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Patients treated with a mobile stroke unit in New York City had significantly shorter times than patients treated with conventional care on three measures: mean dispatch-to-thrombolysis, onset-to-thrombolysis, and ambulance arrival-to-thrombolysis.

The use of a mobile stroke unit (MSU) to transport stroke patients cut time-to-thrombolysis even in the most densely populated borough of the most densely populated city in the US, New York City, a December 17, 2019 study in the Journal of the American Heart Association found.

The researcherswho compared an MSU from New York's Weill Cornell Medical Center and Columbia University Irving Medical Center to a conventional ambulance transport operating within two catchment areas in Manhattan during alternating two-week periods from October 2016 to September 2017found that the dispatch-to-thrombolysis times were significantly reduced in patients transported by the MSU.

The patients were part of the METRONOME (Metropolitan New York Mobile Stroke) registry with suspected acute ischemic stroke whose primary outcome was dispatch-to-thrombolysis time.

MSUs have gained traction in several US cities since their introduction in Houston in 2014. Yet some stroke experts have expressed skepticism about their efficacy in densely populated urban settings with large numbers of proximate dedicated stroke centers and complex traffic patterns.

In these areas, the study authors wrote, a given emergency scene location may be close to a high number of stroke-capable hospitals, resulting in shorter travel times for emergency transport vehicles. This could potentially reduce or nullify the beneficial effect of MSU care on thrombolysis time that has been demonstrated in less densely populated regions.

Lead study author Matthew E. Fink, MD, FAAN, chair of neurology at Weill Cornell Medical Center, said that of the many geographic, demographic, and logistical challenges to emergency stroke response in a location like Manhattan, the most daunting is traffic.

Conventional ambulances have to make a round trip from the hospital to the patient, then back to the hospital. That's twice as long as the one-way trip the MSU has to make, because the MSU is a primary stroke center where patients are treated at the scene, he said.

The study found longer ambulance arrival-to-hospital arrival times for the MSU because of the interval during which the vehicle remained stationary at the scene to administer CT scans and tissue plasminogen activator (tPA) thrombolytic therapy.

At the time of the study, New York City's MSU was in its first year and was the first MSU program on the east coast.

I thought that Manhattan, with its high population and large share of elderly residents, was actually a perfect location for an MSU, Dr. Fink said.

New York City's MSU program is now participating in the BEST-MSU multi-city trial of MSU operations, which runs through 2021.

Dr. Fink and his co-authors conducted a prospective cohort study of a New York Citybased MSU program that was launched in October 2016 by New York Presbyterian (NYP) Hospital and the Fire Department of New York (FDNY). A single MSU operated only in Manhattan from two separate, non-overlapping medical center catchment areasWeill Cornell Medical Center and Columbia University Irving Medical Center. The MSU was on-service within the Weill Cornell catchment area for two on-weeks; then, during the following two weeks, the on- and off-service centers switched, resulting in an alternating biweekly schedule.

All conventional ambulances in the study, including those owned by individual hospitals, operated under the city's 911 emergency medical services (EMS) system and were registered with the FDNY. The MSU, while not an official municipal ambulance unit, functioned as an institutional unit authorized by the FDNY to operate on the EMS network.

To compile the comparison group, a vascular neurologist at each of the two medical centers prospectively reviewed an FDNY database of all EMS ambulance call reports of ambulance transports to each medical center's emergency department. This review flagged all reports of transports that occurred during each campus' two off-weeks, and that were coded as an FDNY EMS call type of CVA (cerebrovascular accident, with stroke symptoms that are evaluated >5 hours from symptom onset) or CVA-C (cerebrovascular accidentcritical, with stroke symptoms that are evaluated within 5 hours of symptom onset or in whom the last known well time is unknown).

For each flagged patient, three vascular neurologists then reviewed all available history and physical examination findings to determine whether the patient would have been eligible for MSU transport had the MSU been available at the time when they were evaluated. Patients who would have been eligible for MSU care were added to the METRONOME registry as part of the conventional care group. The review team was blinded to prehospital care-related time metrics, including dispatch-to-thrombolysis time.

In total, 85 patients met the study criteria, including 66 patients transported via MSU and an additional 19 patients via conventional ambulance in the comparison group. Because seasonal weather in New York City can affect traffic and ambulance travel times, investigators conducted a post-hoc sensitivity analysis adjusting the primary analysis for the season of each patient's ambulance transport date as an additional variable.

Patients treated with MSU care had significantly shorter times than patients treated with conventional care on three measures: mean dispatch-to-thrombolysis, onset-to-thrombolysis, and ambulance arrival-to-thrombolysis times. Compared with patients in the conventional care group, patients in the MSU group had a mean decrease in dispatch-to-thrombolysis time of approximately 29.7 minutes (95% CI, 6.9-52.5).

Within the estimated difference in dispatch-to-thrombolysis time, patients in the MSU group had a mean increase in dispatch-to-ambulance arrival time of 6.5 minutes (95% CI, 2.4-10.6; p=0.002), offset by a mean decrease in ambulance arrival-to-thrombolysis time of 36.2 minutes (95% CI, 58.5 to 13.9; p=0.001). Differences in dispatch-to-thrombolysis time for patients in the MSU group also occurred despite significantly longer ambulance arrival-to-hospital arrival times (due to stationary vehicle status during CT scan and treatment) and longer distances traveled from pick-up to the accepting hospital.

Within the thrombolysis-treated population, the study encountered a higher rate of final diagnosis of stroke mimic among patients who received thrombolysis on the MSU. This was despite the fact that demographic and clinical characteristics, including rates of symptomatic intracranial hemorrhage, were not significantly different between the two groups.

Overall, the study found that fewer patients were transported by the MSU over a 12-month period than in the published accounts of other MSU programs operating in less densely populated areas. Investigators believe that the novelty of New York City's MSU, and the possibility that recognition of acute stroke by emergency dispatchers may be insufficient, could both have contributed to that discrepancy.

James C. Grotta, MD, FAAN, director of Stroke Research at the Clinical Institute for Research and Innovation at Memorial Hermann-Texas Medical Center, director of the Mobile Stroke Unit Consortium, and founder of the country's first MSU program in Houston, said the study's results were consistent with those of other MSU data, which has found that the use of mobile stroke units decreases time to thrombolysis.

This study proved that that's true even in a city like New York, that has a stroke center around the corner from almost any location, said Dr. Grotta, who is the lead investigator on the BEST-MSU trial.

Dr. Grotta noted that the structure of city EMS systems is one factor that may set New York City apart from other urban areas. Houston is more like most American cities than New York is, he said. Our MSUs can treat 10 times the number of patients that New York City can, for two reasons: We have the cooperation of all of the city's stroke centers, so we deliver to all hospital systems. And we have one citywide EMS system that we can coordinate with. Coordination between the EMS systems in New York is more complicated, since many of the hospitals have their own ambulances.

The biggest challenge to cities establishing MSU programs, both Drs. Grotta and Fink acknowledged, is moneybecause the programs save money in the long term but lose it in the near term, and, as Dr. Grotta emphasized, reimbursement is still inadequate. You need outcomes data to convince payers to pay more for an MSU transport, he said.

Peter A. Rasmussen, MD, medical director of the Distance Health Cleveland Clinic, who directed the Cleveland Clinic's mobile stroke unit program when it began operations a few weeks after Houston's opening in 2014, said that while the study highlighted only one aspect of the benefits of the mobile stroke programtime-to-thrombolysisits success points to three other benefits as well.

You're getting the benefit of a stroke expert as soon as possible; I don't know how you gauge the value of an expert eye so quickly, Dr. Rasmussen said. You get near-perfect triage, so in a city like New York, you can get patients to centers of excellence for different types of strokewhether it's hemorrhagic or ischemic stroke, whether it's a primary stroke center or a comprehensive stroke center the first time, and that reduces the subsequent cost of transport. And there's the recognition of a patient that's an interventional mechanical thrombectomy candidate and making sure that patient gets to a thrombectomy-capable center.

For Drs. Grotta and Rasmussen, though, the primary message of the New York City study was its success. Many people think that a mobile stroke unit is impractical, doesn't save time, and is hard to operate, Dr. Grotta said. Now this study has shown that you can make it work in the toughest kind of place. Even in New York City, in fact, it's extremely practical, and it does save time.

