A retired neurologist has admitted in court to sexually assaulting 28 female patients over three decades.

Keith Hoyte, 71, pleaded guilty to 28 counts as his trial was to begin Monday in Calgary. Two counts were stayed because they were melded into charges involving the same victims.

Crown prosecutor Rosalind Greenwood read aloud an agreed statement of facts describing how victims between 17 and 46 felt confused, embarrassed, numb and angry during appointments with Dr. Hoyte.

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The common thread running through the evidence is that Dr. Hoyte was seeking, in each instance, to obtain sexual gratification from his patients, the statement said.

The charges relate to assaults between 1983 or 1984 to 2013.

In the statement, women described being told to undress from the waist up, even though they were there seeking treatment for brain ailments, such as migraines and seizures.

They described Dr. Hoyte fondling their breasts and pricking them with pins, while the doctor made little eye contact or conversation. In some cases, he pushed down gowns without his patients consent.

Court heard that most of the time he did not explain what he was doing or why. In others, he said it was to test reflexes or sensation.

One woman described how Dr. Hoyte instructed her to walk back and forth with her eyes closed, arms outstretched and her gown wide open. She opened her eyes to see him crouching down and looking under the gown. He then grabbed her breast and pushed his body against her, the agreed statement of facts said.

As she left the appointment, she said to herself, What the heck just happened?'" the document said.

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She tried to rationalize what happened. She also thought about reporting the incident, but thought to herself, Whos going to believe me? It would be my word against his.'"

That woman, trusting a family doctor who made the referral, went to see Dr. Hoyte for another appointment six years later, during which he tugged down her gown so hard she could hear the stitching rip, she recalled.

One victim went to police in 1991, one in 2008 and another in 2018. Police charged Dr. Hoyte with three counts of sexual assault in June 2018. After media reports, 25 more women came forward.

Complainants gave varied reasons for not reporting Dr. Hoyte sooner. Many thought they wouldnt be believed. One didnt want to be thought of as a difficult patient when it was so hard to get a referral. Another one had debilitating headaches and she didnt want to risk not getting some answers.

Another young woman recounted staring at her pointy fuchsia shoes during the appointment thinking: Let this end.

The 19-year-old recalled how, when she tried to push his hands away from her breasts, the doctor became angry.

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The look on his face told it all, she said, according to the agreed statement of facts. She recalled saying she was done and leaving the office in tears.

Submitted with the agreed statement of facts was a report from another doctor who said there is no legitimate clinical explanation for what Dr. Hoyte did during the examinations.

The case is next in court Jan. 17 to set a date for sentencing. Defence lawyer Alain Hepner has requested a psychological risk assessment.

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Retired Calgary neurologist pleads guilty to dozens of sexual assaults dating back to 1980s - The Globe and Mail

CHESHIRE Feb 5, 2020 (Thomson StreetEvents) -- Edited Transcript of Alexion Pharmaceuticals Inc earnings conference call or presentation Thursday, January 30, 2020 at 12:30:00pm GMT

Alexion Pharmaceuticals, Inc. - Executive VP & CFO

* Brian M. Goff

Alexion Pharmaceuticals, Inc. - Executive VP & Chief Commercial and Global Operations Officer

* John J. Orloff

Alexion Pharmaceuticals, Inc. - Executive VP and Head of Research & Development

* Ludwig N. Hantson

Alexion Pharmaceuticals, Inc. - CEO & Director

SVB Leerink LLC, Research Division - Director of Therapeutics Research, MD & Senior Biotechnology Analyst

Evercore ISI Institutional Equities, Research Division - Senior MD & Equity Analyst

* Kennen B. MacKay

RBC Capital Markets, Research Division - MD & Co-Head of US Biotechnology Research

Ladies and gentlemen, thank you for standing by. And welcome to the Alexion Pharmaceuticals Fourth Quarter and Full Year 2019 Results Conference Call. (Operator Instructions) Please be advised that today's conference may be recorded.

I would now like to hand the conference over to Morgan Sanford, Director, Investor Relations. Please go ahead, ma'am.

Thank you, operator. Good morning. Thank you for joining us on today's call to discuss Alexion's performance for the fourth quarter and full year 2019.

Today's call will be led by Ludwig Hantson, our CEO. Ludwig will be joined by Aradhana Sarin, our Chief Financial Officer; John Orloff, our Global Head of R&D; and Brian Goff, our Chief Commercial and Global Operations Officer.

You can access the webcast slides that will be presented on this call by going to the Events section of our Investor Relations page on our website.

Before we begin, I would like to point out that we will be making forward-looking statements, and these statements involve certain risks and uncertainties that could cause our actual results to differ materially. Please take a look at the risk factors discussed in our SEC filings for additional detail.

These forward-looking statements apply only as of today, and we undertake no duty to update any of the statements after the call, except as required by law.

I'd also like to remind you that we will be using non-GAAP financial measures, which we believe provide useful information for the understanding of our ongoing business performance. Reconciliations of our financial results and financial guidance are included in our press release. These non-GAAP financial measures should be considered, in addition to but not as a substitute for our GAAP results.

Thank you. Ludwig?

Ludwig N. Hantson, Alexion Pharmaceuticals, Inc. - CEO & Director [3]

Thank you, Morgan, and good morning, everyone. Before we review our fourth quarter and 2019 full year performance, I would like to take a brief moment to announce that we have successfully closed on our acquisition of Achillion Pharmaceuticals, which represents an important step in diversifying our business. Through this acquisition, we add 2 clinical stage assets to our portfolio with danicopan and 5228. We are thrilled to welcome our Achillion colleagues to Alexion and excited about the opportunity to collaborate on the development of these Factor D assets for a broad range of rare diseases.

Turning now to our 2019 performance. We delivered on all of our key objectives, and in many cases, have surpassed our goals. ULTOMIRIS is now the market leader in PNH in our 3 largest markets: the U.S., Germany and Japan. The ULTOMIRIS' aHUS conversion is progressing well in the U.S. and we anticipate launching in the EU and Japan this year. We are also very pleased with the uptake of our neurology franchise, with continued growth of SOLIRIS and gMG and the launch in NMOSD. In just over 2 years, neurology has become our largest franchise in the U.S. by patient volumes. Our ambition is to quadruple the number of MG and NMOSD patients treated by SOLIRIS and eventually ULTOMIRIS in the U.S. by 2025.

Our metabolics portfolio continues to deliver strong growth as we work to expand access for HPP, LAL-D patients. Importantly, we have made great progress on our pipeline, and have an ambition for 10 launches from now until the end of 2023 through a combination of new assets, new formulations and new indications, and once again, have delivered on our financials with 21% revenue growth and 33% non-GAAP earnings growth in 2019.

Turning to Slide 6. We have a clear strategy for long-term value creation. First, we will move past SOLIRIS and establish ULTOMIRIS as market leader in PNH and aHUS in our 3 key geographies. Secondly, we will expand our C5 franchise beyond PNH and aHUS into larger rare diseases. We have ULTOMIRIS programs planned in 6 new indications, including 4 neurology and 2 nephrology indications. In parallel, we will continue to innovate with patients with new formulations and subcu treatment options.

Finally, we will diversify our portfolio beyond C5. Achillion is the most recent example of this effort. With Factor D, we have the opportunity to pursue development in a broad range of indications. Outside of this transaction, we have built a robust rare disease pipeline over the past few years and have clear line of sight to multiple potential blockbuster launches, including treatments for Wilson disease and AL amyloidosis. We have significant financial capacity to continue to diversify our pipeline in the future.

In addition to bringing in external assets to diversify our business, we are evolving our leadership in complement to expand our addressable patient population.

On Slide 7, you can see our business is rapidly moving beyond SOLIRIS. ULTOMIRIS is approved for 2 indications.

(technical difficulty)

This is Ludwig Hantson again. We had a technical issue. I hope that you guys can hear us okay. So what I will do is instead of restarting, we're going to start on Slide 6, and then we'll take it from there.

So turning to Slide 6. We have a clear strategy for long-term value creation. First, we will move past SOLIRIS and establish ULTOMIRIS as market leader in PNH and aHUS in our 3 key geographies. Secondly, we'll expand our C5 franchise beyond PNH and aHUS into larger rare diseases. We have ULTOMIRIS programs planned in 6 new indications, including 4 neurology and 2 nephrology indications. In parallel, we will continue to innovate for patients with new formulations and subcu treatment options.

Finally, we will diversify our portfolio beyond C5. Achillion is the most recent example of this effort. With Factor D, we have the opportunity to pursue development in a broad range of indications. Outside of this transaction, we have built a robust rare disease pipeline over the past few years and have clear line of sight to multiple potential blockbuster launches, including treatments for Wilson disease, and AL amyloidosis. We have significant financial capacity to continue to diversify our pipeline in the future.

In addition to bringing in external assets to diversify our business, we are evolving our leadership in complement to expand our addressable patient population.

On Slide 7, you can see our business is rapidly moving beyond SOLIRIS. ULTOMIRIS is approved for 2 indications and in development for 6 additional indications across neurology and nephrology. This year, we will transition to a high concentration formulation, which will shorten infusions to only 45 minutes. Next year, we plan to launch our once-weekly, on-body, subcu ULTOMIRIS formulation, offering patients a home-based self-administration option.

Our next-generation subcu assets, 1810 and 1720, offer improved patient dosing regimens. And we have significant optionality for indication selection with each of these assets. From there, we will expand with Achillion's Factor D platform. We see immense opportunity for all proximal complement treatments to transform standard of care in many complement-mediated diseases.

On Slide 8, you see that once again, we have delivered strong top and bottom line growth for the fourth quarter and the full year, which provides a solid foundation to continue to deliver on our value creation strategy. Again, I'm very pleased with our strong execution against our 2019 priorities and excited for 2020 as we build on our successes.

