Earlier initiation of clinical care after a concussion was associated with faster recovery in a new study.

Athletes who presented for evaluation within the first week after injury recovered faster than athletes who initially presented 2 to 3 weeks post injury.

"Our results show that following a concussion, patients should seek specialty care involving a comprehensive assessment and clinical exam that allows for more targeted treatments for specific symptoms and impairments as early as possible," lead author Anthony P. Kontos, PhD, told Medscape Medical News.

Kontos, who is research director of UPMC Sports Medicine Concussion Program, University of Pittsburgh, added: "Earlier care with a trained clinician allows patients to begin behavioral management strategies involving physical and cognitive activity, sleep, nutrition, hydration, and stress management, all of which can enhance the recovery process. Patients should not wait for a week or more to seek care to see if things improve on their own; rather, they should seek care as soon as they can to enhance their recovery process."

The study was published online January 6 in JAMA Neurology.

The researchers note that most athletes who experience a concussion do not receive care beyond an initial evaluation or diagnosis at or near the time of injury and that this may result in prolonged time to recovery.

There has been general reticence among clinicians who treat patients with concussion to engage in earlier active intervention because of perceptions that it may result in a prolonged recovery, but recent research suggests that provision of care in the first few days after a concussion, especially active interventions that target specific symptoms and impairments, may play a pivotal role in influencing recovery, the researchers say.

For the current retrospective, cross-sectional study, Kontos and colleagues analyzed data on 162 young people who experienced a concussion while playing organized or recreational sports and who received treatment at a sports medicine concussion clinic.

They compared time to recovery in the 98 patients seen within the first 7 days post injury (the early group) with 64 patients seen within 8 to 20 days post injury (the late group).

The early and late groups did not differ in age (mean, 15.3 years vs 15.4 years); number of female patients (early, 52.0%; late, 62.5%), or other demographic, medical history, or injury factors. The groups were also similar with respect to symptom severity, as well as cognitive, ocular, and vestibular outcomes at the first clinic visit.

Results from a logistical regression indicated that recovery time was increased for patients in the late-treatment group (adjusted odds ratio, 5.8). Having a score >2 on an assessment of visual motion sensitivity was also associated with increased recovery time (adjusted odds ratio, 4.5).

"We found that early access to clinical care was associated with an almost six times increased likelihood of a recovery within 30 days," Kontos said.

In the early group, 52% of patients recovered within 30 days, compared with 19% of those in the late group. Mean recovery time was 51 days in the early group vs 66 days in the late group.

Kontos pointedout that concussion treatment is not just a matter of prolonged rest. "Some patients may rest for 6 months and still have symptoms, but after 1 month of vestibular therapy they are better. The brain is like any other part of the body if it is damaged and you do nothing, it doesn't always repair itself. It needs the right therapy. We used an exposed recovery model which used active targeted treatments for individual symptoms of concussion.

"Earlier care involving a comprehensive assessment and clinical exam allows for more targeted treatments for specific symptoms and impairments," he commented.

"For example, a patient with vestibular impairment would be able to begin therapy earlier and potentially accelerate their recovery simply by coming in for specialty care sooner rather than waiting. In addition, earlier care with a trained clinician allows patients to begin behavioral management strategies involving physical and cognitive activity, sleep, nutrition, hydration, and stress management, all of which can enhance the recovery process."

The researchers note that the earlier initiation of active rehabilitation strategies, including exertion progression and the opportunity to start structured physical therapies (eg, on vestibular, visual, and cervical systems), is one reasonable explanation for the shorter recovery time in the earlier group in this study.

"Further, without clinical guidance and behavioral management recommendations postinjury, athletes may have been engaging in counterproductive recovery strategies, such as strict rest or excessive physical activity," they add.

They point out that this explanation is supported by the fact that athletes recovered in a similar amount of time after the first evaluation. "It appears that all athletes had similar impairments and similar recovery time after they had received initial clinical care, highlighting the importance of clinical care as soon as possible," they conclude.

"As a parent, I would prefer my child to recover quicker from concussion symptoms, and that means accessing care sooner," Kontos added.

Commenting on the study for Medscape Medical News, Sarah Benish, MD, associate professor of neurology at the University of Minnesota, in Minneapolis, said: "I think this article adds to the growing literature that suggest early and active intervention is most likely beneficial to concussion improvement."

However, Benish pointed out that the latter group appeared to have more females, more migraine sufferers, a high rate of loss of consciousness, and a higher rate of posttraumatic amnesia, which may have had a bearing on the results.

"In addition, I would be concerned that there is a selection bias and those who had milder concussion that would self-resolve have been eliminated for the later-care group, as they would not have been seen in the clinic. The only way to truly know would be to do a prospective study where concussion athletes are assigned to an early or late appointment," she added.

"I agree the study suggests patients might benefit from improving access to care for athletes to get help for concussion, but I am not sure this is the definitive study that is needed to convince health systems to invest more money into helping access issues in an area that is historically underserved. However, it is another step towards improving care for concussion patients," she concluded.

Kontos has received grants from the National Football League, personal fees from APA Books, and other compensation from the University of Pittsburgh outside the submitted work.

JAMA Neurology. Published online January 6, 2020. Abstract

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The rest is here:
Earlier Intervention After Concussion Linked to Faster Recovery - Medscape

Reducing dangerous swelling in traumatic brain injury: Injected nanoparticles reduce swelling and secondary brain damage in preclinical research.

After a traumatic brain injury, the most harmful damage is caused by secondary swelling of the brain compressed inside the skull. There is no treatment for this.

In new research, Northwestern Medicine scientists were able to significantly reduce brain swelling and damage after a traumatic brain injury by injecting nanoparticles into the bloodstream within two hours after the injury, they report in a preclinical study.

The results are vastly better than we predicted, said Dr. Jack Kessler, professor of neurology at Northwestern University Feinberg School of Medicine and senior author on the paper. We believe this may provide the first real and practical treatment for people who have a significant traumatic brain injury.

The study will be published today (January 22, 2020) in Annals of Neurology.

The nanoparticles are made of an FDA-approved material table and could easily be loaded into a syringe and given immediately after traumatic brain injury in the field by emergency medical technicians or in the emergency room to prevent secondary damage, Kessler noted.

The scientists have begun first steps to obtain FDA approval for a clinical trial.

Traumatic brain injuries affect approximately 2.5 million people in the U.S. each year, according to a 2010 Centers for Disease Control report. However, these numbers dont account for individuals who did not receive medical care, had outpatient care or who received care at a federal facility, such as persons serving in the U.S. military. Soldiers who serve in the U.S. military are at high risk for traumatic brain injury.

After a traumatic brain injury, the body launches an inflammatory reaction that triggers a cascade of immune responses that result in brain swelling.

A patient can come into the emergency department walking and talking but then their brain swells. They immediately go downhill and can die, Kessler said. Now, the only thing a surgeon can do is open the skull up to relieve the pressure, but the brain still continues to swell.

The nanoparticles work as a decoy to distract the immune cells from charging into the brain and causing more damage. The particles, named IMPS for immune modifying nanoparticles, are merely empty shells and do not contain any drugs or cargo.

After a traumatic brain injury, a specific population of monocytes large white blood cells rush to the injury site and attempt to clean up debris from damaged brain cells and secrete inflammatory proteins that stimulate other immune cells. This immune cascade produces swelling and inflammation that inadvertently damages surrounding healthy brain tissue.