Dr Fink serves as an editor for Relias Learning. Dr. Grotta receives consulting fees from Frazer, Ltd., a manufacturer of mobile stroke units. Dr. Rasmussen reports stock holdings or proceeds from Mehana Medical, Perflow Medical, and Blockade Medical.

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January 31, 2020, 6:04 PM

7 min read

A pair of endangered Florida panther kittens, whose mother was unable to care for them in the wild, have found their forever home at a wildlife conservation.

The 7-month-old brothers, named Cypress and Pepper, arrived at White Oak Conservation in Yulee, Florida, on Jan. 22, the center announced in a statement on its website this week.

"It's been great," Brandon Speeg, director of conservation at White Oak, told Jacksonville ABC affiliate WJXX. "They like to play on their rock structures, keepers are taking care of them. They've had a great first week."

A young male Florida panther, whose mother was unable to care for him in the wild due to a mysterious neurological disorder, is seen at the White Oak Conservation in Yulee, Fla.

The rare duo was rescued by the Florida Fish and Wildlife Conservation Commission last year after their mother suffered from an unknown neurological disorder that is recently affecting wild populations of panthers and bobcats. The mother was observed on trail cameras in early July 2019 struggling to walk and state wildlife officials felt her kittens, estimated to be just 2-weeks-old at the time, would not survive in the wild.

The brothers have been hand-raised in human care ever since, making them unlikely candidates to be released back into the wild. Both kittens have been tested and will continue to be monitored for the neurological disorder.

The pair was cared for and monitored at ZooTampa in Lowry Park, Florida, before being transported to White Oak Conservation last week.

A pair of young male Florida panthers named Cypress and Pepper, whose mother was unable to care for them in the wild due to a mysterious neurological disorder, are seen at the White Oak Conservation in Yulee, Fla.

Located on the banks of the St. Marys River, White Oak Conservation takes up 700 acres of the 13,000 acres of forests and wetlands on White Oak Plantation. The conservation's breeding programs have worked with the Florida Wildlife Conservation Commission as well as the U.S. Fish and Wildlife Service to bolster wild populations of Florida panthers, along with a number of other imperiled species such as rhinoceros and cheetah.

"White Oak is the only place in the world that rehabilitates injured Florida Panthers for release into the wild," Speeg told WJXX.

The Florida panther is a subspecies of the puma, also known as the mountain lion or cougar, and is the only known breeding population of puma that remains in the eastern United States, according to the U.S. Fish and Wildlife Service.

A pair of young male Florida panthers named Cypress and Pepper, whose mother was unable to care for them in the wild due to a mysterious neurological disorder, are seen at the White Oak Conservation in Yulee, Fla.

Florida panther kittens typically stay with their mother for about a year and a half before leaving to form their own territories. They live for about 12 years in the wild but are susceptible to disease, genetic disorders and getting hit by cars, according to the National Wildlife Federation.

Perceived as a threat to humans, livestock and game animals, the big cats were heavily hunted and nearly went extinct by the mid-1950s, according to the National Park Service. The Florida panther was added to the U.S. endangered species list in 1967.

A pair of young male Florida panthers named Cypress and Pepper, whose mother was unable to care for them in the wild due to a mysterious neurological disorder, are seen at the White Oak Conservation in Yulee, Fla.

The mammals are reclusive, typically living in remote, undeveloped areas of southern Florida, and thus are rarely seen by people. However, they are under threat from increasing human population and development in their habitat. Less than 130 Florida panthers are estimated to remain in the wild in a restricted range in South Florida, according to White Oak Conservation.

"They play a really important role in Florida ecology," Speeg told WJXX. "It's like playing Jenga. If you remove something, they all support each other and you aren't sure what impact that's going to have."

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Endangered panther kittens find forever home at wildlife conservation - ABC News

ORLANDO, Florida Chimeric antigen receptor (CAR) T-cell therapy can be safely delivered in the outpatient setting, which could make the life-extending treatment available to patients who don't have access to a major teaching hospital or treatment center, contend investigators who analyzed data from three clinical trials.

Looking at outcomes for patients with large B-cell lymphomas (LBCL) who were treated with the CAR T-cell construct lisocabtagene maraleucel (liso-cel) in the outpatient setting at both university-based and nonacademic medical centers in three clinical trials, Carlos Bachier, MD, from the Sarah Cannon Blood Cancer Network in Nashville, Tennessee, and colleagues found that the incidences of severe adverse events were relatively low and manageable.

"Outpatient administration of liso-cel and subsequent monitoring were successfully implemented in multiple clinical trials at both university and nonuniversity sites," he said here at the Transplantation and Cellular Therapy annual meeting.

Dr Carlos Bachier

The need to monitor and treat serious side effects from CAR T therapy, such as the cytokine release syndrome (CRS) and neurologic toxicities, has previously limited the therapy to major treatment centers with extensive resources. Yet most patients in the US with relapsed or refractory large B-cell non-Hodgkin lymphoma are treated at nonacademic centers where cancer therapies are typically delivered in outpatient infusion centers, Bachier said.

"Infusion and monitoring of patients receiving CAR T-cell therapy in the outpatient setting can lead to wider utilization and improved access," he said.

To get a better idea of the safety and efficacy of CAR T-cell therapy in the outpatient setting, Bachier and colleagues examined outcomes from the phase 1 TRANSCEND NHL 001 trial of liso-cel in one or two doses for a variety of aggressive lymphoma histologies, conducted in both university-based and nonuniversity centers; the phase 2 TRANSCEND-OUTREACH trial of outpatient liso-cel therapy after two or more prior lines of therapy against various lymphomas and lymphoproliferative disorders, conducted in nonuniversity centers; and the phase 2 TRANSCEND-PILOT-017006, testing liso-cel in patients with LBCL relapsed or refractory after a single line of immunochemotherapy who were ineligible for either high-dose chemotherapy or stem cell transplant. This trial was conducted in both university and nonuniversity settings.

In OUTREACH and PILOT, liso-cel was administered at a dose of 100 x 106 CAR-positive T cells; in TRANSCEND, it was given at doses of 50, 100, or150 x 106.

To qualify for outpatient administration and monitoring, both university centers and nonuniversity specialty oncology centers had to have at least hematopoietic stem cell therapy (HSCT) or phase 1 trial capability, an outpatient infusion center or inpatient infusion unit with same-day discharge; an affiliated aphereseis center; and a multidisciplinary medical team that can coordinate care between inpatient and outpatient settings, have standard operating procedures for outpatient monitoring and admissions when necessary, and an oncologist on call at all times.

In addition, each center had to have one designated hospital for care of CAR T-cell recipients with staff trained to manage typical CAR T-cell toxicities and a ready supply of tocilizumab (Actemra, Genentech) for treating CRS.

For their part, patients needed to have caregiver support and stay within 1 hour travel of the treatment center for the first 30 days after infusions, had to commit to returning to the site for immediate medical evaluation as necessary, and had to be educated about the early signs and symptoms of CRS and neurologic toxicities.

The analysis included data on 44 patients with a median age of 62 years (range 24 to 82), including 25 enrolled in TRANSCEND, 13 in OUTREACH, and 6 in PILOT. Eighteen patients were age 65 or older, 12 had high tumor burden, and 6 had lactate dehydrogenase (LDH) levels of 500 U/L or higher.

Treatment-related adverse events (TEAEs) occurring in at least 25% of outpatients were similar to those among all patients in TRANSCEND, with the most frequent grade 3 or 4 events being neutropenia, anemia, and thrombocytopenia. There were no treatment-related deaths among those monitored as outpatients.

CRS of any grade occurred in 12 of 25 outpatients (48%) in TRANSCEND, in 5 of 13 (38%) in OUTREACH, and in none of the 6 outpatients in PILOT. Grade 3 or 4 CRS was seen in 1 outpatient in TRANSCEND, but in none of the other patients in the other two trials.

Grade 3 or 4 neurologic events occurred in two outpatients in TRANSCEND, but were not seen in any outpatients in OUTREACH or PILOT.

Three patients in TRANSCEND and two in OUTREACH received either tocilizumab or corticosteroids for CRS, and five patients in TRANSCEND received corticosteroids for neurologic adverse events. Prolonged grade 3 or greater cytopenias were seen in three patients in TRANSCEND, five in OUTREACH, and one in PILOT.

