The cost of prescription drugs for patients with multiple sclerosis (MS) nearly tripled over 7 years and the generic version of 1 of the most common drugs had little overall effect on prices, according to a study published in Neurology.

The study examined costs for disease-modifying drugs for patients with MS between 2011 and 2017 based on a Medicaid database. Researchers found spending on 15 MS drugs within the Medicaid program increased from $453 million to $1.32 billion during this time.

Increased spending was driven by increases in prescription costs that doubled during the 7 years, according to the study. Most of the drugs cost more than $70,000 per year on average and costs for these drugs are among the highest spending areas for private insurers, as well as Medicare and Medicaid.

After adjusting for average rebate amounts paid to the Medicaid program, spending was lower but still more than doubled from $278 million to $600 million per year. Spending more than doubled from $2.00 per Medicaid enrollee to $4.06 per enrollee during the study period. However, researchers found that some of the increase was due to the expansion of Medicaid through the Affordable Care Act.

A generic version of the drug glatiramer acetate was introduced in 2015. The study showed that when the generic version was introduced, the cost of the brand name drug immediately increased by $441 per prescription, followed by a slowing of the upward monthly trend.

Before the introduction of the generic drugs, the maker of the brand name drug worked to push its market share from the 20 mg dose to the 40 mg dose, which was not interchangeable with the new generic. The low market share for the generic drug was also because of the generic drug at 20 mg at approximately the same cost as the 40 mg dose when it launched, Daniel Hartung, PharmD, MPH, study author said in a press release.

A second company introduced a generic version of glatiramer acetate in October 2017, near the end of the study. By the end of 2017, 36% of all glatiramer acetate was generic, according to Hartung. Despite this release, there is an urgent need for more robust competition from generics for these MS drugs.

One limitation of the study is that it is based on the Medicaid program for patients from low-income households and patients with disabilities. It may not reflect the entire population of patients with MS, the authors noted.

ReferenceStudy: MS Drug Costs Nearly Triple over Seven Years, Even With Introduction of Generic [press release]. American Academy of Neurology. Published January 15, 2020. https://www.aan.com/PressRoom/Home/PressRelease/3766. Accessed January 20, 2020.

Excerpt from:
Multiple Sclerosis Drug Costs Nearly Tripled Over 7 Years - Pharmacy Times

Neuromodulation Market size is projected to experience significant growth from 2019 to 2025.Neuromodulation market will experience a significant growth in the forth coming years, due to increasing prevalence of neurological disorders. As per a study by NCBI, it has been estimated that about 30 million people are diagnosed with some form of neurological disorder in India, and the rate of prevalence is growing with time. Hence, supporting the growth of the neuromodulation market.

Recent technological advancements in the field of neuromodulation devices will augment the growth of the market. Technological enhancements such as Spinal Cord Stimulation (SCS) has been proven as one of the most efficient therapy for the management of intractable pain syndromes. Such technological advancements will support the neuromodulation market growth in the forecast time frame.

Unavailability of favorable reimbursement policies for neurological ailments will restrain the growth of the market. Furthermore, lack of trained professionals in the field neurological treatment solutions will be a hindrance. Hence, the aforementioned reasons might assist in declining the market growth.

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The transcutaneous supraorbital neurostimulator is an FDA approved neuromodulation device for both acute and preventive treatment of migraine. It is estimated to witness a considerable growth in the forecast period due to rising prevalence of migraine headache. The easy accessibility and efficient outcomes of the device helps in augmenting the demand of the product thus, increasing the growth of neuromodulation market.

The internal neuromodulation market is driven by the growing incidence of Parkinsons disease, failed back surgeries, urinary incontinence and other related syndromes. As well as, it is experiencing a new surge of technological enhancements. For instance, there has been major technical advancements of burst stimulation and high-frequency in the Traditional (40-50 Hz) spinal column stimulation cutting down its ineffectiveness in certain criteria. Thus, augmenting market growth.

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Depression is the leading cause of disease burden worldwide and major contributor in the rising incidence of disability. The global prevalence of depressive symptoms has been rising in the recent years and the majority of case are increasing among the millennials. Hence, the rising prevalence of depressions and depressive symptoms will boost the growth of the neuromodulation devices market.

Polymeric bio materials are used because of the flexibility, biocompatible nature, ease of fabrication and as well as their wide range of electrical, mechanical, thermal and chemical behaviors when combined with different materials as composites. Hence, the growing use of neuromodulation devices will augment the market of polymeric bio material market.

Clinics are expected to hold majority of the share in the field of neuromodulation market, as neurological therapy solutions are mostly available in the clinical settings. The state of art facilities available in the clinics for the treatment of neurological syndromes will augment the growth of the market.

U.S neuromodulation market is estimated to hold the majority of market share owing to advancements in technology in and venture capital investments by major market players. Hence technological advancements coupled with capital investments for product pipelines by major players will boost the growth of the market. Apart from U.S., India is another country leading the neuromodulation market, this is due to increasing prevalence of chronic pain related syndromes and other neurological diseases.

Some of the key industry players operating in neuromodulation market are, Medtronic, Inc, ST. Jude Medical, Inc., Nevro Corporation, Neurosigma, Inc., Boston Scientific Corporation, Cyberonics, Inc., Biocontrol Medical, Neuropace, Inc., Synapse Biomedical, Inc., Neuronetics, Inc. These companies opt for mergers, acquisitions and partnerships in order to increase their efficiency and sustain in the market by providing better solutions. Additionally, they are even focused on technological advancements and miniaturization of their devices.

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Neuromodulation Market drivers of growth analyzed in a new research report - Technology Magazine

The source of essential tremor--a movement disorder that causes involuntary trembling of the hands, arms, and head--has been enigmatic, impeding the development of effective treatments for a condition that affects 4% of people over 40.

Now a new study from Columbia University Irving Medical Center and NewYork-Presbyterian suggests the tremors are caused by overactive brain waves at the base of the brain, raising the possibility of treating the disorder with neuromodulation to calm the oscillations.

"Past studies have identified changes in brain structure in people with essential tremor, but we didn't know how those changes caused tremors," says Sheng-Han Kuo, MD, the study's senior author and assistant professor of neurology at Columbia University Vagelos College of Physicians and Surgeons.

"This study pins down how those structural changes affect brain activity to drive tremor."

The study was published online today in Science Translational Medicine.

Essential tremor is the most common movement disorder in the United States, affecting about 10 million Americans (approximately eight times as many people as Parkinson's disease). The condition causes involuntary, rhythmic trembling, usually in the hands, and is exacerbated during such activities as buttoning a shirt or using utensils. Although essential tremor is not life-threatening, it can severely impact quality of life.

Some beta blockers and anti-epileptic drugs can reduce symptoms, but they carry side effects, such as fatigue and shortness of breath. They also don't work very well in essential tremor patients, which Kuo says isn't surprising since the cause of the condition hasn't been well understood.

The researchers have previously identified structural changes in the cerebellum of essential tremor patients and used a new cerebellar encephalogram (EEG) technique to search for unusual brain waves in this part of the brain.

Among 20 essential tremor patients examined with cerebellar EEG, most had strong oscillations (between 4 and 12 Hz) in the cerebellum that were not found in any of the 20 control subjects. Patients with more severe tremors had stronger oscillations.

The researchers first discovered the cerebellar oscillations in mice that had developed tremors closely resembling those seen in essential tremor patients.

The tremors could be turned on and off by stimulating certain neurons in the mouse brain, alternately suppressing and unleashing the oscillations. "These results established a causal relationship between the brain oscillations and tremor, which cannot be directly tested in patients," says Kuo, who is also an assistant attending neurologist at NewYork-Presbyterian/Columbia University Irving Medical Center.