With that, I will now turn the call over to Rana.

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Aradhana Sarin, Alexion Pharmaceuticals, Inc. - Executive VP & CFO [4]

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Thank you, Ludwig. Starting with Slide 10, we reported fourth quarter total revenues of approximately $1.4 billion, an increase of 23% year-over-year. This was driven by strength in our neurology franchise, continued growth in the core businesses and ULTOMIRIS launch. Our non-GAAP operating margin was 51%, a reduction of 155 basis points versus prior year, driven by increased R&D spend as we advanced and further build our development portfolio. Non-GAAP EPS was $2.71, representing 27% growth year-over-year, driven primarily by strong top line growth and lower effective tax rate.

Moving to Slide 11. Fourth quarter total net product sales were primarily driven by patient volume growth in our key markets.

Turning to Slide 12. SOLIRIS revenues in the fourth quarter were approximately $1 billion, with year-over-year growth of 4%. SOLIRIS revenue growth was driven primarily by gMG revenues, partially offset by ULTOMIRIS' conversion dynamics. ULTOMIRIS revenues in the fourth quarter were $170 million, which now includes contributions from atypical HUS in the United States.

Metabolics revenues in the fourth quarter were $201 million, representing 32% year-over-year growth.

Turning to the P&L, on Slide 13. During the quarter, non-GAAP R&D expense was $227 million or 16% of revenues. Non-GAAP SG&A expense was $340 million or 25% of revenues. The non-GAAP effective tax rate in the quarter was approximately 12% and continued to benefit from certain onetime events, including the release of state income tax reserves related to the conclusion of an audit.

We reported fourth quarter non-GAAP EPS of $2.71, growing 27% year-over-year. GAAP earnings per share were $4. We ended the fourth quarter with approximately $2.7 billion in cash and marketable securities. This is not adjusted for the Achillion transaction.

I'll now turn to Slide 14 for our 2020 financial guidance. We are guiding to total revenues between $5.5 billion and $5.56 billion. This represents 11% growth year-over-year at the midpoint of the range. For SOLIRIS and ULTOMIRIS, our revenue guidance is $4.755 billion to $4.800 billion. This assumes continued momentum for SOLIRIS in gMG, our ongoing launch of SOLIRIS in NMOSD and the launches of ULTOMIRIS for PNH and atypical HUS.

Turning to metabolics. Our revenue guidance is $745 million to $760 million for both STRENSIQ and KANUMA. This includes the impact of the strategic pricing decision for STRENSIQ in the U.S. to support sustainability and access given weight-based dosing.

In 2020 and beyond, it is important to consider the dynamics associated with conversion from SOLIRIS to ULTOMIRIS, as it relates to the annual cost per patient. There's a revenue benefit when each patient starts ULTOMIRIS' PNH treatment due to the increased number of vials consumed during the loading dose. We benefited from this loading dose dynamic having converted 60-plus percent of patients in PNH to ULTOMIRIS over the course of 2019. We now expect to be impacted by lower annual treatment cost per patient, as the majority of patients move to maintenance dosing.

In atypical HUS and other indications in development, we will see a lower annual cost per patient compared to SOLIRIS for both loading dose and maintenance dosing. It is also important to consider quarter-over-quarter variability due to every 8-week dosing for ULTOMIRIS. However, this quarterly fluctuation will even out on an annual basis.

We have included a slide in the Appendix of this presentation to provide a summary of this dynamic and to serve as a reference going forward.

Non-GAAP operating margin is expected to be between 53.5% and 54.5% of revenues. Non-GAAP R&D expense is expected to be between 17.5% and 18.5% of revenues and represents a step-up of approximately $270 million versus prior year, consistent with our intention to further build out and progress the pipeline.

Clinical program spend, particularly for late-stage development, is planned to increase in 2020. R&D expense also includes program costs and potential milestones for previously-announced BD transactions and collaborations.

Non-GAAP SG&A spend is expected to be between 19.5% and 20.5% of revenues for the full year 2020 and reflects increased leverage from top line growth. We expect the non-GAAP effective tax rate to be between 16% and 17%.

In 2019, the non-GAAP effective tax rate benefited from certain onetime items. Absent these onetime benefits, our 2019 non-GAAP tax rate would have been approximately 15%. We expect our non-GAAP effective tax rate to increase in the future as a result of tax regulation changes outside the U.S.

GAAP EPS is expected to be between $7.91 and $8.71. Non-GAAP EPS is expected to be between $10.65 and $10.85. The midpoint of the non-GAAP EPS is approximately 2% growth year-over-year as a result of increased R&D spend and an increased tax rate compared to prior year. This guidance reflects the financial impact of our recently closed Achillion acquisition, but does not reflect any future M&A that we may pursue.

As you can see on Slide 15, we have established a track record of strong financial execution. Since 2017, we have delivered double-digit total revenue and non-GAAP EPS growth, while maintaining a competitive non-GAAP operating margin. We continue to invest in our R&D programs and have increased our non-GAAP R&D spend as a percentage of revenues to within 16% to 19%, in line with our biotech peers. With the current momentum of the business, we are well positioned to deliver on our 2020 financial goals.

I'll now turn the call over to John to provide an update on R&D.

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John J. Orloff, Alexion Pharmaceuticals, Inc. - Executive VP and Head of Research & Development [5]

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Thank you, Aradhana. On Slide 17, you can see our current development portfolio. We now have 19 planned clinical stage development programs for 2020. In the coming weeks and months, we expect to report interim data from our Phase III once-weekly, on-body, subcutaneous ULTOMIRIS program; an update on our anti-FcRn studies; and interim data from the Phase II study of danicopan and C3G. We're excited about the acquisition of Achillion and look forward to providing additional detail in the coming months as we embark on the integration.

Just a few weeks ago, we reiterated our ambition to execute 10 launches by 2023 from our current portfolio. On Slide 18, you can see our R&D highlights, which summarized these programs, including stage in clinical development and the estimated addressable population. We are expanding our C5 presence well beyond the PNH and atypical HUS business and are advancing ULTOMIRIS into 5 additional indications across neurology and nephrology. Together, the ULTOMIRIS programs present an opportunity to expand our treated patient population by tens of thousands of patients. We believe in the compelling value proposition of ULTOMIRIS, which has been received well by patients, physicians and other key stakeholders, and are continuing to innovate with a high-dose concentration, reducing infusion time to 45 minutes and a once-weekly, on-body ULTOMIRIS subcutaneous formulation.

In addition to ULTOMIRIS indication expansion programs, we see opportunity to diversify our business beyond C5, with 4 additional late-stage novel assets. Our Phase III Superiority Trial for ALXN1840 in Wilson's disease remains ongoing. 1840 is an oral, once-daily therapy, with 10,000-fold higher affinity for copper than current standard of care chelators, which have core compliance rates due to burdensome dosing regimens. We're on the verge of completing enrollment and expect a top line readout in the first half of next year.

We plan to initiate a Phase II/III program for CAEL-101 in AL amyloidosis in the coming months. We see potential for this late-stage asset to transform the treatment of AL amyloidosis, a disease characterized by misfolded kappa and lambda light chains, resulting in abnormal deposits of amyloid, which can lead to organ failure. Patients are currently treated with chemotherapeutic agents not approved for amyloidosis, and median survival rates are only 18 months post-diagnosis.

Clinical data supporting our rationale for the collaboration showed a 63% overall organ response rate in addition to efficacy on cardiac and renal endpoints. Our Phase II/III program will look at an overall survival primary endpoint with patient function, quality of life and cardiac imaging serving as secondary endpoints.

Last year, we announced a license agreement with Eidos, to develop and commercialize AG10 for ATTR cardiomyopathy in Japan. AG10 is a small molecule designed to address destabilized and misfolded transthyretin protein, which is the root cause of ATTR. We believe AG10 has potential to stabilize TTR and halt disease progression. Pending regulatory discussions, we plan to extend the AG10 development program into Japan later this year.

Finally, we are excited about our acquisition of Achillion and its Factor D platform. Achillion reported positive Phase II data for danicopan in PNH patients with extravascular hemolysis at a medical conference last year. We see opportunity for danicopan in a small subset of PNH patients with extravascular hemolysis. We see additional opportunity for danicopan and C3G, and expect interim Phase II data in the coming weeks, and we see great potential for ACH-5228, as twice daily, best-in-class Factor D oral treatment in PNH and a broad range of rare diseases.

We are excited about the opportunity for these 10 potential launches to significantly expand the number of treated patients and look forward to providing you with updates as we progress through the year.

Moving to Slide 19. We have plans to further expand and diversify our C5 leadership with our next-generation assets. Starting on the left, our weekly subcutaneous formulation of ULTOMIRIS for use in PNH and atypical HUS is in an ongoing Phase III PK-based trial. Leveraging the West Gen on-body device, we believe this will provide patients with the flexibility to choose how they wish to manage their disease within their lifestyle. We are expecting interim PK data in the second quarter of this year with a potential launch in 2021.

Next, we have the opportunity to evolve our terminal complement subcutaneous treatment options with ALXN1720 and 1810. 1720 is our internally-designed bi-specific C5 inhibitor. At only 25 kilodaltons, 1720 is a unique mini-body tailor-made for convenient subcutaneous administration. We see opportunity for this asset in a number of larger rare disease indications, and we look to initiate a proof-of-concept study in the first half of next year.

Finally, 1810 is our co-formulation of ULTOMIRIS in Halozyme's PH20 hyaluronidase, which allows for biweekly subcutaneous dosing. We've recently disclosed our plans to start a Phase II renal basket trial with 1810 and look forward to providing additional updates as this program progresses.