The median onset of CRS was 5 days, and the median onset of neurologic toxicities was 8 days among all outpatients, and was similar to combined inpatient and outpatient population in TRANSCEND. The median duration of the events 6 days for CRS, 16 days for neurologic events was also similar to that seen in TRANSCEND.

Of the 44 patients from all three trials, 24 (55%) were hospitalized after liso-cel administration, for a median of 6.5 days (range 2-23). The median time to hospitalization was 5 days. One third of the hospitalizations were for either CRS or neurologic events. There were 2 cases of ICU admissions after liso-cel administration, for a median ICU stay of 4 days.

In all, 45% of outpatients did not require hospitalization, and there was no increase in ICU admissions compared with inpatients, Bachier pointed out.

The overall response rate was 80%, with a complete response rate of 55%, similar to that seen in TRANSCEND, he said.

In an interview with Medscape Medical News seeking objective commentary on the findings, Yago Nieto, MD, from the University of Texas MD Anderson Cancer Center in Houston, said that he would be comfortable with CAR T-cell therapy in the outpatient setting, provided that several key components of care are in place.

"It requires an organized effort to be able to see those patients in an outpatient clinic weekdays and weekends, having every contingency discussed beforehand, including for ICU team members to admit patients into the ICU if necessary which is unusual, particularly with liso-cel but it has to be all worked out in advance in a multidisciplinary effort," he said.

Nieto comoderated the session where the data were presented, but was not involved in the study.

Comoderator Mazyar Shadman, MD, MPH, from the Fred Hutchinson Cancer Research Center in Seattle, Washington, who was not involved in the study, told Medscape that his center treats patients with CAR T therapy in the outpatient setting.

"But it's important to know that when you talk about outpatient care, it's not your outpatient clinic where you see patients once a week," he said. "These are intensive outpatient centers. We have a team that's just outpatient, but we see these patients on a daily basis, we have dedicated nurses and practitioners, and we have labs and immunotherapy services for getting results quickly."

"I feel comfortable giving CAR T therapy to a patient in this setting," he added, "but not to a patient being treated in the middle of nowhere."

The study was funded by Juno Therapeutics, a Bristol-Myers Squibb company. Bachier disclosed advisory board activities for various companies, not including Juno or BMS. Nieto disclosed research funding and consultancy for various companies not including the sponsors of this study. Shadman disclosed research funding, honoraria, and consultancy with various companies not including Juno or BMS.

Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR 2020: Abstract29. Presented February 19, 2020.

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CAR T Cells to Go? Outpatient Therapy Can Be Safe - Medscape

Editor's Note:The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

A 40-year-old man is referred for neurologic evaluation after presenting with peripheral neuropathy. Three years ago, he noted numbness, burning pain, and reduced temperature sensation in his feet. For the past 2 years, he has had dry eyes and dry mouth; urinary retention that requires self-catheterization; gastrointestinal symptoms, including alternating diarrhea and constipation; and nausea. His weight has decreased by 40 lb (18.1 kg) over 12 months. He has noticed decreased sweating.

For several months, he has had frequent syncopal episodes triggered by positional change. In hindsight, he reports intermittent dizziness associated with a "daydreaming" feeling that began 8 years ago; however, these spells were not associated with loss of consciousness. He was also recently diagnosed with Sjgren syndrome.

He reports no chest pain, palpitations, shortness of breath, or edema. A review of systems is otherwise unremarkable. His past medical history is notable for hypothyroidism. His family history is notable for a grandfather who had gastrointestinal problems and a sister who has palpitations. His parents are alive and have no neurologic symptoms. He takes no medications or supplements.

Medscape2020WebMD, LLC

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Amanda Kennedy,Jeffrey Kaplan,Dianna Quan.A 40-Year-Old Man With Dizziness, Confusion, and Neuropathy-Medscape-Jan21,2020.

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A 40-Year-Old Man With Dizziness, Confusion, and Neuropathy - Medscape

People living close to major roads or highways are at a greater risk ofmultiple sclerosis (MS),a database study of people in metropolitan Vancouver reports.

Parks and other green spaces in urban areas that might lower exposure to air pollutants did not affect a persons overall risk of developing MS, but can lessen the likelihood of other neurological diseases.

These findings were in the study Road proximity, air pollution, noise, green space and neurologic disease incidence: a population-based cohort study, published in the journal Environmental Health.

The risk of neurological conditions like MS, non-Alzheimers dementia (NAD), Parkinsons disease, and Alzheimers diseaseincreases with age, and is particularly high in people between 60 and 70 years old. As the population ages, the prevalence (proportion of people living with a disease at a given time) of these neurological ills is expected to rise.

Although certain lifestyle habits, such as smoking and physical activity, are seen to influence the risk of developing these conditions, it is not well known if other factors related to the peoples surroundings can play a role too.

A team of researchers atThe University of British Columbia (UBC), Canada,investigated a possible link between exposure to environmental factors like road proximity, air pollution, greenness and noise, and the risk of MS, NAD, Parkinsons, and Alzheimers disease.

The team analyzed data covering about678,000 people, ages45 to 84, who had been living in Metro Vancouver between January 1994 and December 1998. Researchers investigated if environmental factors over this four-year exposure periodinfluenced the development of any of these neurological conditionsin these people.

They were then followed for another four years, from January 1999 to December 2003, and reported changes in their health noted.

Over these followup years, researchers identified 13,170 cases of NAD, 4,201 cases of Parkinsons disease, 1,277 cases of Alzheimers disease, and 658 cases of MS.

Results showed that living close to a major road or highway specifically, less than 50 meters (about 54 yards) away from a major road, or less than 150 meters (about 1 mile) away from a highway was linked to a higher incidence (rate of new disease cases over a given time) of all the neurological conditions studied, including MS.

Air pollution exposure increased the risk of NAD and Parkinsons disease, the study reported. Because of the low number ofAlzheimers and MS cases in the group analyzed, researchers were unable to identify an association between these two conditions and air pollution. A larger cohort (study group) is needed to draw conclusions here, they said.

Data, however, suggested that the presence of fine particulate matter (PM2.5, produced by combustion) may contribute to the risk of MS.

Living close to green spaces within cities lowered the incidence of NAD and Parkinsons,but not of MS. Researchers speculated that this could be because of limits on data in their statistical model.

Noise from nearby major roadways also was not seen to affect the risk of developing any of the conditions studied.

For the first time, we have confirmed a link between air pollution and traffic proximity with a higher risk of dementia, Parkinsons, Alzheimers, and MS at the population level, Weiran Yuchi, the studys lead author, said in a UBC press release.

The good news is that green spaces appear to have some protective effects in reducing the risk of developing one or more of these disorders, Yuchi added. More research is needed, but our findings do suggest that urban planning efforts to increase accessibility to green spaces and to reduce motor vehicle traffic would be beneficial for neurological health.

The team believes that the findings underscore the importance of city planning, and support the incorporation of greenery and parks.

For people who are exposed to a higher level of green space, they are more likely to be physically active and may also have more social interactions.There may even be benefits from just the visual aspects of vegetation, said Michael Brauer, the studys senior author.

Given the high proportion of the population living in proximity to traffic and the growing prevalence of neurological disorders, future studies in other urban areas which address potential joint effects of multiple environmental exposures are warranted, the team concluded.

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Living Near Major Roadways Raises Risk of MS and Other Neurologic... - Multiple Sclerosis News Today

Pharmaceutical company GlaxoSmithKline has paused production and distribution ofsome of its Excedrin products,which many people use to treat their migraines.

A GSK spokesperson said there were inconsistencies in how we transfer and weigh ingredients for Excedrin Extra Strength Caplets and Geltabs and Excedrin Migraine Caplets and Geltabs.

But the company does not believe the products pose a safety risk to consumers.

In a statement to WKBW, a spokesperson said:

Patient safety and product quality are our utmost priorities at GSK. Based on the available data, GSK believes that the product does not pose a safety risk to consumers. However, as a precautionary measure, GSK Consumer Healthcare voluntarily implemented a temporary discontinuation of production and distribution.

This is a short term issue for which we expect production to begin again shortly. In the meantime, other Excedrin products are available along with other pain-relieving drugs, but dosages may differ. Consumers should consult their pharmacist for the most suitable alternative product.

