The Lead

Findings from a report written by the Canadian Association of Physicians for the Environment show that the chemicals involved in the fracking of natural gas have wide-ranging impacts on humans including the potential for birth defects, cancer, neurological issues, psychological impacts, disease and illness, reports the Toronto Star.

According to Dr. Melissa Lem, a board member of the association, the majority of the reports research comes from the United States. She stressed that Canadas fracking practices still need to be better understood.

Canadians have to be aware that fracking is happening in our country and that its causing some extreme harms to our water sources, our air quality, our land, and also contributing to the climate crisis, she said.

Were hoping by bringing the health voice to this issue, that we can help change peoples minds and just make them more aware.

The report says that Canada is the fourth largest producer of natural gas in the world and recommends a rapid and just transition away from natural gas and oil extracted with fracking to clean and equitable renewable energy sources.

Internationally

Ovintiv Inc. previously Encana Corp. is expected to meet with investors today to discuss the companys progress since purchasing Newfield Exploration Co. for US$5.5 billion in 2018. The oil giant decided to ditch Canada in order to improve its standing, but there hasnt been a large improvement since Ovintiv began to trade on the U.S. market this past Monday. Shares have dropped nine per cent in two days, according to Bloomberg.

On Wednesday morning, Brent Crude was at US$59.13 and West Texas Intermediate US$53.64.

In Canada

Canadian Natural Resources Ltd. is opposed to Enbridge Inc.s newest proposal to turn services from the mainline pipeline project into long-term contracts, as opposed to the existing monthly services. According to a filing that the company made with the Canada Energy Regulator, changing the contracts would be an abuse of Enbridges market power, reported Bloomberg.

The proposed conversation of the Mainline from common carriage to contract carriage is unprecedented and inconsistent with the common carriage obligations established in the CER Act, Canadian Natural wrote in the filing.

In other news, the federal government has until the end of February to decide whether or not to approve the $20.6 billion Frontier mine proposed by Teck Resources Ltd. There is also the potential that the minority Liberal government could delay the project, Environment Minister Jonathan Wilkinson stated, according to the Calgary Herald.

Noteworthy

In Opinion

When asked about the indecision on the Frontier mine project on Monday, Premier Jason Kenney said responding to First Nations and Indigenous Canadians doesnt simply mean saying no when theres some opposition. It means saying yes to projects and prosperity when there is a broad Indigenous support. Rick Bell has more in his latest for the Calgary Herald.

More from iPolitics

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The Drilldown: Neurological problems, birth defects and cancer among possible health risks linked to fracking - iPolitics.ca

CLEARWATER, Fla., Feb. 4, 2020 /PRNewswire/ --Florida Spine Institute (FSI)is the leading, and one of the most trusted, medical facilities specializing in pain management, neurology, surgery, physical medicine and rehabilitationin Tampa Bay. FSI offers a comprehensive wellness program with a multi-disciplinary spine care team, and board-certified diagnostic, medical, and surgical specialists that provide the most advanced care available. All patient consultations and most treatments are done on a single campus.

The state-of-the-art treatment modalities offered range from physical therapy and a variety of injections to procedures including radiofrequency ablation, spinal cord stimulation implants, toKetamine treatmentsand regenerative medicinesuch as stem cell treatments. Each patient's treatment is customized for the best results.

The Florida Spine Institute has a team of elite spine, neuro, and orthopedic surgeonswho combine surgical skills with experience for the most accurate and effective treatment. Our focus is on minimally invasive spine surgical techniques, motion preservation surgery, cervical and lumbar disc replacement surgery, as well as disc restoration.

FSI offers physical medicine and rehabilitation, a branch of medicine emphasizing the prevention, diagnosis, and treatment of nerve, muscle, bone and brain disorders. The Florida Spine Institute also has a friendly and relaxed in-house MRI imaging center, saving our patients valuable time to access this sophisticated procedure.

Neurologytreats disorders of the nervous system which include the brain and spinal cord, and the peripheral nervous system. Our staff neurologistis board certified by the American Board of Psychiatry & Neurology, the American Board of Electrodiagnostic Medicine, and the American Academy of Balance Medicine. He specializes in the treatment of headache, stroke, and epilepsy.

Botox injections, an FDA-approved treatment, has been safely used for treating various medical conditions since 1989, including muscle spasms, myofascial pain, headache, and back and neck pain. Our physicians can use Botox injections in a safe and effective manner to help ease your pain.

A relatively new cutting-edge treatment, Radiofrequency Ablation (RFA), is often favored over laser spine surgery because it utilizes smaller needles, so it is less invasive and is covered by insurance. RFA is used to treat not only neck and back pain, but also hip and knee pain.

IV Ketamine Infusion Therapy is the latest breakthrough treatment that is producing extraordinary results. Ketamine blocks receptors in the brain that, when overstimulated, are responsible for releasing chemicals that cause inflammation of the nervous system. IV Ketamine treatment has been found to be very effective in treating Depression, Pain, CRPS, PTSD, Fibromyalgia, Lyme Disease and more with excellent results.

Regenerative medicine is a game-changing area of medicine with the potential to heal damaged tissues and organs, offering solutions and hope for people who have conditions that might otherwise be thought to be beyond repair. The Florida Spine Institute offers cutting-edge regenerative medicine therapies that can help you feel better. From stem cell therapy to amniotic tissue treatments, we have a solution that is customized for you.

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But now, at ages 81 and 73, respectively, Dershowitz and Starr are back at center stage. They are the latest faded luminaries seeking to revive their fameand blemish their reputationby shilling for Donald Trump. Call it the revenge of the has-beens.

Theres nothing new about aging celebrities craving a return to the limelight. Many of Americas most famous athletesMichael Jordan, Mario Lemieux, Reggie White, Ryne Sandbergcame out of retirement, usually with unhappy results. Gary Harta serious contender for the Democratic presidential nomination in 1984 and 1988almost launched a long-shot bid two decades later, in 2004. George McGovern, the Democratic nominee in 1972, ran again quixotically in 1984. Mike Gravel, a former senator from Alaska who achieved notoriety by entering the Pentagon Papers into the official Senate record in 1971, unsuccessfully sought the 2008 Democratic and libertarian presidential nominations and enteredand soon dropped out ofthe Democratic presidential race last year, at the age of 89.

The impulse isnt hard to understand. Donna Rockwell, a co-author of one of the few academic studies on the psychology of celebrity, told me, Fame is an addiction like any other addiction where ones neurological set gets acclimated to a particular level of incoming stimuli. When that recedes, the neurology keeps grasping after that People become addicted to being in the show. And once youve been in the show and you know the heady experience that that is, there is a clamoring forevermore to be back in the show. A former child actor told Rockwell, Ive been addicted to almost every substance known to man at one point or another, and the most addicting of them all is fame.

David Graham: Does anyone dare tell Trump the truth?

Whats new in the Trump era isnt the yearning for political rehabilitation, but the opportunity. Trumps recklessness, cruelty, and corruption have led many Republicans in the prime of their career to avoid working for, or publicly defending, him. Help Wanted, read a 2017 Washington Post headline: Why Republicans Wont Work for the Trump Administration. In 2018, CNN reported that Trump was experiencing an unheard-of problem: The president cant find a lawyer.

This has provided the has-beens their opening. One early example was Paul Manafort, who in the Ronald Reagan era helped run a lobbying firm that Newsweek once called the hottest shop in town. But by 2016, as my colleague Franklin Foer has detailed, this once indispensable man, now in his late 60s, was no longer missed in professional circles. He was without a big-paying client, and held heavy debts. The Trump campaign, which Manafort briefly ran, offered a return to relevance.

While Manafort was angling to be Trumps campaign manager, Newt Gingrich was angling to be his running mate. Two decades earlier, Time had named Gingrich, then the 52-year-old Republican speaker of the House, its Man of the Year. But after a failed 2012 presidential bid, Gingrichs star had dimmed, an excruciating prospect for a man who once said, If youre not in The Washington Post every day, you might as well not exist.

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Defending Trump Is a Has-Beens Best Hope - The Atlantic

January 21, 2020

The 5 'anxiety traps' you fall into at workand how to escape them (Monday, Jan. 13)Writing for the Harvard Business Review, leadership adviser Sabina Nawaz outlines five "anxiety traps" that often occur at work and how to deal with them.

This flu season could be one of the worst in decades (Tuesday, Jan. 14)Officials are comparing this season to the 2017-2018 season, which was the deadliest in more than 40 years.

Between life and death: What a neurologist learned when his brother-in-law fell into a coma (Wednesday, Jan. 15)In neurology, there's a "middle ground" between life and death that providers and patients' family members alike struggle to navigatebut a new subspecialty could help improve communication around patients' care, Joseph Stern, a neurologist who's found himself on both the provider and family side of these difficult brain injuries, writes for the New York Times' "Well."

The happiest physiciansand the most burned-out ones in 2020, according to Medscape (Thursday, Jan. 16)More than 40% of physicians are burned out, but some specialtiesand generationsare suffering more than others, according to Medscape's 2020 National Physicians Burnout & Depression Report.

Millennials are sicker and poorer than prior generations. Here's how that's changing health care. (Friday, Jan. 17)Millennials are delaying care because of costs, have higher medical debt than previous generations, and are sicker than earlier generations were at the same agebut the generation is also poised to spur change in the U.S. health system, Daily Briefing's Ashley Fuoco Antonelli writes.

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Weekly review: The 5 'anxiety traps' you fall into at workand how to escape them - The Daily Briefing

Article In Brief

The Physician Fee Schedule for 2020 brought better news this year, as neurologists and other cognitive specialists will be able to bill for more of their time for E/M codes, among other changes.

What a difference a year makes!

In the summer of 2018, the Centers for Medicare and Medicaid Services (CMS) issued proposed changes to the Medicare Physician Fee Schedule that would have collapsed the existing five-tier Evaluation and Management (E/M) code structure, with blended payment rates for office and outpatient visits billed at the second through fifth levels.

Clinicians practicing in a number of specialties stood to lose reimbursement dollars under the proposal, but neurologists would have taken one of the worst hits.