Together, these 3 assets represent an opportunity for Alexion to expand our offerings for patients living with complement-mediated rare disease. Our development portfolio has grown significantly in the last 2.5 years, and I'm incredibly proud of all the hard work undertaken by the entire R&D organization.

With that, I'll turn the call over to Brian to provide commercial highlights for the quarter. Brian?

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Brian M. Goff, Alexion Pharmaceuticals, Inc. - Executive VP & Chief Commercial and Global Operations Officer [6]

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Thank you, John. Turning first to Slide 22. We've seen unprecedented progress in establishing ULTOMIRIS as the market leader in PNH. This is due in large part to the compelling value proposition, which includes strong data from the largest and most inclusive PNH clinical program ever conducted. The broad inclusion criteria in the 2 Phase III trials ensure their study patient population would be representative of the real-world PNH population.

Specifically, we enrolled transfusion-independent and transfusion-dependent patients, with no baseline hemoglobin or absolute reticulocyte count requirements. We also included patients with prior history of bone marrow failure, which is critical because roughly 40% to 50% of PNH patients have a history of bone marrow failure or aplastic anemia.

As of Monday of this week, we've converted 60% of PNH patients to ULTOMIRIS in the U.S., 62% in Germany and 53% in Japan, making ULTOMIRIS the PNH market leader in our 3 largest volume countries.

Our latest launch of ULTOMIRIS in atypical HUS in the U.S. is also off to a strong start. While it's still early days, conversion is tracking in line with the PNH conversion curve at the same time point since launch.

Our neurology business is now our largest franchise by patient volume, and this was achieved in just 2 years since launch. On Slide 23, you can see we exited the fourth quarter with 1,885 patients on treatment with SOLIRIS for gMG and NMOSD in the U.S. We've made significant progress advancing our presence in gMG and with our NMOSD launch. gMG patients continue to have broad access to SOLIRIS. Our strong NMOSD launch is underpinned by our remarkable Phase III data, showing 98% of patients relapse-free at 48 weeks, with sustained efficacy out to 3 years. We're making progress educating payers on the severity of NMOSD attacks, the objective of preventing all relapses and the difference between NMOSD and MS. As a result of these efforts, payer adoption of coverage policies for NMOSD has been rapid, and we're seeing strong adherence to SOLIRIS therapy in both gMG and NMOSD.

Looking ahead, we're well positioned to deliver on our ambition of quadrupling our U.S. gMG and NMOSD-treated patient population within the next 5 years, with potential for ULTOMIRIS to launch in late 2022 or early 2023 as an every 8-week infusion. Our once-weekly, on-body subcutaneous formulation plan to launch simultaneously with the IV formulation will provide another important treatment option for patients who prefer self or home-based administration.

Our target gMG population represents more severe, uncontrolled patients, and we believe this is a unique space where SOLIRIS, and then ULTOMIRIS, can serve as a highly effective treatment option. In NMOSD, our target patient population mirrors inclusion criteria in our Phase III SOLIRIS PREVENT trial. With our dedicated neurology team, we believe our commercial organization is well positioned to deliver on our 2025 ambitions.

I'd like to take a brief moment to thank both our global commercial and global operations organizations for their hard work and dedication, which has enabled us to excel with multiple launches and continue to bring hope to the rare disease patients we serve.

I'll now turn the call back to Ludwig for closing comments. Ludwig?

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Ludwig N. Hantson, Alexion Pharmaceuticals, Inc. - CEO & Director [7]

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Thank you, Brian. Once again, I'm very proud of what the team delivered in 2019. We're well positioned to further build on our momentum in 2020, and there is much to look forward to this year. We have laid out a clear strategy to deliver long-term shareholder value by establishing ULTOMIRIS as market leader in PNH and aHUS, expanding our presence in C5, including planned programs in neurology and nephrology and continue to look for opportunities to diversify our business beyond C5.

Importantly, we maintain our unwavering focus on patients and our commitment to advance our mission to deliver life-changing therapies to people living with rare diseases.

With that, we will now open the call to questions. Operator?

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Questions and Answers

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Operator [1]

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(Operator Instructions) Our first question comes from Cory Kasimov of JPMorgan.

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Edited Transcript of ALXN earnings conference call or presentation 30-Jan-20 12:30pm GMT - Yahoo Finance

Illinois-based AbbVie and La Jolla, California-based The Scripps Research Institute entered into a broad research collaboration in oncology, immunology, neurology and fibrosis.

Based on our strong switchable CAR-T alliance launched in 2018, we feel the expanded relationship with AbbVie represents a robust path forward for some of our programs, complementing a diverse ecosystem of innovation weve created over the past several years at Scripps to advance life-changing therapies, said Peter Schultz, chief executive officer of Scripps Research and Calibr, its drug discovery division.

Under the terms of the 2018 agreement, AbbVie paid Calibr an upfront license fee and picked up exclusive access to Calibrs switchable CAR-T platform for up to four years. The plan was to develop T-cell therapies against solid tumor targets chosen by AbbVie. AbbVie had the option to develop more cell therapies toward its targets and license existing Calibr cell therapy programs in hematological and solid cancers, including Calibrs lead programs.

In the new collaboration, in addition to the initial programs, Scripps will offer AbbVie a certain number of preclinical programs each year to be included in the partnership. They will work together in parallel to advance CD3 bispecifics against cancer targets picked by AbbVie

Under the terms of the deal, Scripps will run preclinical R&D, and in some cases, Phase I clinical trials. AbbVie will have an exclusive option to continue development and possible commercialization activities.

Once AbbVie chooses to exercise its option on any given program, it will pay Scripps additional payments that include option exercise fees, success-based development and commercial milestone payments, and tiered royalties. At hitting a milestone, AbbVie will make an undisclosed upfront payment as well as near-term milestone payments.

The best way to develop transformational medicines is through collaborations that bring together the brightest minds, said Mohit Trikha, vice president and head of oncology early development at AbbVie. This partnership with Scripps Research will collaboratively advance next generation programs, build stronger relationships with proven and emerging scientific leaders, and most importantly help us advance novel medicines for patients.

Trikha added, We are eager to partner with Scripps on these assets as they enter the clinic over the next few years as Scripps has one of the strongest track records of any academic institution when it comes to advancing novel medicines for patients.

Although neither organization released financial terms, they did say the partnership requires antitrust review. Under the law, reports The San Diego Union-Tribune, antitrust review has to be conducted for deals exceeding $84.4 million.

The Tribune notes, A deal of that size will bolster the La Jolla biomedical science institutes troubled finances for several years, and perhaps much longer. And if approved cancer therapies result, the payout could be gigantic.

The early work will be on an immuno-oncology treatment for lymphoma, which Calibr plans to launch in the clinic in 2020.

What were developing is a fully controllable, universal switchable CAR-T cell platform that allows a physician fine control over the activation and specificity of the CAR-T cells, Travis Young, director of protein sciences at Calibr told The Tribune.

At the moment, there are two CAR-T products approved, Novartis Kymriah and Gilead Sciences Yescarta. Both are quite effective in certain patient populations, but the process is expensive and time-consuming, requiring immune cells be collected from the patient, engineered to focus on the patients specific cancer, then be infused back into the patient. A number of companies are working on off-the-shelf CAR-T, that would not require the specific engineering catered to each patient.

CAR-T and other immunotherapy approaches also have high risks of immune reactions, although Novartis and Gilead have both developed protocols for minimizing or dealing with them. Scripps argues that their type of CAR-T improves over these, particularly in terms of safety, convenience and versatility.

These antibody-based switches bridge the CAR-T cells to the target cell. And so, by forming that bridge, they develop an immunological synapse, which redirects the CARs very specifically towards the target cells, said Young.

They also claim they can control the intensity of the response by varying the number of antibodies infused, would should minimize the adverse immune reactions.

The Tribune notes that in recent years Scripps has reported annual deficits that have hit as high as $20 million. The company currently has a drug in early clinical trials for osteoarthritis and is prepping another for prostate cancer, which it is hoping to partner with a company for commercialization.

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AbbVie and Scripps Research Enter Research Partnership in Cancer, Immunology, Neurology and Fibrosis - BioSpace

SANTA CLARA, Calif., Jan. 9, 2020 /PRNewswire/ --Based on its recent analysis of the North American essential tremor (ET) treatment market, Frost & Sullivan recognizesCala Health, Inc.with the 2019 North American Technology Innovation Award for its Cala Trio, a prescription-only, wrist-worn device. This non-invasive, patient-friendly therapy causes minimal side-effects and is more cost-effective than current ET treatment methods. The on-demand electrical stimulation is based on the individual tremor patterns, and takes personalized therapy to the next level. ET is the most prevalent tremor disorder and one of the most common neurological disorders, affecting an estimated seven million people in the United States.

"Cala Health has emerged a pioneer in treating ET for the upper limbs through peripheral nerve stimulation. The Cala Trio delivers precise electrical pulses to the median and radial nerves in the wrist, which in turn target the central tremor network to address the underlying cause of ET. The therapy is a more convenient method of managing the condition without systemic side effects," said Neeraj Jadhav Industry Analyst. "Compared to surgical procedures, Cala Trio is cost effective, causes no patient downtime, and allows patients to control the pulses' intensity based on their comfort level."

According to the PROSPECT study presented in September 2019, physicians, patients, and objective motion sensors reported statistically significant improvement in tremor after three months of daily use. About 62 percent of the patients experienced reduced tremor severity according to physician-rated scales, while patient-rated scales indicated 68 percent of patients. Importantly, an endpoint analysis of motion sensor data demonstrated that 54 percent of patients experienced more than a 50 percent decrease in tremor power during the study period.