A Tops Markets spokesperson tells WKBW that they are out of the Excedrin Migraine medicines, and are working to learn more specifics on the shortages.

A lot of people use over-the-counter medicine, like Excedrin, to treat their migraines.

Dr. Jennifer McVige, a Pediatric and Adult Neurologist at the Dent Neurology Institute, said there are migraine-specific medications that a doctor can prescribe.

Weve always hadTriptan-based medications that we could prescribe. Also, theres these new CGRP inhibitors that are coming out.

Dr. McVige warns that taking over-the-counter medication, like Excedrin, too frequently can make things worse.

Theres something called medication overuse headache that can occur if you take over the counter medications more than three days over the week, she said.

Dr. McVige said to try and avoid getting migraines, make sure to get enough sleep, drink enough water, eliminate stress and get some exercise.

This story was originally published by Ala Errebhi at WKBW.

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When harsh headaches strike, identifying the cause of your pain can be the least of your worries. Instead, you kick into survival mode, seeking refuge in a dark, quiet room, ice packs on deck.

But, should you be investigating your symptoms more?

If your gut is convinced something greatly differentiates this headache from those you've experienced prior, it's important to see a doctor to rule out the possibility of a secondary headache.

Unlike common migraine, tension, or cluster headaches (which fall under the primary category), secondary headaches are often telling of underlying health problems.

Before you go Google diagnosing yourself in a panic, follow up with your doctor for a proper diagnosis. For more info on the topic of mind, read through this guide to secondary headaches from Dr. Stephen A. Kulick, MD, a neurology specialist in Staten Island, ahead.

Secondary headaches are actually the symptom of another cause, like encephalitis or meningitis, for example as opposed to primary headaches, which aren't the result of another medical condition.

According to Dr. Kulick, 10 percent of all headaches are secondary, making them a lot less common than primary.

Since secondary headaches are often indicative of an undiagnosed health issue, Dr. Kulick insisted that they always warrant professional attention and a diagnosis from a neurologist.

If you're struggling to determine whether or not you have a primary or secondary headache, Dr. Kulick suggested asking yourself the following questions:

These are all reasons to see a doctor in order to rule out any serious issues and receive proper pain-relieving medication.

Remember: there is no need to stress about what your headache means until you have spoken to a doctor.

But, it's important to seek emergency care if the headache is painful or debilitating, or accompanied by confusion, fainting, or high fever, Dr. Kulick said. He also noted that secondary headaches can be attributed to imbalances in the body for example, high blood pressure, renal, thyroid, allergy, or sleep problems, and even dehydration but they could also be attributed to other dangerous conditions affecting the brain.

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The PSNI has confirmed it is assessing whether any criminal offences have been identified following the recall of more than 3,000 neurology patients in Northern Ireland.

The recall happened last year after an independent review of work carried out by consultant neurologist Dr Michael Watt, who has been suspended from practising medicine.

Recent BBC Spotlight programmes reported that one-in-five of the patients who were re-examined were found to have been misdiagnosed by the neurologist.

Dr Watt, who worked at the Royal Victoria Hospital in Belfast, dealt with conditions such as epilepsy, Parkinsons Disease and multiple sclerosis. A report into the cases that was due to be published in June of last year by the Norths Department of Health. However, it never was.

Spotlight reported that it had obtained details of the report and that it indicated that out of almost 3,000 patients, about 2,000 were said to have received a secure diagnosis. More than 600 were given insecure diagnoses, while another 329 diagnoses were uncertain, the BBC programme reported.

The PSNI on Wednesday said it was investigating the matter.

We are aware of the recall of neurology patients by the Belfast Health and Social Care Trust and have met with senior officials within the Department of Health to discuss the issue, a PSNI spokeswoman said.

The department has agreed to provide us with further information so that we can assess how best to move forward and to enable us to determine if any potential criminal offences can be identified.

SDLP deputy leader Nichola Mallon, who has campaigned on behalf of Dr Watts patients, said she had seen at first hand the emotional and mental impact of the ordeal on the patients.

There are serious questions for the Belfast Trust and Department of Health about how theyve handled this situation, she said. These patients were also promised openness and transparency and yet they are continually met with a wall of silence...They feel abandoned and ignored. They deserve better.

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PSNI assessing if any offences linked to recall of 3,000 neurology patients - The Irish Times

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The Neurovascular or Interventional Neurology Devices market report shows a point by point division (Cerebral Thrombectomy Devices, Carotid Artery Stenting (CAS) System, Cerebral Aneurysm and AVM Endovascular Embolization Systems, Intracranial Stent Systems, Flow Diverter for Aneurysm) of the overall market reliant on development, product type, application, and distinctive techniques and systems. The point-to-point elucidation of the Neurovascular or Interventional Neurology Devices market's assembling system, the usage of advancement, conclusions of the world market players, dealers and shippers' order, and the explicit business data and their improvement plans would help our customers for future courses of action and movement planned to make due in the Neurovascular or Interventional Neurology Devices market.

The Neurovascular or Interventional Neurology Devices market report includes the latest mechanical enhancements and new releases to engage our customers to the configuration, settle on taught business decisions, and complete their required executions in the future. The Neurovascular or Interventional Neurology Devices market report moreover focuses more on current business and present-day headways, future methodology changes, and open entryways for the Neurovascular or Interventional Neurology Devices market. Nearby progression frameworks and projections are one of the key segments that clear up overall execution and incorporate key geological analysis (Hospital, Clinic).

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The overall Neurovascular or Interventional Neurology Devices market is made with the fundamental and direct conclusion to exploit the Neurovascular or Interventional Neurology Devices market and participate in business progression for imperative business openings. The correct figures and the graphical depiction of the Neurovascular or Interventional Neurology Devices market are shown in a represented strategy. The report shows an examination of conceivable contention, current market designs and other basic characteristics all around the world.

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Global Neurovascular or Interventional Neurology Devices Market 2019 by Manufacturers, Regions, Type and Application, Forecast to 2025 - Industry News...

Brain Tumor and Neuro Oncology

Surgery of the Cerebellopontine Angle

By: Nicholas C. Bambakidis, Cliff A. Megerian, Robert F. Spetzler

Textbook of Epilepsy Surgery

Edited by: Hans O. Lders, MD, PhD

The Myth of Alzheimers

By: Peter J. Whitehouse, M.D., Ph.D. with Daniel George, M.Sc.

What you arent being told about todays most dreaded diagnosis.

Treating Dementia: Do We Have a Pill for It?

By: Jesse F. Ballenger PhD (Editor), Peter J. Whitehouse MD PhD (Editor), Constantine G. Lyketsos MD MHS (Editor), Peter V. Rabins MD MPH (Editor), Jason H. T. Karlawish MD (Editor)

Special feature on how culture, language and values affect drug marketing for dementia treatment options around the world.

Electromyography in Clinical Practice: A Case Study Approach

By: Bashar Katirji, M.D.

In its second edition, this textbook is used in training programs across the country.

Electromyography and Neuromuscular Disorders: Clinical-Electrophysiologic Correlations

By: David C. Preston, M.D. and Barbara E. Shapiro, M.D., Ph.D.

In its second edition, this textbook with CD-ROM is recognized among the best textbooks for students, residents and practitioners.

Neuromuscular Disorders in Clinical Practice

Editors: Bashar Katirji, MD, Henry J. Kaminski, MD, David C. Preston, MD, Robert L. Ruff, MD, Barbara E. Shapiro, MD, PhD

The most comprehensive and authoritative textbook in the field with chapters contributed by the Neuromuscular Center staff.

Diagnostic Criteria in Neurology

By: Alan J. Lerner, M.D.

Encyclopedia of the Neurological Sciences

By: Michael J. Aminoff, M.D., DSc, FRCP and Robert B. Daroff, M.D.

Neurology in Clinical Practice

By: Walter G. Bradley, D.M., FRCP, Robert B. Daroff, M.D., Gerald Fenichel, M.D., Joseph Jankovic, M.D.

In its fifth edition, this book addresses the most current clinical neurology and leads you through the thought processes of seasoned clinicians.

The Little Black Book of Neurology

By: Alan J. Lerner, M.D.

Neuroimaging in Neurology

By: David C. Preston and Barbara E. Shapiro

The Neurology of Eye Movements, Fourth Edition

By: R. John Leigh and David S. Zee

Struck by the Hand of God

The Collision of Stroke and World History

By: Michael DeGeorgia, M.D.