But when the scientists inject the nanoparticles into the bloodstream shortly after the injury, these monocytes are tricked into thinking the nanoparticles are invading foreign materials. They engulf the particles and usher them to the spleen for disposal. The distracted monocytes are no longer around to enter the brain and cause problems.

In the study, mice that received the nanoparticles after a traumatic brain injury had greatly reduced swelling and half the damage to brain tissue compared to those who did not receive the nanoparticles. One of the injury models mimicked a closed head traumatic brain injury common in humans. In that model, the animals motor and visual function improved after the nanoparticle injection.

We predicted there would be an effect, but the effect turned out to be quite startling. It is remarkable how well the animals do, said lead author Sripadh Sharma, a Feinberg MD-PhD student.

Sharma, who is doing his neurology rotation, sees potential for helping young and professional athletes as well as soldiers. These particles selectively knock out the damaging cells that begin infiltrating the brain within a couple of hours of the injury and reach their peak in three days. We can intervene before the secondary damage begins.

Northwestern scientist Stephen Miller originally co-developed the nanoparticles to introduce food allergens to the immune system to create tolerance in food allergies. The microparticles also were used to treat multiple sclerosis by introducing myelin to the immune system to reduce its reactivity to it.

Then, in a 2014 Science Translational Medicine paper, Miller noted the microparticles prevented death in mice infected with West Nile Encephalitis virus. That led to the work in other models of acute inflammation including heart attack, colitis, and peritonitis. Mostly recently, Miller began collaborating with Kessler, whose research focus is brain and spinal cord injury.

Reference: Intravenous Immunomodulatory Nanoparticle Treatment for Traumatic Brain Injury by Sripadh Sharma PhD; Igal Ifergan PhD; Jonathan E. Kurz MD, PhD; Robert A. Linsenmeier PhD; Dan Xu PhD; John G. Cooper PhD; Stephen D. Miller PhD and John A. Kessler MD, 10 January 2020, Annals of Neurology.DOI: 10.1002/ana.25675

Miller is the Judy Gugenheim Research Professor of Microbiology-Immunology at Feinberg.

The nanotechnology was licensed toCOUR Pharmaceuticals Co., a biotech based in Northbrook, Illinois, co-founded by Miller. Miller, who is on the COUR scientific advisory board, is a stock grantee and a paid consultant for the company. Northwestern University has a financial interest in COUR.

The research was supported by grants F31 NS105451-02 from the National Institute of Neurologic Disease and Stroke, R01 AG054429 from the National Institute on Aging and R01 EB-013198 from the National Institute of Biomedical Imaging and Engineering, all of the National Institutes of Health.

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Injected Nanoparticles May Provide First Real Treatment for Traumatic Brain Injury - SciTechDaily

The "Advanced Visualization Technologies Improving Medical Imaging and Diagnosis" report has been added to ResearchAndMarkets.com's offering.

This research service (RS) highlights the innovations in advanced visualization platforms, including artificial intelligence (AI)-based systems, three-dimensional (3D) imaging, and other technologies, such as augmented reality (AR), virtual reality (VR), and 3D printing.

The report showcases the application of these technologies in areas such as cardiology, neurology, and also for surgical planning and intraoperative procedure assistance. It also discusses the impact of these innovations, funding, drivers, and challenges, and future growth opportunities.

Conventional visualization methods that depend on two-dimensional (2D) medical images have been fraught with challenges such as difficulty in interpreting the information due to the static nature of the content and lack of availability of volumetric data. To address these limitations, imaging preferences of the medical community are shifting toward technologies that offer improved measurement precision, enhanced depth of imaging structures, shortened scan time, improved clinical productivity, capturing of hard to image anatomical areas and systems that provide higher diagnostic confidence.

Key Topics Covered:

1. Executive Summary

1.1 Scope of the Research

1.2 Research Methodology

1.3 Key Findings

2. Industry Overview

2.1 Changing Dynamics in Advanced Visualization

2.2 Number of CT and MRI Exams, by Major Countries

3. Technology Snapshot

3.1 Technology Segments in Advanced Visualization

3.1.1 Artificial Intelligence-based Visualization Systems for Medical Imaging

3.1.2 AI-based Visualization Systems for Cardiovascular Imaging

3.1.3 AI-based Visualization Systems for Lung Imaging

3.1.4 AI-based Visualization Systems for Neurological Imaging-Dementia Diagnosis

3.1.5 AI-based Visualization Systems for Neurological Imaging-Stroke Diagnosis

3.1.6 AI-based Visualization Systems for Breast Imaging

3.1.7 AI-based Visualization Systems for Bone Imaging

3.2 Technology Segments in Advanced Visualization

3.2.1 Improving Radiological Diagnosis and Surgical Planning through 3D Imaging

3.2.2 Enhanced Breast Specimen Visualization through 3D Imaging

3.2.3 3D Image Visualization Platforms for Faster Exam Read Times

3.3 Technology Segments in Advanced Visualization

3.3.1 Improved Understanding of Human Anatomy Variations through Other Advanced Visualization Technologies

3.3.1.1 Augmented Reality Technologies

3.3.1.2 Augmented Reality (AR) Platforms for Intraoperative Procedure Assistance

3.3.1.3 AR Platforms for Enhanced Surgical Planning

3.3.2.1 Virtual Reality Technologies

3.3.2.2 Immersive Pre-operative Planning through Virtual Reality Systems

3.3.3.1 3D Printing Platforms

3.3.3.2 Developing Anatomical Models through 3D Printing for Pre-procedural Planning

4. Impact Assessment and Analysis

4.1 Impact of Technology Accelerators and Challenges

4.1.1 Superior Specificity and Image Processing Capabilities to Aid Market Adoption

4.1.2 Cyber Security Issues and Product-associated Challenges to Impede Systems Use

4.2 Impact of Market Accelerators and Challenges

4.2.1 Expanding Therapeutic Applications and Financing Support to Drive Market Growth

4.2.2 Cumbersome Regulations and Clinicians Workforce Shortfall to hinder Systems Adoption

5. Funding Assessment and Growth Opportunity

5.1 Assessment of Federal Funding for Advanced Visualization Platforms

5.1 Assessment of Federal Funding for Advanced Visualization Platforms (continued)

5.2 AI-based Medical Imaging Platforms Receive Maximum Funding Compared to AR, and VR Visualization Systems

5.3 Assessment of Key Partnerships Involving Advanced Visualization Companies

5.4 Growth Opportunities for AI-based Visualization Platforms

5.5 Strategic Recommendations

6. Key Industry Contacts

For more information about this report visit https://www.researchandmarkets.com/r/d0t980

View source version on businesswire.com: https://www.businesswire.com/news/home/20200124005161/en/

Contacts

ResearchAndMarkets.comLaura Wood, Senior Press Managerpress@researchandmarkets.com For E.S.T Office Hours Call 1-917-300-0470For U.S./CAN Toll Free Call 1-800-526-8630For GMT Office Hours Call +353-1-416-8900

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2019 Report on Advanced Visualization Technologies Improving Medical Imaging and Diagnosis in Cardiology, Neurology, Surgical Planning and...

For people with Parkinsons disease, deep brain stimulation can calm the tremors and tame the unwanted movements that come with the progressive neurodegenerative disease. Electrodes implanted in the brain, controlled by a device placed under the skin of the chest and equipped with an on-off switch, can ease troubling symptoms and synchronize complex motions.

A new paper reports a worrying development: Nine proficient swimmers lost their ability to swim after DBS surgery for Parkinsons, even though the implant improved other movements walking, for one that require coordination of the limbs. Why swimming mastery disappeared remains a mystery, but the doctors who described the cases Wednesday in Neurology wanted to sound an alarm right away.