A study published in JAMA Neurology calculated that neurologists would lose a median of $3,226 annually and cardiologists would lose a median of $3,203, while dermatologists and orthopedists would get an annual median boost of $16,655 and $6,239, respectively.

A veritable blizzard of comments and advocacy from neurologists and other physicians practicing in cognitively-focused specialtiesmuch of it led by the AANconvinced the CMS to delay and re-evaluate their proposal. And then, on July 29, 2019, the agency unveiled a new plan, designed to align its E/M coding with changes laid out by the American Medical Association (AMA)'s CPT Editorial Panel for office/outpatient E/M visits.

The Final Rule, officially released on November 1 for implementation in 2021, maintains the existing five levels of coding for established patients and reduces the number of levels for new patients to four, by eliminating the code 99201.

The proposed changes also allow clinicians to choose E/M visit levels using either medical decision-making or time. CMS also proposed the addition of an add-on code (15-minute increment) for prolonged service time, and a separate add-on code to recognize the complexity inherent to E/M services that are part of ongoing care related to a patient's single, serious, or complex chronic condition.

What does that mean for practicing neurologists? It's a swing of $150 million a year annually in the positive direction, Daniel Spirn, AAN's senior regulatory counsel told Neurology Today. Documentation guidelines have also been simplified, news that every practicing neurologist will likely welcome. This really is one of our biggest advocacy wins ever, he said.

It's a major landmark success, agrees Brad C. Klein, MD, MBA, FAAN, a neurologist in private practice at Abington Neurological Associates in Willow Grove, Pennsylvania and clinical associate professor of neurology at Thomas Jefferson University who is a member of the AAN Board of Directors and chair of the Medical Economics and Practice Committee.

For years it's felt like our reimbursement for cognitive care has continued to drop at the expense of other more procedural specialties, and this is a major turnaround. That face-to-face time we spend with patients can really change a person's life.

Last year's proposal posed a major threat to neurologists' time with patients, said Kara Stavros, MD, a neurologist at Rhode Island Hospital and assistant professor of neurology at The Warren Alpert Medical School of Brown University, and a member of the AAN Advocacy Committee.

E/M services are so important for what we do as neurologiststhe time we spend with patients to make the diagnosis, counsel, and manage the condition. For example, I'm a neuromuscular specialist treating patients with very complex conditions like muscular dystrophy or ALS, and if I can't spend an appropriate amount of time with them, their care will suffer. It's gratifying to see that the intensity of what we do is valued by CMS, and that they recognize the importance of the time we spend with our patients.

Advocacy by the AAN and its members across the country played a critical role in CMS' about-face, Spirn says. We quickly and aggressively responded to last year's proposed fee schedule. In the last half of 2018 alone, we had five different meetings with staffers at the Department of Health and Human Services and 54 meetings on Capitol Hill, all pushing CMS not to collapse the E/M codes. And over 700 AAN members contacted their Members of Congress in response to our advocacy alerts.

A January 2019 letter to the AAN from Deputy Secretary of Health and Human Services Eric Hargan praised the organization's efforts, saying We appreciated the input of Dr. [Marc] Raphaelson [a member of the AAN Health Policy Subcommittee and AAN RVS Update Committee (RUC) Representative] and Mr. Spirn, who highlighted for us the challenges faced by neurologists in today's reimbursement environment and the advantages of using time as a variable in coding E&M visits.

The Academy also received the American Association of Medical Society Executives (AAMSE) Profiles of Excellence award for its regulatory advocacy pushing back against the proposed changes. This truly was a full court press and the AAN pulled it off, said the AAMSE award judge.

And the AAN didn't rest on its laurels after the 2018 success. In March 2019, AAN members and staff met with CMS leadership, stating the case for the value of E/M services and their critical importance to neurologists. The Academy also participated in all the meetings of the AMA's E/M workgroup, setting the groundwork for what CMS ultimately proposed and finalized this year in the November Final Rule for 2021 implementation.

Even after the proposal came out in July, we have been actively involved in making sure that CMS would finalize these very positive reimbursement trends for neurology, Spirn said.

These efforts included a 41-page comment letter to CMS and an editorial from AAN President James C. Stevens, MD, FAAN, and the president of the American College of Rheumatology published in Fierce Healthcare, both supplementing the AAN's previous meetings with CMS on the subject. In the end, CMS did finalize the proposal as we wanted to see it, Spirn said.

Although the rule is titled 2020 Medicare Physician Fee Schedule, that name is misleadingthe new codes won't go into effect until January 1, 2021.

Dr. Klein said that the AAN will offer a host of educational programming over the next year to help members prepare for the new fee schedule, beginning with a webinar on December 12 and including extensive offerings at the 2020 Annual Meeting in Toronto in April. (See the website at http://www.aan.com for further details and updates.)

Not all the news about reimbursement for next year is good. CMS has also established a new coding structure for reporting long-term EEG monitoring services beginning in 2020 that likely will have a negative financial impact on some neurologists.

These changes had been in the works since November 2016, when CMS identified CPT Code 95951 (long-term EEG monitoring with video) as a high-volume service, as growth in Medicare claims exceeded 10,000 and increased by at least 100% from 2009 -2014.

The problem with this code is that it was really intended for a monitored service in the inpatient setting, but the description is left open to interpretation such that it could be done in an unattended outpatient setting, not requiring much expense, and generate a lot of income, said Dr. Klein. In short, CMS felt it was being reimbursed too much.

Among the changes in the revision:

These changes will lead to a significant decrease in reimbursement for some neurologists and institutions, particularly given that physician work RVUs (wRVUs) are lower than for the current codes, reflecting efficiencies that have developed in EEG monitoring over the past two decades.

But it could have been worse. Medicare's original proposal rejected the RVU valuations for four of the ten physician work proposed by the AMA's RVS Update Committee (RUC) based on surveys of neurologists across the country.

In response, the AAN engaged in a major advocacy effort in partnership with the American Epilepsy Society, the National Association of Epilepsy Centers, and the American Clinical Neurophysiology Society, to educate Medicare that the devaluation of these four RUC values was not fair or accurate, said Dr. Klein. Ultimately, CMS agreed to bring those code values back up to the level recommended by the RUC. Even though this represents a financial loss to neurologists, there were a lot of steps along the way where it could have been a lot worse.

In another new wrinkle, Medicare elected not to establish national values for the technical component codes. Instead, rates will be set by each Medicare Administrative Contractor (MAC), for their geographic jurisdiction. Private health care insurers will also set their own payment rates and are subject to independent negotiations with health care providers, as is the case with any existing service.

This is something physicians rarely considered, said Dr. Klein. Previously, we always had a global value for the work involved in EEG services. Now, we will see a value of zero for the technical components. To find out our payment rates for these codes, we have to take the extra step and reach out to our local MACs, and these rates will be non-negotiable. However, we will also have to reach out to our commercial payers, where these rates may be up for discussion. Regardless, these changes are going to have an impact on decisions like buying new equipment, staffing, and what services will be provided. Whether in an academic center or private practice, providers will need to understand these nuances to make the right decisions for their practice.

Unlike the physician fee schedule, the EEG changes officially go into effect on January 1, 2020. We are working to help our members who do a lot of EEG work transition to the new codes, said Elaine C. Jones, MD, FAAN, a member of the AAN's Board of Directors who has chaired the AAN's Government Relations Committee and currently chairs the Coding and Payment Policy Subcommittee.

We will also be working with the insurers on the payment decisions that are being pushed back to the regional MAC carriers regarding what is appropriate reimbursement and monitoring how that rolls out going forward as well.

Dr. Jones also urged members to pay attention to changes in chronic care management codes, which include new and enhanced care management services and even two new codes for Principal Care Management.

When the original codes initially came out, they were rather difficult for neurologists to use because of excessive documentation requirements, and because it was unclear whether or not they could be billed by multiple providerssuch as discharge monitoring and transitions of care for a patient who has visits with both a primary care provider and a neurologist, she says.

Now, I think these changes mean we will be able to incorporate them a little more easily. We're already doing this kind of care management now, and it's less difficult to bill for than it was, so this represents revenue we can start picking up.

This is a real opportunity for those who can take advantage of these codes, said Joel M. Kaufman, MD, FAAN, chair of the Care Delivery Subcommittee of the AAN's Medical Economics & Practice Committee.

It's true that procedures like long-term EEG monitoring have been an incredibly useful tool in neurology, but with these changes, there's an opportunity to balance the need to do procedures with the importance of managing patients with chronic conditions.

Overall, said Spirn, these developments underscore the AAN's growing role as a thought leader in healthcare policy. There used to be a time when we could only hope CMS and HHS leaders would meet with us. Now, we often meet several times a year, and agency leadership takes time to write us letters thanking us for our feedback and involvement. That's an incredible shift in how they see the AANas a resource they can go to when making policy.

That shift can be credited to the AAN's approach to advocacy. It's not about protecting the physicians' pocketbooks or making more money; it's about the right thing for the patients, Dr. Jones said.

We feel that we do better by making our care better and improving our patients lives. That's what the AAN focuses on, and as a result, it has really become recognized as a fair and thoughtful voice out there for the right way to do health care.

Dr. Klein has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Allergan, Amgen, Biohaven, Depomed/Assertio, Eli Lilly and Company, Teva, US WorldMeds, Promius, Eagalet, and the AAN. Dr. Klein has received compensation for serving on the board of directors of Appsbydocs, LLC, and Makers of P-Cog. Dr. Klein has received research support from Allergan, Alder Pharmaceuticals, and Eli Lilly and Company. Dr. Jones has been reimbursed for travel and lectures for MER, a CME company.

Link:
Neurologists and Neurologic Care to Benefit from... : Neurology Today - LWW Journals

Spinalcord stimulation (SCS) with a closed-loop system that uses recorded evokedcompound action potentials (ECAPs) is superior to a fixed-output, open-loopsystem for patients with chronic back and leg pain, according to study resultspublished in Lancet Neurology.

While SCS has been a well-established treatment for chronic pain for more than 50 years, the results are suboptimal. The major challenge in SCS is the changing distance between the stimulating electrodes and their spinal cord target, because while the spinal cord changes position within the cerebrospinal fluid with every movement, the electrode is fixed in the epidural space.