In previous studies of postmortem brain tissue from essential tremor patients, the Columbia team discovered that patients with essential tremor had an abnormally high number of synapses, or connections, between two types of nerve cells in the brain's cerebellum--climbing fibers and Purkinje cells.

In the current study, again using postmortem brain tissue, the researchers found that the formation of these synapses appears to be influenced by a protein called glutamate receptor delta 2 (GluR?2). "When this protein is underexpressed, any excess synapses that form between climbing fibers and Purkinje cells are not eliminated, resulting in too many neuronal connections," says Kuo.

When the team reduced expression of GluR?2 in mice, the animals developed tremors similar to those seen in humans. Restoring GluR?2 function suppressed the tremors, proving that the protein plays a key role in essential tremor.

The study opens several new possibilities for treatment of essential tremor, Kuo says.

"Using cerebellar EEG as a guide, we may be able to use neuromodulation techniques such as tDCS or TMS (transcranial direct-current stimulation or transcranial magnetic stimulation) to reduce tremor, or even drugs to reduce transmission between the climbing fibers and Purkinje cells."

Kuo is also working to develop medications that increase GluR?2 expression in the brain, which may reduce tremor.

Reference: Pan, M.-K., Li, Y.-S., Wong, S.-B., Ni, C.-L., Wang, Y.-M., Liu, W.-C., Lu, L.-Y., Lee, J.-C., Cortes, E. P., Vonsattel, J.-P. G., Sun, Q., Louis, E. D., Faust, P. L., & Kuo, S.-H. (2020). Cerebellar oscillations driven by synaptic pruning deficits of cerebellar climbing fibers contribute to tremor pathophysiology. Science Translational Medicine, 12(526). https://doi.org/10.1126/scitranslmed.aay1769

This article has been republished from the following materials. Note: material may have been edited for length and content. For further information, please contact the cited source.

Link:
Could Essential Tremor Be Caused by Overactive Brain Waves? - Technology Networks

Acute cerebral perfusion imaging should be part of the routine evaluation of patients with acute ischemic stroke secondary to large vessel occlusion presenting beyond 6 hours from time last known well, and may help identify those who may benefit from endovascular perfusion therapy. However, it is important to understand the limitations of automated CT perfusion (CTP), which are detailed in a review published in Neurology.

The clinical benefit of endovascular reperfusion therapy was impressive in 2 randomized trials (DAWN and DEFUSE 3) for patients with acute ischemic stroke with larger vessel occlusion who presented beyond 6 hours from last known well and were deemed to be good candidates based on cerebral perfusion imaging. The capability to perform and interpret perfusion imaging, either CTP or magnetic resonance perfusion-weighted imaging, should be available in every center treating patients with acute stroke.

A few commercially available, automated software packages, such as RAPID automated perfusion postprocessing software, can detect the presence of irreversible brain tissue injury, based on cerebral blood flow compared with that seen in contralateral perfused tissue by CTP or magnetic resonance perfusion, and assist in selecting appropriate candidates for endovascular therapy.

Simply put, CTP consists of a sequence of images obtained during the wash-in and the wash-out of an intravenous iodinated contrast agent. This is followed by transferring the source images to the workstation with the dedicated postprocessing software, which provides calculation of hemodynamic parameters. The automated assessment overcomes possible observer variability associated with subjective inspection.

There are disagreements about the quantitative thresholds between the ischemic core (the critically hypoperfused tissue with low cerebral blood flow) and the ischemic penumbra (the potentially salvageable tissue that may recover if reperfusion is achieved), and different software packages recommend slightly different thresholds. The automated software RAPID generated specific thresholds to identify good candidates for delayed endovascular: relative cerebral blood flow <30% and Tmax (time from the start of the scan until the maximum intensity of contrast bolus arrives at each voxel) >6 seconds.

Although perfusion imaging can be very valuable, there are several diagnostic pitfalls and challenges, and the review details the common technical and clinical pitfalls, along with practical pearls.

Technical pitfalls refer to the image quality from a technical standpoint and include several important challenges:

Clinical challenges to consider in routine practice:

Magnetic resonance perfusion is less quantitative compared with CTP and requires the use of echo planar imaging, which can have multiple artifacts. Furthermore, MRI is not as commonly available in urgent cases.

Lead author Achala Vagal, MD, professor of radiology at the University of Cincinnati Medical Center, Ohio, told Neurology Advisor, CTP is an important tool in the triage and treatment decision making in acute ischemic stroke. However, like any other technique, it is imperative to understand its limitations, especially when these decisions have to be made quickly. She goes on to add that automated CTP output maps are now available within minutes on our PACS, phones and emails; all the more reason to be cognizant of the pitfalls leading to inaccurate estimations of core and penumbra. A quick checklist can be very helpful.

Reference

Vagal A, Wintermark M, Nael K, et al. Automated CT perfusion imaging for acute ischemic stroke: pearls and pitfalls for real-world use. Neurology. 2019;93(20):888-898

Link:
Clinical Pearls and Pitfalls of Automated CT Perfusion for Acute Ischemic Stroke - Neurology Advisor

RESEARCH TRIANGLE PARK, N.C., Nov. 4, 2019 /PRNewswire/ -- T3D Therapeutics, a clinical stage drug development company engaged in the development of T3D-959, a new orally administered treatment for Alzheimer's disease (AD), announced today that it has closed on a $15 million financing from a cornerstone investor. These funds, along with support from the National Institute on Aging (NIA), part of NIH, completes the funding needed to begin the PIONEER Study of T3D-959, a novel, metabolic-focused AD drug treatment.

"We believe T3D-959 has the potential to be Alzheimer's disease remedial, to either slow, stop, or even reverse the course of disease as a single drug therapy," said Chief Executive OfficerJohn Didsbury, Ph.D. "Our drug works to overcome aberrant glucose (sugar) and lipid (fat) metabolism in the brain that is inherent in AD. This dysfunctional metabolism causes protein mis-folding which in turn leads to plaques, tangles and inflammation."

Warren Strittmatter, M.D., Chief Medical Officer of T3D Therapeutics,Emeritus Professor of Neurology at Duke University Medical Center and Alzheimer's Association Zenith Award winner said, "We are eager to expand our testing of T3D-959 in Alzheimer's patients in this new Phase 2 study since it uniquely targets mechanisms which we believe underlie the development of the memory deficits in this disorder."

About PIONEER

The Phase 2 PIONEER study (Prospective therapy to Inhibit and Overcome Alzheimer's Disease Neurodegeneration via Brain EnErgetics and Metabolism Restoration) is expected to initiate patient dosing in early 2020. PIONEER is adouble-blind, placebo-controlled, parallel-group Phase 2 safety and efficacy study expected to enroll up to 256 adults with mild-to-moderate Alzheimer's disease (MMSE 16-26). PIONEER will enroll subjects who will receive one of three different doses of T3D-959 or a placebo for 24 weeks. PIONEER is projected to start enrolling subjects in the first quarter of 2020.

PIONEER is supported by the NIA under award number R01AG061122.

About T3D Therapeutics, Inc.

T3D Therapeutics, Inc. is a privately-held, Research Triangle Park, NC-based company. The Company has an exclusive license to T3D-959, its lead product candidate, and a platform of structurally-related molecules. T3D Therapeutics' mission is to develop and commercialize T3D-959 for the treatment of Alzheimer's disease and Mild Cognitive Impairment. T3D-959 is a small molecule, orally-delivered, brain-penetrating dual nuclear receptor agonist designed to improve glucose and lipid metabolism dysfunctions present in AD and other neurodegenerative disorders.

For more information visit http://www.t3dtherapeutics.com/.