Patients and neurologists should be aware of the potential loss of the ability to swim following subthalamic DBS, Dr. Christian Baumann, study co-author and an associate professor of neurology and a neurologist at University Hospital Zurich, told STAT. We warn all patients to be cautious when going into deep waters.

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One patient, a 69-year-old man who owned a lakeside house, found this out in dramatic fashion. Feeling confident after DBS because of his good motor outcomes, he literally jumped into the lake, where he would have drowned if he had not been rescued by a family member, the researchers wrote.

A 61-year-old woman complained that although she was a competitive swimmer who had regularly raced across Lake Zurich, when her DBS was activated, she could swim only a little over a tenth of a mile, and only with an awkward stroke.

When three other patients switched off their DBS devices, they could immediately swim again. But their other movements and neuropsychological symptoms deteriorated so rapidly that they turned the DBS back on.

Deep brain stimulation, approved to treat Parkinsons in the U.S. in 1997, has become the standard of care for people whose tremors and motor fluctuations are no longer responding to medical treatment. After other Parkinsons drugs stop working, patients typically take levodopa, a precursor to dopamine, to restore levels of the neurotransmitter that their bodies no longer make in sufficient quantities. But levodopas effects fade, too. Doses wear off, patients sometimes freeze while walking, and they have involuntary movements.

Instead of restoring dopamine, DBS sends electrical signals from surgically implanted electrodes directly to neurons thought to be responsible for movement. Why patients could still walk but not swim made the researchers wonder if DBS affects the brain in a different way than levodopa does. Patients with DBS, which they can turn on when needed to control tremors, continue to take levodopa.

I think that imprinted synchronized activity in different brain structures, which have been learnt, may be changed by DBS, i.e. the change of activity in one network piece alters the whole network, which might explain this outcome, Baumann said. But this is hypothetical.

Dr. Michael Okun, medical director of the Parkinsons Foundation and executive director of the Norman Fixel Institute for Neurological Diseases at University of Florida Health, noted the preliminary nature of the case reports as well as changes in how much dopamine the patients were taking after DBS. He was not involved in the study.

All of the patients in their series had dopaminergic reductions in medication greater than 50% post-surgery and it is possible that this factor may have played a large role in the decline in function, he said. Proper prospective testing of the device in the on- and off-medication condition, as well as in the pre- and post-operative testing conditions, will be required to sort out the root causes of this phenomenon. In the meantime, Parkinsons patients with or without DBS should not swim without a buddy.

Other complex motor behaviors, such as skiing, playing golf, or skating, might also be affected, Baumann said. But swimming is the most worrisome not just for people with DBS, Okun warned.

One important piece of advice for all Parkinsons patients is to never swim alone, Okun said. The risk of medication wearing off and freezing has been known to be associated with drowning in Parkinsons disease regardless of whether or not a deep brain stimulator has been implanted.

Read the original post:
Swimming and deep brain stimulation do not mix, researchers warn - STAT

Patients now have a new place to go after a Pismo Beach neurology office closed up shop.

Dignity Health has opened a new clinic at the Matthew Will Memorial Medical Center in Arroyo Grande to serve former CoastNeuro patients.

That office closed abruptly in early December after nine years in business. More than 5,000 patients were left without a doctor.

"The best thing that people need to understand is that we still have neurologists here in the community," said Dr. Scott Robertson, Pacific Central Coast Health Centers President/CEO. "Most of them are the same neurologists that have been caring for them and their families over the last decade so these services are still here, the physicians are still here, and from their point of view, other than the location, nothing should be any different."

The new clinic started seeing patients last Thursday.

We're told you can call the old CoastNeuro phone number to make an appointment.

See more here:
UPDATE: New neurology office opens for thousands of patients left without care in Pismo Beach - KSBY San Luis Obispo News

Note:The views expressed by the authors are their own and do not represent an official statement by the American Heart Association/American Stroke Association.

Stroke was defined by the World Health Organization (WHO) more than 40 years ago as rapidly developing clinical signs of focal (or global) disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin.1This was a working definition created for a study assessing the prevalence and natural history of stroke, and it served its purpose at the time.

The ensuing decades have witnessed major advances in basic science, pathophysiology and neuroimaging that have dramatically improved our understanding of ischemia, infarction and haemorrhage in the central nervous system (CNS). There is little doubt that permanent injury occurs well before the 24-hour threshold, and therefore purely time-based definitions are inaccurate and obsolete. Further, neuroimaging has demonstrated that clinically transient symptoms are often associated with evidence of acute cerebral infarction and that infarction may occur without overt symptoms.

In 2009, the American Heart Association/American Stroke Association (AHA/ASA) published a scientific statement redefining transient ischemic attack (TIA) as, a transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischemia without acute infarction.2This statement formally addressed only one side of the proverbial coin, but clearly implied that objective evidence of infarction should be considered as a defining feature of stroke.

In the spring of 2013, the AHA/ASA published an expert consensus document with a new definition of stroke to reflect these advances.3Authors with expertise in the fields of neurology, neurosurgery, neuroradiology, neuropathology, clinical research methods, epidemiology, biomarkers, policy and global public health were invited from within the AHA/ASA, as well as the American Academy of Neurology, the American Association of Neurological Surgeons and Congress of Neurological Surgeons, U.S. Centers for Disease Control and Prevention, the National Institute of Neurological Disorders and Stroke, the European Stroke Organization (ESO), the World Stroke Organization (WSO) and others to establish a universal definition of stroke.

The major fundamental change compared with older definitions is that the new broader definition of stroke includes any objective evidence of permanent brain, spinal cord or retinal cell death due to a vascular cause based upon pathological or imaging evidence with or without the presence of clinical symptoms. Ultimately, the leaders of the ESO and WSO withdrew from participation and declined to endorse the statement because they disagreed about the inclusion of silent cerebral infarction and silent cerebral haemorrhage within the lexicon of stroke. (See Stroke Definition in the ICD-11 at the WHO.)

The AHA/ASA defined CNS infarction based on pathological, imaging or other objective evidence of infarction. In the absence of this evidence, the persistence of symptoms of at least 24 hours or until death remained a method to define stroke.At present, imaging is not always available and also is not perfect. In much of the developing world and in rural parts of more developed regions, neither [CT or MRI] may be available in the acute setting, if at all, which limits the global applicability of an imaging-based definition of stroke.

Silent lesions have been recognized pathologically as infarctions and haemorrhages since the 1960s but were deemed of uncertain importance. However, they may not be entirely asymptomatic, as patients may have subtle cognitive, gait or other functional impairments in the absence of a typical acute presentation. To some extent, the silence of an infarction or haemorrhage depends on the eye of the beholder. Patients may not be aware of their symptoms due to neglect, denial or simply may attribute them to another cause and not seek a medical opinion. Physicians and other health care providers may vary in their ability to detect mild neurologic abnormalities, or they, too, may ascribe them to an alternative cause.

The AHA/ASA included silent CNS infarctions and haemorrhages within the broadest definition of stroke for multiple reasons.

The new tissue-based definition of CNS infarction depends on either early objective (currently neuroimaging) evidence of infarction or persistence of symptoms for at least 24 hours. If early imaging is not available, then clinicians are left with a diagnostic dilemma in those first 24 hours since the event cannot be clearly classified as stroke.