Theavailable SCS systems are open-loop systems and do not measure or adjust forchanges in the electrical field strength reaching the spinal cord, leading tounpredictable inhibition of pain-processing pathways. An ECAP-controlled,closed-loop system can change the stimulation output current as needed.

Thegoal of the current double-blind, randomized-controlled study was to comparethe safety and efficacy of ECAP-controlled, closed loop SCS with that of fixed-output,open-loop SCS for patients with chronic back and leg pain.

Thestudy included patients with chronic intractable pain of the back and legs whowere refractory to conservative therapy and on stable medications. Theparticipants were randomly assigned to receive ECAP-controlled closed-loop SCSor fixed-output, open-loop SCS.

Theprimary objective was to show noninferiority, and then to test the superiority,of closed-loop SCS compared with open-loop SCS. The primary outcome, tested at3 and 12 months after the permanent implant, was a composite outcome thatincluded the proportion of patients who responded to SCS with a 50% reductionin overall back and leg pain as determined by visual analog scale score, withno increase in analgesics.

Thestudy enrolled 134 participants: 67 were assigned to closed-loop(investigational) group and 67 to open-loop (control) group.

Inthe intent-to-treat population, the percentage of responders with 50% reductionin overall back and leg pain and no increase in pain medications at 3 monthswas 82.3% (51 of 62 patients) in the closed-loop group vs 60.3% (38 of 63 patients)in the open-loop group. At 12 months the response rates were 83.1% (49 of 59patients) and 61.0% (36 of 59 patients), respectively. Noninferiority was demonstratedat 3 months (P <.0001) and 12 months (P <.0001), as wassuperiority (3 months, P =.0052; 12 months, P =.0060).

Thetype, nature, and severity of adverse events were similar between treatmentgroups. There were 23 adverse events in 13 patients (19%) in the closed-loopgroup and 11 adverse events in 11 patients (16%) in the open-loop group. Themost common study-related adverse events were lead migration, implantable pulsegenerator pocket pain and muscle spasm or cramps.

LawrencePoree, MD, MPH, PhD, Director of Neuromodulation Service, Division of PainMedicine at University of California, San Francisco and the senior author ofthe study commented that these are impressive clinical outcomes forcomprehensively managing patients pain effectively over the long term. Themore than 50 percent of closed-loop patients who reached high responder statusof greater than or equal to 80% reduction in overall pain also demonstratedclinically meaningful changes in secondary patient-reported outcomes,emphasizing the value of achieving this high threshold.

Closed-loopspinal cord stimulation provided greater levels of spinal cord activation,within the therapeutic window, which suggests a mechanistic explanation for thesuperior results. Although preliminary, we believe this is the first step inthe field of neuromodulation, moving towards a mechanism-based, personalisedtherapy founded on an objective outcome measure, concluded theresearchers.

Disclosure: This clinical trial was supported by Saluda Medical. Please see the original reference for a full list of authors disclosures.

Reference

Mekhail N, Levy RM, Deer TR, et al. Long-term safety and efficacy of closed-loop spinal cord stimulation to treat chronic back and leg pain (Evoke): a double-blind, randomised, controlled trial [published online ahead of print, 2019 Dec 20]. Lancet Neurol. 2019;S1474-4422(19)30414-4. doi:10.1016/S1474-4422(19)30414-4

This is part 1 of a 2 part feature. In part 2 Neurology Advisor interviews Nagy Mekhail, MD, PhD, Professor at the Cleveland Clinic Lerner College of Medicine, Director of Evidence-Based Pain Medicine Research and Education in the Department of Pain Management at the Cleveland Clinic, and first author of this study.

See the article here:
Closed-Loop Spinal Cord Stimulation for the Management of Chronic Back and Leg Pain [Part 1] - Neurology Advisor

By Jamie Talan January 9, 2020

A new study suggests that disrupted sleep throughout older age is accompanied by microglial cells that age faster and become overly active, potentially contributing to cognitive impairment.

Older adults who had experienced greater fragmented sleep showed higher levels of a gene signature suggestive of aged microglia, and they performed worse on annual cognitive tests.

The findingswhich were based on data from two prospective, observational, community-based studies of older persons who had donated their brains and medical records for research purposesunderscore the role that poor sleep can play in late life and cognition.

These findings add more evidence that fragmented sleep is bad for the brain, said Andrew S.P. Lim, MD, associate professor of neurology at University of Toronto and senior investigator of the study, published December 11 in Science Advances. It means that sleep problems in older people need to be taken seriously.

More research is needed to test whether modifying sleep can reverse these changes, and to figure out how much sleep fragmentation is enough to trigger activated microglia or other changes in the brain's innate immune cells that regulate inflammation and other immune system functions, Dr. Lim said.

There is growing evidence that microglia play a role in Alzheimer's disease (AD) and in sleep. Understanding microglia biology could ultimately allow us to target pathways in the brain that can reverse these problems, said Dr. Lim, a sleep neurologist.

Dr. Lim and his colleagues drew data from the Rush Memory and Aging Project and the Religious Orders Study. At the time of this assessment, 685 adults, 65-years-old or older265 with AD and 420 withoutwere enrolled in the study. A subset of study participants agreed to an annual test to measure movement during sleep. Results from this wristwatch-like accelerometer were paired with their yearly cognitive test scores. In subsets of participants, the autopsied tissue was also tested in two ways: first, neocortical microglial gene expression was quantified by RNA sequencing and then, neocortical microglial density and morphologic activation was assessed by immunohistochemistry.

The researchers reported that people who had more sleep fragmentation had higher expression of marker genes characteristic of aged microglia, an increased level of activated microglia, and worse cognition before they died. The problems with sleep fragmentation and its relationship to expression of genes related to aging microglia, and worsening scores on cognitive tests were present in patients with AD, as well as people who were not diagnosed with AD, said Dr. Lim.

The transcriptional changes were independent of chronological age, density of microglia, and dementia-related brain pathologies and were not completely accounted for by the increased density of morphologically activated microglia, the study authors wrote. ...These findings raise the possibility that microglial aging and activation may be a consequence of sleep fragmentation and may link sleep fragmentation to poor cognition in older adults.

The researchers are still not sure whether microglial aging or activated microglia leads to sleep fragmentation or whether waking up throughout the night triggers microglial aging and activation, and how this contributes to dementia pathologies.

It is possible that both processes play a role in what Dr. Lim and his colleagues called a two-hit model.

They wrote that it is also possible that greater sleep fragmentation is associated with higher expression of genes characteristic of aged microglia, irrespective of the presence or absence of AD pathology, but the subsequent impact of microglial transcriptional aging on cognition is greatest in those who also have AD pathology, in whom microglial transcriptional aging amplifies the cognitive impact of AD pathology.

The scientists said that they need to study sleep fragmentation in middle-aged people to understand how long the problem exists before it leads to changes in gene expression and activated microglia.

This is an exciting and interesting paper linking sleep fragmentation to microglial function that could open the door to new insights into how sleep protects the brain, said Erik S. Musiek, MD, PhD, associate professor of neurology at Washington University School of Medicine in St. Louis.

There are a number of studies suggesting that sleep disruption can increase inflammation in the periphery, and some animal studies show a relationship between sleep loss and inflammation in the brain. This study supports those previous findings and adds a new wrinklesleep fragmentation. This method to measure sleep fragmentation is quite powerful and has previously been used to correlate sleep fragmentation and risk of incident dementia. The participants in the study had their sleep measured on average about 1.5 years before they died, and there are correlations between sleep fragmentation and microglial gene expression.

In general, Dr. Musiek added, microglia gene expression patterns suggest aging and microglial activation, indicative of inflammation, in people with sleep fragmentation. Sleep fragmentation and microglial changes were also correlated with poor memory performance. This suggests that sleep fragmentation may contribute to brain inflammation via microglial activation in aging.

He added that some caveats include the fact that all of the findings are correlational, and further experiments would be needed to show true causality. Also, the use of post-mortem tissue can be a problem, as death and postmortem interval may alter microglial gene expression. Confirmation of these finding using CSF biomarkers in living people would be an important next step. Finally, sleep fragmentation may result from disruption of the circadian clock, which has also been implicated in regulation of neuroinflammation.

This is another study that supports the importance of sleep for cognition, added Rachel Marie E. Salas, MD, FAAN, associate professor of neurology at Johns Hopkins Medicine and assistant medical director for the Johns Hopkins Center for Sleep.

Fragmented sleep is so common with older adults for many reasons. It is very important to address and optimize your sleep environment or it can have negative consequences. Sleep is a basic human need and we tell our patients that only they can make it a priority. Not only do we need enough sleep but it has to be quality sleep.

Although the pathways linking sleep and circadian rhythms with neurologic health are likely multifactorialincluding alterations in interstitial and CSF flow dynamics, neuronal metabolism, and oxidative stressrecent evidence in animals indicate that alterations in microglial function, together with microglial activation and neuro-inflammation are potential common pathways, added Phyllis C. Zee, MD, PhD, professor of neurology and director of the Center for Circadian and Sleep Medicine at Northwestern University Feinberg School of Medicine.

Although the causal role of sleep fragmentation and alterations in microglial aging was not directly addressable in the study, we now have further insight into accelerated microglial aging as a potential mechanism linking sleep disturbance and neurodegeneration in humans.

Dr. Zee added: The results from the current study are clinically significant because they highlight the importance of sleep and circadian health for successful brain aging, but also point to the potential of sleep and circadianbased approaches as a component for disease modification therapies in age-related cognitive decline and dementia.

Drs. Lim, Musiek, Salas, and Zee had no competing interests.

See the article here:
The Role that Fragmented Sleep Plays in Cognition : Neurology Today - LWW Journals

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Annals of Neurology is one of the most prestigious medical publications in the world, publishing high-impact clinical and basic research in neurology and neuroscience.

The journalpublishes articles of broad interest with potential for high impact in understanding the mechanisms and treatment of diseases of the human nervous system. All areas of clinical and basic neuroscience, including new technologies, cellular and molecular neurobiology, population sciences, and studies of behavior, addiction, and psychiatric diseases are of interest to the journal. Annals of Neurologyis particularly interested in clinical trials and other large-scale studies that inform the practice of medicine.Trials reporting negative data will be considered.