Investor Contact|

John Didsbury, Ph.D., CEOT3D Therapeutics, Inc.1-919-237-4897Email: info@t3dtherapeutics.com

View original content:http://www.prnewswire.com/news-releases/t3d-therapeutics-closes-15m-financing-to-advance-phase-2-development-of-t3d-959-in-a-new-approach-to-treating-alzheimers-disease-300950374.html

SOURCE T3D Therapeutics, Inc.

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T3D Therapeutics Closes $15M Financing to Advance Phase 2 Development of T3D-959 in a New Approach to Treating Alzheimer's Disease. - BioSpace

While the brain only weighs around three pounds and is the size of two clenched fists, it is a highly complex organ made up of many different parts. Much like muscles and joints, certain cells in the brain can stiffen up too and this causes declines in memory and cognitive abilities. The normal ageing process brings subtle changes in cognitive abilities and as one reaches middle age, the brain changes from subtle to measurable ways. The overall volume of the brain begins to shrink in the 30s or 40s with the rate of shrinkage increasing around age 60. Thankfully, there are a few ways one can improve brain health and taking a creatine supplement may help.

Creatine is the number one supplement for improving performance in the gym, however, it has also been shown to help with the brain and protecting against neurological disease.

Creatine is an amino acid found only in animal flesh but most abundantly in skeletal muscle flesh.

It is not an essential amino acid as it can be synthesised from other amino acids found in plant foods.

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Best supplements for tiredness: Taking a certain vitamin has been proven to boost energy

Creatine is a substance that is found naturally in muscle cells. It helps muscles produce energy during heavy lifting or high-intensity exercise.

Chemically speaking, it shares many similarities with amino acids. When a person supplements, they increase their stores of phosphocreatine.

This is a form of stored energy in the cells, as it helps your body produce more of a high-energy molecule called ATP.

ATP is often called the bodys energy currency and when a person has more ATP, the body can better perform.

Just like the muscles, the brain stores phosphocreatine and requires plenty of ATP for optimal function.

Researchers who study cognition and athletic performance often advised on creatine supplements.

DONT MISS

What the studies say

In a study with the US National Library of Medicine National Institutes of Health, creatines effect on improved repercussion and neuroprotection was analysed.

The study noted that stroke leads to energy failure and subsequent neuronal cell loss.

Creatine and phosphocreatine constitute a cellular energy buffering and transport system and dietary creatine supplementation was shown to protect neutrons in several models.

In another study, oral creatine supplements were analysed on how it improves brain performance.

The study said: Creatine supplementation is in widespread use to enhance sports fitness performance and has been trialled successfully in the treatment of neurological and neuromuscular disease.

"Creatine plays a pivotal role in brain energy homeostasis.

"Creatine supplementation had a significant positive effect on both memory and intelligence.

Every brain changes with age and mental decline is very common being one of themes feared consequences of ageing.

However, cognitive impairment is not inevitable.

Along with taking supplements to boost the brains health, other proven ways to improve brain health include reducing stress, taking more naps, meditation, exercising, improving health conditions and being vigilant with your diet.

Continued here:
Best supplements for the brain: This supplement could reduce risk of neurological diseases - Express

Dr. Max Wiznitzer is a graduate of Northwestern University School of Medicine. He trained in pediatrics and developmental disorders at Cincinnati Childrens Hospital and in pediatric neurology at Childrens Hospital of Philadelphia.

He then did a National Institutes of Health funded fellowship in disorders of higher cortical functioning in children at the Albert Einstein College of Medicine, Bronx, NY. Since 1986, he has been a pediatric neurologist at Rainbow Babies & Childrens Hospital in Cleveland. He is a professor of pediatrics and neurology at Case Western Reserve University.

Dr. Wiznitzer has a longstanding interest in neurodevelopmental disabilities, especially attention deficit hyperactivity disorder and autism, and has been involved in local, state and national committees and initiatives, including autism treatment research, Ohio autism service guidelines, autism screening, and early identification of developmental disabilities He is on the editorial board of Lancet Neurology and Journal of Child Neurology and the Professional Advisory Board of CHADD, the national ADHD advocacy organization, and lectures nationally and internationally about various neurodevelopmental disabilities.

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Max Wiznitzer, MD, Pediatric Neurology, UH Cleveland ...

Our pediatric neurology team at University Hospitals Rainbow Babies & Childrens is recognized as a center of excellence. Among the best programsin the nation, we have the expertise to accurately evaluate, diagnose and treat the full range of neurological disorders children using the latest, most scientifically advanced diagnostic equipment, therapies, techniques and medications available. With a focus on family-centered care, we involve and educate patients and their families every step of the journey so together we can successfully manage or cure any neurological condition.

Because our team of neurologists have the experience and specialized expertiseacross a full range of neurological services, we help patients with any need, including:

Many of our team are also involved in regional and national clinical trials and other research projects to advance the quality of care and treatment of children with neurological conditions. In a collaborative manner, our patients have not only the neurology research resources available, but we bring together any pediatric specialties within UH Rainbow Babies & Childrens for your childs unique medical needs. Our goal is your goal to provide high quality, integrated and comprehensive care to your child.

Since 2001, the Epilepsy Center at UH Rainbow Babies & Childrens, led by specially trained pediatric epileptologists, has been recognized by the National Association of Epilepsy Centers as a Comprehensive Level IV Pediatric Epilepsy Center the highest designation possible.

Level IV Epilepsy Centers are experienced in the most complex forms of intensive neurodiagnostics monitoring, as well as more extensive medical, neuropsychological and psychosocial treatments. This national designation also includes complete evaluations for epilepsy surgery, including intracranial electrodes, and provides a broad range of expert surgical procedures.

In addition, our adult epilepsy program at UH Cleveland Medical Center has this unique national distinction as well, so patients who transition from our pediatric center to the adult center continue to receive the highest level of integrated and comprehensive care.

Historically, spinal muscular atrophy (SMA) was considered virtually untreatable. Medical care was used primarily to ensure adequate nutrition and avoid or delay respiratory failure.

At UH Rainbow Babies & Childrens advanced SMA Clinic, we are changing that prognosis. We offer Spinraza (nusinersen), a recently approved prescription drug that gives hope to those with SMA. It is a new spinal muscular atrophy treatment that is injected directly into the fluid surrounding the spinal cord and has shown great promise when used, especially in treating infants. Our dedicated neurology specialists embrace new treatment options such as Spinraza, as they strive to enhance the treatment and care of SMA patients of all ages.

For more information about any of our neurology, epilepsy or SMA programs or treatments, or if your child is displaying any developmental concerns, please contact our pediatric neurology experts. For urgent concerns, we offer same day appointments with neurology specialists through our convenient clinic locations. For an appointment, call 216-844-3691.

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Pediatric Neurology l UH Rainbow Babies & Childrens ...

At University Hospitals, our board-certified stroke specialists include vascular neurologists, neurosurgeons, neuro-critical care intensivists and interventional specialists, work together to combine their training and skill to handle the most complex neurovascular disorders.

Anyone who has experienced a suspected stroke or transient ischemic attack should call 9-1-1 to get to the emergency room for the right care, right away. Immediate care can make the difference in a successful recovery. At UH, our emergency team is trained to quickly recognize any suspected stroke symptoms, and this triggers a consult with our stroke specialists who will determine next steps.

There are a variety of symptoms that could indicate a possible stroke, including a sudden, severe, and uncharacteristic headache, slurred speech or difficulty talking or understanding, numbness or weakness, especially if it involves one side of the body, sudden trouble walking or standing or sudden blurred or lost vision involving one eye or seeing to one side.

A hemorrhagic stroke occurs when a blood vessel in the brain ruptures or leaks causing bleeding into or around the brain. There are two main kinds of hemorrhagic stroke.