Ultimately, diagnostic techniques and/or time will help define infarct or haemorrhage based on objective imaging, or TIA in the absence of positive imaging and resolution of symptoms within 24 hours from onset. A major challenge for the future will be the achievement of access to diagnostic and treatment tools in the developing world, where a substantial portion of the global burden of stroke occurs.

The inclusion of silent infarcts and microhemorrhages within the AHA/ASA definition of stroke opens many questions for clinicians. In regions with little or no access to neuroimaging, this change in definition may prove irrelevant for many years to come. However, for those with such access, silent lesions are likely to be detected as a result of the widespread use of MRI for non-cerebrovascular symptoms such as headache or dizziness.

Updating the definition of the disease can have prominent effects on disease surveillance and assessments of public health. In the case of adding a large number of silent infarction cases to the existing number of stroke cases, this will increase the total number of stroke cases while likely decreasing the mortality rate due to the addition of a number of minor/silent cases.4Updating the definition of stroke could result in reclassification of stroke cases for incidence, prevalence, and mortality in national and international statistics, disease classification coding systems and existing health surveys. This is particularly problematic if definitions are applied differently in each region of the globe, and this is a major concern of all stroke organizations. Therefore, the AHA/ASA recommended that symptomatic and silent infarctions and haemorrhages should be counted separately to allow for valid analyses of temporal and geographic trends in stroke. Although the WSO, ESO and WHO will not include the silent lesions within the definition of stroke, they recognize their importance and are going to start counting them within the scope of cerebrovascular disorders in the ICD-11.

Read the full article

At the time of print, Kasner is with the University of Pennsylvania and Sacco is with the University of Miami.

References

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Implications of the AHA/ASA Updated Definition of Stroke for the 21st Century - WFN News

Article In Brief

Neurologists and neuroethicists discuss the different pathways to careers and involvement in ethical decisions involving neurology patients.

Ethics is a critical component of all medical practice, but perhaps no other medical specialty deals with basic ethical issues more frequently than does neurology, because the brain and its function is so central to human identity. An individual could undergo a heart, lung, kidney, or liver transplant and still remain essentially the same person, but even if such a thing as a brain transplant were medically possible, it would alter the fundamental essence of who that person is. States of consciousness, ability to communicate and consent, issues of cognitive enhancementall pose inherent ethical challenges to the clinician.

The very nature of neurologic disease, in that it affects the brain, means that our patients are highly vulnerable, said Justin A. Sattin, MD, associate professor of neurology at the University of Wisconsin and a former member of the AAN's Ethics, Law, and Humanities Committee. Ethical concerns attach to their conditions, whether it's emergent decision-making in stroke, which is my area of subspecialty interest, or end-of-life-care, or disorders of consciousness such as minimally conscious and persistent vegetative states.

While every neurologist confronts ethical questions in his or her clinical practice periodicallysome more than otherssome clinicians have elected to take a deeper dive into the specialty's ethical questions by doing work in the field of neuroethics. As Neurology Today found when we spoke with several leaders in the field, there is no single training or career path that leads to a professional focus on neuroethics.

Some clinicians who specialize in neurology and ethics have undergone advanced specialty training in the field, while others have found themselves drawn into roles on ethics committees at their institutions through on-the-job training. But they all typically share a passion for the intersection of medicine and the humanitiesa passion that manifested itself early in their medical training.

Neuroethics pioneer Joseph J. Fins, MD, MACP, FRCP, the E. William Davis, Jr., M.D., Professor of Medical Ethics, professor of medicine, and chief of the division of medical ethics at Weill Cornell Medical College, is an internist and not a neurologist by training, although he has a secondary appointment in neurology. He majored in the humanities as an undergraduate, studying literature, history, and philosophy at Wesleyan University. During his fellowship in general internal medicine at The New York Hospital-Cornell Medical Center, he also served as a visiting associate at the Hastings Center, a bioethics research institute. In 2000, he was appointed Weill Cornell's inaugural chief of its division of medical ethics. He also teaches at Yale Law School.

A few years later, his interest in ethics intersected with neurology when two events aligned: He was editing an ethics rounds column for the Journal of Pain and Symptom Management when he received a submission about a patient in a coma in the ICU, which raised questions about whether the patient might perceive pain or experience depression.

Nicholas D. Schiff, MD, now the Jerold B. Katz Professor of Neurology and Neuroscience in the Feil Family Brain and Mind Research Institute at Weill Cornell, was studying disorders of consciousness, and Dr. Fins asked him to write a commentary for the journal. That conversation has led to a more than 20-year collaboration investigating disorders of consciousness and understanding the mechanisms of brain injury and resilience. Together, Drs. Fins and Schiff co-direct the Consortium for the Advanced Study of Brain Injury at Weill Cornell and Rockefeller University.

Neurointensivist Michael Rubin, MD, associate professor of neurology and neurotherapeutics at UT Southwestern Medical Center in Dallas and chair of the UT Southwestern Ethics Committee, followed a similar undergraduate path to Dr. Fins.

As a college student studying the humanities, I knew I wanted to be an MD but always was looking for ways to incorporate my love of literature and philosophy into daily practice. Clinical ethics was that way for me to work on those problems, he said. While completing his neurocritical care fellowship at Washington University School of Medicine in St. Louis, he also earned his master's degree in bioethics from Loyola University. He has since served on the AAN Ethics, Law, and Humanities Committeea joint committee of the AAN, American Neurological Association, and Child Neurology Societyincluding the committee's Brain Death Working Group.

Dr. Rubin noted that most people who get involved in neuroethics, however, are traditional autodidacts, having entered the field after being asked to serve on a hospital ethics committee or reading ethics-focused articles in Neurology and other scientific journals. For example, renowned neuroethicist James L. Bernat, MD, FAAN, the Louis and Ruth Frank Professor of Neuroscience at Dartmouth Medical School, who directs the Program in Clinical Ethics at Dartmouth-Hitchcock and has authored seminal texts in the field, including Ethical Issues in Neurology, contributed to the development of the field before there was accessible graduate training in clinical ethics or neuroethics.

Dr. Sattin found his way into clinical neuroethics after participating for a number of years as a member of University of Wisconsin's institutional review board. I've always had an interest in the more philosophical aspects of our field. The protection of human subjects has a major ethical domain, and that was my first entry into that world. But unlike some of my colleagues, I have not pursued formal fellowship training in bioethics.

While Dr. Sattin does not serve on the hospital's ethics committee, he has been asked to serve as a consultant to the committee for certain cases, such as one involving a patient with multifocal brain infarcts and disordered consciousness, in which he provided expertise on the patient's likely outcome and rehabilitative needs.

Dr. Sattin estimated that, as a stroke neurologist, some ethical issues arise during the treatment of as many as one-third of his patients. I estimate it to be so high because my patients are often quite ill, and a relatively high percentage of them lack decision-making capacity. Even someone who is aphasic has impaired decision-making ability, so it's truly a daily part of my practice when I'm on service.

Ariane Lewis, MD, director of the division of neurocritical care at NYU Langone Health and a member of the AAN's Ethics, Law, and Humanities Committee who has led a course on ethical conundrums in neurology at the AAN Annual Meeting, is another of those autodidacts who has rapidly become a thought leader in neuroethics.

With Dr. Bernat, Dr. Lewis guest edited a 2018 edition of Seminars in Neurology focused on ethics. Like Drs. Fins and Rubin, who majored in the humanities, her undergraduate major was not in biology or chemistry, but rather in psychology. I always liked thinking about decision-making, and the many questions in medicine that fit into the category of ethics, she said.