Cala Health supports patients, when needed, with therapy initiation and during the course of the therapy with data flowing directly from the connected devices. Due to its best-in-class engineering, it can capture the frequency of hand tremors during tasks that are assigned to patients at the onset. The accelerometers in the device measure the patients' motion, which is used by the onboard software to characterize the tremors, and provide stimulation patterns that are calibrated to the users' tremor frequency.

"In addition to ET, Cala Health's therapy is exploring applications in neurology, psychiatry, and cardiology," noted Jadhav. "Cala Health is also actively licensing technologies from academic medical centers to incorporate them in its neuromodulation platform. For instance, it licensed Partners Healthcare's and Massachusetts General Hospital's neuromodulation technology, which is based on the research on respiratory-gated vagal afferent nerve stimulation and transcutaneous vagus nerve stimulation. This commitment to innovation is expected to keep Cala ahead of the technology curve and ensure long-term success."

Each year, Frost & Sullivan presents this award to the company that has developed a product with innovative features and functionality that is gaining rapid acceptance in the market. The award recognizes the quality of the solution and the customer value enhancements it enables.

Frost & Sullivan Best Practices awards recognize companies in a variety of regional and global markets for demonstrating outstanding achievement and superior performance in areas such as leadership, technological innovation, customer service, and strategic product development. Industry analysts compare market participants and measure performance through in-depth interviews, analysis, and extensive secondary research to identify best practices in the industry.

About Frost & Sullivan

For over five decades, Frost & Sullivan has become world-renowned for its role in helping investors, corporate leaders and governments navigate economic changes and identify disruptive technologies, Mega Trends, new business models and companies to action, resulting in a continuous flow of growth opportunities to drive future success.Contact us: Start the discussion.

Contact:

Harley GadomskiP: 12104778469E:harley.gadomski@frost.com

About Cala Health, Inc.

Cala Health is a bioelectronic medicine company transforming the standard of care for chronic disease. The company's wearable neuromodulation therapies merge innovations in neuroscience and technology to deliver individualized peripheral nerve stimulation. Cala Health's lead product, Cala Trio, is the only non-invasive prescription therapy for essential tremor and is now available through a unique digital commercial model of direct-to-patient solutions. New therapies are under development in neurology, cardiology, and psychiatry. The company is headquartered in the San Francisco Bay Area and backed by leading investors in both healthcare and technology. For more information, visit CalaHealth.com.

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SOURCE Frost & Sullivan

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Cala Health Applauded by Frost & Sullivan for Revolutionizing the Essential Tremor Market with its Body-worn Neuromodulation Therapy, Cala Trio(TM) -...

Daylight saving time (DST) officially ended in the United States at 2 a.m. on November 3, but three neurologists at Vanderbilt University say that the practice should be totally done away with permanently.

Drs. Beth A. Malow, Olivia J. Veatch and Kanika Bagai collaborated on a piece published in JAMA Neurology on Monday that brought evidence of the detrimental effects of DST on the brain, citing specifically the negative impact it may have on circadian rhythms, the internal clock that regulates the body's sleep-wake cycle.

They wrote that the transition to and from daylight saving time has been associated with several health complications, including an increased risk of stroke.

"The rate of ischemic stroke was significantly higher during the first 2 days after DST transition, with women, older age, and malignancy showing increased susceptibility," the piece read.

Studies have also indicated that the transition negatively affects sleep patterns, especially among adolescents, causing them "an average of 15 to 20 fewer minutes of sleep." The authors pointed to data indicating that teenagers averaged about 7 hours and 30 minutes of sleep per night after the transition. This, they said, was not in-line with efforts to help them get enough sleep.

"While it is important to recognize that this study only involved 40 students and was limited to the week following the DST transition," the authors wrote, "an American Academy of Sleep Medicine consensus statement has recommended 8 to 10 hours of sleep for adolescents on a regular basis."

All in all, the benefits don't outweigh the risks.

"Based on these data, we advocate for the elimination of transitions to DST," the authors wrote.

Daylight saving time has certainly not always existed, nor does it lack opponents.

Scholars of American history (and fans of the 2004 Nicholas Cage thriller, National Treasure) may recall that it was inventor and founding father Benjamin Franklin who first introduced the idea of daylight saving time in the 1780s. However, as CNN reported, the practice did not begin to be implemented widely in the United States until 1966, following the passage of the Uniform Time Act. Our current system, in which which DST runs from March to November, has only been in place since 2007.

Further, the neurologists' professional opinion may be good news for Americans, most of whom, according to a recent poll, oppose the yearly hour-switching that daylight saving time necessitates.

According to the poll, conducted by The Associated Press-NORC Center for Public Affairs Research and reported by the Associated Press, 71 percent of Americans would prefer to toss the tradition. However, respondents could not come to a consensus as to whether the country's clocks ought to stay locked on standard time or on daylight saving time all year. According to the Associated Press, 40 percent said they would prefer to keep standard time for the duration of the year, while 31 percent expressed support for always operating on daylight saving time and never switching back to standard.

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Some Neurologists Want To End Daylight Saving Time, Calling It Unhealthy - Newsweek

Vaught Neurological Services, PLLC, is expanding to provide easier access of care to the people of Wyoming County, and BK Vaught, MD, and Rachael Riggins, MSN, FNP-C, are accepting patients at their new satellite office location in Oceana, three days a week.

OnMonday, Wednesday and Friday at 833 Cook Parkway in Oceana, they are sharingoffices with The Foot and Ankle Clinic of the Virginias, which will continue to serveits patients Tuesday and Thursday.

According to a press release, Riggins has already begun seeing patients as of Nov. 18, and Vaught will begin seeing patients Dec. 13.

The new location will offer follow-up visits for established patients who have been seen at least once in Beckley by Vaught,EMG/NCV testing for established or new patients. The testing is performed by Vaught (a board-certified EMG specialist) and is typically scheduled on Fridays, the press release stated.

All insurances are accepted, but a referral is required. All scheduling will be coordinated through the main location in Beckley.

Contact 304-252-4222 for more information, to make an appointment, or to change an existing appointment.

Email: jnelson@register-herald.com; follow on Twitter @jnelsonRH

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Vaught Neurological to expand services to Wyoming County - Beckley Register-Herald

The neurology team at University Hospitals offers innovations in testing, diagnosis and treatment of neuromuscular diseases all in a collaborative setting to ensure our patients maintain a high quality of life.

The keys to managing a neuromuscular disorder is early detection and focused treatment. If you or your doctor suspect you have a neuromuscular issue, it is important to see a specialist as soon as possible.

For certain diseases, such as myasthenia gravis, if care is delayed, the disease can become more resistant to drug therapy, making it harder to treat. For conditions like amyotrophic lateral sclerosis (ALS), which currently has no known cure, early detection allows us to better manage ALS symptoms, extending your quality of life for as long as possible.

Our neurology team is leading research efforts with several clinical trials and pioneering nationally-funded laboratory research. Several of our experts have written comprehensive textbooks that serve as definitive resources for the treatment of neuromuscular conditions.

We also use the latest technology to diagnose and guide treatment. For example, UH has one of the few neuromuscular ultrasounds in the country allowing us to respond to neuromuscular disorders faster and more effectively. In addition, our use of electromyography (EMG) has dramatically changed the way we address disorders like entrapment neuropathy.

Our team treats a wide range of neuromuscular conditions, including:

With extensive experience and expertise in ALS treatment, University Hospitals is one of only a few facilities in the country with an ALS Clinic sponsored in part by the ALS Foundation. Through this important collaboration, we have access to groundbreaking research and technology. Our ALS dedicated team includes:

With a focus on discovering new therapies, our researchers developed a special breathing device that allows ALS patients to breathe on their own, helping them better participate in a daily routine and prolonging their quality of life. Our ALS Programbrings together specialists from the Neuromuscular Center, rehabilitative services, surgery and pulmonary medicine to deliver the best possible outcomes.

We also have a Muscular Disease Clinicthat is focused on the diagnosis and treatment of several inherited muscular disorders, including muscular dystrophy and inherited neuropathy.

In addition, our Myasthenia Gravis Programtreats patients with immunosuppressive drugs, plasma exchange and intravenous immunoglobulin.

For more information about our specialized services for neuromuscular diseases, content one of our team members at any of our convenient locationsacross the region.

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Neuromuscular Disorders l Neurology l University Hospitals ...

Report byProf. Tissa Wijeratne MD FRACP FRCP (Edin) FRCP (London) FAHA FAAN (USA)

Over four thousand neurologists from a hundred and twenty-six countries gathered in Dubai for the 24th World Congress of Neurology.

The beautiful, warm Dubai was greeted with a real treat on the Battle to Beat Parkinsons Disease by Professor Patric Brundin, honoured recipient of the Fulton award on 27th October 2019.

Professor Brundin discussed several recent studies that have shed new light and new clues on the pathogenesis of Parkinson's. These suggest that prion-like propagation, neuroinflammation and cellular energy deficits play key roles in the pathogenesis of PD.

The plenary lecture on molecular precision in neurology and contributions by autozygome was exemplary.

The 24th World Congress of Neurology is the largest conference of its kind in this region.This massive task is a byproduct of collaboration between the Emirates Society of Neurology (EMINS) and the World Federation of Neurology. We are proud to deliver aprogram featuring 232 lectures, 158 workshops, and 1438 posters on numerous aspects of cutting edge research findings, to promote better brain health worldwide.

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Highlights from Day One of the World Congress of Neurology 2019 - WFN News

Most of the time when we think about genetic mutations, we think about the ones that spell disaster. But sometimes, our genes can have the opposite effect: Instead of increasing our risk for certain diseases, they can protect us from them.

This has turned out to be the case with a Colombian woman in her 70s. By all indications, she shouldhave developed Alzheimers disease by her mid-40s. She has one of three rare mutations that lead to early-onset Alzheimers diseasepeople with this mutation only make up about 1% the 44 million individuals living with Alzheimers globally. And yet, by the time she turned 70 she was still mostly healthy; although she has developed mild cognitive impairment, which can be a warning sign for Alzheimers, she may never experience dementia.