Intracerebral hemorrhage: This occurs when a fragile brain artery ruptures causing bleeding into the brain tissue. This rupture is very sudden and can be severe causing brain damage and swelling. The most common causes are:

Subarachnoid hemorrhage: results from bleeding around the brain, often causing a severe, "worst of my life" headache. Although this type of stroke only causes 5 percent of all strokes, it is the most severe. The most common causes are:

Hemorrhagic types of strokes can be very serious and sometimes life-threatening. Now with advanced imaging techniques such as CT angiography or MR angiography, many of these conditions can be identified before they cause severe bleeding and can be treated and repaired to prevent a stroke.

If you or someone you love has symptoms of a hemorrhagic stroke or is found to have an AVM or an aneurysm that might cause a hemorrhagic stroke, it is important to seek treatment right away from a clinical specialist especially one that has the specialized training and experience in neurovascular specific disorders.

Using the latest imaging technology, our neurology team at University Hospitals will pinpoint your exact problem and determine the best treatment for your individual condition. Our specialists are available 24 hours a day, every day and respond within minutes to emergency situations. If surgery is necessary, our specialists will determine the best treatments available and discuss the options with you- whether traditional surgery or minimally invasive or endovascular techniques and arrange for rapid treatment to get the best outcomes.

Our post-operative unit teams are also highly-qualified to monitor patients recovering from neurovascular injuries. People who have had a stroke can be more susceptible to having another one or having a other medical problems, such as a heart attack or pneumonia. Depending on the severity of each condition, a patient may remain in our neurological intensive care unit, the neuro intermediate care unit or be seen in one of our post-operative areas. Either way, the stroke specialists can work as a team with specialists from medicine, surgery and anesthesia across University Hospitals system to help patients recover from their stroke or from surgery for improved health.

In addition to our emergency response efforts, our stroke specialists use a multidisciplinary approach to manage neurovascular conditions over time. Collaborative meetings happen every day, but every week, the team meets to discuss complex cases, review the individuals current state of health, treatment progress and next steps. By bringing multiple perspectives together with the expertise of an entire team, we provide the latest therapies and move you swiftly along the road to recovery.

The Comprehensive Stroke Center at University Hospitals Neurological Institute in Cleveland, Ohio has a legacy of innovation in advancing care protocols and overall excellence in outcomes.

Our entire neuroscience team at University Hospitals has a strong commitment to find better, faster and more effective ways to treat neurovascular conditions. With this dedication to research and discovery, our team participates in national and international clinical trials that offer the most cutting-edge and innovative treatments to our patients. These, along with other research efforts, keep us up-to-date on the newest therapies and prompt us to continuously re-envision how we address any neurological disorder.

With an experienced and skilled clinical team, collaborative treatment and sophisticated diagnostic technology, University Hospitals is equipped to handle all types and severity of neurovascular illness, especially the most complex. As a result, patients from near and far come to our facilities to receive care.

If you or someone you love is experiencing any of the symptoms associated with neurovascular disorders, our stroke specialist team can help. For more information, contact one of our team members at convenient locations across our system of care.

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Vascular Neurology | Neurology | University Hospitals ...

From Parkinsons disease, strokes and brain tumors to degenerative disc disease and sleep disorders, Florida Hospitaloffers patients a broad range of expert neurological care at treatment hubs across the state: The Florida Hospital Neuroscience Institutein Orlando and Tampa, andThe Brain & Spine Surgery Associates of Florida Hospital Memorial Medical Center in Volusia. Whether treatment stems from injury or illness, our specialized physicians utilize todays most effective diagnostic measures to determine the best course of care.

At Florida Hospital Neuroscience Institute, neurological care involves an interdisciplinary team approach to diagnosis and treatment, supported by todays leading diagnostic, medical and surgical techniques.Being at the forefront of neurological medicine means we are committed to excellence in education, treatment, research, and care of all patients with neurological disorders and injuriesfrom newborns to adults. Our physicians specialize in a variety of areas including:

Our programs are led by skilled physicians and highly trained healthcare professionals working together to determine the best path of care for each patient.Request an appointmenttoday with a neuroscience specialist at Florida Hospital.

Continued here:
Neurology (Neuroscience) Florida Hospital

Our experienced audiologists have the ability to provide a full range of audiometric testing for adults and children. Visit our page to learn more!

Do you have questions about pregnancy, labor and delivery? Baby Talk with MyExcelaDoc has been created to help answer those questions!

It all begins at the Excela Health Family Additions Maternity Center inside Excela Westmoreland Hospital where experienced nurses and on-site pediatricians work side by side with doctors to deliver right here in Westmoreland County.Take the baby tour today!

Our Excela Health QuikDraw and QuikDraw PLUS locations throughout the region make diagnostic testing simple. Find out more and find a location near you!

We perform more than 275,000 outpatient Bone Density screenings per year. Find a location near you to schedule your next appointment.

We are the leading Heart and Vascular Center in Westmoreland County. Learn more about our dedication and contributions to cardiovascular health!

Heart services at Excela Health have been recognized by national, regional and local groups. Visit our page to learn more about our latest recognition!

Our cardiothoracic surgeons have the reputation for excellence in patient care and quality outcomes right here in Westmoreland

The care Excela Health offers you throughout your life and your children, addresses your individual needs, through pregnancy and the miracle of birth and beyond.

Robotic surgery at Excela Health can perform relatively complex operations with greater precision, better range of motion and increased visibility.

To promote community health and wellness, Excela Health provides a variety of community-based health screenings and wellness events like Wellness Check blood screenings, blood pressure, stroke, vision and bone density screenings.

Excela Health's Concussion Clinic has a double-sided objective of providing education to prevent concussion and using the latest techniques to treat and evaluate recovery.

The Westmoreland County Crisis Hotline operates 365 days a year and is answered 24 hours a day, seven days a week, responding to depression, suicide, and other issues.

Our emergency medicine physicians and nurses who are dedicated to the care of patients with broken arms and broken hearts to stroke or sudden pain and more.

We perform more than 275,000 outpatient x-ray procedures a year through our of state-of-the-art technologies and attention to patient care from our highly skilled staff.

Because multiple images are taken within seconds, a 3D image is produced and allows the radiologist to see more detail inside the breast in a way not possible until now.

The digestive system is the power plant that keeps the body going day by day. Call us today to learn more!

Welcome to MedCare Equipment Company, a premier provider of home medical equipment (HME), supplies and respiratory care products. Call us today to learn more!

When a medical emergency happens, its good to know that help is close by. Excela Health's cutting edge emergency department is the best in the region!

Managing your diabetes usually isnt difficult, but it is very personal. Becoming an active participant in your care is what we do at Excela Health!

Flu like symptoms can be nerve-wracking. Call us today to set up an appointment to get your flu like symptoms evaluated. We are dedicated to your well-being.

While no one wants to have surgery, its good to know that top surgeons with specialized training and the best technology are right in your own backyard. Excela offers a range of surgical specialties and various options.

Heart services at Excela Health have been recognized by national, regional and local groups. Learn more about our most recent recognition.

Urgent orthopedic care for fractures and injuries are treated by surgeons specializing in reconstructive surgery, neurosurgery, hand surgery and foot and ankle surgery.

Welcome to MedCare Equipment Company, a premier provider of home medical equipment (HME), supplies and respiratory care products. As an innovative leader in HME, we can help those with a temporary need or chronic issues meet the demands of daily living in a variety of settings.

A hospitalist is a doctor who specializes in caring for hospitalized patients only. Excela Health hospitalists are board certified physicians with expertise in hospital-based medicine. Our hospitalists direct your care during your hospital stay and provide information related to your hospitalization to your primary care physician.

Whether its a routine blood test or a specialized x-ray procedure, our QuikDraw and QuikDraw PLUS locations throughout the region make diagnostic testing simple.