Most hospital ethics committees are very welcoming to those with a genuine interest, said Dr. Rubin, who first began participating in ethics committee work as a medical student. It's a great way for people to explore their interest and decide if ethics is something they want to explore in their career, similarly to how medical students rotate through other specialties.

Virtually all hospitals now have some form of ethics committee, but not all operate exactly the same way. Dr. Fins chairs the ethics committee at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, which is composed of credentialed ethicists approved by the hospital's medical board, which takes calls 24/7.

These cases are often brought to us by the clinical team based on a conflict or an uncertainty about goals of care. We help to cultivate the narrative, bring relevant ethical analysis to the case, and provide guidance in framing the kind of discussions that are important. We don't make decisions; we help make decision-making better.

NYU Langone has two different committees that address ethical issues: the ethics committee, which leads discussion about cases but does not help to formulate a decision, and the Case Review Escalation Support Team (CREST), which takes consultative calls from any service in the hospital with regard to whether it is medically, ethically, and/or legally appropriate to perform certain procedures.

For example, a consult could address the question of whether or not it's appropriate to do an exploratory laparotomy on a patient who has anoxic brain injury, said Dr. Lewis, who serves on both teams. CREST decision-making is binding in a particular case, while the ethics committee meets once a month to discuss major issues of clinical importance and is more didactically based rather than interacting directly with practice.

Issues of consciousness, brain activity, enduring neurologic impairment, and quality of life considerations are some of the most common triggers for a neuroethics consultation, said Dr. Fins, who noted that the evolution in the medical and scientific understanding of consciousness over the past two decades has led to major changes in how disorders of consciousness are categorized and characterized.

Things are very different today from when I was a medical student learning about the vegetative state. We had little understanding about other brain states or disorders of consciousness that have emerged since, said Dr. Fins, whose book, Rights Come to Mind: Brain Injury, Ethics, and the Struggle for Consciousness (Cambridge University Press, 2015) explores the clinical and ethical questions involved in caring for patients with severe brain injuries.

Patients who might appear unconscious at the bedside may actually be conscious, he said. More than 40 percent of patients thought to be vegetative from traumatic brain injury in chronic care facilities when carefully assessed with the Coma Recovery Scale are minimally conscious, rather than vegetative. This has major implications for how we think about their prospects for recovery, their perception of pain, and their isolation.

He noted that recent advances in the use of functional MRI and machine learning have also suggested that as many as 15 percent of individuals who look unresponsive in the neuro-ICU actually may be conscious and in a state that Dr. Schiff has termed cognitive motor dissociation, in which they cannot purposefully move but demonstrate brain activity on neuroimaging associated with volitional prompts.

We have to do something paradoxical and bimodal in neuroethics, which is preserving a patient's right to die and at the same time affirming the right to care for those patients and families who desire care, he argued, while also giving people a better sense of which patients can and cannot be helped through the development of better biomarkers.

So much of this depends on our ability to take limited data that we have on individual patients and come up with an idea of what the future may hold for them, so that we can provide proper guidance to families, said Dr. Rubin.

They all have the same questions: If my loved one is to survive this, what is their life going to be like? Will they wake up, talk, be independent? Our ethical challenge as neurologists in these situations is to provide the most reliable prognosis we can, and to engage with families in way that helps elicit their values so that we can, in a shared decision-making process, figure out the best choices for that patient and family.

Although these existential questions may seem daunting to address on a regular basis, Dr. Fins believes that pursuing medical ethics can be sustaining for the practicing neurologist. Medical ethics is a marvelous way to bridge science and humanities in a meaningful way. For me, it's a good balance between the active and contemplative life and keeps me engaged and bringing ideas into the clinic, he said.

Even if neurologists don't become clinical ethicists, by gaining an awareness of ethics, they will have more tools to engage in ethical reasoning and think about choices. Having the vocabulary to translate one's reasoning into angst or concern will help build resilience, prevent burnout, and make them better neurologists.

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How These Neurologists and Neuroethicists Navigate the... : Neurology Today - LWW Journals

Alexandra Angelova was 16 when she began experiencing blurry vision and occasional dizzy spells. Instead of going away, symptoms gradually grew worse. Now nearly a decade later, with her vision at one percent of its original strength and with balance problems that prevent standing or walking unassisted, these symptoms inform every aspect of her daily life.

Angelova gets around the house and walks her dog, Sunny, using a rollator, or seated walker. She presses her back against the wall for balance when going up and down stairs. Every item in her house has a set location so she can find it with her limited vision.

I cannot perform many basic things which are normal for a healthy person, Angelova said. I have to plan every movement and how to do it--how to hold a fork, how to take a shower, and so on.

Angelovas case is typical for people with spinocerebellar ataxia type 7, or SCA7, a chronic, inherited neurodegenerative disease. A child with a parent with SCA7 has a 50 percent chance of inheriting the condition. It is caused by a genetic mutation which causes the body to produce a malformed, toxic version of a normally healthy protein.

Read the full story on Magnify, an online magazine from the Duke University School of Medicine.

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Finding hope in darkness: Duke neurologist develops and tests new therapy to help understand and prevent neurodegenerative diseases - Duke Department...

I often repeat her presentation to medical students: my only patient ever to fall walking into a clinic visit had progressive supranuclear palsy (PSP).

Her impaired postural reflexes were no match for a set of brick steps. Perhaps she didn't notice the ramp, or didn't appreciate how rapidly her balance had deteriorated. Fortunately, her injuries that day were only minor. As is often the case with PSP, that would not always be the case.

In June 1963, neurologist Dr James Richardson reported eight cases of what would come to be called PSP at the American Neurological Association meeting. A year later, he and his neurologist colleagues John Steele and Jerzy Olszewski first described the disease in the literature.

The classical PSP syndromecalled "Richardson syndrome"is characterized by poor balance, vertical gaze abnormalities, executive dysfunction, and speech impairment. Falls are frequent, and often injurious. Patients can also present with impaired facial expressions, changes in mood, and waning dexterity. Given its rarity and diffuse array of symptoms, PSP is often misdiagnosed as Parkinson disease, or even Alzheimer disease.

The challenge for clinicians is that PSP is an incredibly varied condition, with not all patients presenting the same way. Beyond the classic symptoms, they may also experience a freezing gait, or corticobasal syndrome, an atypical form of parkinsonism. PSP pathology can even present with predominant language impairment, known as "primary progressive aphasia."

I'll call my patient Mrs X. Once she was in the exam room, her abnormal eye movements, changes in speech, and reduced facial expressions confirmed the diagnosis suggested by her falls. She showed classic signs of this little known neurodegenerative disease.

Not surprisingly, she and her husband had never heard of PSP. Most medical students will never learn about it unless they encounter it during their neurology rotation. I reviewed the prognosis and treatment options and introduced an ongoing clinical trial, in which she ultimately enrolled.

Over many visits, I learned about her grandson, whose soccer games she often attended with her husband. We bantered about the local college basketball team. As her disease progressed, I learned how devoted her husband was to her and how appreciative she was for his care. Given the grievous combination of physical and mental impairment that comes with PSP, having support from friends and family can be an essential part of care.

PSP is rare, but not as rare as once thought. The disorder occurs in about 5 in 100,000 persons, a prevalence similar to that of amyotrophic lateral sclerosis. However, given that clinicians have only recently come to appreciate the disease, it is probably underdiagnosed, or misdiagnosed as another movement disorder.

[M]edications rarely help the motor symptoms of PSP. Falls intensify; speech and swallowing worsen....

