parkinsons, Essential Tremor, and some other movement disorders.

The objective of the report is to present a comprehensive analysis of the Global Pediatric Neurology Devices Market including all the stakeholders of the industry. The past and current status of the industry with forecasted market size and trends are presented in the report with the analysis of complicated data in simple language. The report covers all the aspects of the industry with a dedicated study of key players that includes market leaders, followers and new entrants. PORTER, SVOR, PESTEL analysis with the potential impact of micro-economic factors of the market have been presented in the report. External as well as internal factors that are supposed to affect the business positively or negatively have been analyzed, which will give a clear futuristic view of the industry to the decision-makers.The report also helps in understanding Global Pediatric Neurology Devices Market dynamics, structure by analyzing the market segments and project the Global Pediatric Neurology Devices Market size. Clear representation of competitive analysis of key players by Application, price, financial position, Product portfolio, growth strategies, and regional presence in the Global Pediatric Neurology Devices Market make the report investors guide.

DO INQUIRY BEFORE PURCHASING REPORT HERE: https://www.maximizemarketresearch.com/inquiry-before-buying/53953

Scope of the Global Pediatric Neurology Devices Market

Global Pediatric Neurology Devices Market, By Product Type

Neurosurgery Devices Neurostimulator Cerebrospinal Fluid (CSF) Management DevicesGlobal Pediatric Neurology Devices Market, By Service

Electroencephalogram Intrathecal Baclofen Therapy Neurological Evaluations Vagal Nerve StimulationGlobal Pediatric Neurology Devices Market, By Neurological Subspecialties

Neuro-Oncology Neuromuscular Neonatal Neurology Neuroimmunology Stroke OthersGlobal Pediatric Neurology Devices Market, By Application

Hospitals Healthcare Centers Neurological Research CentersGlobal Pediatric Neurology Devices Market, by Regions

North America Europe Asia-Pacific Latin America Middle East and Africa (MEA)Key Players operating in Global Pediatric Neurology Devices Market

Abbot Elana Inova Healthcare System Medtronic The Nemours Foundation Stryker Boston Scientific B.Braun Melsungen Integra LifeSciences St. Jude Medical

MAJOR TOC OF THE REPORT

Chapter One: Pediatric Neurology Devices Market Overview

Chapter Two: Manufacturers Profiles

Chapter Three: Global Pediatric Neurology Devices Market Competition, by Players

Chapter Four: Global Pediatric Neurology Devices Market Size by Regions

Chapter Five: North America Pediatric Neurology Devices Revenue by Countries

Chapter Six: Europe Pediatric Neurology Devices Revenue by Countries

Chapter Seven: Asia-Pacific Pediatric Neurology Devices Revenue by Countries

Chapter Eight: South America Pediatric Neurology Devices Revenue by Countries

Chapter Nine: Middle East and Africa Revenue Pediatric Neurology Devices by Countries

Chapter Ten: Global Pediatric Neurology Devices Market Segment by Type

Chapter Eleven: Global Pediatric Neurology Devices Market Segment by Application

Chapter Twelve: Global Pediatric Neurology Devices Market Size Forecast (2019-2026)

Browse Full Report with Facts and Figures of Pediatric Neurology Devices Market Report at: https://www.maximizemarketresearch.com/market-report/global-pediatric-neurology-devices-market/53953/

About Us:

Maximize Market Research provides B2B and B2C market research on 20,000 high growth emerging technologies & opportunities in Chemical, Healthcare, Pharmaceuticals, Electronics & Communications, Internet of Things, Food and Beverages, Aerospace and Defense and other manufacturing sectors.

Contact info:

Name: Vikas Godage

Organization: MAXIMIZE MARKET RESEARCH PVT. LTD.

Email: sales@maximizemarketresearch.com

Contact: +919607065656/ +919607195908

Website:www.maximizemarketresearch.com

See the original post here:
Global Pediatric Neurology Devices Market- Industry Analysis and Forecast (2020-2027) by Product Type, Service, Neurological Subspecialties,...