Submission requirements for the Annals of Neurology are in accordance with the ICMJE Uniform Requirements. Please review the following document prior to submission of your manuscript: http://www.icmje.org/recommendations/.

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Annals of Neurology | American Neurological Association (ANA)

By Jamie Talan December 5, 2019

Brain MRI scans revealed cognitive and movement changes in astronauts who participated in long space flights. Researchers advise advanced neuroimaging protocols and long-term follow-up imaging in this population.

Astronauts who have participated in long space flights appear to have structural alterations in the brain that are associated with changes in measures of cognition and movement about a month after they return to Earth's atmosphere, suggests a study published online October 17 in the American Journal of Neuroradiology.

Our findings support the need for advanced neuroimaging protocols and long-term follow-up imaging of the astronaut population, the study authors wrote. Most important, understanding the influences of gravity on CSF homeostasis and brain health may provide insights into abnormalities of CSF homeostasis such as idiopathic normal pressure hydrocephalus.

In the retrospective study, Donna Roberts, MD, associate professor of radiology at the Medical University of South Carolina, and her colleagues looked at brain MRI scans from 19 NASA astronauts who had scans done before an International Space Station mission or a Space Shuttle flight and again after they returned. The scientists also had access to pre- and post-clinical assessments and tests conducted to identify cognitive and movement changes.

They found a significant 10.7 percent change in total ventricular volume in astronauts who returned from long-duration International Space Station (ISS) missions compared with no changes in ventricular volume in astronauts who returned from short-duration Space Shuttle missions.

Dr. Roberts met earlier in November with NASA scientists to discuss the findings. I believe NASA should make this a priority, she said. We need to understand what changes to brain structure and physiology are occurring during these long-duration spaceflights, whether or not these changes have any clinical consequences and, if so, then in what ways can we protect against these changes. We also don't know whether these brain changes persist after some time back in the gravity environment of Earth.

In a 2017 study in The New England Journal of Medicine, the South Carolina scientists looked at the MRI results from long-duration flights and found enlargement of the ventricles, an upshift in the brain, and a narrowing of the cerebrospinal fluid spaces at the top of the brain. The brain tissue seemed crowded, Dr. Roberts explained. With this observation in hand, she and her colleagues returned to the NASA files to obtain performance data that they could use to see if it matched with the MRI changes.

The scientists worked with data provided by the NASA Lifetime Surveillance of Astronaut Health office. They received pre-and-post flight MRI scans on 12 astronauts who spent time on the ISS and seven others who made shorter shuttle missions. Four of the astronauts on the ISS mission had spaceflight-associated neuro-ocular syndrome (SANS), which is characterized by changes to the retina that alter visual acuity and swelling of the optic nerve. These visual problems were first identified in 2005 and prompted NASA to add brain scans to a long list of tests to understand the health effects of space flight. The agency has been collecting MRI data for about a decade. Some of the astronauts had consented to a lumbar puncture, as well, that was used to measure intercranial pressure. When ISS astronauts touched down in Kazakhstan to begin their re-adaptation to the Earth's atmosphere, crew members put them through a series of tests to measure their motor skills. They assessed whether the astronauts could climb a ladder, open a hatch, get out of a seat and maneuver an easy obstacle course, and maintain their balance when carrying out these tasks.

Dr. Roberts and her team also had access to pre- and post-flight cognitive data that are now being collected on all astronauts who complete a mission. Both these post-flight functional and cognitive tests were done within a few days of re-entry. The MRI scans were also done within a few days of re-entry.

The scientists reported a 10.7 percent increase in the total ventricular volume post-flight compared with preflight in the ISS astronauts. There was no change in the shuttle astronauts. They reported that the younger astronauts were more likely to have enlarged ventricles on MRI, and the MRI findings were negatively correlated with the visual deficits of SANS, which tends to occur in older astronauts. The percentage of ventricle change was greater in those who participated in longer missions. There were no significant changes on pre- to postflight in the total volume of gray matter or white matter for either the Shuttle or ISS astronauts. The team also had access to cognitive testing data, primarily the Spaceflight Cognitive Assessment Tool for Windows (WinSCAT). This test was developed by NASA as a screening tool to monitor cognitive status during missions so flight surgeons could identify any performance issues. They analyzed data from sub-tests of the WinSCAT, including tests that measured speed and efficiency, memory, working memory, mathematical processing, and sustained attention.

They did not see a change in pre- and post-flight scores or an association between performance on the test and the length of the mission. They did find that astronauts showed a decrement in accuracy on processing speed and learning tests but showed faster reaction times on a subset of tests on sustained attention. They were also able to link it to changes in volume in three white matter regions on the scans.

The researchers found that the structural changes in the left caudate nucleus correlated with a worsening on tests of balance control. That does not mean that these volume changes caused these problems, Dr. Roberts said, and no one knows whether the structural changes persist over time.

We are trying to raise awareness so that NASA can better understand what happens to the brain in space, Dr. Roberts added. We have no idea whether these changes are a positive adaptive response to space flight, or a maladaptive consequence. As we send more astronauts into space and with the rising interest in space tourism we want to make sure we understand what is happening to the human brain in space. We will be able to develop countermeasures but we first need to understand what is happening.

There is a lot we don't know about what is happening to the brain in space, said Stephen A. McGuire, MD, FAAN, adjunct professor of neurology at the University of Texas Health Sciences Center San Antonio. It is not surprising that whatever is causing fluid shifts in the brain would be associated with changes in cognition. But you have to be careful. How much is learned behavior and remodeling of the brain and how much is environmentally-induced structural change? The ataxia that astronauts experience may just be a part of readjusting to gravity. Are these permanent changes? Astronauts are very high performers, which makes it difficult to appreciate any long-term effects. We just don't know.

Dr. McGuire has studied the effects of high altitude on U2 pilots and identified long-term deficits in cognition (following a five to 15-year period of extreme hypobaric exposure) that were correlated with white matter changes compared to Air Force pilot controls. But, he said, the effects were not clinically significant.

There are lots of unanswered questions, Dr. McGuire said. How significant are these problems in the astronauts and is this something we really need to be concerned about?

Jonathan B. Clark MD, MPH, associate professor of neurology and space medicine in the department of neurology in the Center for Space Medicine at Baylor College of Medicine, said that one of the problems in studying long-term effects of space flight on the brain is getting access to astronauts. They had small numbers but it bears further consideration and evaluation. The fact that they correlated these ventricular changes with cognitive and motor behaviors tells us that we need to keep an eye on this.

Also, he said, part of the problem with the data is that the MRI scans were generally done in the first three weeks after landing and the functional tests are done within the first few days. And during those first few days, they are landing in Kazakhstan and immediately flown to Russia and then to the United States. They are back in the US within 48-hours and you can imagine that they have the weight of gravity to contend with and the multiple flights.

It is a fascinating finding, he said. Space changes all organ systems so it would not be surprising that the brain would be affected, cautioning that they may still be in an adaptive phase. The scientists did not find any gray or white matter changes and that would be when you worry. The functional effects will generally recover after a week or two. The anatomy is arguably what will change slower.

He said that NASA is now evaluating 24 cases of SANS. This study only captured four of these cases.

Jennifer Fogarty, PhD, is the chief scientist for NASA's human research program, and oversees a portfolio of studies on astronauts during space: How their bodies change and adapt and whether the changes could create a health or performance risk. The key is interpreting the change on brain imaging scans, she said of the Medical University of South Carolina study. They identified a correlation but that doesn't tell us if it is causality.

The ataxia that astronauts experience may just be a part of readjusting to gravity. Are these permanent changes? Astronauts are very high performers, which makes it difficult to appreciate any long-term effects. We just don't know.

DR. STEPHEN MCGUIRE

She said that the agency has been trying to understand SANS and design ways to protect against it during long-term spaceflight. NASA has neurologists, neuroscientists, and neuro-ophthalmologists assessing the SANS data we collect. So far, nothing has reached a clear clinical threshold.

Dr. Fogarty said that NASA engineers are designing devices to use lower body negative pressure to pull blood volume and CSF back down. The device will be tested in 2021. There are also ongoing studies to see whether elevated CO2 levels on the Space Station help contribute to changes in the eye.

Using data like this, she said, referring to the Medical University of South Carolina study, helps us to go in different directions.

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Prolonged Space Flight Affects Human Brain Structure and... : Neurology Today - LWW Journals

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This is a vibrant and exciting time for clinical neurosciences at Stanford. With over 130 faculty with primary appointments within the Department, Stanford is considered one of the larger programs nationally, yet still retains a close-knit and collegial training environment. Stanford Neurology faculty are among the world leaders in many areas within the clinical and basic neurosciences. Many of our subspecialty divisions and programs are the largest on the West Coast, and are at the top nationwide in terms of clinical activity, cutting-edge research, and influence within their respective fields. Every significant subspecialty within Neurology is well-represented. Certain areas are unique strengths, including our Neurology-basedneuro-oncology groupand our neuro-autonomic program. Stanford boasts a world-renownComprehensive Epilepsy Center,Movement Disorders Center,Alzheimers Disease Research Center,Udall Center of Excellence for Parkinson's Disease Research, the countrys firstComprehensive Stroke Center, the largestChild Neurologydivision of the West Coast, a large and well-developed intraoperative monitoring (IOM) program, a model multidisciplinaryHeadache (Pain) Clinic, and the pioneeringCenter for Sleep Sciences and Medicine. Our trainees have a vast array of clinical, research, and other academic opportunities available to them. Prospective applicants are invited to explore this website (and those of each subspecialty division) and its many links to gain an appreciation for the incredible scope and quality of experiences that are available at Stanford Neurology with post-graduate training in the clinical neurosciences.