The early symptoms of PSP can mimic those of Parkinson disease, which is much more common. The lack of response to medications used for Parkinson diseasenamely, levodopaand PSP's more rapid progression can lead to the diagnosis being revised. Singer Linda Ronstadt recently publicly shared that she has PSP, which negatively affected her ability to sing. It was first reported that she had Parkinson disease.

The cause of PSP is unknown. Pathologic reports show that the brains of people with the condition have accumulations of tau protein, a finding also seen in other "tauopathies," such as Alzheimer disease and chronic traumatic encephalopathy. And although variants in the gene coding for tau have been associated with PSP, the condition rarely runs in families. It's for the most part a sporadic condition.

Unlike in Parkinson disease, medications rarely help the motor symptoms of PSP. Physical, occupational, and speech therapy, on the other hand, can be useful, encouraging patients to develop compensatory mechanisms and strategies to reduce falls and improve speech and swallowing. But ultimately, falls intensify; speech and swallowing worsen; and independence is eventually lost.

As is the case with all neurodegenerative diseases, the major unmet need in PSP is a treatment that stops or slows the disorderin other words, a disease-modifying therapy. A number of ongoing treatment trials are investigating monoclonal antibodies directed at tau. Many believe that the accumulation of abnormal tau is pathogenic in PSP, and that clearing it from the extracellular space will disrupt the spread of further pathology. Time will tell whether this strategy pans out.

A silver lining to the rapid decline seen in patients with PSP is that changes in neurologic functioning are easily measured. As more and more therapies are tested, any disease-modifying effect should be evident relatively quickly, which is not the case in many other neurodegenerative disorders, such as Alzheimer disease.

It is a helpless feeling to watch patients worsen, yet have no way to stop their disease or even improve their symptoms. Participating in clinical trials is one way for patients and providers to combat the helplessness. Providing compassionate, multidisciplinary care, when that is all that is available, is another.

Watching Mrs X decline over time, especially her increasingly impaired ability to walk safely, only confirmed for me the importance of developing treatments to lessen the burden of PSP.

Matthew J. Barrett is an associate professor of neurology and a movement disorder specialist at Virginia Commonwealth University in Richmond, Virginia.

Go here to see the original:
The Falls and Frustrations of Progressive Supranuclear Palsy - Medscape

Article In Brief

Evidence from a study of children who had stroke found the safety profile for the use of endovascular recanalization in those with acute, large-vessel occlusion was similar to findings from studies of adult stroke patients. The data support off-label thrombectomy for pediatric stroke.

Pediatric stroke patients undergoing endovascular thrombectomy appear to have mostly favorable neurologic outcomes with low complication rates, a new multicenter retrospective review indicated.

The findings lend support to performing mechanical recanalization for childhood stroke even though prospective randomized clinical trials have investigated its use only in adults, the authors reported in the Save ChildS study published online October 14 in JAMA Neurology.

After reviewing the databases from 27 stroke centers in Europe and the United States, the researchers concluded that endovascular recanalization appeared to be safe with positive outcomes in a real-world setting. The overall proportion of successful recanalization totaled 87 percent.

Several sizeable randomized clinical trials in adults have demonstrated the safety and efficacy of thrombectomy for large intracranial vessel occlusions. However, other than small case series, the potential for this intervention in children had not yet been examined systematically, the study's authors noted.

Etiologies are very different in children and adults, said lead author Peter B. Sporns, MD, MHBA, assistant professor of radiology/neuroradiology at University Hospital Muenster in Muenster, Germany. Results from adult trials cannot be extrapolated to pediatric populations, Dr. Sporns told Neurology Today.

Few children experience this emergency, posing challenges to researchers in designing randomized clinical trials. Arterial ischemic stroke rarely occurs in childhood, but when it strikes two to eight of 100,000 children per year, it can inflict severe disabilities with long-term social and financial consequences. Standard of care relies on supportive medical management tailored to the underlying etiology of arterial ischemic stroke. Thrombolytic and endovascular therapy is only recommended as a last resort, the authors noted.

Dr. Sporns expects the findings to have implications for current treatment guidelines. Endovascular recanalization will become first-line therapy in children with acute ischemic stroke due to large-vessel occlusion, he said. The main message is that endovascular thrombectomy in children can be performed with a similar safety profile and recanalization rate as in adults. Therefore, all physicians should keep this in mind and refer their patients to highly specialized neurointerventional centers.

Meanwhile, Dr. Sporns emphasized the need for pediatric stroke centers worldwide to contribute data to the Save ChildS Pro registry, which he is launching in 2020. We hope that this registry will provide the highest level of evidence for the use of endovascular thrombectomy in children with large intracranial arterial occlusion, he said.

From January 1, 2000 to December 31, 2018, researchers analyzed data for all pediatric patients (<18 years) with ischemic stroke who underwent endovascular recanalization at 27 participating stroke centers. The researchers initially had contacted 42 tertiary stroke centers, but 15 of those centers (36 percent) did not treat any pediatric patients with this technique.

The total cohort at 27 centers consisted of 73 children, with a median age of 11.3 years. Sixty-three children (86 percent) had treatment for anterior circulation occlusion and 10 patients (14 percent) received intervention for posterior circulation occlusion; 16 patients (22 percent) underwent intravenous thrombolysis concomitantly. Median follow-up was 16 months.

The primary outcome was a decline on the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score from admission day; the score ranges from 0 for no deficit to 34 for maximum deficit.

Secondary clinical outcomes, measured on the modified Rankin scale (mRS)where 0 (for no deficit) to 6 (death)at six and 24 months, evaluated the rate of complications.

The researchers reported improvements in neurologic outcome, with a median PedNIHSS score of 14.0 at admission and 4.0 at day seven. Median mRS score was 1.0 at six months and at 24 months. One patient developed postinterventional bleeding and four patients exhibited transient peri-interventional vasospasm.

To facilitate interpretation of the results in a broader context, investigators compared long-term outcomes in their Save ChildS study to available data from the HERMES meta-analysis trials of adults. They extracted data from intervention arms of seven published HERMES trials.

The proportion of symptomatic intracerebral hemorrhage events in Save ChildS was 1.37 compared with 2.79 in the HERMES meta-analysis.

This is a very optimistic time for pediatric stroke because these techniques of mechanical recanalization are so powerful in adults, said Christine Fox, MD, MAS, co-author of an editorial published concurrently in JAMA Neurology and associate professor of neurology and director of the Pediatric Stroke and Cerebrovascular Disease Center at the University of California, San Francisco.

While she was enthusiastic about the investigation of recanalization in children, Dr. Fox and her co-author advised caution in interpreting long-term outcome measures from the Save ChildS research.

Stroke recovery is heterogeneous in children at various stages of brain development, and the natural history of recovery may be good even in the absence of recanalization, they wrote.

For instance, they pointed out that while only 4 percent of children in the Swiss Neuropediatric Stroke Registry underwent thrombolysis, about half experienced good outcomes without functional deficits. In addition, despite the positive two-year outcomes in the Save ChildS study, selection bias may have affected the results due to data missing for more than one-third of subjects.

More complete data were available for earlier outcomes, but this may not represent the full picture, considering that disabilities in children could emerge over time.

Cognitive and language deficits may initially go unrecognized in a toddler but become apparent as skills required for success in school grow increasingly complex, the editorialists noted.

Furthermore, there are drawbacks to using published studies for comparison purposes. The modified Rankin scales may not accurately reflect outcomes in the youngest children in the Save ChildS study. In addition, outcomes in different studies may not be measured in parallel ways: For example, in the Save ChildS study, the outcomes were evaluated at discharge and at 180 days, compared to at 90 days in the HERMES trials, rendering the comparisons questionable.