Interventional Neurology Devices Market Industry Forecast To 2024

Garner Insights has titled a new research report named as Interventional Neurology Devices Market 2020 to its consistently extending database. The report clarifies this through a series of channels which include data ranging from rudimentary data to an undeniable estimate. It consolidates all the fundamental factors that are foreseen to change inside the market. The information would thus be used to heighten an organizations standing in the worldwide market.

Interventional neurology refers to endovascular, catheter-based techniques using fluoroscopy and angiography to diagnose and treat vascular disease of the central nervous system. Neurointerventional procedures use imaging technology and are minimally invasive, meaning they can be accomplished through small incisions, rather than open surgery.

Get a Sample Report @:https://www.garnerinsights.com/Global-Interventional-Neurology-Devices-Market-2018-by-Manufacturers-Regions-Type-and-Application-Forecast-to-2023#request-sample

Based on the industrial chain, this report mainly elaborates the definition, types, applications and major players of Interventional Neurology Devices market in details. Deep analysis about Interventional Neurology Devices market status (2014-2019), enterprise competition pattern, advantages and disadvantages of enterprise products, industry development trends (2020-2024), regional industrial layout characteristics and policies has also be included.

Major Manufacturer Detail:Abbott, DePuy Synthes, Medtronic, Stryker, Terumo, Acandis, Bayer, Boston Scientific, Biosensors International, evonos, Merit Medical Systems, MicroPort Scientific, Neurosign, Penumbra, Spiegelberg, Surtex Instruments

The Important Type Coverage:Carotid Artery Angioplasty and Stenting, Carotid Artery Stents, Embolic Protection Systems, Balloon Occlusion Devices, Aneurysm Coiling and Embolization Devices, Flow Diversion Devices, Liquid Embolic Devices, Embolic coils, Micr-Support Devices, Microcatheters

Segment by ApplicationsArteriovenous Malformation and Fistulas, Cerebral Aneurysms, Schemic Strokes, Intracranial Atherosclerotic Disease

The Interventional Neurology Devices report consists of streamlined financial data obtained from various research sources to provide specific and trustworthy analysis. Evaluation of the key market trends with a positive impact on the market over the following couple of years, including an in-depth analysis of the market segmentation, comprising of sub-markets, on a regional and global basis. The report also provides a detailed outlook of the Interventional Neurology Devices market share along with strategic recommendations, on the basis of emerging segments.

Enquire Here For Discount Or Report @https://www.garnerinsights.com/Global-Interventional-Neurology-Devices-Market-2018-by-Manufacturers-Regions-Type-and-Application-Forecast-to-2023#discount

Some Of The Major Geographies Included In This Study:

North America (U.S and Canada and Rest of North America)Europe (Germany, France, Italy and Rest of Europe)Asia-Pacific (China, Japan, India, South Korea and Rest of Asia-Pacific)LAMEA (Brazil, Turkey, Saudi Arabia, South Africa and Rest of LAMEA)

Some major points covered in this Interventional Neurology Devices Market report:

1. An overall outlook of the market that helps in picking up essential data.2. The market has been segmented on the basis of the product types, applications, end-users, as well as the industry verticals, in light of numerous factors. Considering the market segmentation, further analysis has been carried out in an effective manner. For better understanding and a thorough analysis of the market, the key segments have further been partitioned into sub-segments.3. In the next section, factors responsible for the growth of the market have been included. This data has been collected from the primary and secondary sources and has been approved by the industry specialists. It helps in understanding the key market segments and their future trends.4. The report also includes the study of the latest developments and the profiles of major industry players.5. The Interventional Neurology Devices market research report also presents an eight-year forecast on the basis of how the market is predicted to grow.

View Full Report @ https://garnerinsights.com/Global-Interventional-Neurology-Devices-Market-2018-by-Manufacturers-Regions-Type-and-Application-Forecast-to-2023

About Us:Garner Insights is a Market Intelligence and consulting firm with an all-inclusive experience and vast knowledge of the market research industry.Our vast storage of research reports across various categories, gives you a complete view of the ever changing and developing trends and current topics worldwide. Our constant endeavor is to keep on improving our storage information by providing rich market reports and constantly improving them.