What if the strokes of Woodrow Wilson, FDR, Winston Churchill, and other world leaders had been treated today? Perhaps the pen of history would have written a different story.

Continued here:
Books | UH Neurological Institute | University Hospitals ...

Aron S. Buchman

From the Rush Alzheimer's Disease Center (A.S.B., L.Y., R.S.W., R.J.D., C.G., S.E.L., J.A.S., D.A.B.), and Departments of Neurological Sciences (A.S.B., L.Y., R.S.W., C.G., S.E.L., J.A.S., D.A.B.), Radiology (R.J.D.), Psychology (R.S.W.), and Pathology (Neuropathology) (J.A.S.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), University of Toronto, Canada.

Lei Yu

From the Rush Alzheimer's Disease Center (A.S.B., L.Y., R.S.W., R.J.D., C.G., S.E.L., J.A.S., D.A.B.), and Departments of Neurological Sciences (A.S.B., L.Y., R.S.W., C.G., S.E.L., J.A.S., D.A.B.), Radiology (R.J.D.), Psychology (R.S.W.), and Pathology (Neuropathology) (J.A.S.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), University of Toronto, Canada.

Robert S. Wilson

From the Rush Alzheimer's Disease Center (A.S.B., L.Y., R.S.W., R.J.D., C.G., S.E.L., J.A.S., D.A.B.), and Departments of Neurological Sciences (A.S.B., L.Y., R.S.W., C.G., S.E.L., J.A.S., D.A.B.), Radiology (R.J.D.), Psychology (R.S.W.), and Pathology (Neuropathology) (J.A.S.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), University of Toronto, Canada.

Andrew Lim

From the Rush Alzheimer's Disease Center (A.S.B., L.Y., R.S.W., R.J.D., C.G., S.E.L., J.A.S., D.A.B.), and Departments of Neurological Sciences (A.S.B., L.Y., R.S.W., C.G., S.E.L., J.A.S., D.A.B.), Radiology (R.J.D.), Psychology (R.S.W.), and Pathology (Neuropathology) (J.A.S.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), University of Toronto, Canada.

Robert J. Dawe

From the Rush Alzheimer's Disease Center (A.S.B., L.Y., R.S.W., R.J.D., C.G., S.E.L., J.A.S., D.A.B.), and Departments of Neurological Sciences (A.S.B., L.Y., R.S.W., C.G., S.E.L., J.A.S., D.A.B.), Radiology (R.J.D.), Psychology (R.S.W.), and Pathology (Neuropathology) (J.A.S.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), University of Toronto, Canada.

Chris Gaiteri

From the Rush Alzheimer's Disease Center (A.S.B., L.Y., R.S.W., R.J.D., C.G., S.E.L., J.A.S., D.A.B.), and Departments of Neurological Sciences (A.S.B., L.Y., R.S.W., C.G., S.E.L., J.A.S., D.A.B.), Radiology (R.J.D.), Psychology (R.S.W.), and Pathology (Neuropathology) (J.A.S.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), University of Toronto, Canada.

Sue E. Leurgans

From the Rush Alzheimer's Disease Center (A.S.B., L.Y., R.S.W., R.J.D., C.G., S.E.L., J.A.S., D.A.B.), and Departments of Neurological Sciences (A.S.B., L.Y., R.S.W., C.G., S.E.L., J.A.S., D.A.B.), Radiology (R.J.D.), Psychology (R.S.W.), and Pathology (Neuropathology) (J.A.S.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), University of Toronto, Canada.

Julie A. Schneider

From the Rush Alzheimer's Disease Center (A.S.B., L.Y., R.S.W., R.J.D., C.G., S.E.L., J.A.S., D.A.B.), and Departments of Neurological Sciences (A.S.B., L.Y., R.S.W., C.G., S.E.L., J.A.S., D.A.B.), Radiology (R.J.D.), Psychology (R.S.W.), and Pathology (Neuropathology) (J.A.S.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), University of Toronto, Canada.

David A. Bennett

From the Rush Alzheimer's Disease Center (A.S.B., L.Y., R.S.W., R.J.D., C.G., S.E.L., J.A.S., D.A.B.), and Departments of Neurological Sciences (A.S.B., L.Y., R.S.W., C.G., S.E.L., J.A.S., D.A.B.), Radiology (R.J.D.), Psychology (R.S.W.), and Pathology (Neuropathology) (J.A.S.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), University of Toronto, Canada.

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Physical activity, common brain pathologies ... - n.neurology.org

DUBLIN--(BUSINESS WIRE)--The "Europe Pacemakers Market to 2027 - Regional Analysis and Forecasts By Product Type By Technology, By End User, and Country" report has been added to ResearchAndMarkets.com's offering.

The Europe pacemaker market is expected to reach US$ 2,408.5 Mn in 2027 from US$ 1,248.7 Mn in 2018. The market is projected to grow with a CAGR of 7.7% from 2019-2027.

Electronic implants are playing a pioneering role that helps to detect specific medical parameters. Additionally, these implants are able to take immediately autonomous therapeutic measures, combining diagnosis and treatment in a single system. The electronic medical implant is an emerging field in the medical industry and has led to various developments of the products, in the field of cardiology, neurology, and otology. Many of the market players are developing novel products in order to minimize the burden of cardiovascular diseases, neurological disorders, and hearing disorders.

For instance, in November 2017, Medtronic launched Azure pacemakers with BlueSync technology that increases the life of the pacemakers, thus reducing the number of device replacements. It also enables to secure and automatic wireless data transmission to physicians. Similarly, in July 2016, BIOTRONIK headquartered in Germany received CE approval for its new Edora pacemakers and cardiac resynchronization therapy pacemakers (CRT-Ps).

Moreover, the presence of pacemaker manufacturers in the European region is also likely to influence the pacemaker market in the European region. Osypka Medical GmbH, Cardiac Impulse S.R.L., Sorin Biomedica C.R.M., S.R.L. are manufacturers located in Europe.

In 2018, Europe pacemaker market held a market share of 22.8% of the global pacemaker market. The implantable pacemakers segment expected to dominate its market share and was valued at US$ 855.5 Mn in 2018 and is anticipated to reach US$ 1,687.2 Mn by 2027. On the other hand, implantable pacemakers segment is also anticipated to witness the fastest growth rate of 8.0% during the forecast period, 2019 to 2027.

Similarly, in 2018 single-chambered pacemaker segment by technology was valued at US$ 890.2 Mn in 2018 and is anticipated to reach US$ 1,736.8 Mn by 2027 and is also expected to grow at the fastest growth rate of 7.9% during the forecast period.

Furthermore, the hospitals & clinics segment held the largest market share of is also anticipated to witness the fastest growth rate of 8.0% during the forecast period, 2019 to 2027. This segment is also expected to dominate the market in 2027 as it is the primary care center for most of the population.

Key Topics Covered:

1. Introduction

1.1 Scope Of The Study

1.2 Research Report Guidance

2. Europe Pacemakers Market - Key Takeaways

3. Europe Pacemakers Market - Market Landscape

3.1 Overview

3.2 Market Segmentation

3.3 Pest Analysis

4. Europe Pacemakers Market- Key Market Dynamics

4.1 Key Market Drivers

4.1.1 Increasing Number Of New Cases of Cardiovascular Diseases (CVD) in Europe

4.1.2 Rapid Technological Advancements in Europe

4.2 Key Market Restraints

4.2.1 Faulty Pacemaker Raises Concerns Over Implantation

4.3 Key Market Opportunities

4.3.1 Growing Medical Technology Industry The European Region

4.4 Future Trends

4.4.1 The Leadless Pacemaker is a New Era In Cardiac Pacing

4.5 Impact analysis

5. Pacemakers Market - Europe Analysis

5.1 Europe Pacemakers Market Revenue Forecasts And Analysis

5.2 Market Positioning

5.3 Performance Of Key Players

6. Pacemakers Market - Europe Regulatory Scenario

7. Europe Pacemakers Market Analysis - By Product Type

7.1 Overview

7.2 Europe Pacemakers Market, By Product Type, 2018 & 2027 (%)

7.3 Europe Pacemakers Market Revenue And Forecasts To 2027, By Product Type (Us$ Mn)

7.4 Implantable Pacemakers Market

7.5 External Pacemakers Market

8. Europe Pacemakers Market Analysis - By Technology

8.1 Overview

8.2 Europe Pacemakers Market, By Technology, 2018 & 2027 (%)

8.3 Europe Pacemakers Market Revenue And Forecasts To 2027, By Technology (Us$ Mn)

8.4 Single Chambered Market

8.5 Dual Chambered Market

8.6 Bi-Ventricular Market

9. Europe Pacemakers Market Analysis - By End User

9.1 Overview

9.2 Europe Pacemakers Market, By End User, 2018 & 2027 (%)

9.3 Europe Pacemakers Market Revenue And Forecasts To 2027, By End User (Us$ Mn)

9.4 Hospitals Market

9.5 Ambulatory Surgical Centres Market

9.6 Others Market

10. Europe Pacemakers market

11. Pacemakers Market - Industry Landscape

11.1 Overview

11.2 Comparative Company Analysis

11.3 Growth Strategies Done By The Companies In The Market, (%)

11.4 Organic Developments

11.5 Inorganic Developments

12. Pacemakers Market-Key Company Profiles

For more information about this report visit https://www.researchandmarkets.com/r/gwns81