However, Dr. Fox stressed the significance of the Save ChildS research. Childhood stroke is difficult to study because it's a relatively uncommon event, she acknowledged. Parents and pediatricians may not recognize symptoms swiftly after onset and within the four-and-a-half-hour treatment window. Bringing together experts across related fields would advance knowledge of stroke mechanisms and recovery with the aim of prevention and better outcomes, Dr. Fox told Neurology Today.

Those with a common interest in childhood cerebrovascular diseasefrom physicians and surgeons to nurses, psychologists, therapists, and scientistscan share their insights through professional groups, she said. Among them is the International Pediatric Stroke Organization, founded in February 2019.

To really understand how to best treat children who have a stroke, we need to continue to collaborate broadly across a number of different disciplines, said Dr. Fox, who often consults with neurointerventional radiologists, neurosurgeons, physiatrists, and hematologists.

If publication of the Save ChildS study raises awareness of pediatric stroke, the heightened attention would be a positive step toward encouraging the design of improved protocols to streamline diagnosis and deliver time-sensitive treatment, said David Y. Huang, MD, PhD, FAHA, FAAN, FANA, professor and chief of the division of stroke and vascular neurology at the University of North Carolina at Chapel Hill.

It's heartening because some data is better than the absence of data, Dr. Huang said, allowing neurologists to feel more confident in recommending endovascular thrombectomy to parents of sick children now that there is data supporting the safety of the procedure. Furthermore, in the absence of alternatives, most parents would agree to it, he added.

In rural areas without a large stroke center in relatively close proximity, it is important to consider lowering the threshold for suspecting a stroke and prompting physicians to seek outside input sooner rather than later, Dr. Huang said.

Even in an era of advanced emergency medical services and improved public awareness of stroke, few pediatric patients arrive at hospitals within the optimal treatment window, said Dana D. Cummings, MD, PhD, associate professor of pediatrics and director of the pediatric stroke program at the University of Pittsburgh Medical Center's Children's Hospital of Pittsburgh.

My hat is off to the centers that provided thrombectomy for these patients at the early time frame in the study, but that's going to be hard to replicate in most settings, said Dr. Cummings, who would like to see a study looking at outcomes in children who present more than 4.5 hours after stroke onset and undergo mechanical recanalization.

As the editorial commentators noted, there may be more neuroplasticity in kids, which complicates the interpretation of outcomes, he said. You wouldn't want to have a stroke at any age, but if you have a stroke at age three, you probably have maximal plasticity for recovery.

The editorial also addressed special considerations for performing thrombectomy in children. It should ideally be undertaken by neurointerventional radiologists skilled in both pediatric endovascular procedures and stroke embolectomy to guide selection of devices appropriate for the smaller cerebrovasculature in children. However, as stent retriever devices have been developed for embolectomy of more distal cerebral arteries, size may become less of a barrier in experienced hands. Caution remains advisable even early after stroke, particularly in young or small patients, the authors wrote.

Planning for a neurointerventional procedure in a child is inherently different, and most adult cases are handled at hospitals with minimal or no pediatric experience.

Clinicians with only adult experience shouldn't feel a sense of obligation to undertake pediatric cases based on this study alone, said Heather Fullerton, MD, MAS, professor and chief of the division of child neurology and medical director of the Pediatric Brain Center in the Benioff Children's Hospital at the University of California, San Francisco.

I am aware of complications anecdotally that haven't been reported in medical literature, she said, citing the tendency to publish successful cases. Nonetheless, the Save ChildS study is a great contribution to this field. It's the first large series on children who have received hyperacute therapy for stroke since all of these new thrombectomy trials really changed standard of care in adults.

To make additional strides in treating childhood stroke, rigorous prospective studies are needed. That's the only way we're going to get really reliable safety data, Dr. Fullerton said.

Dr. Sporns, Fox, and Fullerton had no competing interests. Dr. Cummings has received fees as a consultant on pediatric cerebrovascular disorders from the Vaccine Injury Compensation Program. Dr. Huang has received honoraria for service on a data safety and monitoring boards for Cerenova, LLC and ReNeuron.

Excerpt from:
Endovascular Recanalization Is Safe and Effective for... : Neurology Today - LWW Journals

While there is a clear association between major depressive disorder (MDD) and migraine, data published in Cephalgia provide evidence for divergent association of lifetime MDD, and MDD subtypes, with the prevalence and severity of symptoms in patients with migraine with and without aura.

It is well known that migraine and depression show a high rate of comorbidity and previous studies have suggested the association is bidirectional, with each disorder increasing the risk for onset of the other. However, limited data are available on the association between MDD subtypes and migraine.

The goal of this cross-sectional study was to assess the associations between atypical, melancholic, combined, and unspecified subtypes of MDD and migraine with and without aura. In addition, the researchers aimed to explore the associations between MDD and its subtypes with the severity of migraine.

The study included 446 patients with migraine (294 with migraine without and 152 with migraine with aura) from the population-based CoLaus/PsyCoLaus cohort study. Researchers only included patients with available information on the comorbidity of MDD. The control group was comprised of 2511 patients with MDD, or its subtypes, but no migraine.

Despite a significant association between lifetime MDD and migraine regardless of subtype, a stronger association was observed in migraine with vs without aura. Further, while all MDD subtypes were associated with migraine in general, all subtypes but atypical MDD were associated with migraine with aura; only melancholic MDD was significantly associated with increased frequency of migraine without aura.

As for the association between MDD and migraine intensity, the statistical analysis revealed a significant association between unspecified MDD subtype with higher migraine intensity only in patients with but not without aura.

Combined MDD, which included subjects with both melancholic and atypical characteristics, was found to be associated with higher migraine frequency, regardless of migraine subtype.

The researchers acknowledged that the study had several limitations, including its cross-sectional design, use of semi-structured interviews that can be associated with inaccurate recall of remote episodes, and a relatively small sample of patients with atypical or combined MDD.

Further studies exploring the pathophysiological mechanisms shared between melancholic depression and migraine are warranted, concluded the researchers.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors disclosures

Reference

Pisanu C, Lundin E, Preisig M, et al. Major depression subtypes are differentially associated with migraine subtype, prevalence and severity. [published online October 1, 2019]. Cephalgia. doi:10.1177/0333102419884935

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The Association Between Different Subtypes of Major Depressive Disorder and Migraine - Neurology Advisor

GENEVA--(BUSINESS WIRE)--Regulatory News:

GeNeuro (Paris:GNRO) (Euronext Paris: CH0308403085 - GNRO), announced today a collaboration for a new clinical trial of temelimab in multiple sclerosis (MS) with clinical researchers of Karolinska Institutet and the Academic Specialist Center (ASC), Stockholm, Sweden. This single-center study will be led by Dr. Fredrik Piehl, Professor of Neurology at the Department of Clinical Neurosciences of the Karolinska Institutet, and head of research at the MS clinic at ASC.

The trial will be conducted at Center for Neurology of ASC, the largest MS center in Sweden with approximately 2,400 patients. The one-year trial will enroll patients whose disability progresses without relapses, and will document the safety and tolerability of temelimab following higher doses, as well as efficacy based on the latest biomarkers associated with disease progression. The study aims to start enrolling patients in Q1 2020.