The reason for her continued health? A super rare mutation to both copies of anothergene related to Alzheimers, called APOE. Called the Christchurch mutation (for the town in New Zealand where scientists discovered it in the 1980s), it seems to somehow counteract the risk of Alzheimers diseaseand could inspire future treatments or preventions for it. Researchers in the US and in Colombia published the womans case study on Monday, Nov. 4 in the journal Nature Medicine.

The woman, who is still alive and living in Colombia, comes from a family where dominantly-inherited Alzheimers is common. She and some 6,000 members of her kindred participate in the Colombia Alzheimers Prevention Registry, which is run by Francisco Lopera, a neurologist at the University of Antioquia in Colombia. Some 1,200 people in the registry have a mutation that causes them to over-produce amyloid protein in the brain, one of the hallmark signs of the disease. Everyone in the registry can enroll in clinical research trials for Alzheimers.

This particular woman, however, never got sick. When researchers maintaining the registry noticed that it took her three decades to even develop mild cognitive impairment, they flew her to Boston, where she agreed to let researchers at Harvard University conduct a series of tests.

What they found in her brain imaging shocked them. She had the highest amyloid beta burden of anyone else in the cohort, says Eric Reiman, a neurologist with the Banner Alzheimers Institute in Arizona, who co-authored the paper. This was consistent with her dominantly-inherited Alzheimers mutation. Normally, these high levels of amyloid are thought to lead to buildups of another deformed protein, called tau, along with inflammation and the ultimate destruction of neurons.

But the woman didnt have the characteristic tangles of tau. And the regions of her brain that are most commonly affected by Alzheimers still seemed to be working just like they would in an otherwise healthy adult.

When they sequenced her whole genome, researchers found that her APOE gene had two copies of the Christchurch mutation: a single basepair switch that tweaks the protein produced by the gene. Somehow, this tweaked version of the protein seemed to mitigate the effects of the extra amyloid in her brain.

That means targeting these downstream effects, in addition to amyloid itself, may be a viable treatment for Alzheimersalthough its not clear how to go about that just yet. The vast majority of drug trials targeting amyloid have failed, with the notable exception of one trial from the drug company Biogen that appears to have had positive results. Having more targets increases the likelihood of having more successful treatments that work for more people, or even combination therapies.

This case study leads us to think about the importance of such studies in relatively understudied populations, says Nilufer Ertekin-Taner, a neurogeneticist with the Mayo Clinic in Jacksonville, Florida, who was not involved with the study. Scientific knowledge of the Christchurch mutation suggests that its incredibly rare, but that could be because the majority of research on Alzheimers and dementia has been done on white populations. By including more diverse populations in future research, scientists can get a better idea of how this mutation works in other healthy populationsand ultimately, how it could mitigate the disease overall.

Correction (Nov. 4): An earlier version of this story accidentally mis-named Eric Reiman as Dan Reiman.

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Rare genetic mutations protected a woman from developing Alzheimer's - Quartz

Morning Report is a daily clinical conference discussing admissions and consults of the previous night. This conference takes place every morning from 8:00 to 9:00 a.m., and is directed by the Chairperson and other faculty members. The conference discusses medical, social and pathophysiological aspects of admitted patients. Attendance is required by all residents, medical students and rotating house staff from other departments.

Grand Rounds is a weekly clinical conference that takes place every Friday in conjunction with the Department of Neurosurgery and basic neurosciences. Our Triple "N" (Neurology/Neurosurgery/Neuroradiology) Conference follows Grand Rounds and is a multi-specialty endeavor.

Subspecialty conferences are held weekly on stroke, epilepsy, movement disorders, neuromuscular diseases, etc. for residents and medical students. These conferences are presented to the residents and medical students by the respective experts on these topics. The conferences are scheduled by the chief residents, the Residency Program Director and the Chairperson of Neurology.

Basic neurosciences are currently taught by Dr. Ausim Azizi on Tuesdays to neurology, neurosurgery and psychiatry residents.

The department participates and organizes continuing neurological education programs for community physicians and neurologists.

Finally, and most importantly, bedside clinical teaching to house staff and medical students takes place on a daily basis by Department of Neurology faculty.

Excerpt from:
Neurology Residency Program Conferences | Lewis Katz ...

Resident Research Requirements

Residents are expected to be academically productive appropriate to their level of training within the program. Junior residents are expected to work on case reports, book chapters, and/or assist senior residents with ongoing projects. Senior residents are expected to produce academic publications based on their laboratory and clinical experience prior to graduation from the program. Notably, residents have recieved the Synthes Award for Resident Research on Spinal Cord and Spinal Column Injury for three consecutive years for excellent clinical and laboratory work done during their research year.

The Neurosurgery Department has worked with several labs at Temple, covering a variety of areas in research. Some examples include:

Dr. Ronald Tuma, Department of Physiology:Focus on investigations of inflammatory reactions that contribute to CNS injury following stroke, trauma or autoimmune disease via the use of experimental animal models.

Dr. S. Ausim Azizi, Department of Neurology:Focus on cell-based therapies for repair and regeneration of the damaged CNS, signaling pathways of differentiation of adult stem cells into useful neuroal cells, and the feasibility of neurotransplantation.

Dr. Weaver/Dr. Khalili, Departments of Neurosurgery/Neuroscience:Several topics including molecular biology of neurotropic viruses in the brain, and a program in viral oncology focusing on CNS neoplasms.

Several clinical trials are also in progress at TUH under the guidance of the Neurosurgery faculty.

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Neurosurgery Residency Research | Lewis Katz School of ...

ARTICLE IN BRIEF

Five training modules in telemedicine skills are proposed for neurologists in training.

Teleneurology practice has been gaining steam for more than a decade, driven by the huge successes of remote stroke care (telestroke), the ongoing neurologist shortage, the aging of the U.S. population, and the demands of rural health care. Yet while training exists as part of some residency programs and continuing medical education (CME) offerings, there are no national standards for teleneurology curriculum and certification.

A paper published in the August 2 online issue of Neurology with input from the AAN's Telemedicine Work Group hopes to address that, by proposing a curricular framework that could become the nationally standardized basis to train residents in teleneurology and ultimately medical students, practicing physicians, and allied health professionals as well.

We are hearing from residency program directors that residents are starting to practice and are being asked for documentation of teleneurology training for credentialing purposes when no formal training curricula exist, said the lead author of the paper, Raghav Govindarajan, MD, assistant professor of neurology at the University of Missouri School of Medicine and chair of the Telemedicine Work Group. That's the gap we're trying to address with this curriculum.

Establishing a curriculum will help create national teleneurology practice standards, replacing the existing patchwork of state and local parameters. As physicians, we traditionally practice in one geographic location, and our practice is regulated by the state medical board, said Eric Anderson, MD, PhD, a study co-author, vice chair of the AAN Practice Committee, and director of telemedicine at CortiCare, a US-based telemetry diagnostic company. In telemedicine, most states have taken it upon themselves to set varying rules and regulations regarding the practice, resulting in potentially 50 differing sets of rules.

We want to present a compelling argument and recommendations to the Accreditation Council for Graduate Medical Education [ACGME] to make the teleneurology curriculum an elective for all residencies, said Bart M. Demaerschalk, MD, MSc, FRCPC, professor of neurology at the Mayo Clinic College of Medicine in Phoenix, AZ, medical director of Synchronous Telemedicine Services at the Mayo Clinic Center for Connected Care, and a member of the AAN Telemedicine Work Group. Mayo has specified a telestroke requirement in our vascular neurology training, and ACGME will hold us accountable to that, but that's not coming from the top down. There remains an opportunity for ACGME to standardize teleneurology training.

Among his goals, Dr. Demaerschalk said he would like to see the teleneurology curriculum integrated into all aspects of training, addressing acute and chronic conditions, as well as both hospitals and clinics across neurology specialties.

The Neurology paper divides teleneurology training into five basic equivalencies, beginning with fluency with the technology itself both its abilities and its limitations.

Seeing your first patients via teleneurology can be a clumsy process, and it is easy for us to forget this once we become more experienced, said Amanda Jagolino-Cole, MD, assistant professor of neurology at the McGovern Medical School at the University of Texas Health Sciences Center at Houston, whose work in developing telestroke/teleneurology training in the University of Texas's vascular neurology fellowship appeared in a paper last year in Neurology. Fellows must demonstrate that they are comfortable using the camera, opening images, and completing a note prior to seeing patients and every trainee starts with different skill sets that pertain to teleneurology.

The proposed teleneurology curriculum stresses the importance of knowing not only what teleneurology can efficiently do, but also what it may not be best for vestibular testing, for example, or a comprehensive neuromuscular exam. Parts of the neurology exam are one of the pitfalls of teleneurology, said Scott Vota, DO, a co-author on the paper and interim chair of the department of neurology and director of the adult neurology residency program at Virginia Commonwealth University (VCU). We know it's very helpful in acute stroke and in movement disorders. In neuromuscular diseases, there are some limitations. Evaluating the strength of a muscle or assessing tone are difficult to do over telemedicine.

Dr. Vota's residents initiated the drive for teleneurology training within the VCU program, which started four years ago. Learners today want to understand this and know how to use these tools, he said. They understand that this is the future of neurology practice.

Another training module addresses licensure and medicolegal issues and ethics, which become exponentially more complex when teleneurology providers practice across state lines. The Neurology paper suggests a case-based didactic approach to teaching these issues that includes input from legal and regulatory advisors at individual teaching hospitals. Training also touches on interstate reimbursement issues. Residents and practicing physicians need to stay up to date on constantly changing regulations of all types in the states in which they practice, the authors of the paper wrote.