Contact Us:Mr. Kevin Thomas+1 513 549 5911 (US)+44 203 318 2846 (UK)Email: sales@garnerinsights.com

Read the rest here:
Informative Report On Interventional Neurology Devices Market 2020 With keyplayer Abbott, DePuy Synthes, Medtronic, Stryker, Terumo, Acandis, Bayer,...

The negative impact of the COVID-19 pandemic on specialty medical practices may lift by the start of next month, according to a new report issued by the market research company Spherix Global Insights.

"Our frontline healthcare leaders are scared, worried, and frustrated. Collectively, they estimate it being eight to nine weeks before things begin to improve and 83 percent of those surveyed last week (April 1) expect things to get worse in the next two weeks. In the words of one neurologist, "(My greatest concern is) that it will linger on to some degree for much of the year and dramatically and permanently affect people's livelihoods, relationships, and dreams," according to a statement issued by Spherix.

The company surveyed 252 rheumatologists, dermatologists, gastroenterologists, nephrologists and neurologists early this month findng that office visits are down by at least 80 percent, despite the adoption of telemedicine. Doctors, the report said, have had challenges with telemedicine and are still unclear about reimbursement policies for the use of telemedicine in place of in-office visits. "Though telemedicine consults have seen successive increases each week, it is not coming close to bridging the gap, and some specialties are having a more difficult time than others," Spherix stated.

The drop in cases has placed financial strain on office-based practices, particularly for dermatologists and gastroenterologists who rely heavily on elective procedures. Many practices have furloughed or staff or laid off works altogehter. If the lockdown and pandemic continues for another two months, some private practices may not survive. "Those in smaller practices are most concerned," the report stated.

While 23 percent of physicians belive the stimulus package will help their practice, more than one-third anticipate little to no impact from government assistance and the majority of physicians have ranked President Trump's handling of the crisis "low satisfaction."

"Drugs associated with being more targeted regarding their immunosuppression and generally considered as having favorable safety profiles may come off the least scathed: Amgen's Otezla for psoriasis and psoriatic arthritis (PsA) and Takeda's Entyvio for inflammatory bowel disease (IBD), though the latter will be counter-balanced by tempered use of infusion products. For most leading brands in the autoimmune space, there have been minimal issues with the supply chain, the exceptions being hydroxychloroquine (84% of rheumatologists report issues) and Genentech's Actemra (34% of rheumatologists report issues). Products that require administration by a healthcare professional, such as Sun Dermatology's Ilumya for psoriasis, also face a challenging scenario," the report stated.

Drug suppliers, such as AbbVie, have been in frequent communication with dermatology, gastroenterology and rheumatology specialists. "It seems that AbbVie in particular is attempting to thwart any launch setbacks for their next generation JAK inhibitor (Rinvoq), as the company was listed the most frequently by rheumatologists as continuing to provide samples via mail and engage in e-detailing platforms."

"Nephrologists have been a bit more buffered than other specialists with regard to patient volume decreases, as their dialysis population continues to require thrice weekly treatment to survive. However, their patient population immunosuppressed kidney transplant patients, elderly dialysis patients receiving care in group settings, and a patient base with chronic kidney disease that typically has multiple other co-morbidities is associated with a significantly higher risk of COVID-19 complications. Over the past two weeks, nephrologists increasingly reported having action plans in place for dealing with a COVID-19 outbreak at a dialysis unit; the vast majority are prepared. Most of those surveyed give high satisfaction ratings to dialysis organizations, such as Fresenius and DaVita, and the American Society of Nephrology, for their communication around COVID-19. Only 22% feel that the pharmaceutical industry is providing a high level of support/communication, and more than half say that increased samples, largely to help bridge patients with financial hardship, would be appreciated."

Approximatley half of neurologists are now starting fewer multiple sclerosis patients on their first disease-modifying therapy (DMT) or switching patients to new treatments, compared to prior to the COVID-19 outbreak. "While concerns related to immunosuppression are definitely a factor, access to infusion centers and delayed scheduling of next doses may also be playing an increasing role in the decreased use, as three out of five neurologists indicate that at least some patients are having difficulty getting their Ocrevus treatments (compared to only 28% for a high-efficacy oral DMT like Novartis' Gilenya)."