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Europe Pacemakers Market to 2027 - Regional Analysis and Forecasts By Product Type, Technology, End User, and Country - ResearchAndMarkets.com -...

Nicholas C. Bambakidis,MD, FAHA, FAANS

University Hospitals Neurological Institute combines a comprehensive team of neurology and neurosurgery specialists throughout the Northeast Ohio. Our providers are world-class experts who are readily available to care for patients with any number of neurological disorders, offering treatment for the entire spectrum of both medical and surgical diseases of the brain and spine. These include diagnosis such as stroke and cerebrovascular disease, brain and spinal tumors and cancer, headache, movement disorders such as Parkinsons Disease, and many other complex neurological problems.

The specialists within UH Neurological Institute are also part of a multidisciplinary team within the University Hospitals Spine Institute that treat patients with all manner of spinal disorders and pain syndromes. Our physicians perform nationally recognized research throughout this disease spectrum as well, and this means that patients often have access to the latest clinical trials and research protocols.

Our specialists and patient-centric approach to care is unrivaled not just in Northeast Ohio but nationally and internationally as well. As director of UH Neurological Institute, I am proud of our efforts in bringing this care to those who entrust their care to us.

Sincerely,

Nicholas C. Bambakidis, MD, FAHA, FAANSDirector and Vice President, University Hospitals Neurological InstituteProfessor of Neurological Surgery, Case Western Reserve University School of Medicine

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Letter from the Director | UH Neurological Institute ...

Diagnosing and treating more than 500 neurological conditions

Mayo Clinic's top-ranked team of neurologists diagnoses and treats more than 500 neurological conditions, including many rare or complex disorders.

The Mayo Clinic Department of Neurology is one of the largest in the world. It includes more than 100 subspecialized experts trained in epilepsy, movement disorders, dementias and other cognitive conditions, stroke and cerebrovascular diseases, neuro-oncology, multiple sclerosis and demyelinating disorders, autoimmune neurology, pediatric neurology, neurophysiology, headache, neuromuscular diseases, peripheral nerve, sleep neurology, and speech pathology. These care providers work together to evaluate and treat people utilizing the most advanced techniques and technologies.

Neurological services are also provided to children at Mayo Clinic in Rochester, Minnesota. Neurologists trained in treating children work in collaboration with doctors trained in treating children and adolescents as well as other pediatric specialists.

Many Mayo Clinic Health System facilities also provide neurological care. Neurologists at Mayo Clinic's campus in Minnesota also provide care for people at several regional clinics and hospitals each week. A primary care provider at the location refers individuals for appointments with the visiting neurologist.

Mayo Clinic Health System clinics, hospitals and health care facilities serve more than 60 communities in Iowa, Wisconsin and Minnesota. These sites provide Mayo Clinic neurology and neurosurgery care to their local communities.

April 11, 2018

Follow this link:
Neurology - Overview - Mayo Clinic

Appointment GuidelinesWe accept new cases only if they are referrals from a veterinarian. This ensures that the patient is initially referred to the most appropriate service within the Veterinary Hospital. Some cases, particularly orthopedic or cardiac cases, can show very similar signs to neurologic cases. This policy is also important because once discharged from the hospital, we will need to work with the patients veterinarian in order to provide continued, high quality care.

Appointment Hours

Emergency ServicesThere is always a board-certified neurologist on call to provide expert consultation and, where indicated, evaluation of emergency cases that present through the Veterinary Hospital emergency service.

How Do I Get An Appointment?Our service works on a referral only basis, so the primary veterinarian must first evaluate the patient and then contact our service directly to initiate the referral, if needed. The final arrangements for the date and time of the appointment are usually made directly with the client. If you do not have a referral, ask your primary veterinarian to give you one in order to make an appointment. We prefer to have the owner bring the patient to the neurology appointment rather than delegate this to a friend or relative, as it is often crucial to the management and outcome of the case that an accurate history be obtained. In many cases, this will involve information that only the owner is aware of.

What will happen during an appointment?

For the first appointment at the Veterinary Hospital, please allow 2-3 hours. The visit will start at the admission desk where a medical record is set up for the patient.

The client and patient will be met by either a student, clinical technician or veterinarian who will then take the patients history information. An initial review of any radiographs, bloodwork or other referral information from the primary veterinarian is also done at this time. It is the owners responsibility to ensure that this information is conveyed to the Veterinary Hospital in time for the appointment as the primary veterinarian may not be aware of the exact date of the appointment.

A physical examination will then be performed on the patient, followed by a neurologic examination. These may be performed initially by a student, intern or visiting resident. Following this, a neurology clinician (either a neurology resident or senior neurologist) will speak with the client to review the examination findings and to make recommendations on any other specific tests that are recommended to make a precise diagnosis. Depending upon the diagnostics needed and the treatment plan prescribed, the patient may need to be hospitalized for several days.

Frequently-Asked Questions

When will the diagnostic tests be performed?It is very important to realize that the major diagnostic tests are often run one or two days after the patient is brought to the Veterinary Hospital. This is done in order to refine exactly which tests will be required and to determine whether the patient can be safely anesthetized.

Can a diagnosis be given via a telephone consult?Unfortunately, it is usually impossible to determine a specific diagnosis from a telephone description provided by the client or from the referring veterinarian. In nearly all cases, a full patient history, thorough physical and neurologic examinations, and a series of tests are needed before we can provide a diagnosis for the patients condition.

What is a neurology specialist?

Specialists in veterinary neurology are certified by the ACVIM parent organization. Specialists (sometimes also known as Diplomates) have to meet strict training requirements as outlined below. In order to become a Neurology specialist, a veterinarian must:

Complete a one-year internship or equivalent training.Complete a residency training program (two or three year depending on the institution). In some schools, such as at NC State University, the residency training includes both medical neurology and neurosurgery.Fulfill the prescribed credentials requirements.Pass both the general Internal Medicine examination and the Neurology certifying examination.

Why might I need a neurology specialist?If your pet has a neurological problem of any sort, we would strongly recommend that you seek the advice of a board-certified neurologist. Under the term ACVIM Neurology board certification, a veterinary neurologist is considered to be an expert in neurology, which can include both medical neurology and neurosurgery. Some neurologists have more training in neurosurgery than others, and some neurologists choose not to do neurosurgery. The four neurologists at the Veterinary Hospital are all trained in neurosurgery as well as medical neurology.

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NC State Veterinary Hospital Neurology Service | NC State ...

The Neurology Center - Houston, Texas Neurologists | Privia Skip to content

The Neurology Center can attribute their success to their highly skilled team of dedicated neurologists who work hard for our patients prolonged treatment and care.

Our goal at The Neurology Center is to ensure that all of our patients receive quality care and expert treatment. Well work with you to ensure you live a full, healthy life.

FINALLY,

A CONVENIENT DOCTORS APPOINTMENTTHAT WORKS FOR YOU.

MAKE YOUR NEXT APPOINTMENT A VIRTUAL VISIT

Dear Patients: We are moving! Beginning February 16, 2017, The Neurology Center will be in our new location at the Houston Medical Center Plaza, 6655 Travis St., Suite 600, Houston, Read More

As of August 9, 2016, we are proud members of Privia Medical Group!