Dr. Anderson pointed out that different risks may apply in different settings. When you're treating acute stroke patients in an emergency department (ED) setting, for example, you are co-managing a patient with a physician on the other end, he said. When you're remotely treating patients in their homes, there isn't necessarily another physician present with the patient, or a telepresenter, and there's potentially a higher legal liability.

Webside manners, the technique of building and maintaining a rapport with patients who are seen remotely, is another critical part of the curriculum. Even in-person bedside manners can be challenging to some residents, and those challenges are often shifted and amplified over video, with touch and physical presence removed from the clinical encounter. Technology can make it harder to build a relationship, said Dr. Vota. Not being in the room, it can be harder to understand non-verbal cues, to know when to pause, when to let the patient speak.

Something as simple as introducing yourself as a neurologist, stating where you are located, and explaining why you are seeing the patient via telemedicine rather than in person, can go a long way in establishing rapport, said Dr. Jagolino-Cole. We encourage neurovascular fellows and neurology residents to work out proper verbiage for patients and families before getting on the camera.

Another training module focuses on informed consent, patient privacy, and disclosure. Questions arise about what information the patient is disclosing and who will have access to it, or how much of the patient's environment can be seen on camera, and what that might reveal if they are being examined from their home. And finally, the suggested curriculum addresses skills in remote examination and taking a remote history either with or without a telepresenter, a health care provider in the room with the patient who can assist with hands-on aspects of the exam, and clinical documentation of telemedicine exams.

As teleneurology training advances, a key question will be how to adapt a basic curriculum to the needs of subspecialties and specialized patient populations. Probably 90 percent or more of teleneurology practice right now is telestroke, said Dr. Anderson, adding that how telestroke is practiced and its benefits for patients are well-defined. But, he said, Telemedicine for other neurological conditions like headache, or epilepsy is promising, but still relatively lacking. We don't have the same overwhelming body of evidence for those uses yet.

We'll need training on telemedicine in critical care; in epilepsy, with remote monitoring of EEGs; in MS; in dementias, said Dr. Demaerschalk. There will also need to be some unique facets of working with children via connected care, just as treating them in-person is not the same as treating adults.

It is already clear that teleneurology is especially valuable for certain patient populations. Steven S. Schreiber, MD, chief of neurology at the Tibor Rubin VA Medical Center in Long Beach, CA, and professor of neurology in residence at the University of California, Irvine, has studied the successes of teleneurology among veterans living in urban areas. In more rural areas, telemedicine is really crucial because patients often live hundreds of miles away from care sites, he said. Our patients in the Veterans Administration health system are only about 40 miles away from our location, but we find that they actually prefer to have their appointments via teleneurology and avoid logistical inconveniences like heavy traffic.

Teleneurology also makes a marked difference for patients with advanced movement disorders and other incapacitating neurological diseases. For patients with motor neuron disease, for example, who are on a ventilator, getting out of the house to a medical appointment can consume an entire day, Dr. Schreiber said. Being examined in their own homes through a 30- to 60-minute teleneurology encounter is far easier and much less stressful for those patients, and visiting nurses can be trained to assist in those exams.

Geographically isolated Native American patients are another group for whom technology can sometimes be the only way to access care. In Arizona, Dr. Demaerschalk has worked with the Indian Health Service to gradually and respectfully introduce technology to Indian health care provider sites, an endeavor that he says has been very successful. Tribal hospitals have been some of our most fabulous partners, and especially given the remoteness of many Native American communities, technology has been extremely useful, he said.

Between easing logistics for patients who can't get to care sites, caring for an aging population, and coping with the ongoing dearth of neurologists, remote care will become more and more essential. People are increasingly becoming aware that telemedicine is an integral part of value-based patient care, said Dr. Anderson. The writing is on the wall.

Excerpt from:
Professionalism: A Proposed ACGME Curriculum in Telemedicine for Neurology Residents - LWW Journals

Machteld Hillen, MD

Program Director, Adult Neurology

Hello and welcome to the Neurology Residency Program at Rutgers, New Jersey Medical School. The goal of our program is to prepare residents for a successful career in clinical or academic neurology, and its related subspecialties. We strive to provide our residents with a supportive environment and the best training available. This is achieved through our broad clinical experience and a strong commitment of teaching from our faculty. Our didactic curriculum covers all aspects of Neurology Medicine equipping our graduating residents with the knowledge required for successful board certification.

Success for both the program and the resident is a balance between a residents needs, ability and attitude as well as the programs ability to help the resident develop into a competent and caring neurologist. Our Department seeks motivated residents with a desire to make a positive impact on a patients life. One who is dependable, possesses a strong work ethic, and maintains a positive and professional attitude.

We hope you consider our residency program as you prepare for your next phase of training in your career. We sincerely thank you for your interest in our program and encourage you to contact us if you have additional questions not covered here on our website.

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Adult Neurology Residency Program - New Jersey Medical School

University Hospitals is a National Association of Epilepsy Centers Tier 4 treatment centerthe highest designation for epilepsy care. Our board-certified neurology team provides expert care from relatively mild epilepsy cases to the most complex.

Our epilepsy specialists, called epileptologists, are involved in innovative research, conducting clinical trials and participating in national and international programsthat dig deeper into epilepsys causes and therapies. We also have a dedicated team focused on pediatric epilepsy to make sure we meet the unique needs of children of all ages.

The science around epilepsy is evolving, and our knowledgeable team is committed to staying on top of new developments to make sure the epilepsy treatment we offer can help our patients live a comfortable and fulfilling life.

Epilepsy is a brain disorder that causes a person to have sudden, recurring seizures. These can result in a loss of consciousness, convulsions or other serious physical effects.

If you or your loved one has had a seizure, it is critical to see an epileptologist right away. With specialized training in the diagnosis and treatment of epilepsy, our UH epileptolgists have the experience and expertise to care for your specific needs.

The majority of people diagnosed with epilepsy can be effectively treated with medication. There are many different epilepsy medications available, and our specialists are well-versed in the benefits and side effects of epilepsy medications available.

Some patients are more prone to epilepsy medication side effects, including elderly patients and pregnant women. Future moms also can have an increased risk of seizures, and depending on the medication, there may be an elevated chance for birth defects. At University Hospitals, our team takes a multidisciplinary approach to effective epilepsy management for expectant moms by bringing together a team of specialists. For women with epilepsy that are considering starting a family, or are already pregnant, our high-risk maternal fetal medicine specialists are part of your care team.

By coming to a specialty team of epileptologists, with the advanced training in epileptic seizures and seizure disorders, you will receive the most appropriate path of care for your epilepsy management.

If your medications are not managing your seizures effectively, you may be referred to UHs epilepsy monitoring unit (EMU) that uses advanced technology to continuously monitor brain activity. EMU patients either stop taking or reduce their dose of anti-seizure medications to induce a seizure in a medically supervised, safe environment. This helps our experts determine more information about your disease, including where in the brain seizures are occurring. Our team then pursues more targeted therapy ranging from different medications to possibly surgery.

Some epileptic patients do not respond well to medications despite trying multiple therapies. The good news is there are procedures available that can effectively treat epilepsy and reduce the number of seizures - and even possibly leave the patient seizure free with limited loss of memory. University Hospitals is one of only a few facilities in the country that has the expertise to perform multiple hippocampal transection. Unlike traditional epilepsy procedures, this treatment can limit the spread and synchronization of seizures while leaving the brain intact. For many patients, this procedure can completely eliminate seizures and significantly improve quality of life.

Before any procedure, our neurosurgery team uses the latest imaging technology to make sure we have a clear vision of the surgical area, improving the likelihood of positive outcomes. We also provide advanced Surgical Theater technology, allowing our neurosurgeons to discuss the procedure with patients during a virtual reality walk through of a 3-D simulation of their brain.

Our virtual reality technology eases patient concerns by allowing a visualization of the details of their specific brain surgery before it happens. Through an interactive discussion between patient and surgeon, patients better understand what to expect with surgery and recovery.

Once our team has created and implemented a care plan that works for you, we provide follow-up care, medication management and access to other therapies at many of our locations throughout northeast Ohio. Even if you are referred to us from outside the UH system, we will work with your primary care doctor to manage your condition over the long-term, letting you remain close to home while receiving state-of-the-art treatment from the experts at UH.

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Epilepsy | Neurology | University Hospitals | Northeast ...

"As neurology research continues to evolve at a rapid rate, we saw the need to create a specialized IRB model that conducts neurology-focused scientific and regulatory review for multi-site studies," said Eli Alford, Schulman's Chief Operating Officer. "Together with NBREC, we're excited to launch CNR and look forward to supporting the development of the latest techniques, methodologies and discoveries in neurology research."

CNR features a scientific review committee to complement Schulman's best-in-class IRB review. CNR is therapeutically focused and comprised of distinguished scientists and industry leaders who have experience conducting neurology research. By combining the robust expertise of a local IRB, the collaborative capabilities of a central IRB, and the leading minds in neurology research, CNR delivers independent, objective and authoritative review services.

About Schulman IRB

Schulman IRB has been a leader in the protection of human research participants in the U.S., Puerto Rico and Canada since 1983. Schulman offers thorough, timely IRB review services including dedicated review capabilities for all phases of research across all therapeutic areas to clinical trial sponsors, CROs, investigators and institutions. Schulman also provides global consulting services in clinical quality assurance (CQA) and human research protections (HRP), and it also offers a commercial institutional biosafety committee (IBC) service. Fully accredited by the Association for the Accreditation of Human Research Protection Programs (AAHRPP), Schulman has an unparalleled clean audit history with the Food and Drug Administration (FDA).