Read more here:
Specialty Physicians Weigh in on the State of Practice After COVID-19 - Rheumatology Network

Although respiratory distress is the predominant complication of COVID-19, there are also rare, yet serious, neurological ailments that may arise. A survey of UK hospitals found that some patients also experience strokes, dementia-like symptoms, and delirium. The findings were published on June 25 in The Lancet Psychiatry.

Throughout April, neurologists in the United Kingdom used databases to find 125 hospitalized patients who tested positive for COVID-19 and also experienced certain neurological afflictions. More than half of the patients suffered a cerebrovascular event, with 57 patients enduring an ischemic stroke, while nine had an intracerebral hemorrhage.

These relatively rare but incredibly severe complications get missed, like needles in a haystack, Benedict Michael, a neurologist at the University of Liverpool and senior author of the paper, tells Science News. Now that we know the rough idea of the scale of this, we desperately need research that gets to the disease mechanisms.

An altered mental state was the second most common neurological malady, with 39 patients experiencing new-onset psychosis, neurocognitive decline, or other conditions.

The patients from the survey ranged in age from 2394. While patients of all ages were roughly equally likely to experience an altered mental state, those over age 60 were more than four times more likely to have a cerebrovascular event than their younger counterparts were.

This actually is a direct effect, in some people, of the virus going into brains, Mark George, a psychiatrist and neurologist at the Medical University of South Carolina who was not involved with the study, tells STAT.

It isnt clear whether these symptoms of delirium are coming from the virus or if the hospitals stressful conditions are at least partially to blame. The New York Times reports that some changes aimed to minimize the spread of SARS-CoV-2 in hospitals, such as little human contact from the use of head-to-toe protective equipment for healthcare workers and the lack of visitors, have made hospitalization more stressful than normal. On top of that, fighting the virus has its own inherent challenges, including decreased oxygen intake and cumbersome attachments to machines.

Its like the perfect storm to generate delirium, it really, really is, delirium expert Sharon Inouye of the Hospital Life Elder Program tells the Times. The article recounts the case of a 31-year-old COVID-19 patient from Tennessee, not included in the survey, who experienced hospital delirium as a terrifying ordeal, hallucinating situations such as burning alive, being attacked by cats, and being experimented on in another country. Once, the visions were so vivid and scary that she ended up pulling out her ventilator tube.

Because the UK survey focused on hospitalized patients, it does not shed any light on how many people with COVID-19 might be experiencing milder neurological symptoms, such as fatigue, anxiety, or altered sensory perception. It is also unclear how long patients could expect to experience these symptoms.

Theres increased risk for temporary or even permanent cognitive deficits, psychiatrist Lawrence Kaplan tells the Times. It is actually more devastating than people realize.

Originally posted here:
Severe Neurological Ailments Reported in COVID-19 Patients - The Scientist

At The Spero Clinic, instead of just treating the pain, we focus on the body as a whole, helping patients go into complete remission with non-invasive and holistic treatments, said Dr. Katinka. Our team is here to remind you that hope is alive.

FAYETTEVILLE, Ark. (PRWEB) June 24, 2020

Dr. Katinka van der Merwe, the creator of the worlds leading 12 week pain relief program, has been the most requested guest on the True Grit and Grace podcast. She explains her outside-the-box, holistic approach to treating CRPS and how important it is to have hope and knowing remission is possible.

After being diagnosed with CRPS about 10 years ago, Amberly Lago, the host of the True Grit and Grace podcast, understands the impact of chronic pain. Dubbed the suicide disease, CRPS often leads to feelings of hopelessness and depression in those suffering. In this podcast, Dr. Katinka stresses the importance of maintaining hope and having a support team during remission, along with incorporating the body, mind, and spirit into the treatment process.

At The Spero Clinic, instead of just treating the pain, we focus on the body as a whole, helping patients go into complete remission with non-invasive and holistic treatments, said Dr. Katinka. Our team is here to remind you that hope is alive.