The intensive care unit has the most dedicated and experienced staff in the region. Visit our site to learn more about how we provide excellence in healthcare!

Joint Replacement At Excela Health can be one of the best decisions you make. Visit our site to learn more about our joint replacement care team!

At Excela Health, an exceptional patient experience is our top priority. Thats why we have a joint replacement education program called Joint Works,

If you need a knee replacement, you will be taken care of at Excela Health with the most talented and experienced fellowship-trained surgeons in the region!

Excela Health laboratories are committed to providing high quality, cost effective laboratory services for Westmoreland County and beyond. Call us today!

Lifeline Emergency Response is the key to ensuring great help is close by. Dedicated emergency physicians are dedicated to the care of many different patients!

Mammography in Westmoreland County is one of the services we do best at Excela Health. Visit our site to learn more about how we can provide excellence in healthcare.

Welcome to MedCare Equipment Company, a premier provider of home medical equipment (HME), supplies and respiratory care products. Call us today to learn more!

Mental Health Services in Westmoreland County are provided by Excela Health. Learn more about how we provide excellence in healthcare with Mental health!

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Annually, more than 1,600 babies are delivered at the Family Additions Maternity Center and through it all, we offer individual sensitivity and care as well as professionalism and expertise.

Excela Healths Family Additions Maternity Center at our Westmoreland Hospital campus delivers award-winning quality care in family-friendly surroundings. To do that takes more than just a high level of attentive care. It also requires well-trained people, from physician specialists and physicians assistants to nurse practitioners, obstetrical nurses and other health care professionals.

Occupational therapy moves the patient toward greater independence. We teach the safest ways to perform daily activities, such as getting dressed, doing laundry, cooking and cleaning.

While no one wants to have surgery, its good to know that top surgeons with specialized training and the best technology are right in your own backyard. Excela offers a range of surgical specialties and various options.

If you are one of the millions of Americans who suffer from pain, you know that it can take a toll on your life - both physically and emotionally. But, you do not have to accepth chronic pain as a normal part of life in all cases.

If you are one of the millions of Americans who suffer from pain, you know that it can take a toll on your life - both physically and emotionally. But, you do not have to accepth chronic pain as a normal part of life in all cases.

If you and your doctor feel you need rehabilitation, such as physical therapy, occupational therapy and speech therapy after an operation or an injury, the quality of care you receive is vitally important. Excela Health Outpatient Rehabilitation delivers just that, of course. But convenience and accessibility make a big difference, too.

Getting you healthy and getting you home, equipped with the skills you need to deal with your daily life safely and efficiently: thats what we aim for at EPIC Rehab, the Excela Physical Improvement Center.

Of all the relationships we develop in life, one of the most important is that between the patient and the physician. Our primary care providers follow the Patient-Centered Medical Home model. This means that they value care coordination and communication the way you, as the patient, would. Your well-being is at the center of all they do. They will direct your care toward specialists or other services, if needed, and help you manage your overall health and wellness.

Heart services at Excela Health have been recognized by national, regional and local groups and include: Consumer Reports Ranks Excelas cardiothoracic surgical program among the nation's best with the Excela Health physician practice of Cardio-Thoracic Surgical Associates ranking among the Top 10 Percent nationally, receiving the highest rating from the Society of Thoracic Surgeons (STS). Highmark Blue Cross Blue Shield Blue Distinction Center Plus for Cardiac Care ACE - Accreditation for

At our QuikDraw and QuikDraw PLUS sites, we make diagnostic testing simple. Just bring your doctor's order to any of our locations listed below for prompt and reliable test results. No appointment necessary for blood work, x-ray or EKG, however, all other tests require scheduling

Interventional Radiology allows radiologists to specialize in minimally invasive, targeted treatments using image guidance that, in particular instances, replaces the need for open surgery. Benefits to patients include: Less pain, shorter recovery and no large incisions.

If you and your doctor feel you need rehabilitation, such as physical therapy, occupational therapy and speech therapy after an operation or an injury, the quality of care you receive is vitally important. Excela Health Outpatient Rehabilitation delivers just that, of course. But convenience and accessibility make a big difference, too.

Because multiple images are taken within seconds, a 3D image is produced and allows the radiologist to see more detail inside the breast in a way not possible until now.

Urgent orthopedic care for fractures and injuries are treated by fellowship-trained surgeons specializing in adult reconstructive surgery, neurosurgery, hand surgery and foot and ankle surgery. Urgent appointments are available today with convenient locations throughout Westmoreland County.

While no one wants to have surgery, its good to know that top surgeons with specialized training and the best technology are right in your own backyard. Excela offers a range of surgical specialties and various options.

Whats keeping you or those you love up at night? Could be a sleep disorder. Some sleep problems can lead to serious health issues such as heart attack, stroke, high blood pressure, fatigue-related motor vehicle accidents, and decreased quality of life.

Speakers are available FREE of charge based on speaker availability for businesses, community groups and churches on a number of health-related topics.

Speech therapy covers a broad range of patient needs: not only improving speech, but also swallowing. A speech therapist can help with reading and writing skills, and with attention to needs such as attention span, memory and judgment.

Urgent orthopedic care for fractures and injuries are treated by fellowship-trained surgeons specializing in adult reconstructive surgery, neurosurgery, hand surgery and foot and ankle surgery. Urgent appointments are available today with convenient locations throughout Westmoreland County.

At Excela Health, we perform more than 275,000 outpatient x-ray procedures a year through a combination of state-of-the-art technologies and attention to patient care and comfort from our highly skilled, professional staff. We pride ourselves on efficiency, so that patient diagnoses can occur more quickly while attending to the medical needs and dignity of our patients, all serving as a foundation for patient-centered imaging services.

Through our dedicated electrophysiology lab, those with heart rhythm disturbances can get top quality care from highly trained specialists while remaining close to home.

If a problem arises from the veins and arteries rather than the heart, vascular surgeons from the Excela Health Heart and Vascular Center work to get you back in circulation.

At Excela Health, we perform more than 275,000 outpatient x-ray procedures a year through a combination of state-of-the-art technologies and attention to patient care and comfort from our highly skilled, professional staff. We pride ourselves on efficiency, so that patient diagnoses can occur more quickly while attending to the medical needs and dignity of our patients, all serving as a foundation for patient-centered imaging services.

When you volunteer at Excela Health, you become part of a unique group of individuals motivated by various reasons but together, working toward one goal improving the health and well-being of every life touched. And the opportunities to volunteer are as varied as the people seeking to help.

Excela Healths medical professionals understand the many complex reasons that can cause a weight problem. And we put together the latest surgical techniques with a focus on individual support, before and after surgery, to make your steps to a healthier life clearer, simpler and easier.

Excela Health offers a wide variety of health-related screenings, educational classes, support groups, a Speaker's Bureau and health fairs to make health care more accessible to the communities it serves. Through these venues, and others, you have the opportunity to pursue a course of wellness, find needed support, learn about Excela Health capabilities and how we can help, or discover unknown health conditions early on, so treatment can begin quickly while offering the best possible chance for

At Excela Health, we perform more than 275,000 outpatient x-ray procedures a year through a combination of state-of-the-art technologies and attention to patient care and comfort from our highly skilled, professional staff. We pride ourselves on efficiency, so that patient diagnoses can occur more quickly while attending to the medical needs and dignity of our patients, all serving as a foundation for patient-centered imaging services.

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Neurology - Excela Health

Motor neurone disease sufferers in Bendigo forced to drive hours for 20-minute medical appointments.

Carolyn Hutchison has to travel hours to Melbourne for routine neurology appointments as short as 20-minutes. Pictures: DARREN HOWE

A California Gully woman with motor neurone disease says a dearth of specialistneurologists in Bendigois forcing patients with complex conditionsinto lengthy round trips for routine appointments.