For more information, please visit http://www.sairb.com or follow @SchulmanIRB on Twitter or on LinkedIn.

About NBREC

Established in 2012as a Nevada-based 501(c)(3)not-for-profitorganization, the National Biomedical Research Ethics Council (NBREC) is committed tothe goals of assuringindividual researchvolunteer safety through the expanded use of single ethics committees, expanding international awareness for research ethics and improving population public health efforts allied with disease surveillance and control.

For more information, please visit http://nbrec.org.

View original content with multimedia:http://www.prnewswire.com/news-releases/schulman-irb-launches-central-neurology-review-cnr-service-300496536.html

SOURCE Schulman IRB

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Schulman IRB Launches Central Neurology Review (CNR) Service - PR Newswire (press release)

To improve the quality of life for neurology inpatients, a panel of experts, led by UC San Francisco neurologist S. Andrew Josephson, MD, has released quality measurements.

Increased scrutiny on quality and safety in hospitals nationwide has led to the development of multiple metrics for inpatients across a variety of specialties [but] few quality metrics exist specifically for disorders of the nervous system, said Josephson, chair of the UCSF Department of Neurology, in an article he authored in the journal Neurology, published on July 21, 2017.

Quality measurements are defined as a diagnostic or treatment activity that should be performed in the majority of patients and can be measured using objective criteria.

While there are thousands of guidelines published for treating patients in the hospital, most physicians are unaware of these and do not track their adherence, according to Josephson. To address this, Josephson, together with 30 or so national experts assembled by the American Academy of Neurology and two other national societies, have established these quality measurements.

Josephson and other members of the Inpatient and Emergency Neurology Quality Measurement Set Work Group identified 12 areas in which quality metrics will be used to drive improvements in patient care. These run the gamut from the percentage of neurology inpatients in which brain death was diagnosed using proper procedures, to the percentage of patients suspected of having meningitis who were given a steroid to reduce inflammation at the same time as they were given the first dose of antibiotics.

Rather than allow insurers or non-neurologists to define quality across neurologic conditions, this effort aims to garner neurologic expertise by defining measures that were supported by evidence and were relevant to the practicing neurologist.

The metrics have since been distributed to every neurologist in the nation.

These metrics have the potential to launch a new era in neurologic inpatient medicine, where attention is carefully paid to practicing consistency of evidence-based care, said Josephson, who is also professor of neurology, and director and founder of the UCSF Neurohospitalist Program. This effort will enable physicians and health care systems to work together, reporting rates of adherence to quality metrics that can be easily accessible to other providers, payors and the public at large, driving better care for our patients.

Read more from the original source:
Increasing Quality of Life for Neurology Inpatients is Goal of Newly Established Metrics - UCSF News Services

Story Highlights

When Chle Swarbrick, an MP in New Zealand's Parliament, responded to a colleague's interruption of her speech with "Ok, boomer," media outlets around the world scrambled to explain Swarbrick's remark.

Many of them chastised Swarbrick for insulting baby boomers -- and were criticized in turn by their own audiences. "Ok, boomer" originated on social media platform TikTok to mock condescending closed-mindedness, not age.

The confusion around Swarbrick's comment confirms what leaders of a multigenerational workforce already know: Different generations in the workplace -- and there can be five in the same office -- have very different perspectives. Smoothing them over is a challenge.

Gallup analytics has a solution: Don't.

Instead, focus on your employees' most important differences.

Giving up on smoothing over has important implications. To begin with, those five generations really do expect different things from work.

As Gallup analytics shows, millennials are more likely than the previous generation to say that development opportunities and "quality of manager" are extremely important in a new job.

Millennial employees are dead serious about advancement, are motivated more by mission than money and want coaching, not bossing. Maybe that's not so different than what people of all generations really want but millennials' high quit rate shows they'll leave rather than accept the kind of management the baby boomer generation has tolerated.

That seems like a major generational difference -- and leaders should take it seriously -- but it's really small potatoes compared to the differences between employees' CliftonStrengths. A reflection of deep neurology, our CliftonStrengths influence the way we think, feel and behave, the way we see the world and react to it. That influence is orders of magnitude stronger than any generational characteristic. And each person's unique strengths explain -- and predict -- performance with such acuity that generational labels seem feeble by comparison.

A reflection of deep neurology, our CliftonStrengths influence the way we think, feel and behave, the way we see the world and react to it.

Managers make differences good. And effective.

When team members understand the way their brains work, the way they relate to each other changes. They can't claim Sharon's extreme productivity is due to her baby boomer work ethic (and neither can Sharon, for that matter) -- it's because Achiever is among her top five CliftonStrengths themes. Jason's aversion to forced ranking is not some kind of Gen Xer apathy -- it's because Competition is last on his CliftonStrengths profile. Intense Command, not the infamous "millennial entitlement," drives Taylor to take charge.

Knowing coworkers in this profoundly meaningful way doesn't make differences seem unimportant -- it makes differences seem even more important. It makes differences good.

A canny manager uses a team's understanding of these deep, intractable differences to bring people together: An employee who needs help hitting a deadline needs Sharon. Jason should be part of designing the onboarding routine. Taylor will rally the troops when a project is going to pieces. And even though Sharon thinks paycheck is purpose enough while Taylor feels work ought to have real meaning, high-Command Taylor may be Achiever-driven Sharon's saving grace when she isn't getting enough achieved.

Strengths' influence on behavior is orders of magnitude stronger than any generational characteristic. And strengths explain -- and predict -- performance with such acuity that generational labels seem feeble by comparison.

And if that canny manager coaches people to use their strengths deliberately, the team's performance can be extraordinary: On average, workgroups that receive strengths coaching have up to 19% increased sales, 29% increased profit, 7% higher customer engagement, 16% lower turnover (in low-turnover organizations), 72% lower turnover (in high-turnover organizations), a 15% increase in engagement and 59% fewer safety incidents than teams that don't receive strengths coaching.

Sure, generational expectations in the workplace are real and can have a real impact on your business. Leaders should not ignore them. But talents -- which define us on a profoundly meaningful level -- prove our differences are a thing to admire and use, not insult.

It's all a matter of approach.

Which brings us back to New Zealand. Insults aren't uncommon within its Parliament, and MPs often respond with more heat than Chle Swarbrick did. Nonetheless, Swarbrick got worldwide flak for her remark, which she responded to in a Guardian op-ed. "My 'OK, boomer' comment in Parliament was off the cuff, albeit symbolic of the collective exhaustion of multiple generations," she said, "set to inherit ever-amplifying problems in an ever-diminishing window of time."

Her eagerness to solve big problems is laudable, and likely why constituents voted for her. They may feel she's doing the right thing the right way.

But if she were your employee, you probably wouldn't. You might commend her zeal, you might be relieved that she noted "multiple generations." But you'd know that whatever "Ok, boomer" originally meant, it sounds like an insult. It sounds like prejudice.

Yes, people will always make presumptions about others. No, you can't change that. But you can change what people presume of each other. Indeed, you have the rare power to make people's presumptions accurate. CliftonStrengths gives it to you. Use it.

As the generational composition shifts within companies, the potential for miscommunication and misunderstanding grows. Things could get ugly. Or a lot better -- it depends on your approach.

Show people how they're really different, and you'll show them why they're valuable. Why everyone is valuable. That perspective is a lot more meaningful than demographics, and far better for your business.

Jennifer Robison is a Senior Editor at Gallup.

Klayton Kasperbauer contributed to this article.

See the article here:
How the 'OK, Boomer' Comment Sparked Conversation on Managing Generational Differences - Gallup

France-based MedDay Pharmaceuticals announced its MED1003 failed to meet its primary and secondary endpoints in the second pivotal Phase III trial for progressive multiple sclerosis (MS).

The trial, dubbed SPI2, evaluated the safety and efficacy of three daily doses of 100mg of MD1003 compared to placebo in 642 patients with progressive MS without recent relapses, which is also called not-active progressive MS. The primary endpoint was reversal of functional disability, which was measured by the proportion of patients with an improvement in either the Expanded Disability Status Scale (EDSS) or in how long it took patients to walk 25 feet (TW25) over a 12-month time frame and then confirmed at 15 months.

Secondary endpoints were the relative decrease in the risk of disability progression, global impression of response to the drug as evaluated by both the patient and their physician, and the mean change in TW25. Other exploratory endpoints included brain MRI measures, quality of life measures and measurements of ambulation using a Fitbit wearable device.

MD1003 is a neurometabolic modulator that targets both neurodegenerative and demyelination processes through a non-immunological mechanism.

We are clearly disappointed that SPI2 did not meet its primary and secondary endpoints, said Catherine Moukheibir, MedDays chief executive officer. Going forward, we will continue to evaluate the trial data and confer with regulators. We would like to thank our collaborators including the participating clinicians, medical staff and, most importantly, the patients for all of their efforts and participation in the trial. All were invaluable partners throughout the process of completing the SPI2 trial.

MD1003 is also being evaluated in Charcot-Marie-Tooth disease and in hepatic encephalopathy. The company also acquired the SPECMET metabolic platform that is in preclinical development for amyotrophic lateral sclerosis (ALS) and brain aging. In 2018, the company acquired the health division of Profilomic SA, a spin-off company from the Comite dEnergie Atomique (CEA). This allowed MedDay to extend its database and laboratory equipment with a team of researchers with expertise in metabolomics and lipidomics. SPECMET created a biobank of 700 cerebrospinal fluid (CSF) samples from all major neurodegenerative diseases, including rare inborn errors of metabolism.

MS is an autoimmune disease where the patients immune system attacks myelin, the substance that coats nerve fibers in the brain and spinal cord. Most clinical therapies involve tweaking the immune system, but MD1003 targets metabolic pathways, stimulating the Krebs cycle to give more energy to demyelinated nerve fibers with the hopes of boosting the developing of an insulating layer of myelin. The Krebs cycle, also known as the citric acid cycle or the TCA cycle, is a chain of chemical reactions used by all aerobic organisms to release stored energy.