Dr. Katinka and Amberly also touch on how chronic pain patients should practice healthy eating habits, providing helpful nutrition tips to those diagnosed with CRPS. While its essential to maintain your physical health, patients should first focus on having a resilient mindset to overcome the physical and emotional pain that comes with CRPS.

For more information on The Spero Clinics treatments and success stories, visit The Spero Clinic website.

More About The Spero Clinic At The Spero Clinic, Dr. Katinka van der Merwe and her team use a Neurologic Recovery Program to help patients who are suffering from severe chronic pain like RSD/CRPS. They focus on Neurologic Rehabilitation and restoring balance to the Autonomic Nervous System. Dr. Katinkas world leading 12 week pain relief program helps treat hopeless cases worldwide.

For more information, please visit https://thesperoclinic.com/ or call us at (479) 304-8202.

Share article on social media or email:

Visit link:
Finding Hope and Pain Relief For CRPS with Dr. Katinka van der Merwe on the True Grit and Grace Podcast - PR Web

The report offers detailed study of the Global Neurology Software Market. The study on Global Neurology Software Market, offers deep insights about the Neurology Software Market covering all the crucial aspects of the market. Moreover, the report provides historical information with future forecast over the forecast period. Various important factors such as market trends, revenue growth patterns market shares and demand and supply are included in almost all the market research report for every industry. Some of the important aspects analyzed in the report includes market share, production, key regions, revenue rate as well as key players.

This study covers following key players:EpicBizmaticsAthenahealthhealthfusionAllscriptsNextgenBrainlabGreenway HealthKareoPractice FusionAdvanced Data SystemsNueMD

Request a sample of this report @ https://www.orbisresearch.com/contacts/request-sample/4339179?utm_source=Biren

The study is done with the help of analysis such as SWOT analysis and PESTEL analysis. There are different marketing strategies that every marketer looks up to in order to ace the competition in the Global market. Some of the primary marketing strategies that is needed for every business to be successful are Passion, Focus, Watching the Data, Communicating the value To Your Customers, Your Understanding of Your Target Market. There is a target set in market that every marketing strategy has to reach.

One of the ways for the estimation for the growth of the market is estimation of the market share by the regions which is likely to contribute to the growth of the market in the estimated forecast period. In this, the growth and fall of the each regions is covered which is likely to boost the growth of the Neurology Software market. In addition, to determine and use precise methods, research methodology such as the qualitative and quantitative data is used for the estimation and determination of the Global Neurology Software Market. It consists of the detailed study of current market trends along with the past statistics. The past years are considered as reference to get the predicted data for the forecasted period. The report covers complete analysis of the Neurology Software Market on the basis of regional and global level. Various important factors such as market trends, revenue growth patterns market shares and demand and supply are included in almost all the market research report for every industry.

Access Complete Report @ https://www.orbisresearch.com/reports/index/global-neurology-software-market-growth-status-and-outlook-2020-2025?utm_source=Biren

Market segment by Type, the product can be split intoAdvanced Neurology EMR SoftwareOther

Market segment by Application, split intoHospitalsCollege & Research InstitutesOther

In addition, it also covers political and social factors which is likely to affect the growth of the market. It also covers and analysis several segments which are present in the market. A significant development has been recorded by the market of Neurology Software, in past few years. It is also for it to grow further. Various important factors such as market trends, revenue growth patterns market shares and demand and supply are included in almost all the market research report for every industry.

For Enquiry before buying report @ https://www.orbisresearch.com/contacts/enquiry-before-buying/4339179?utm_source=Biren

About Us:Orbis Research (orbisresearch.com) is a single point aid for all your market research requirements. We have vast database of reports from the leading publishers and authors across the globe. We specialize in delivering customized reports as per the requirements of our clients. We have complete information about our publishers and hence are sure about the accuracy of the industries and verticals of their specialization. This helps our clients to map their needs and we produce the perfect required market research study for our clients.

Contact Us:Hector CostelloSenior Manager Client Engagements4144N Central Expressway,Suite 600, Dallas,Texas 75204, U.S.A.Phone No.: USA: +1 (972)-362-8199 | IND: +91 895 659 5155

Read the original:
Global Neurology Software Market 2020: Industry Analysis by Types, Application, Growth Opportunities, Key Players Analysis & Forecast Report 2025...