Stanford Neurology attracts patients with serious and complex neurologic disorders from all over the world primarily the Western United Stated and the Pacific Rim. The tremendous population growth of the metropolitan area around Silicon Valley ensures a steady source of diverse patients with a wide range of neurological diseases.Stanford Hospital is nearly always at full capacity which leads to a dynamic and rich training environment. The volume of Neurology patients at Stanford is currently the second highest of all university hospitals in California.Similarly, Neurology outpatient volumes are tremendous, with over 60,000 annual patient visits in our multiple clinics at Stanford Healthcare, Stanford Childrens Health, Santa Clara Valley Medical Center and the VA. We have beautiful state-of-the-art facilities including two newmulti-billion dollar hospitals and the Stanford Neuroscience Health Center, a first of its kind one stop outpatient neuroscience center. This is all to say that despite the ample research and academic opportunities available (see below), our training programs remain patient focused and clinically intensive. Trainees should expect a broad exposure to a large volume of complex patients while on their clinical rotations. First and foremost, we are looking to train top-flight physicians with excellent clinical skills.

Our excellent clinical training in Neurology at Stanford is complemented by exposure to thefaculty,resources, andfacilitiesof one of the worlds leading neuroscience research institutions. Stanford sits on the cutting edge of 21stCentury neuroscience and translational research. Stanfords multidisciplinary neurosciences institute, under the direction ofDr. William Newsome, brings together clinicians and scientists in the School of Medicine and many other Stanford University Schools and Departments who share a common interest in clinical and basic neuroscience. With several hundred faculty participants dedicated to expanding the frontiers of neuroscience, the institute builds on Stanford's expertise in Medicine, Humanities and Sciences, Engineering, Law, and Business to form a world-class interdisciplinary program to provide innovative solutions to clinical medicine. This distinguished group of Stanford neuroscientists includes multiple members of the National Academy of Sciences, Institute of Medicine, and Nobel Prize laureates. Our trainees have direct access to these investigators and thought leaders as most are physically located on the School of Medicine campus. The Stanford academic community has a great tradition of innovation, along with a spirit of openness and collaboration. Along with an extensive and vigorous clinical experience, our residency program includes a neuroscience research track and Investigator Training Pipeline that allow our trainees to fully leverage this remarkable research setting Stanford also participates in the Biohub physician-scientist fellowship program for additional mentored biomedical and clinical research that does not require prior research experience. Opportunities for pushing the boundaries in neuroscience research, both basic/translational and clinical, exist at Stanford like nowhere else.

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Stanford Neurology thrives on a culture of teaching and learning. Our faculty devote their time to educate and mentor trainees with an emphasis on career development and close faculty-trainee interactions. Our trainees graduate as leading medical educators while working closely with students from the Stanford School of Medicine, currently ranked the #3 research medical school in the United States byU.S. News and World Report. In fact, recently the Neurology Department has won the Association of University Professors of Neurology (AUPN) Successful Recruitment award two years in a row by having the highest percentage of medical students matching into Neurology of any school in the U.S. In addition, the AAMC annual survey of US medical students has identified the Stanford Neurology core rotation as the top rated core rotation at Stanford for the past 6 years and among the highest rated neurology rotations in the US. This remarkable track record is largely a testament to the dedication, enthusiasm and focus on the development of teaching and mentoring skills of our residents and fellows who interact with these excellent student on a daily basis. Professional development for trainees in medical education include novel training courses at theStanford Faculty Development Center (SFDC) for Medical Teachers, Stanford Medicine Teaching and Mentoring Academy, and Clinical Teaching Seminar Series.

Stanford is an innovator in medical education research. Trainees may earn an honors certificate in medical education after completion of a scholarly project and receive intramural grant funding to support their work. These projects may involve Stanfords cutting-edge medical simulation program, trainee-focused diversity program, or our leading wellbeing curriculum.

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Education | Neurology & Neurological Sciences | Stanford ...

Objective: To examine the association between Miller Fisher syndrome (MFS) and antecedent Haemophilus influenzae infection.

Background: Little is known about agents in prior respiratory tract infection of MFS, whereas antecedent upper respiratory symptoms are frequent. H. influenzae is a major pathogen that can cause human respiratory tract infection.

Methods: The authors used ELISA to detect serum antibody against the bacterium in 70 consecutive patients with MFS and 110 with GuillainBarr syndrome (GBS).

Results: Serum antiH. influenzae IgG and IgM antibody activities were significantly higher in the MFS group than in age- and sex-matched patients with other neurologic diseases (n = 62) and normal control subjects (n = 82). The GBS group showed no significant increase in any class of antibody activities compared with control groups. Serologic evidence of recent infection was found in five (7%) of the patients with MFS and two (2%) of 110 patients with GBS, all of whom had a history of antecedent respiratory tract infection. They frequently showed ophthalmoplegia, but other neurologic features were not remarkable. Serum anti-GQ1b IgG antibody that had cross-reactivity with GT1a ganglioside was detected in six of these seven patients. Thin-layer chromatography with immunostaining showed that serum IgG from H. influenzaeseropositive patients with high anti-GQ1b and anti-GT1a IgG antibody titers bound to the lipopolysaccharide fraction extracted from the type b H. influenzae serostrain. These bands were also stained by anti-GT1a monoclonal antibody (GMR11), indicating that the lipopolysaccharide bears the GT1a epitope.

Conclusions: These findings point to H. influenzae being an agent associated with MFS. Epitopic overlap between H. influenzae and human nerve tissue may be involved in the development of MFS much as GBS is associated with Campylobacter jejuni enteritis.

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Miller Fisher syndrome and Haemophilus ... - n.neurology.org