Carolyn Hutchison says she and other MND sufferers have to drive to Melbourne for appointments as short as 20 minutes becausethe one part-time neurologist in Bendigo does not specialise in the condition.

Theres a few other people here in Bendigo with MND who also travel down and see the same neurologist, she says.

They try and do a lot of appointments while were down there so its a whole day out travelling and when youre already tired,having to get up at 7.30 in the morning for an appointment at 10.30 is just crazy and you dont get home until after dinner.

Ms Hutchison saysher Melbourne neurologistcansometimesspeak to her via video link, but there are times when she has no choice but to make the trip, even though her condition means she is unable to drive and has to rely on family to get her there.

Carolyn Hutchison is one of at least five MND sufferers in Bendigo who are unable to access the specialist neurology they need outside Melbourne.

Ms Hutchinsons 18-year-oldson, Zamien, also travels to Melbourne for neurology appointments after suffering a stroke as a childresulting from complications from cancer, and she sayseven having a part time Bendigo-based doctor would make a big difference for both of them.

Hes also linked up with [the Peter MacCallum Cancer Centre]but Peter Mac actually come up to Bendigo every six months, so we can have our Peter Mac appointments here but we cant see the neurosurgeon, she says.

Weve got this beautiful big new hospital and we just donthave the staff, it just seems a shame, it really does.

Ms Hutchison saysshe is aware of at least four other patientsin the regionwho all have to drive to Melbourne to see the same neurologist.

We have an MND meet-up every month and theres a gentleman that comes from Castlemaine, theres myself, theres [another man] and a lady who comes from Rochester as well and were hoping to get a new member soon, she says.

So theres at least five of us that are within this area that could benefit from a neurologist if he visited Bendigo.

A Bendigo Health spokeswoman said whilethehospital did not have a neurologist on staff, it hada number of physicians with extensive neurology expertise.

As part of the development of our next strategic plan, Bendigo Health is currently undertaking extensive planning regarding our service delivery profile for the future to ensure we continue to play our role in the state-wide service delivery framework, she said.

St John of God Hospital Bendigo was contacted for comment.

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Bendigo neurology patients forced to drive hours for specialist care - Bendigo Advertiser

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We manage a wide variety of neurologic ailments, with the treatment plan tailored towards each patient's needs.

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Mendelsohn & Maltese Neurology Consultants

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Mendelsohn & Maltese Neurology Consultants

*Please be advised*The only way to contact your provider is through our phone systemsIn order to reduce wait times, we have instated voicemail boxes for each providerYou can find the extensions here(If you are experiencing a medical emergency seek immediate attention)

South Shore Neurologic Associates, PC is a comprehensive Neurologic care facility which is dedicated to alleviating the symptoms of neurological illness, neurological injury and chronic pain through excellence in patient care, advocacy, service, education and research. We have been providing neurologic care for people living in Suffolk County, Long Island since 1980. We have expanded our practice over the years to set standards in neurologic care on Long Island; through research and innovative treatments while providing comprehensive and personal patient care at our offices in Islip, Patchogue, and Riverhead as well as affiliated hospitals.

We are currently affiliated with Southside Hospital in Bayshore, Brookhaven Memorial Hospital Medical Center in Patchogue, and Peconic Bay Medical Center in Riverhead.

Our seventeen Neurologists are supported by a professional staff with specializations in Neuroradiology, Infusion Nursing, Clinical Research, Physical Therapy, Chiropractic, Pain Management, and Acupuncture.

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South Shore Neurologic Associates, PC

Evotec has reached a collaboration with Censo Biotechnologies, using the latters patient-derived induced pluripotent stem cells (iPSC) to expand its platform for drug discovery.

Scientists get iPSCs by reprograming human adult somatic cells to make them resemble embryonic stem cells, which can become any cell type of the body. For this alliance, Censo will use its donors sourcing and cell reprograming technologies to create a bespoke library of hundreds of patient-derived iPS cell lines, and Evotec will use them for target validation, drug screening, drug metabolism and pharmacokinetics analyses.

These stem cell-like cells created from people suffering from a disease allow researchers to replicate or mimic the disease ex vivo under lab conditions. This approach is particularly helpful for understanding of the mechanism of diseases such as Parkinsons and Alzheimers. The current contract between Evotec and Censo, with an initial two-year term, will first focus on central nervous system diseases, an area that both companies excel in.

RELATED:Axiogenesis in stem cell collab with ion channel expert Metrion

The Hamburg, Germany-based Evotec has been involved in neurological research for over two decades, having taken part in the discovery process of about a dozen preclinical candidates. The CROs expertise spans some key target classes such as enzymes, GPCRs and ion channels, and in therapeutic areas of neurodegenerative diseases, neuroinflammation, among others.

Censo is the product of a 2016 merger between Roslin Cellab and Roslin Cell Sciencestwo spinouts from the Roslin Institute both focused on using stem cells for drug discovery. Operating from its Edinburgh and Cambridge facilities in the U.K., Censo can generate iPSCs from large cohorts of samples for drug researches, and usually partner with other companies for assay development.

Continued here:
Evotec in neurology iPSC drug discovery collaboration with stem-cell specialist Censo - FierceBiotech

In the August/September 2017 issue ofNeurology Now, we feature letters in response to various stories in the June/July 2017 issue. Here, we include other letters we didn't have room to print. Our story on Peg Van Horn, an 87-year-old who has had spasmodic dysphonia for more than 20 years, was particularly resonant.

Many Voices

Thank you for publishing an article about Peg Van Horn in Pictures of You ("Talking Points," June/July 2017, bit.ly/NN-TalkingPoints).Ialso have spasmodic dysphonia and have been involved with the National Spasmodic Dysphonia Association (NSDA) community since 1989.Our community has thousands of members who live vibrantly like Peg Van Horn.We in the NSDA are always happy when word gets out about this rare neurologic voice disorder.We want everyone with spasmodic dysphonia to know that there is help and hope. You are not alone.

Mary Bifaro

Charlotte, NC

I enjoyed reading the latest issue of Neurology Now and especially the Pictures of You interview with Peg Van Horn. I was diagnosed with adductor spasmodic dysphonia more than 16 years ago and Peg's description of and experience with this rare voice condition is very much what I have experienced. Thank you for shining a light on this condition, and my sincere appreciation to Peg Van Horn for sharing her insights, frustrations, and delightful way of encouraging all living with this disorder. The NSDA is an invaluable organization and resource for patients and their families living with this rare voice disorder.

Charlie Reavis

President

National Spasmodic Dysphonia Association

Alpharetta, GA

I was delighted to read the article about Peg van Horn and her spasmodic dysphonia (SD) in the recent edition of Neurology Now. Thank you for such an excellent and informative article, and for helping spread awareness about SD both in the neurologic community and to the wider public.The article is well written, and shows the positive attitude Peg has after living with the disorder for more than 20 years. Your article ticks all the boxes in terms of reaching and educating the right audience.Thank you for writing about Peg Van Horn and putting a human face to our voice disorder. David Barton Past President NSDA

Auckland, NZ

Thoughts on Diet

I just finished reading the current issue and was particularly interested in comments about the Feingold diet ("Brain Food," June/July 2016, bit.ly/NN-BrainFood).Reading about the diet more than 40 years ago made a major difference in our family's life.