Article In Brief

Researchers suggest smoking may reduce risk of Parkinson's disease related death, and for those who smoked longer the risk was even less.

A six-decade follow-up study of nearly 30,000 British male doctors found that those who smoked tobacco when the study began in 1951 had a 30 percent lower risk of death from Parkinson's disease (PD), while those who continued to smoke had 40 percent lower risk, according to a report published in the May 5 online edition of Neurology.

The cohort study, which was followed up for 65-years, does not prove cause and effectthat smoking tobacco protects against PDbut it adds to previous findings that suggest that tobacco smoking is beneficial when it comes to the risk of developing PD. Researchers suspect that the nicotine found in tobacco may have a protective effect.

The researchers were careful to point out that the study should not be seen as advocating for smoking. Rather, they said that there needs to be a better understanding of why smoking may reduce the risk of PD because that might help explain the causes of the disease.

Current smoking is the leading cause of premature death and disability worldwide, and any such hazards would greatly exceed any beneficial effects of smoking on risk of Parkinson's disease, said study coauthor Robert Clarke, MD, professor of epidemiology and public health medicine at the University of Oxford, in an email to Neurology Today.

Little is known about the modifiable risk factors for PD, but previous studies have reported positive associations of PD with head injury, pesticide exposure, and consumption of dairy products, and inverse associations with caffeine, serum urate, physical activity, ibuprofen, and tobacco smoking, the study authors wrote.

The authors noted that a 2015 meta-analysis of observational studies reported that current smoking was associated with 60 percent lower risk of PD, but cautioned there is substantial uncertainty about the causal relevance of this inverse association. On the other hand, the authors cited a 2014 large case-control study from Denmark that suggested that the lower risk of PD in current smokers may be due to reverse causality bias, whereby early non-motor signs of PD may include a reduced response to nicotine stimulation, prompting current smokers to quit smoking before the diagnosis of PD can be made.

The current study, led by Benjamin Mappin-Kasirer, MSc, used data collected for the British Doctors Study, a prospective cohort begun in 1951 by Sir Richard Doll to examine the effects of tobacco smoking on disease-specific mortality. The study, which started with more than 34,000 doctors, was one of the first to establish the link between smoking and lung cancer.

The doctors who participated filled out a short questionnaire on their smoking status (current, ex, or never), amount smoked and in what form (cigarette, pipe or cigar). Ex-smokers were asked the questions about the time when they did smoke and about when they quit smoking.

Surviving participants were resurveyed by mail about changes in their smoking habits on six occasions between 1958 and 1998. The researchers collected cause-specific mortality for the doctors through November 20, 2016, using national mortality registries and personal inquiries. Complete mortality information was available for 99 percent of the study participants. The long follow-up period of the study coincided with a time when cigarette smoking was declining in the British population. Among doctors aged 65 to 69, the prevalence of current smoking declined from 67 perceny in 1951 to 8 percent in 1998, the study said.

The new analysis was based on information on 29,737 doctors. There were 25.879 deaths in the group, including 283 deaths that listed PD as the underlying cause. The average age of PD death was 82 years. The unadjusted rates of PD death were lower in current smokers (30 deaths per 100,000 person-years) compared with those who never smoked at baseline (46 deaths per 100,000 person- years). After the researchers did statistical adjustments for age-at-risk, current smokers at baseline had a 30 percent lower risk of PD, and the current smokers (classified as such using updated smoking habits on sequential resurveys) had a 40 percent lower risk of PD compared with doctors who never smoked.

The risks of PD were inversely associated with the amount of tobacco smoked, the researchers reported. Also, the protective effect of current smoking versus never smoking for PD was attenuated by increasing duration since quitting smoking.

Current smoking is the leading cause of premature death and disability worldwide, and any such hazards would greatly exceed any beneficial effects of smoking on risk of Parkinson's disease.

DR. ROBERT CLARKE

The investigators concluded in contrast with previous suggestions, the present report demonstrates a causally protective effect of current smoking on risk of PD.