Name: Select or start typingAdetunji, Ezekiel O.Adkins, William B.Agbetoyin, Adeyinka A.Akhigbe, Kelvin O.Akin, Eric D.Alhaddad, Mohsin T.Ammons, DrewAnderson, Charles B.Anderson, MichaelAnsah, Martinson A.Appleton, Nicolas B.Arcuri, NicolasArinze, Festus N.Arnold, JohnAsmar, Salomon N.Atkinson, RobinAwan, ObaidBada, Samuel O.Baldwin, Harold S.Baldwin, Shawn A.Ball, John J.Bansal, AnkushBarrow, William CharlesBateman, Mark R.Bellor-Yeh, Pei C.Blackstock, Drew S.Blair, Kelly L.Blake, Jeremy T.Bocirnea, Ioana A. Bomb, RitinBond Jr., Elias K.Bourji, NajiBoxell, Sandra J.Boyapati, MadhavBroussard, Heath J.Bryan, Jennifer A.Burgess, Anna E.Carney, William R.Carranza, DafnisCarroll, Loren S.Castle, ScottCawthon, Anthony J.Chappell, Brandon A.Chaudhry, SufiyanCherqui, Alice M.Coleman, Joseph C.Collier, Stephen E.Cooper, Cedric K.Cowley Jr., DewightCurwen, Davidson C.Dailey, Zachariah AlanDavis, Jean Aiko HamaguchiDavis-Tharpe, Vernessa L.Dees, Mary E.DeJarnatt, Alan C.Dickey, Mary JaneDieudonne, Gina M.Ditah, Fausta A. Dodd, Debra A.Donahue, Sean P.Doyle, Thomas P.Drewery, Richard K.Duncan, KarlDuncan, KurtDunnebacke, Robert H.Emberson, JohnEmison, Tony R.Enyenihi, Henry N.Epps, John M.Evans, Pamela R.Evans, T. PaulExil, VernatEze, Gift E.Fakorede, FolusoFarr Jr, John F.Figueroa, MarioFish, Frank A.Flack, EnglishFouche', JosephFrancisco, Susan M.Freeman, Charles M.Freshwater, Ashada T.Frischhertz, Benjamin P.Fu, ShuangGardner, Peter T.Garey, David L.Garrett, David C.Ghodadra, Tony M.Glass, Jorge N.Go Jr., Victor V.Godown, JustinGooch, Joseph L.Gray, Jean P.Green, Diane E.Green, KellyGreen, RichardGreene, Catherine M.Guidi, John F.Guthrie, Scott O.Hager, Dana D.Haltom Jr., John D.Hamadani, Aley M.Hamm, Shawn M.Hammond Jr., Stephen D.Hammond, Jere D.Hammond, Stephen D.Harper, Andrea M.Harris, JoAnnHarris, Joe M.Harris, Kelly C.Harrison, Nikki P.Hatcher, Donald B.Hayden, Timothy W.Hayden, William T.Hays Jr., Edwin C.Head, Thomas C.Herford, BaronHerron, Bruce E.Hidaji, Faramarz F.Higgs, Bobby C.Hockaday Jr., Edward E.Hoeldtke, Nathan J.Hollis, Robert A.Holmes, Patrick R.Holt, William TerryHomberg, Eric JHoneycutt, Daniel L.Hoonhorst-Parson, Crystal L.Hopkins, Sharon D.Hopla, Anna K.Hottigoudar, Rashmi U.Howard, Raymond C.Howard, Raymond J.Howerton, Kimberly A.Huff, Gregory E.Hulm, Dennis A.Hundley, Ethan J.Hunley, Trace E.Hunt-Okolo, Stacey E.Hutchison, Jason T.Hutchison, Timothy N.Igbinigie, Vera O.Inman, Dustin P.Isom, Jonathan MiltonJames, David F.Janssen, Dana R.Jayashankar, Ashok A.Jenkins, John M.Joglekar, Kanchan S.Joglekar, Shirish S.Johns, James A.Johnson, Frederick D.Johnson, Larry DavidJohnson, Samuel T.Jones, Brian ShappleyJones, Deborah P.Jordan, Frank E.Joshi, Mahendra K.Joshi, Vijaya M.Kannankeril, Prince J.Karlosky, Loran E.Kaufman, Dwight C.Kaufman-Codjoe, KarenKaushik, NeeruKavanaugh-McHugh, Ann L.Kayal, Daniel P.Keeley, Phillip M.Khamapirad, Tawan S.Killen, Stacy A.Knight, Cameron D.Kollar, Matthew J.Koonce, Edward D.Kovalic, Jeffrey J.Kraus, Neal D.Kurland, Jr, Ross A.Laird, David M.Lam, Michael G.Lamptey, Aubrey A.Larsen, David M.Lawrence, Alice P.Lawrence, Bethany J.Lawrence, Peter G.Lents, Russell S.Levien, Joel A.Lewis, Christopher L.Lewis, Donald R.Lindsey, Brian ALittle, Brittain D.Lofton, William B.Londino, Elizabeth S.Lopez, Emilio E. Love, Timothy P.Lui, Henry K.Luka, Adam K.Madduri, Nirupama S.Mah, May L.Mahajan, Natasha C.Mahalati, KamranMaley, Bruce B.Manning, James L.Mariencheck Jr., William I.Markel, Thomas O.Markham, Larry W.Marlar, Justin L.Martin, Michael J.Martindale, Michael L.Mason, Alexis T.Masterson, John P.Maynord, Patrick O.McBride, Gary L.McClinton, Ernest J.McCowan, Jon G.McCullough, Ricky J.McDaniel, Brock G.McDowell, Michael WestMcElroy, Steven J.McGuire, William L.McKnight Jr., Donald T.Menzies, Barbara E.Meriwether, John H.Micetich, Keith A.Miles, John W.Miller III, Tommy L.Miller Jr., Jesse A.Miller, Linda R.Minasyan, TatevikMisulis, Karl E.Mitchell, Christopher W.Mitchell, Gregory E.Mohamed, EmadMoore, James D.Morrison, David G.Muir, Eric W.Murphy Sr., Richard L.Murray II, Earnest L.Murray, Pamela D.Myatt, Jason A.Myers, Andrew G.Naik, Ami K.Narapareddy, Murty N.Nass, RebeccaNass, Rebecca A.Nazario, JaniceNeal, Tyler AlanNeblett Jr., John W.Neel, Sean T.Nelson, Thomas H.Nerland, RyanNicholson, GeorgeNixon, Ralph M.Noel, TamekaNord, Keith D.Norlander, Lisa M.Norsworthy, Thomas P.Nwazue, Victor C.Nwokolo, Chibuzo E.Nyenwe, Ebenezer A.O'Kelley, Ryan N.Oberg, Richard A.Obi, Patricia ReneeOdeh, Osayawe N.Odhav, Satish K.Odukoya, Adewale AdeyinkaOkewole, Simon O.Okolo, Joseph M.Oleru, Aleruchi Y.Oleru, Chima O.Osayamen, Michael O.Owens, Scott E.Palmer Jr., Edmund T.Parra, David A.Patel, Hetal D. Patel, Kandarp B.Patel, Kaushal IPatel, MihirPatel, Nirav A.Patel, Vaishali H.Payne, James A.Pearce, David A.Pechacek, AlanPedigo, Tara K.Perkins, Keith L.Perry, Heather L. Piawa, Dum L.Pickering, David E.Pierce IV, William F.Piercey, Lisa M.Pippin, Michael S. Pitt, John D. Plunk, NathanPoole, Charles T.Pope IV, John C.Preston, William A.Prewitt, Sr., Darrion JPriester, William BradProctor, Evanna S.Pucek, Kelly D.Pueschel, JordanPuzdrakiewicz, Michelle G.Quadeer, Abdul R.Qualls, Brian C.Radbill, Andrew E.Ragon Jr, William S.Ragon, Joseph L.Rainey, Debra L.Ralston, Michael D.Randolph, Fielding A.Rashid, AbdulReese Jr., Eugene P.Revelle, Michael A.Rhear, Raymond W.Rickman, Christopher E.Riley, Elly K.Rimrodt, SherylRoberts, David E.Robinson, Antwan D.Robinson, Marilyn A.Rodriquez, Juan F.Rogers, Lisa W.Rothrock, Alan C.Roy, Ryan A.Russell, Tori S.Sachan, Nitin SinghSadler, Scott M.Sarkar, ShyamalSathanandan, Sumathira T.Schmidt, Roy A.Scott, William W. Seabrook, Robert T.Seay, RaymondSeely III, William E.Self Jr., David L.Self, Amelia E.Shah, ShahzadShaw Jr., John L.Shelby-Kennedy, Hannah L.Shi, Peter Y.Shires, Jay G.Short, Brian C.Short, Ronald M.Shuplock, Jacqueline M.Sickle, David M.Sievers, Eric M.Simmons, Jill H.Sims, Paul J.Sioson - Aherrera, Priscilla B.Sioson Jr., Conrado B.Smigielski, Michael J.Smiley, Linda M.Smith, Adam M.Smith, Clyde E.Smith, Garrison B.Smith, Theresa T.Soll, David J.Soslow, Jonathan H.Souder, Bob T.Spalding III, Alanson R.Sparrow, John G.Speck, K. ElizabethSpencer, Racquel D.Sprague, EveSprague, Eve O.Staton, Rodney J.Stonecipher, Lowell F.Story, SaraStudebaker, Grant K.Studtmann, Karl E.Suara, Rahaman O.Sullivan, Jason M.Summerlin, AdamSweo, Timothy D.Szych, Gregory A.Tahsin, SaifTaylor, Jackie L.Taylor, Keith H.Taylor, Ronald F.Taylor-Moragne, Mechelle E.Teague, Todd A.Teer, Patrick B.Thomas, John C.Thomas, Timothy H.Thorne, Steven R.Thrower, Daniel R.Tillman, Ronald C.Timpone, Anastasia H. Torstrick, Robert F.Townes-Bougard, Tracy A.Turner III, Robert E.Turner, Justin R. Turner, KevinTygart, Bryan P.Utley, NancyVaddadi, LalithaVaikunth, Sachin S.Valdivia, Remy A.Vance, Nicholas G. Vance, Stacey DVasilopoulos, S. DebbieVera, Kimberly B.Verlander, Jr, Leo DVermani, PrathibaVillarreal, DavidWainscott, William K.Walker, Armie W.Walker, Brian N.Wallace-Wilding, Kellie L.Waller III, Benjamin R.Ward, Jewell C.Wardlow, Bethany A.Warmbrod Jr., James G.Warren, Leah B.Watlington, David J.Weaver, Jonathan B. Weaver, Steven G.Webb, Bradley M.Webb, Demareo J.Weeks, Albert E.Weiner, Ronald I.Weitkamp, Joern H.Welch, Jennifer W.Welsch, Christopher T.West, Henry E.Wetzel, Glenn T.Wheatley, KevinWheeler, Brian J.White II, John S.Wiedel, Lisa M.Wilkerson, MichaelWilkerson, Michael R.William W. ScottWilliams, Chloe L. Williams, John C.Williams, Lane E.Williams, StevenWilliams, William K.Williamson III, Felix E.Willis, William A.Wilroy Jr., Robert S.Wilson, Donald A.Wilson, TinaWitherington III, James B.Wittber, Glynn M.Wolfe, Emily T. Woods Jr., William H.Woods, Arthur H.Woods, John B.Worthington, W. BradleyWright III, Lucius F.Wright, Archie W.Wright, Jeremiah H.Wright, Rosilin K.Yarbro, Edward S.Yellen, Marshall R.Younis, NaveedZada, YasinZamber, Jon E.

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This official journal of the American Academy of Neurology features best practices, evidence-based research and articles on topics that directly affect practicing neurologists - AVAILABLE ONLY AS PART OF THE NEUROLOGY AND NEUROLOGY: CLINICAL PRACTICE BUNDLE

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Editorial content includes full-length Articles, Clinical/Scientific Notes, Views & Reviews (including Medical Hypothesis papers), Issues of Neurological Practice, Historical Neurology, NeuroImages, Humanities, Correspondence, Book Reviews, Software Reviews, Calendar Listings, and position papers from the American Academy of Neurology.

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Neurology - Ovid

Yaakov Stern

From the Cognitive Neuroscience Division, Department of Neurology and Taub Institute (Y.S., A.M.-B., Q.R., E.A.), Department of Biostatistics (S.L.), and Department of Psychiatry, Division of Behavioral Medicine (P.M., K.M., R.P.S.), Columbia University, New York; Division of Clinical Research (A.M.-B.), Nathan Kline Institute for Psychiatric Research, Orangeburg; Division of Biostatistics (S.L.), New York State Psychiatric Institute; and Cardiopulmonary Rehabilitation and the Human Performance Laboratory (M.B.), Columbia Presbyterian Medical Center, New York, NY.

Anna MacKay-Brandt

From the Cognitive Neuroscience Division, Department of Neurology and Taub Institute (Y.S., A.M.-B., Q.R., E.A.), Department of Biostatistics (S.L.), and Department of Psychiatry, Division of Behavioral Medicine (P.M., K.M., R.P.S.), Columbia University, New York; Division of Clinical Research (A.M.-B.), Nathan Kline Institute for Psychiatric Research, Orangeburg; Division of Biostatistics (S.L.), New York State Psychiatric Institute; and Cardiopulmonary Rehabilitation and the Human Performance Laboratory (M.B.), Columbia Presbyterian Medical Center, New York, NY.

Seonjoo Lee

From the Cognitive Neuroscience Division, Department of Neurology and Taub Institute (Y.S., A.M.-B., Q.R., E.A.), Department of Biostatistics (S.L.), and Department of Psychiatry, Division of Behavioral Medicine (P.M., K.M., R.P.S.), Columbia University, New York; Division of Clinical Research (A.M.-B.), Nathan Kline Institute for Psychiatric Research, Orangeburg; Division of Biostatistics (S.L.), New York State Psychiatric Institute; and Cardiopulmonary Rehabilitation and the Human Performance Laboratory (M.B.), Columbia Presbyterian Medical Center, New York, NY.

Paula McKinley

From the Cognitive Neuroscience Division, Department of Neurology and Taub Institute (Y.S., A.M.-B., Q.R., E.A.), Department of Biostatistics (S.L.), and Department of Psychiatry, Division of Behavioral Medicine (P.M., K.M., R.P.S.), Columbia University, New York; Division of Clinical Research (A.M.-B.), Nathan Kline Institute for Psychiatric Research, Orangeburg; Division of Biostatistics (S.L.), New York State Psychiatric Institute; and Cardiopulmonary Rehabilitation and the Human Performance Laboratory (M.B.), Columbia Presbyterian Medical Center, New York, NY.