The Neurology Center is a proud member of Privia Medical Group. The best doctors in our community have joined together to form Privia Medical Group (PMG), a multi-specialty, high-performance medical group that puts patients first. Our physicians are united by the mission of providing better, more coordinated care for their patients.

To learn more about Privia Medical Group and find other Privia doctors, please visit our website.

6655 Travis Street Suite 600

Privia Medical Group offers patients personalized and secure 24/7 online access to their health records, as well as the ability to communicate with your medical care team through our patient portal.

The easiest way to book an appointment with your provider.

Review prescription medications and request prescription renewals.

Send and receive secure messages with your medical care team.

Quick access to your secure electronic medical record and test results.

Pay your invoices by credit card, securely and conveniently.

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The Neurology Center - Houston, Texas Neurologists | Privia

Article In Brief

Stroke specialists discuss strategies to make endovascular thrombectomy (EVT) more accessible to many patients who don't have access to the therapy.

Fewer than one-fifth of Americans have ready access to hospitals that offer endovascular thrombectomy (EVT), and in some parts of the country the availability of the clot-busting procedure is even more scant.

Approximately 61 million (19.8 percent) of Americans have direct EVT-access within 15 minutes, while 95 million (30.9 percent ) Americans are within 30 minutes of a center that offers the procedure, the study reported in the February 19 online edition of Stroke.

In addition to analyzing the availability of EVT around the US, the study also considered whether it would be more beneficial to add more EVT programs or to implement policies that allow emergency medical crews to bypass closer non-EVT centers to get to a center with EVTeven if that takes more time.

Bypassing [closer non-EVT centers] showed more potential for maximizing direct EVT access, the study concluded. National and state efforts should focus on identifying gaps and tailoring solutions to improve EVT access.

James C. Grotta, MD, FAAN, a study coauthor and director of stroke research and director of the Mobile Stroke Unit at Memorial Hermann Hospital in Houston, said EVT is not unlike some other new therapies and technologies that took off without much thought to the issue of access.

We have this treatment (EVT) that is relatively new and very effective and requires specialized teams to carry it out, so now there is a tremendous amount of interest in reorganizing systems of care to improve the number of patients who can get treated, Dr. Grotta told Neurology Today.

The study authors noted that EVT improves clinical outcomes, reduces disability and saves lives for patients with acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion (LVO).

Several clinical trials showed that EVT is effective if done within six hours of the last known point of wellness, though two recent trials known as DAWN and DEFUSE 3, have shown that EVT is efficacious and safe up to 24 hours in selected patients.

Current stroke care algorithms largely prioritize initial transport of stroke patients to the closest hospital equipped with the ability to administer IV-tPA. Therefore, the majority of patients only have access to EVT through inter-hospital transfers (drip and ship model), which are associated with significant treatment delays and worse outcomes, the paper said.

To study access, the researchers used 2017 claims data for Medicare and Medicaid to identify stroke centers that were EVT-capable. Of 1,941 stroke centers nationwide, 713 (37 percent) reported having done one or more EVTs for acute ischemic stroke. The researchers used geomapping techniques and 2010 census data to determine that 19.8 percent of the US population have direct access (within 15-minutes travel time) and 30.9 percent of the population could reach a center within 30 minutes.

Ready access to EVT varies greatly among states. Eight states have greater than 25 percent EVT coverage within 15 minutes, 34 states have 10 to 25 percent coverage, and nine states have less than 10 percent coverage, the study reported. Among the higher-access states were Arizona, California, Florida, Nevada, and North Dakota. Among the lower-access states were Alabama, Arkansas, Iowa, Mississippi, and New Hampshire.

The researchers then used mathematical models to ask the question of how EVT access could be improved. Would it be better to open more EVT centers, which they referred to as flipping? Or would it be better to make changes in emergency transportation systems to allow ambulances to bypass the closest non-EVT center to instead take patients who appear to have LVO to a center that offers EVT?

The researchers found that converting the top 10 percent of non-EVT centers to EVT centers would increase the direct coverage level from 19.8 percent to 27.1 percent. In comparison, using the bypass approach would increase access to EVT by 36.5 percent nationwide, with better or less results in some regions.

Overall, for the majority of states bypassing resulted in better coverage than flipping, the researchers concluded.

The study had several limitations, including the fact that the researchers used the criterion of one or more EVT claims to determine if a center was EVT-capable. The study did not consider volume of EVT procedures, outcomes, or costs of adding an EVT center at a hospital. They also did not consider the details of any given region or community, such as geography, traffic, availability of specialists who perform EVT, or the risk for stroke in the community. The makeup and size of a community's ambulance system could also influence whether the flipping or bypass model is better. The Mobile Stroke Unit in Houston, for example, is equipped to do CTs (which can detect LVO) and start tPA en route to the hospital.

One size by all means does not fit all, said Dr. Grotta. But he said every community should give thought to how to best improve access to EVT because this treatment (EVT) is extremely effective so there is an urgency to address this question.

David S. Liebeskind, MD, FAAN, professor of neurology at University of California Los Angeles and director of the UCLA Comprehensive Stroke Center, said that while the new study provided a useful theoretical look at how to improve access to EVT, any real-time local or state planning needs to engage all the stakeholders, including doctors, hospitals, community members, and public health officials. He said outcomes should be a key focus because there is a correlation between the number of EVTs done at a hospital and patient outcomes, with higher volume associated with better outcomes.

Everyone at the onset of stroke thinks the treatment should be straight forward and easy... that as long as you do your part (with EVT) the patient will do fine, said Dr. Liebeskind, president of the Society of Vascular and Interventional Neurology. But many stroke cases are complex and require expertise at all phases of care, not just in the endovascular suite.

Dr. Liebeskind said EVT centers tend to be financially desirable to hospitals, but he said market forces don't necessarily lead to an efficient distribution of resources or a system that gets the right patient to the right center at the right time.

He said there are more than 20 EVT centers in Los Angeles County, yet there are some pockets of the community that have limited access, whether due to geography or traffic congestion at peak times of day.

Dr. Liebeskind said that advances in telemedicineincluding the potential to perform EVT procedures remotelycould help improve access issues in rural or more remote communities.

Johanna T. Fifi, MD, FAAN, associate professor of neurology, neurosurgery and radiology and associate director of the Cerebrovascular Center at Mt. Sinai Hospital in New York City, said her hospital system has devised a model of care in which a team of EVT providers covers four different sites, including the main hospital and three others in its network.

Our team travels to the patient, she said. That model leads to our providers being very experienced. We do it (EVT) more often so our team is more experienced.

She said that the model also produces good outcomes by measure of the time it takes to get stroke patients into the procedure.

We find it's basically faster, than transferring the patient to the comprehensive stroke center, said Dr. Fifi, who added that a student researcher presented some of the results at the International Stroke Conference last month in Los Angeles.

Dr. Fifi said that while New York City overall has adopted a model of care that allows for ambulances to bypass a non-EVT center in favor of an EVT center based on a clinical assessment scale, she does not think that the bypass model favored in the new study is perfect.

No matter what, you are going to have some transfers of stroke patients from one center to another, Dr. Fifi said. You can't say you are going to do bypassing and expect no transfers.

M. Shazam Hussain, MD, director of the Cerebrovascular Center at the Cleveland Clinic, said that while it makes sense to say emergency responders should strive to identify patients who probably have LVO and could benefit if they are taken to an EVT center, what you really want to do is identify whether it's a severe stroke or a not a severe stroke. More severe strokes, regardless of the reason, need to be treated in larger, more equipped centers.

The Cleveland Clinic, a 12-hospital network, offers EVT at its main campus and three network hospitals, Dr. Hussain said, and some other hospitals in the area offer it as well.

Dr. Hussain said that a downside to adding more EVT centers to improve access in underserved areas is that you end up diluting the number of patients at each center, which could affect quality. But the bypass model, has some downsides as well, such as tying up emergency responders, and potentially delaying other critical treatments, such as thrombolysis, he said.

In organizing the ideal design and distribution of stroke care, so much comes down to regional and local factors, he said. Trying to mandate something so broadly across the country would be impossible.