We will review the findings in detail to understand these outcomes to help inform future clinical research in progressive MS and other neurological diseases, said Frederic Sedel, chief scientific officer and co-founder of MedDay. I remain confident of the importance of the neurometabolic approach to neurodegenerative diseases with high unmet medical need.

The company is presenting detailed data from the trial on April 29 in Toronto, Ontario, Canada, at the American Academy of Neurology (AAN) 2020 Annual Meeting.

Link:
Back to the Drawing Board: MedDay's MS Therapy Fails in Phase III Trial - BioSpace

GP Dr Nassif Mansour explains why the latest National Institute for Health and Care Excellence (NICE) guidance on neurological conditions is so useful for GPs.

Adapted from Univadis from Medscape. This transcript has been edited for clarity.

My name is Nassif Mansour. I am a GP from south-west London. I was one of the two GPs who sat and advised NICE in developing the guidelines on suspected Neurological conditions.

One in 10 people who present in general practice are coming in with neurological symptoms.

So NICE produced an overarching set of guidelines that will help us in primary care in order to be able to identify those patients and recognise the conditions that can be managed safely in primary care but also those that need to be referred in a timely fashion to secondary care.

This short film will help us as GPs and trainees to be able to use these guidelines practically during the consultation.

Neurological Condition Assessment

The neurological condition assessment starts from calling the patient from the waiting room. The way they walk in and the way they sit in front of us in general practice.

The best way to start the consultation in my opinion would be to put them at rest and to help them to share the information that they want to share with us.

The important clues are all in the history of any neurological condition. We can then do a brief examination in order to confirm certain aspects from the history.

Red Flags

Also, it is important to identify the red flags. This will determine the urgency of the referrals and the guidelines help us to achieve that.

A couple of examples of red flags would be for example a patient presenting with blackouts. If there are features in the history to suggest that they might have had epilepsy, then this is something we should take note of.

Another example would be patients coming in presentingwith poor balance and whilst the patient is sitting there in front of me shows resting tremor on the left or the right side. That to me would indicate Parkinsons disease.

Thirty percent of referrals to secondary care are for patients with transient loss of consciousness and the vast majority of them have got syncopal attack, which is a simple fainting attack that is very common in the population, but it is filling up the neurology clinics up and down the country.

So the guideline was designed to try and help us identify between the vasovagal attacks and the epilepsy, or to think of these 2 conditions mainly. And if it is likely to be a syncopal attack then we dont need to refer unless there are other conditions related to it.

I would suggest that if the patient presents with a blackout and this is the opening complaint, thats when I would very quickly have the guidelines ready and opened in order to just view the evidence that is there.

Another example, and I believe a useful area covered by the guidelines, are tremors and different movement disorders. So patients will present with all sorts of different movement disorders, for example shaking of the hands, or abnormal tics, or facial movements, or rippling of muscles.

Movement Disorders

The guidelines help us to at least remember the important ones. The important ones are the Parkinson's tremors because this helps us reach the diagnosis of Parkinson's disease, and as well as the essential tremors because these are probably the most common movement disorder.

Essential tremors are usually symmetrical. Both hands are affected at the same time, whilst with Parkinson's disease the vast majority of patients will present with a tremor on one side before it marches onto the second side of the body.

The essential tremors are tremors in action, so when the patients are actually using their hands, picking up a cup of tea for example, it will shake.

Unlike the Parkinson's tremor, which is usually at rest, so when they actually use their hand the tremor might disappear.

The guidelines from NICE are very clear that if we suspect Parkinson's disease, we need to refer patients on for a confirmation of diagnosis and treatment.

However, for essential tremors, these guidelines help us and protect us and support us as GPs that we do not need to refer the patients unless they are not responding to the first-line treatment.

The guidelines protect us if we did not refer the patient. So if I did not refer the patient with classical essential tremors, and later on he developed Parkinson's disease, I have the guidelines to fall back on, to support me, that I have managed you as the patient according to the guidelines.

Sleep Disorders

Another area that I believe was well covered in the guidelines is sleep and sleep disorders. It is a very challenging problem that faces us as GPs. The commonest one of them would be lack of sleep (insomnia), and the guidelines make it clear that we do not need to refer patients with insomnia.

Also, it encourages us not to refer patients for example when they get, for the first time or repeatedly, jerking movements, for example one of their limbs, a leg or an arm when they go off to sleep. This is a normal physiological phenomenon and it is not epilepsy.

The guidelines make it very clear however that we need to make sure that we are not missing epilepsy and if there is any doubt, the guidelines will easily direct us through the hyperlink to the epilepsy evidence which will help us differentiate between a simple physiological phenomenon and from epilepsy.

Other sleep disorders that are commonly, and possibly inappropriately, referred to the neurology clinic are sleep disorders related to sleep apnoea.

We use the Epworth scale to reach our diagnosis and if it is suspected then we use the sleep apnoea referral pathway that is agreed locally.

Similarly, conditions like narcolepsy and catalepsy, if they are suspected and sleep apnoea is excluded, then they are happy for us to refer, and it encourages us to refer to secondary care.

I am very excited about these guidelines, not just because it covered a very challenging area in general practice, it also gives us the support we need to be able to manage patients safely and effectively.

These guidelines are very useful as they link to other common neurological problems that are challenging, that need our urgent attention.

I would encourage you all to use the guidelines, to embrace them, to have them in the background on your desktop, to assist you during the consultation. I promise you it will help you to feel confident and comfortable managing patients who are presenting with neurological symptoms.

Thank you for watching.

Follow this link:
What's in NICE Guidance on Neurological Conditions for GPs? - Medscape

Later today I'll lose consciousness for a few hours to rest and repair. There's a good chance you will, too. Yet as ubiquitous as sleep is, we know very little about which parts of the brain are fundamental to staying awake.

Thanks to a recent experiment that stimulated the brains of anaesthetised macaques, we have a clearer idea of just which neurological structures might be primarily responsible for switching us on each day.

The results not only help us to better understand the processes behind anaesthesia;for those trapped in vegetative or comatose states by illness or injury it could mean a pathway out again.

While we can use brain-scanning technologies to watch how different parts of the brain activate as a subject falls unconscious, it's a lot harder to work out how any single area produces a specific response, let alone which are the most crucial.

Studies on sleeping and comatose patients have given researchers a sound idea of the kinds of structures involved, from the brain stem to the prefrontal cortex. Needless to say, many different parts of our nervous system determine our state of awareness.

Researchers from the University of Wisconsin in the US and the Israel Institute of Technology noticed one tiny piece of tissue deep inside our forebrain the central lateral thalamus had a rather prominent role in directing our neurological affairs.

Based on its connectivity, it seemed to be pivotal in influencing how signals were passed from the higher-order 'thinking' sections such as the cortex to deeper structures such as the thalamus and back again areas known to be integral to consciousness.

Researchers often focus on different parts of the brain in relative isolation to work out how relevant they might be to any given task.

In this case, the team were interested in the precise way this tiny piece of brain tissue communicated with other areas during different states of activity, requiring a more holistic approach.

"We decided to go beyond the classical approach of recording from one area at a time," says neuroscientist Yuri Saalmann from the University of Wisconsin.

"We recorded from multiple areas at the same time to see how the entire network behaves."

To get past the hurdles of using human subjects for such a task, the researchers used the macaque as their model, imaging the animals' brain structures before inserting specially tailored electrodes.

These electrodes were then used to monitor activity while the monkeys were awake, asleep, and under the effects of a strong anaesthetic.

The variations in electrical activity confirmed suspicions that the central lateral thalamus played a role in maintaining consciousness, at least in macaques. But it's one thing to find activity, and another to prove that a part of the brain is responsible for causing it.

To do this, the team used their remarkably fine electrodes to stimulate the small patch of neurons with incredible precision, tickling them into action while the macaques were knocked out with a good dose of ketamine.

"We found that when we stimulated this tiny little brain area, we could wake the animals up and reinstate all the neural activity that you'd normally see in the cortex during wakefulness," says Saalmann.

"They acted just as they would if they were awake."

Incredibly, once the stimulation stopped, the macaques drifted right back off to sleep within seconds. It was like the central lateral thalamus acted like a consciousness switch, directing mental traffic when active to give rise to awareness, and reinstating unconsciousness when it was quiet.

None of this helps much with the big questions around what consciousness is on a more philosophical level, and of course drawing conclusions about our own species based on non-human models is also problematic.

But this is one more piece of evidence we can use to fine-tune a physical model of how a brain like ours switches between different states of function.

Given we're still unclear on how anaesthesia renders us oblivious and, shockingly, even if it's always effective it helps having precise knowledge of how the smallest bundles of nerves affect one another while we're slipping in and out of awareness.

As for people whose brains are permanently locked into a state of consciousness, having avenues for treatment would be a welcome product of studies like this one.

Previous research has already provided strong evidence that stimulating the thalamus could help some comatose patients regain awareness.

In 2007, deep brain stimulation saw a patient who'd been minimally conscious for 6 years following a traumatic brain injury slowly regain movements and control over some body functions, including a small improvement in speech.

"There are many exciting implications for this work," says University of Wisconsin psychologist Michelle Redinbaugh.

"It's possible we may be able to use these kinds of deep-brain stimulating electrodes to bring people out of comas. Our findings may also be useful for developing new ways to monitor patients under clinical anaesthesia, to make sure they are safely unconscious."

This research was published in Neuron.

Link:
Monkeys Wake From Anaesthetic When Brain Region Linked to Consciousness Is Stimulated - ScienceAlert