Kathleen McIntyre

From the Cognitive Neuroscience Division, Department of Neurology and Taub Institute (Y.S., A.M.-B., Q.R., E.A.), Department of Biostatistics (S.L.), and Department of Psychiatry, Division of Behavioral Medicine (P.M., K.M., R.P.S.), Columbia University, New York; Division of Clinical Research (A.M.-B.), Nathan Kline Institute for Psychiatric Research, Orangeburg; Division of Biostatistics (S.L.), New York State Psychiatric Institute; and Cardiopulmonary Rehabilitation and the Human Performance Laboratory (M.B.), Columbia Presbyterian Medical Center, New York, NY.

Qolamreza Razlighi

From the Cognitive Neuroscience Division, Department of Neurology and Taub Institute (Y.S., A.M.-B., Q.R., E.A.), Department of Biostatistics (S.L.), and Department of Psychiatry, Division of Behavioral Medicine (P.M., K.M., R.P.S.), Columbia University, New York; Division of Clinical Research (A.M.-B.), Nathan Kline Institute for Psychiatric Research, Orangeburg; Division of Biostatistics (S.L.), New York State Psychiatric Institute; and Cardiopulmonary Rehabilitation and the Human Performance Laboratory (M.B.), Columbia Presbyterian Medical Center, New York, NY.

Emil Agarunov

From the Cognitive Neuroscience Division, Department of Neurology and Taub Institute (Y.S., A.M.-B., Q.R., E.A.), Department of Biostatistics (S.L.), and Department of Psychiatry, Division of Behavioral Medicine (P.M., K.M., R.P.S.), Columbia University, New York; Division of Clinical Research (A.M.-B.), Nathan Kline Institute for Psychiatric Research, Orangeburg; Division of Biostatistics (S.L.), New York State Psychiatric Institute; and Cardiopulmonary Rehabilitation and the Human Performance Laboratory (M.B.), Columbia Presbyterian Medical Center, New York, NY.

Matthew Bartels

From the Cognitive Neuroscience Division, Department of Neurology and Taub Institute (Y.S., A.M.-B., Q.R., E.A.), Department of Biostatistics (S.L.), and Department of Psychiatry, Division of Behavioral Medicine (P.M., K.M., R.P.S.), Columbia University, New York; Division of Clinical Research (A.M.-B.), Nathan Kline Institute for Psychiatric Research, Orangeburg; Division of Biostatistics (S.L.), New York State Psychiatric Institute; and Cardiopulmonary Rehabilitation and the Human Performance Laboratory (M.B.), Columbia Presbyterian Medical Center, New York, NY.

Richard P. Sloan

From the Cognitive Neuroscience Division, Department of Neurology and Taub Institute (Y.S., A.M.-B., Q.R., E.A.), Department of Biostatistics (S.L.), and Department of Psychiatry, Division of Behavioral Medicine (P.M., K.M., R.P.S.), Columbia University, New York; Division of Clinical Research (A.M.-B.), Nathan Kline Institute for Psychiatric Research, Orangeburg; Division of Biostatistics (S.L.), New York State Psychiatric Institute; and Cardiopulmonary Rehabilitation and the Human Performance Laboratory (M.B.), Columbia Presbyterian Medical Center, New York, NY.

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Effect of aerobic exercise on cognition in ... - n.neurology.org

Adults infected with the Zika virus can develop a number of serious neurological conditions, a new study finds.

Until now, the most troubling Zika-related illness in adults has been Guillain-Barre syndrome, which causes muscle weakness and paralysis.

A review of 35 Zika-infected patients in Brazil with neurological symptoms found that most had Guillain-Barre. But other neurological conditions were also discovered, most often inflammation and swelling of the brain and spinal cord.

"Overall, the risk of Guillain-Barre for a person who contracts Zika is probably still very low, but it's important to know there's neurological conditions associated with Zika virus," said study co-author Dr. Jennifer Frontera, chief of neurology for NYU Lutheran Medical Center in New York City.

Frontera and other infectious disease experts said pregnant women still carry the most risk from Zika infection, since the virus can cause devastating neurological birth defects such as microcephaly.

Michael Osterholm is director of the University of Minnesota's Center for Infectious Disease Research and Policy in Minneapolis.

"Now we're realizing that adults may be impacted," he said. "There are clinical implications, as was well demonstrated in this paper."

The research team tracked patients who were referred to an academic hospital in Rio de Janeiro that specializes in treating neurological illnesses.

During the Zika epidemic in Brazil in 2015-16, admissions at this hospital for Guillain-Barre increased more than fivefold, Frontera said. On average, doctors there saw one case of Guillain-Barre a month before the outbreak; that rose to more than five a month as Zika raged through the country.

Out of a group of 40 patients, 35 tested positive for recent Zika infection. The Zika-affected group contained 27 people with Guillain-Barre syndrome, but also included five patients suffering from swelling of the brain (encephalitis) and two who had swelling of the spinal cord (transverse myelitis).

Another Zika-infected patient was diagnosed with chronic inflammatory demyelinating polyneuropathy, a condition closely related to Guillain-Barre that causes long-term nerve damage, muscle weakness and paralysis.

Nine of the patients required admission to an intensive care unit, and five had to be placed on a mechanical ventilator. Two patients died, including one with Guillain-Barre and one with encephalitis.

Dr. Amesh Adalja, a senior associate with the Johns Hopkins Center for Health Security said, "Follow-up studies will be important to determine the frequency of such complications and the associated risk factors. It will also be essential to definitely establish that Zika is involved as many related viruses circulate in the area in which this study was conducted."

Dr. Richard Temes is director of the Center for Neurocritical Care at North Shore University Hospital in Manhasset, N.Y. He said it makes sense that Guillain-Barre and these other conditions could appear following a Zika infection.

All of the neurological conditions researchers observed in Zika patients are "thought of as post-infectious syndromes, where you have a viral infection, you clear the infection by mounting an antibody response, and the antibodies actually attack parts of the central and peripheral nervous system, causing these neurological symptoms."

Zika spreads mainly through mosquito bite. So far, this year has been relatively calm in terms of Zika outbreaks, Osterholm said.

"This is characteristic of these infections," Osterholm said. "The virus infection comes and goes in the population. You can have a bad year or two, and then have a year where there's less infection and some people feel it's going away, which is not the case at all. It will come back. We have to understand we're in this for the long haul."

The study was published online in August in JAMA Neurology.

Pregnant or trying? Don't let your Zika guard down

Zika poses even greater risk for birth defects than was previously known, CDC reports

Zika can also strike eyes of adults, report reveals

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Zika virus tied to neurological issues in adults - Chicago Tribune

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We are a neurology group that has served Arlington, Mansfield, Grand Prairie, and surrounding areas since 1983. Our services include diagnosis, treatment, and clinical research. We use electronic medical records and provide a patient portal.

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Neurology Associates of Arlington, P.A.

NEW YORK, March 05, 2020 (GLOBE NEWSWIRE) -- Ovid Therapeutics Inc. (OVID), a biopharmaceutical company committed to developing medicines that transform the lives of people with rare neurological diseases, today announced multiple poster presentations across its rare neurological disease platform at the American Academy of Neurology (AAN) 2020 Annual Meeting in Toronto (April 25-May 1).

We are pleased by the breadth of data selected for presentation at this years AAN conference, which underscores our efforts to find treatments for patients living with rare neurological conditions like Angelman syndrome, Fragile X syndrome and rare epilepsies, said Amit Rakhit, M.D., MBA, President and Chief Medical Officer at Ovid. We look forward to joining world-renowned neurologists and researchers attending AAN to present our findings and continue to push the envelope in the name of patients and their families, who inspire us every day.

AAN 2020 Annual Meeting Presentation Details

Presentations on OV101 (gaboxadol) in Neurodevelopmental Disorders:

Title: The adaptation and utility of the Clinical Global Impression scale for studying treatment outcomes in neurodevelopmental conditionsPoster No.: 009Poster Session 5: Research Methodology, Education, and HistoryDate and Time:Monday, April 27, 8:009:00 a.m. ET

Title: The pivotal Phase 3 NEPTUNE trial investigating gaboxadol in Angelman syndrome: Study designPoster No.: 015Poster Session 13: Neuromuscular and Clinical Neurophysiology (EMG)Date and Time:Wednesday, April 29, 5:30 6:30 p.m. ET

Title: Evidence of pharmacodynamic tolerance during repeated daily gaboxadol exposure in individuals with Angelman syndrome Poster No.: 011Poster Session 13: Neuromuscular and Clinical Neurophysiology (EMG)Date and Time:Wednesday, April 29, 5:30 6:30 p.m. ET

Title: Physiologically based pharmacokinetic modeling (PBPK) for gaboxadol exposure in children with Angelman syndromePoster No.: 012Poster Session 13: Neuromuscular and Clinical Neurophysiology (EMG)Date and Time:Wednesday, April 29, 5:30 6:30 p.m. ET

Title: Caregiver insight on the core domains in Angelman syndromePoster No.: 013Poster Session 13: Neuromuscular and Clinical Neurophysiology (EMG)Date and Time:Wednesday, April 29, 5:30 6:30 p.m. ET

Title: Quality of life in adolescent and adult individuals with Angelman syndrome: Baseline results from the Phase 2 STARS studyPoster No.: 014Poster Session 13: Neuromuscular and Clinical Neurophysiology (EMG)Date and Time:Wednesday, April 29, 5:30 6:30 p.m. ET

Title: Concomitant medication in adolescent and adult individuals with Angelman syndrome: Baseline results from the Phase 2 STARS studyPoster No.: 011Poster Session 14: Neuromuscular and Clinical Neurophysiology (EMG)Date and Time:Thursday, April 30, 8:00 9:00 a.m. ET

Title: The Phase 2a ROCKET trial investigating gaboxadol in adolescents and young adults with Fragile X syndrome: Study designPoster No.: 003Poster Session 14: Neuromuscular and Clinical Neurophysiology (EMG)Date and Time:Thursday, April 30, 8:00 9:00 a.m. ET

Presentations on OV935/TAK935 (soticlestat) in Rare Developmental and Epileptic Encephalopathies (DEE):

Title: Initial data from the ongoing ENDYMION open-label extension trial of soticlestat (TAK-935/OV935) in participants with developmental and/or epileptic encephalopathies (DEE)Poster No.: 007Poster Session 10: Practice, Policy, and EthicsDate and Time: Tuesday, April 28, 5:30 6:30 p.m. ET

Title: A Phase 1b/2a study of soticlestat (TAK-935/OV935) as adjunctive therapy in adults with developmental and/or epileptic encephalopathies (DEE)Poster No.: 008Poster Session 10: Practice, Policy, and EthicsDate and Time: Tuesday, April 28, 5:30 6:30 p.m. ET

About Ovid TherapeuticsOvid Therapeutics Inc. is a New York-based biopharmaceutical company using its BoldMedicine approach to develop medicines that transform the lives of patients with rare neurological disorders. Ovid has a broad pipeline of potential first-in-class medicines. The companys most advanced investigational medicine, OV101 (gaboxadol), is currently in clinical development for the treatment of Angelman syndrome and Fragile X syndrome. Ovid is also developing OV935/TAK935 (soticlestat) in collaboration with Takeda Pharmaceutical Company Limited for the potential treatment of rare developmental and epileptic encephalopathies (DEE).