Dr. Clarke said that while more needs to be learned, the most likely explanation is that the nicotine content in tobacco smoke may have protective properties, possibly by stimulating the release of dopamine, but the effects of other components of tobacco cannot be excluded.

The researchers said the strengths of their study included its large size and lengthy follow-up, a high response rate to the repeated surveys, and the fact that they used several statistical models to account for changes in smoking habits, reverse causality, and age-at-risk of PDeach of which yielded consistent results.

Limitations included the fact that there were only 283 PD cases, participants were all male British doctors, and the surveys did not collect information on family history, caffeine intake or other factors.

Rodolfo Savica, MD, PhD, associate professor of neurology and epidemiology at the Mayo Clinic in Rochester, MN, said the new analysis on smoking and PD is another piece of the puzzle. There is something there, but what is not yet clear.

He said that while nicotine is often singled out, we don't know if it's nicotine. He said that some of the studies using nicotine did not yield any results in Parkinson's disease, and did not find a protective effect.

Dr. Savica, who conducts PD research, said the all-male cohort in the British study makes him question what the effect of smoking tobacco would be on a similarly large study of women, noting that Parkinson's disease can present differently in men and women. Dr. Savica was the lead author on a study published in 2016 in JAMA Neurology that found an increase in PD from 1976 to 2005. The 30-year trend was derived from data collected for the Rochester Epidemiology Project. While the study was unable to conclude why there was an increase in cases, particularly among older men, environmental changes, including less smoking, was suggested as a possible factor.

Dr. Savica said cohort studies need to be interpreted with caution. As a physician it would be criminal for me to say to my patients, Start smoking now. They would die of cancer, he said.

Susan Searles Nielsen, PhD, assistant professor of neurology and a neuroepidemiologist at Washington University in St. Louis, said the inverse association between tobacco smoking and risk of Parkinson's has been strong and very consistent in the medical literature. But she said she does not agree with the Oxford researchers that their findings clearly indicate a causally protective effect, and likewise does not believe cause-and-effect can yet be ascribed to previous such findings.

Dr. Nielsen said that although this and other studies have consistently found a protective effect of tobacco, a very plausible alternative [hypothesis] remains that individuals predisposed to PD might have a different response to nicotine that extends back as far as adolescence, when smoking typically begins.

She said smoking tobacco could, with further study, turn out to be causal, non-causal or a bit of both, in terms of risk for PD. She said a few epidemiologic studies, including one that she coauthored, have found an association between exposure to second-hand tobacco smoke and lower risk of PD.

We don't know what it is about tobacco that might decrease the risk of Parkinson's disease if the association does turn out to be causal, Dr. Nielsen said. She noted that when people smoke tobacco, there is a massive host of other chemicals that come along with the nicotine.

To test the nicotine theory, she conducted a study that collected information on the past dietary habits of newly diagnosed PD patients and non-PD controls to examine whether nicotine-containing edibles from the same botanical family as tobacco might provide any protective effect. The study, published in Annals of Neurology in 2013, suggested that eating nicotine-containing foods, particularly peppers, might be protective against PD, Dr. Nielsen said.

Iris Kim, ScD, a senior epidemiologist at Vertex Pharmaceuticals in Boston (who did post-doctoral research at the Big Data Institute of Oxford University, but did not work on this study), said the new study is noteworthy.

That the follow-up period is so long is the major strength of the study, she said, as well as the fact that it corroborates previous findings that smoking is protective. Dr. Kim said one shortcoming of the study was that it did not collect information on caffeine intake, and so authors could not take into account the participants' caffeine intake, which has been shown to be protective against PD in some studies.

Dr. Kim last year published a large cohort study of 1.3 million women in the United Kingdom that found no association between alcohol intake and PD risk, and another study in 2013 that reported that caffeine intake was associated with a lower risk of Parkinson's disease among men. Both papers were published in Movement Disorders.

She said she agreed with the British researchers that the mechanism through which smoking may be protective are not fully understood. What are the biological agents that are driving this?

Drs. Clarke, Nielsen, and Savica had no disclosures.

Read the original post:
More Evidence that Tobacco Smoking May Protect Against... : Neurology Today - LWW Journals