Our youngest son taught himself how to read before he was 4 years old. Sometimes he was a pleasant child, sometimes he was extremely fidgety, unable to sit still long enough to practice the piano. Or, if we were in the car, he would constantly poke and jab the person next to him.One night he was unable to sleep and chewed the drywall off the bottom ledge of the window in his bedroom, swung on a small closet door, tearing it off the hinges, and was in and out of his toy box.I had to sit in a rocking chair with him and rock him until he calmed down enough to sleep. There were times when he was totally uncooperative and would throw temper tantrums. Then I heard about Feingold's diet, and discovered through trial and error that he could not tolerate sugar, but honey was fine.He couldn't eat chocolate, but carob was okay.Anything with red or yellow food coloring affected him.He could eat a slice of tomato, but could not tolerate tomato sauce.I ended up changing our family's diet by editing all my recipes and buying groceries to accommodate his needs. When my son left home to attend university, I stopped monitoring his diet.I felt dietary choices were now his to make.I may not have followed the diet to the letter, but Feingold's book helped me start to help my son be the wonderful person he is. Marvel Riley Livingston, TX 77399

Fasting and prayer as treatment for pediatric epilepsy was described inMark 9:29, probably 2000 years ago. As for the Feingold Diet, if artificial foodcolorings don't cross the blood brain barrier, they are unlikely to change behavior.

C B Brill, MD

Philadelphia, PA

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Wednesday, July 5, 2017 - LWW Journals (blog)

Researchers have discovered a way of detecting the progression of dementia in people with Parkinsons disease by measuring iron deposits in their brains.

A team of researchers has discovered that it is possible to measure the progression of dementia in people with Parkinsons disease by tracking iron deposits in their brains.

Their findings appeared in the Journal of Neurology, Neurosurgery & Psychiatry.

Scanning for dementia progression in Parkinsons usually focuses on the loss of sections of the brain. However, brain imaging can typically only detect these changes late in the diseases progression.

As a consequence, doctors typically assess dementia progression by tracking symptoms.

The new research suggests that scanning techniques might be able to detect dementia far earlier and more accurately.

According to the National Institute on Aging (NIA), the characteristics of dementia include a loss of the ability to think, reason, or remember. Other signs include changes in a persons behavior that affect their everyday life.

Various diseases can cause dementia, and a person can sometimes have mixed dementias at the same time.

There is a strong association between Parkinsons disease and dementia. Up to 50% of people with Parkinsons are also affected by dementia.

People with Parkinsons may experience stiffness in their joints, shaking or tremors, and difficulty walking.

It develops when a persons brain cells die, although it is not yet clear why this happens. At its extreme, Parkinsons can damage large volumes of a persons brain. It is at this stage that scans can detect it.

It is the loss of this brain volume that often causes the symptoms of dementia.

According to the NIA, people with Parkinsons often have a buildup of protein in their brains, something also seen in people with Alzheimers disease.

The authors of the study in the Journal of Neurology, Neurosurgery & Psychiatry note that the presence of iron in a persons brain a natural part of the aging process has been linked to the increased presence of protein.

According to the lead author of the study Dr. Rimona Weil from University College London (UCL), Queen Square Institute of Neurology in the United Kingdom, Iron in the brain is of growing interest to people researching neurodegenerative diseases, such as Parkinsons and dementias.

As you get older, iron accumulates in the brain, but its also linked to the buildup of harmful brain proteins, so were starting to find evidence that it could be useful in monitoring disease progression, and potentially even in diagnostics.

Rather than measuring Parkinsons by scanning for the loss of brain volume, the researchers instead used a new technique called quantitative susceptibility mapping, which uses magnetic resonance imaging.

The team selected 97 people with Parkinsons disease who had received a diagnosis of the disease within the previous 10 years, as well as a control group of 37 age-equivalent people who did not have the disease.

The researchers tested both groups for their thinking and memory skills, and also for their motor functions that affect balance and movement.

The researchers then used the new scanning technique to measure the presence of iron in each persons brain. They compared the quantity of iron with their scores for thinking, memory, and motor function.

They found that people who had higher amounts of iron in their brains performed worse in their thinking, memory, and motor functions, depending on the location of the iron buildup.

For example, people with more iron in the hippocampus and thalamus regions of their brain, which affect thinking and memory, performed worse in these areas.

The findings are significant as they give researchers a new way of identifying the development of dementia far earlier and with more accuracy than current techniques.

This would be invaluable for researchers conducting clinical studies on the development of Parkinsons and dementia, but could also be potentially valuable for the early diagnosis of dementia.

According to the first author of the study George Thomas, Its really promising to see measures like this, which can potentially track the varying progression of Parkinsons disease, as it could help clinicians devise better treatment plans for people based on how their condition manifests.

The co-author of the study, Dr. Julio Acosta-Cabronero from Tenoke Ltd. and the Wellcome Centre for Human Neuroimaging, UCL, also comments on the findings:

We were surprised at how well the iron levels measured in different regions of the brain with MRI were correlated with cognitive and motor skills.

We hope that brain iron measurement could be useful for a wide range of conditions, such as to gauge dementia severity or to see which brain regions are affected by other movement, neuromuscular, and neuroinflammatory disorders, stroke, traumatic brain injury, and drug abuse.

Dr. Julio Acosta-Cabronero

The team plans to continue tracking the development of dementia in their study participants to gain further information on how the diseases development relates to iron levels in the brain.

Read more here:
Measuring iron in the brain can point to dementia - Medical News Today

The Duke Neurology Departments clinical, translational, and basic science wings came together last Thursday to discuss their work and collaborate at the Division of Translational Brain Sciences and Neurology Residents first joint poster session.

Research faculty, postdoctoral associates, clinical neurology residents, and other members of the Department presented more than 30 ongoing research projects from a variety of disciplines and perspectives.

Chief Resident Abhi Kapuria, MD, gave a short presentation on a pilot project using augmented reality to improve epilepsy surgery; Assistant Professor Simon Davis, PhD, discussed his ongoing research using transcranial magnetic stimulation to analyze how networks within the brain change over the lifespan.

Other projects examined repurposing a medication developed for HIV for use in dystonia, how mutations in the SNCA gene affect nuclear function in Parkinsons disease, and enhancing neural progenitor cell migration after stroke.

The poster session was the first step towards building a strong collaborative community among the research faculty in our new division of Translational Brain Sciences and the clinical side of the Department, said Ornit Chiba-Falek, PhD, Chief of the Departments new Division of Translational Brain Sciences. By working together, our basic and translational scientists, and our clinicians will bring greater success to our Department, with the whole much greater than the sum of its parts.

Chiba-Falek hopes to build on the success of this event by making the session an ongoing biannual event. The next session is scheduled for this October.

The full list of the posters at the session is as follows:

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Poster session unites Duke Neurology's clinical and basic research wings - Duke Department of Neurology

With New York State now having the most number of confirmed cases of coronavirus disease 2019 (COVID-19) on a global scale, physicians within the Department of Neurology at Columbia University Irving Medical Center and the New York Presbyterian Hospital published in Neurology a manuscript highlighting protocols implemented at their respective departments, and guidance for other institutions to consider, when preparing for the influx of patients with COVID-19.

The manuscript authors noted changes for routine meetings with key staff and leadership regarding inpatient and outpatient clinical care activities, human resource issues and public health guidelines helped to ease concerns. Mental health support, through the use of free private counseling services and hospital-wide tele-mental health support, was also a critical part of their efforts.

Training led by nursing leaders were provided for proper use of personal protective equipment (PPE), nasopharyngeal sampling technique, and protocols for screening patients for possible COVID-19 symptoms. A daily checklist was completed by nurses for all patients with possible symptoms and a daily nurse huddle occurs to share information on COVID-19 and to discuss possible and positive cases on the unit. A COVID-19 related binder was created to compile documents such as clinical guidelines, hospital protocols and policies.

Authors also noted that schedules were developed to scale down inpatient services to necessary staff including resident trainees. Further, all teams practiced social distancing and teaching occurred in workrooms, instead of at the bedside, to limit the number of team members entering patient rooms. The departments also cancelled all elective admissions for non-urgent purposes and closed their epilepsy monitoring units to patients and instead resorted to curbside consultations.