Dr. Grotta receives consulting fees from Frazer Ltd., which manufactures mobile stroke units, and grant support from Genentech, which markets tPA. Dr. Liebeskind disclosed that he receives consulting fees from Imaging Core Lab for Cerenovus, Genentech, Medtronic, and Stryker. Dr. Fifi had no disclosures.

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Nearly 80 Percent of Americans Don't Have Timely Access to... : Neurology Today - LWW Journals

The Food and Drug Administration (FDA) has approved Zeposia (ozanimod; Bristol-Myers Squibb) for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults.

Ozanimod, a sphingosine 1-phosphate (S1P) receptor modulator, binds with high affinity to S1P receptors 1 and 5 and blocks the capacity of lymphocytes to egress from lymph nodes, reducing the number of lymphocytes in peripheral blood.The mechanism by which it exerts therapeutic effects in MS is unknown but may involve the reduction of lymphocyte migration into the central nervous system.

The approval was based on data from 2 double-blind, parallel-group, active comparator-controlled clinical trials in patients with relapsing forms of MS. Both studies included patients who had experienced at least 1 relapse within the prior year, or 1 relapse within the prior 2 years with evidence of at least a gadolinium-enhancing (GdE) lesion in the prior year, and had an Expanded Disability Status Scale score from 0 to 5.0 at baseline.

Patients were randomized to receive ozanimod 0.92mg given orally once daily, beginning with a dose titration, or interferon beta-1a 30mcg given intramuscularly once weekly. The primary end point of both studies was annualized relapse rate (ARR) over the treatment period.

Results showed that in both trials, the ARR was statistically significantly lower in patients treated with ozanimod than in patients who received interferon beta-1a (Study 1: ARR 0.181 vs 0.350, respectively; Study 2: ARR 0.172 vs 0.276, respectively). Compared with interferon beta-1a, ozanimod demonstrated a relative reduction in ARR of 48% (P<.0001) through 1 year (Study 1) and 38% (P <.0001) at 2 years (Study 2). A similar effect was observed in exploratory subgroups defined by sex, age, prior nonsteroid therapy for MS, and baseline disease activity.

Moreover, the number of new or enlarging T2 hyperintense lesions and the number of GdE lesions were found to be statistically significantly lower in ozanimod-treated patients compared with patients who received interferon beta-1a.

With regard to safety, the most common adverse reactions associated with treatment included upper respiratory tract infection, hepatic transaminase elevation, orthostatic hypotension, urinary tract infection, back pain, and hypertension.

Ozanimod is contraindicated in patients who in the last 6 months, have experienced a myocardial infarction, unstable angina, stroke, transient ischemic attack, decompensated heart failure requiring hospitalization, or Class III or IV heart failure; have the presence of Mobitz type II second degree or third degree atrioventricular block, sick sinus syndrome, or sinoatrial block, unless the patient has a functioning pacemaker; have severe untreated sleep apnea; or are taking a monoamine oxidase inhibitor.

Before initiating therapy, a complete blood count (with lymphocyte count), an electrocardiogram, and liver function tests should be obtained; in patients with a history of uveitis or macular edema, an ophthalmic assessment is required.

Zeposia is supplied in 0.23mg, 0.46mg, 0.92mg strength capsules. According to BMS, commercialization will be delayed due to the COVID-19 pandemic.

For more information visit bms.com.

This article originally appeared on MPR

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Oral Therapy Ozanimod Approved for Relapsing Forms of Multiple Sclerosis - Neurology Advisor

In the interests of the health, safety and wellbeing of all registered attendees and the wider public, the European Academy of Neurology (EAN) has cancelled all face-to-face activities and in-person attendance at its Annual Congress, scheduled to take place in Paris from May 23-26. Instead, attendees and speakers will have the opportunity to participate from home via the EAN Virtual Congress 2020, which will take place online. This decision has been taken due to the increasing public health burden throughout the world caused by the COVID-19 Coronavirus pandemic and to support public authorities globally in their effort to slow the spread of the disease.

The EAN Virtual Congress 2020 will allow attendees and speakers to participate from their computers without leaving their homes, no matter where they live. Difficult times ask for creative and courageous solutions which may also open new avenues for a better future. says Prof. Claudio Bassetti, Acting President of EAN, who goes on to explain that We must stay positive, strong and united more than ever to come through this crisis, which is why EAN, along with its partners, is playing its part in the fight against the pandemic by offering the online participation in the EAN Virtual Congress free-of-charge.

With conferences across many industries and fields already cancelled without online replacements, the EAN Virtual Congress is set to be one of the few meetings in neurology, as well as the biggest in 2020, as the conventional congress normally attracts more than 6,000 participants each year.

For those who have already registered for the EAN Paris 2020 Congress, fees will be refunded as soon as possible, and EAN is already contacting registered attendees. Registration for the EAN Virtual Congress will open on April 5, 2020 and will be available via the EAN website (www.ean.org).

About EAN

The European Academy of Neurology (EAN) is Europes home of neurology. Founded in 2014, through the merger of two European neurological societies, EAN represents the interests of more than 45,000 individual members and 47 national institutional members from across the continent. Each year, EAN brings together more than 6,000 neurologists and related scientists to the biggest general neurology conference in Europe. In addition to its overarching theme of Predict, Prevent, Repair, which are the three main challenges in dealing with neurological diseases, the EAN Virtual Congress 2020 will also cover all neurological diseases and disorders, including the big seven: epilepsy, stroke, headache, multiple sclerosis, dementia, movement disorders, neuromuscular disorders.

For further updates & information:For support regarding registrations & travel bookings for the Paris congress contact: registration@ean.org

For information related to the industry exhibition and sponsorship contact: industry@ean.org

For general information related to the EAN Virtual Congress see the FAQ page: https://www.ean.org/paris2020/FAQs.4318.0.html

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Neurology congress goes virtual to give attendees access during COVID-19 pandemic - New Zealand Doctor Online

The Global Neurology Software Market report draws precise insights by examining the latest and prospective industry trends and helping readers recognize the products and services that are boosting revenue growth and profitability. The study performs a detailed analysis of all the significant factors, including drivers, constraints, threats, challenges, prospects, and industry-specific trends, impacting the market on a global and regional scale. Additionally, the report cites worldwide market scenario along with competitive landscape of leading participants.

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The Neurology Software market analysis is intended to provide all participants and vendors with pertinent specifics about growth aspects, roadblocks, threats, and lucrative business opportunities that the market is anticipated to reveal in the coming years. This intelligence study also encompasses the revenue share, market size, market potential, and rate of consumption to draw insights pertaining to the rivalry to gain control of a large portion of the market share.

Leading Players in the Neurology Software Market: Epic, Bizmatics, Athenahealth, healthfusion, Allscripts, Nextgen, Brainlab, Greenway Health, Kareo, Practice Fusion, Advanced Data Systems, NueMD and more

Competitive landscape

The Neurology Software Industry is extremely competitive and consolidated because of the existence of several established companies that are adopting different marketing strategies to increase their market share. The vendors engaged in the sector are outlined based on their geographic reach, financial performance, strategic moves, and product portfolio. The vendors are gradually widening their strategic moves, along with customer interaction.

Neurology Software Market Segmented by Region/Country: US, Europe, China, Japan, Middle East & Africa, India, Central & South America

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Type of Neurology Software Market:

Advanced Neurology EMR Software

Other

Application of Neurology Software Market:

Hospitals

College & Research Institutes

Other

Points Covered in the Report:

Access full Report Description, TOC, Table of Figure, Chart, etc. @ https://www.reportsweb.com/buy&RW00013259021/buy/3660

Thanks for reading this article; you can also customize this report to get select chapters or region-wise coverage with regions such as Asia, North America, and Europe.

Table of Content

Chapter 1: Industry Overview

Chapter 2: Neurology Software Market International and China Market Analysis

Chapter 3: Environment Analysis of Market.

Chapter 4: Analysis of Revenue by Classifications

Chapter 5: Analysis of Revenue by Regions and Applications

Chapter 6: Analysis of Neurology Software Market Revenue Market Status.

Chapter 7: Analysis of Industry Key Manufacturers

Chapter 8: Conclusion of the Neurology Software Market Industry Research Report.

Continued to TOC

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Global Neurology Software Market 2020-2025: Increasing demand with Industry Professionals like Greenway Health, Kareo, Practice Fusion, Advanced Data...