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Ovid Therapeutics Announces Multiple Presentations at the American Academy of Neurology 2020 Annual Meeting - Yahoo Finance

A new analysis shows that rates of intracerebral hemorrhage (ICH) have not fallen during recent years, as has been seen with ischemic stroke, and rates appear to be increasing in the elderly.

"Our findings suggest we should be preparing for an increase in ICH rates with the ageing of the population," lead author Vasileios-Arsenios Lioutas, MD, Beth Israel Deaconess Medical Center, Boston, Massachusetts, told Medscape Medical News.

The researchers also discuss whether the increased use of certain medications such as anticoagulants and statins may be playing a role in ICH trends.

The analysis examined data from more than 10,000 individuals from the Framingham study. "This is the longest running population-based cohort with a follow-up period of 68 years, so gives us a unique opportunity to look at ICH trends in a large population over a long period of time," Lioutas said.

The paper was published online June 8 in JAMA Neurology.

There were 129 cases of a primary ICH incident in the study, with an incidence rate of 43 cases per 100,000 person-years. The unadjusted incidence rate increased over time, but the age-adjusted incidence rate showed a slight decrease since 1987.

An age-stratified analysis indicated a continued increase in ICH incidence among patients aged 75 years or older, reaching 176 cases per 100,000 person-years in the period 2000-2016.

"In general, there has been a stabilization of ICH rates since the mid-80s. The rates have flattened out, but we have not seen a large decline in ICH in the past 30 years as has been seen for ischemic stroke. This leads us to ask whether we could be doing better with regard to ICH," Lioutas commented.

"In particular, we saw an increase of ICH since 1985 in older people (aged over 75) whereas there was a slight decrease in those under 75. As the population is aging, we should brace ourselves for an increase in ICH," he added.

The researchers looked at the two different subtypes of ICH, deep and lobar, which are believed to represent different underlying processes.

"We have always thought that deep ICH is generally related to hypertension and lobar ICH is related to amyloid angiopathy the deposit of amyloid protein in the blood vessel walls. But our current results suggest this is not as straightforward as we may have believed," Lioutas explained.

"We found that while deep ICH is indeed related to hypertension, we also found hypertension to be a pretty robust risk factor for lobar ICH as well."

The incidence rate increased substantially with age for both the lobar and deep types of ICH.

"These results suggest we need to be even more aggressive with blood pressure control. This is the one modifiable risk factor we can absolutely act upon and make a difference," Lioutas stressed.

Many risk factors for ICH and ischemic stroke are similar, so, if ischemic stroke rates are falling, why are ICH rates not falling too? "This is the million-dollar question," Lioutas noted.

He said that the current data do not answer that question, but he put forward some suggestions including increased use of certain medications, particularly anticoagulants.

"There has been a sharp increase in the use of anticoagulants these drugs are great at reducing ischemic stroke but they do increase bleeds. The rate of use of anticoagulants has tripled since 1985. This is not a surprise," Lioutas commented.

In the study, use of anticoagulant medications increased from 4.4% in period 2 (1987-1999) to 13.9% in period 3 (2000-2016).

The researchers also discuss the increased use of statins in relation to the ICH rates seen.

"Statins have been linked to ICH but this association is not strong. The jury is out on this as the evidence is conflicting, but statin use has increased dramatically since the mid-1980s," Lioutas commented.

In the paper, the researchers write: "In our cohort, patients with deep ICH had a 4-fold higher likelihood of using statin medications compared with matched individuals in the control group despite no significant differences in cardiovascular disease prevalence. However, we approach this finding with caution given the relatively low number of exposed individuals."

Lioutas added: "We are not making a direct link between our results and the use of either anticoagulants or statins, but only to say that this may be one possible explanation for our observations."

"The beneficial effects of statins and anticoagulants in reducing ischemic events are well proven and their benefits definitely outweigh their risks when used in the right patient populations," he added. "They also probably allow people to live longer so that they may then go on to experience an ICH, but perhaps we could make sure we select patients for these medications more carefully and think about dosage and each individual's risk of hemorrhagic complications."

Commenting on the study for Medscape Medical News, Michael Szarek, PhD, professor Chair of the Department of Epidemiology and Biostatistics at the SUNY Downstate Health Sciences University, New York City, said, "The finding that hemorrhagic stroke incidence appears to be increasing in older patients over time may be explained, at least in part, by competing risks.

"Specifically, as the risk of death from vascular causes, including ischemic stroke, has decreased due to more effective treatments that modify the risk of these events, patients consequently remain at risk for non-modifiable events. Therefore, patients who would have otherwise died at a younger age from vascular causes appear to have higher rates of other negative outcomes, including hemorrhagic stroke."

On the issue of statins and ICH, Szarek points out that meta-analyses of individual patient data from randomized studies have not found statins to be associated with a significantly increased risk for ICH.

"Importantly, these analyses have consistently found substantial benefits of statin therapy in terms of vascular events including ischemic stroke, which are much more frequent than hemorrhagic stroke overall as well as in older patients," he said. "Therefore, even if statin therapy results in an increased risk of hemorrhagic stroke, the possible absolute increase in risk is small relative to the definitive absolute decrease in these other events, indicating the benefits of treatment far outweigh this potential risk."

This study was supported by grants from the National Institute of Neurological Disorders and Stroke, the National Institute on Aging, and the National Heart, Lung, and Blood Institute.

Lioutas reported receiving grants from the National Institutes of Health and the National Institute on Aging during the conduct of the study, and personal fees from Qmetis outside the submitted work. Disclosures for other authors appear in the paper.

JAMA Neurol. 2020. Published online June 8. Abstract.

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Original post:
ICH Rates Rising in the Elderly - Medscape

The mother of a 5-year-old Guatemalan boy sued U.S. Immigration and Customs Enforcement over the medical care he has received in detention for a head injury suffered before the family was arrested.

The lawsuit filed late Friday in California asks a judge to order the child to be taken to a pediatric neurologist or pediatric neurosurgeon. It also seeks to prevent ICE from trying to immediately deport the family.

The boy fell out of a shopping cart in December, fractured his skull and suffered bleeding around his brain. About a month later, he and his family were detained by ICE during what they thought was a routine check-in. The boy, his 1-year-old brother and their mother were taken to ICEs family detention center at Dilley, Texas, while their father was taken to a detention center in California.

The childs relatives and advocates allege thatICE is not properly treating symptomscaused by the accident that began before he was detained. The boy has severe headaches and is hypersensitive to normal levels of sound, according to his aunt and Dr. Amy Cohen, an advocate working with the family. He is also starting to wet himself, according to his aunt. They allege the boys mother has pleaded for medical care, but has been disregarded.

ICE has defended the care the boy has received at Dilley. The agency says medical staff at the detention center conducted multiple check-ups and found no lasting neurological issues. After The Associated Press first inquired about the case on Monday, ICE took the boy to the Childrens Hospital of San Antonio on Tuesday and Wednesday, where he was found to have a normal MRI and no signs of continued bleeding in his skull.

The boy was not seen at the hospital by a pediatric neurologist, according to medical records obtained by his familys attorneys. According to the records, hospital doctors consulted the neurosurgery department and determined that no follow-up was necessary because the MRI was clear.

Cohen said the boy had an appointment to see a neurologist before the family was detained by ICE. The symptoms his family reported began before their detention and could be caused by a head injury even if the initial bleeding is gone, meaning that an MRI would not be enough, she said.

The San Antonio hospital also did not have the paperwork from the California hospital that first treated him, according to the latest records. Doctors at the first hospital determined that the boy needed a neurosurgery follow-up within four weeks.

In a statement Thursday, ICE said it was determined that no issues were present that required the need to elevate the case to another neurological specialist. It declined to comment Saturday on the lawsuit. The Childrens Hospital of San Antonio declined to comment Friday on the case.

The AP is withholding the names of the boy and his family because they fear imminent deportation to Guatemala, where the boys mother says she was threatened.

Originally posted here:
ICE Sued Over Treatment Of 5-Year-Old With Head Injury - KERA News

This study has articulated the Global Neurology Software Market with a detailed view of the Global Neurology Software industry including Global production sales, Global revenue, and CAGR. The report delivers core insights regarding the Neurology Software Market report with an in-depth study of market size, country-level market size, region, segmentation market growth, market share, sales analysis, value chain optimization, market players, the competitive landscape, recent developments, product launches, strategic market growth analysis, trade regulations, opportunities analysis, technological innovations, and area marketplace expanding. Moreover, it critically focuses on the application by analyzing the growth rate and consumption of every individual application.

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Report covers detailed study about the gross margin, production, revenue, the price of the Global Neurology Software Market regarding different regions covered in particular section. It majorly focuses on manufacturing analysis including about the raw materials, cost structure, process, operations, and manufacturing cost strategies. The report introduces the industrial chain analysis, downstream buyers, and raw material sources along with the accurate insights of market dynamics. The Neurology Software Market reports delivers the knowledge about market competition between vendors through regional segmentation of markets in terms of revenue generation potential, business opportunities, demand & supply.

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Major Table of Contents

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Global Neurology Software Market Drivers, Key Players, Regions, Application and Forecast to 2020-2025 - News Times