In-person visits to the resident clinic were converted to telemedicine visits. Any urgent admissions were screened for possible COVID-19 symptoms and rescreening for symptoms was conducted when a patient arrived from a different facility or was directly admitted to the inpatient unit. Patients who had tested positive for COVID-19 were centralized to designated hospitals and specialized teams for treatment.

The authors indicated that their respective neurocritical care units (NICUs) have been coordinating with the intensive care (ICU) to manage the significant number of patients with COVID-19 requiring transfer into the NICU. Faculty within the NICU provided routine education and preparation to staff and trainees regarding acute respiratory distress syndrome (ARDS) management, guidelines for non-invasive positive pressure ventilation, and high flow nasal cannula oxygen for suspected or confirmed patients with COVID-19.

Ambulatory staff members were also trained to screen patients, and those accompanying patients, for symptoms indicative of COVID-19 during tele-neurology visits. Moreover, to further support efforts to practice remotely, laptops and technical support was provided by departments for outpatient practitioners. Lastly, all medical student clerkships were suspended and all non-critical clinical and basic research was slowed. Departments set up a 96-hour ramp down policy to complete ongoing critical experiments, stopped noncritical experiments and all new experiments, and a virtual curriculum was created for medical students on rotation.

The importance of coordinated, multi-disciplinary efforts to prepare neurology departments for the COVID-19 outbreak is essential, manuscript authors noted. They add that We have worked cohesively within the department, the hospital, and university to implement strategies to minimize the risk of COVID-19 transmission and perform the best of care for our patients. The authors emphasized that this pandemic should be taken seriously and that despite challenges ahead, further necessary adjustments will continue to be of importance for neurology departments everywhere.

Reference

Waldman G, Mayeux R, Claassen J, et al. Preparing a neurology department for SARS-CoV-2 (COVID-19): Early experiences at Columbia University Irving Medical Center and the New York Presbyterian Hospital in New York City [published online April 6, 2020]. Neurology. doi:10.1212/WNL.0000000000009519

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Adapting to COVID-19: Protocols Implemented by Neurology Departments in New York Hospitals - Neurology Advisor

WASHINGTON Veterans hoping a new report from the National Academies of Sciences, Engineering and Medicine would vindicate their claims of serious long-term side effects caused by antimalarial drugs were disappointed Tuesday when it failed to draw any concrete links instead only finding that further research was warranted.

The report was the result of a more than year-long process undertaken by the National Academies of Sciences, Engineering and Medicine (NASEM) and sponsored by the Department of Veterans Affairs. The goal was to look into possible long-term neurological and psychiatric effects of antimalarial drugs particularly of mefloquine (brand name Lariam), which has been linked to insomnia, depression, anxiety, severe nightmares and suicidal and homicidal ideation.

FULL REPORT | Assessment of Long-Term Health Effects of Antimalarial Drugs When Used for Prophylaxis

WUSA9 has reported for years on the stories of U.S. servicemen and women, and members of the Peace Corps, who were prescribed mefloquine while deployed in Iraq and Afghanistan and subsequently reported long-term, sometimes permanent, neurological and psychological damage as a result.

RELATED: Army SSGT who pleaded guilty to murdering 16 in Afghanistan wants new civilian trial, says 'mefloquine psychosis' was ignored

RELATED: Navy SEAL sues Roche, claims anti-malaria drug caused permanent paranoia, nightmares

RELATED: After the Peace Corps: a volunteer's harrowing story after using an anti-malaria drug

The FDA ordered mefloquine labeled with a black box warning in 2013, noting that neurological side effects can occur at any time during use, and can last for months to years after the drug is stopped. The military reclassified mefloquine as a drug-of-last-resort following the FDAs black box decision, and its former U.S. manufacturer, Roche, no longer produces it in the United States.

Veterans and advocacy organizations have pushed for the Department of Veterans Affairs to recognize the service-related disabilities they say antimalarials like mefloquine have caused.

But the committee, which was made up of professionals from the fields of epidemiology, psychiatry, neuroscience and other health disciplines, did not come to that conclusion instead finding that the 21 existing studies looking at long-term adverse effects of antimalarial drugs were, taken together, inconclusive.

The committee recognized that adverse events while taking some antimalarial drugs are quite common, but the pressing, well-justified question of whether health problems continue after use has simply not generated the rigorous research needed to answer it, said committee chair Dr. David Savitz, professor of epidemiology at the Brown University School of Public Health in a statement Tuesday. The absence of evidence on long-term health effects of these drugs does not mean the link doesnt exist, only that there is a critical need for well-designed studies to answer important safety questions.

The committee did find there was empirical basis for additional research into possible long-term adverse events caused by four common antimalarials:

The only case where the committee felt there was sufficient evidence to come to a positive conclusion was the link between tafenoquine and vortex keratopathy a harmless condition involving microscopic sediment buildup in the cornea.

Dr. Remington Nevin, a former Army epidemiologist and physician who testified before the committee last January, said the report appeared to have been hamstrung by the Department of Veterans Affairs decision to restrict the committee from conducting its own review of veterans medical records.

"Veterans disabled by the militarys reckless misuse of mefloquine should be deeply disappointed that the VA tied the hands of committee members by preventing them from reviewing their medical records, Nevin said. Expert drug regulators in the U.S., Canada, and the European Union have already concluded on the basis of a careful review of such records that mefloquine does cause permanent neuropsychiatric disability. The committee's rushed and error-filled report represents a tragic missed opportunity to begin to recognize the human suffering caused by this drug. Veterans deserve better.

A spokeswoman for the National Academies said reviewing individual cases was beyond the statement of task the VA set for the committee. She also noted that the committee didn't dispute the body of evidence regarding side effects while actively taking antimalarials:

"There is robust evidence about concurrentside effects of mefloquine. However, not enough studies were designed to specifically determine whether the drugs cause long-termside effects that occur while the drug was in use and persist after cessation; or occur months or years after the drug was stopped. Veterans certainly deserve answers, and even though conducting high-quality research to answer this question is challenging, that should not prevent it from being done."

Committee Chair Dr. David Savitz also released an expanded statement to WUSA9:

Although several other individuals and research groups have reviewed subsets of the literature on mefloquine and its association with adverse health outcomes, they used different frameworks, inclusion criteria, or methods to judge association or causality, and therefore their conclusions may differ from those of this committee. This committee was charged with examining persistent or latent adverse events specifically, not adverse events that occur during use of a drug or immediately after its use has ended. The published literature is very limited in both the number and the quality of studies that examined adverse events 28 days or longer after the use of an antimalarial drug (e.g., mefloquine) ended. Studying the persistent or latent effects of exposures is challenging and there is not one definitive study that can be done to put the issue to rest. But it is possible to design and conduct studies that would contribute to the evidence base on whether there are persistent or latent health outcomes associated with use of an antimalarial drug. Such studies should include explicit documentation of the antimalarial dosage used; timing of both antimalarial drug use and symptom or event occurrence; sufficient sample sizes; extended follow-up of users that includes assessments at multiple time points; and validated documentation of potential confounders and health outcomes, including a careful collection of neurologic and psychiatric outcomes using validated instruments.

RELATED: How a drug prescribed by the Peace Corps shattered a family

RELATED: The Peace Corps and anti-malaria drugs: What you need to know

RELATED: Retired Army General calls on VA leaders to take responsibility for anti-malaria drug side effects

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Jordan Fischer is an investigative reporter with WUSA9. Follow him on Twitter at @JordanOnRecord.

See the article here:
VA-sponsored study says research on long-term dangers of antimalarials is inconclusive - WUSA9.com