It is evident that currently available disease modulatory therapies for MS exert very limited effects on the progressive aspect of MS and that this phase starts early in the disease course. A role of pHERV-W Env in progressive disease worsening is supported by accumulating preclinical and clinical evidence. We are excited to explore the therapeutic potential of temelimab in patients progressing without relapses. This constitutes a key unmet medical need in MS and will allow us to push the boundaries of current therapeutic possibilities, said Prof. Fredrik Piehl, Principal Investigator of the study.

Temelimab is a monoclonal antibody designed to neutralize a pathogenic envelope protein, pHERV-W Env, which has been shown to activate microglia in the brain resulting in an aggressive phenotype attacking myelin1, and to impair the remyelination capacity of the brain through the inhibition of oligodendrocyte precursor cell differentiation2. This collaboration follows the data from GeNeuros ANGEL-MS clinical trial results, presented at ECTRIMS, which demonstrated positive results at two years on key markers associated with disease progression.

Long-term data have confirmed the neuroprotective effect of temelimab in MS and demonstrated its potential to make significant improvements in the lives of patients. We are very proud to be working with Prof. Piehl, who is recognized for his leading research at the Karolinska Institutet and the ASC, to further advance the development of temelimab as a potential treatment against disability progression in MS, said Jess Martin-Garcia, CEO of GeNeuro.

About GeNeuro

GeNeuros mission is to develop safe and effective treatments against neurological disorders and autoimmune diseases, such as multiple sclerosis, by neutralizing causal factors encoded by HERVs, which represent 8% of human DNA. GeNeuro is based in Geneva, Switzerland and has R&D facilities in Lyon, France. It has 24 employees and rights to 17 patent families protecting its technology.

For more information, visit: https://www.geneuro.com

About the Academic Specialist Center

The Academic Specialist Centre is a collaboration between Stockholm Health Care Services and Karolinska Institutet, providing a novel concept for research and intensive outpatient care. It is a part of the Swedish investment in future healthcare aimed at forging stronger links between research and development, education and healthcare.

The ASC provides specialist care to patients with diabetes, MS, Parkinsons and rheumatological disorders, and conducts cutting-edge clinical trials in these indications.

For more information, visit https://ki.se/en/collaboration/collaboration-with-the-health-services

Disclaimer

This press release contains certain forward - looking statements and estimates concerning GeNeuros financial condition, operating results, strategy, projects and future performance and the markets in which it operates. Such forward-looking statements and estimates may be identified by words, such as anticipate, believe, can, could, estimate, expect, intend, is designed to, may, might, plan, potential, predict, objective, should, or the negative of these and similar expressions. They incorporate all topics that are not historical facts. Forward looking statements, forecasts and estimates are based on managements current assumptions and assessment of risks, uncertainties and other factors, known and unknown, which were deemed to be reasonable at the time they were made but which may turn out to be incorrect. Events and outcomes are difficult to predict and depend on factors beyond the companys control. Consequently, the actual results, financial condition, performances and/or achievements of GeNeuro or of the industry may turn out to differ materially from the future results, performances or achievements expressed or implied by these statements, forecasts and estimates. Owing to these uncertainties, no representation is made as to the correctness or fairness of these forward-looking statements, forecasts and estimates. Furthermore, forward-looking statements, forecasts and estimates speak only as of the date on which they are made, and GeNeuro undertakes no obligation to update or revise any of them, whether as a result of new information, future events or otherwise, except as required by law.

1 Kremer et al., PNAS July 20192 Kremer et al., Annals of Neurology, June 2013; Gttle et al, Glia, August 2018

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GeNeuro and the Karolinska Institutet/Academic Specialist Center of Stockholm Agree to Launch a New Clinical Study of Temelimab in Multiple Sclerosis...

Justin B. Echouffo-Tcheugui

From the Division of Endocrinology, Diabetes and Hypertension (J.B.E.-T.), Brigham and Women's Hospital/Harvard Medical School, Boston; National Heart, Lung, and Blood Institute (J.B.E.-T., S.C.C., J.J.H., A.S.B., R.S.V., S.S.), Framingham Heart Study, MA; Department of Neurology (S.C.C., J.J.H., A.S.B., S.S.) and Sections of Preventive Medicine and Epidemiology (R.S.V.) and Cardiology (R.S.V.), Department of Medicine, Boston University School of Medicine; Departments of Biostatistics (J.J.H., A.S.B.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Department of Neurology (P.M., C.S.D.), University of California, Davis, Sacramento; and Glenn Biggs Institute of Alzheimer's and Neurodegenerative Diseases (S.S.), University of Texas Health Sciences Center, San Antonio.

Sarah C. Conner

From the Division of Endocrinology, Diabetes and Hypertension (J.B.E.-T.), Brigham and Women's Hospital/Harvard Medical School, Boston; National Heart, Lung, and Blood Institute (J.B.E.-T., S.C.C., J.J.H., A.S.B., R.S.V., S.S.), Framingham Heart Study, MA; Department of Neurology (S.C.C., J.J.H., A.S.B., S.S.) and Sections of Preventive Medicine and Epidemiology (R.S.V.) and Cardiology (R.S.V.), Department of Medicine, Boston University School of Medicine; Departments of Biostatistics (J.J.H., A.S.B.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Department of Neurology (P.M., C.S.D.), University of California, Davis, Sacramento; and Glenn Biggs Institute of Alzheimer's and Neurodegenerative Diseases (S.S.), University of Texas Health Sciences Center, San Antonio.

Jayandra J. Himali

From the Division of Endocrinology, Diabetes and Hypertension (J.B.E.-T.), Brigham and Women's Hospital/Harvard Medical School, Boston; National Heart, Lung, and Blood Institute (J.B.E.-T., S.C.C., J.J.H., A.S.B., R.S.V., S.S.), Framingham Heart Study, MA; Department of Neurology (S.C.C., J.J.H., A.S.B., S.S.) and Sections of Preventive Medicine and Epidemiology (R.S.V.) and Cardiology (R.S.V.), Department of Medicine, Boston University School of Medicine; Departments of Biostatistics (J.J.H., A.S.B.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Department of Neurology (P.M., C.S.D.), University of California, Davis, Sacramento; and Glenn Biggs Institute of Alzheimer's and Neurodegenerative Diseases (S.S.), University of Texas Health Sciences Center, San Antonio.

Pauline Maillard

From the Division of Endocrinology, Diabetes and Hypertension (J.B.E.-T.), Brigham and Women's Hospital/Harvard Medical School, Boston; National Heart, Lung, and Blood Institute (J.B.E.-T., S.C.C., J.J.H., A.S.B., R.S.V., S.S.), Framingham Heart Study, MA; Department of Neurology (S.C.C., J.J.H., A.S.B., S.S.) and Sections of Preventive Medicine and Epidemiology (R.S.V.) and Cardiology (R.S.V.), Department of Medicine, Boston University School of Medicine; Departments of Biostatistics (J.J.H., A.S.B.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Department of Neurology (P.M., C.S.D.), University of California, Davis, Sacramento; and Glenn Biggs Institute of Alzheimer's and Neurodegenerative Diseases (S.S.), University of Texas Health Sciences Center, San Antonio.

Charles S. DeCarli

From the Division of Endocrinology, Diabetes and Hypertension (J.B.E.-T.), Brigham and Women's Hospital/Harvard Medical School, Boston; National Heart, Lung, and Blood Institute (J.B.E.-T., S.C.C., J.J.H., A.S.B., R.S.V., S.S.), Framingham Heart Study, MA; Department of Neurology (S.C.C., J.J.H., A.S.B., S.S.) and Sections of Preventive Medicine and Epidemiology (R.S.V.) and Cardiology (R.S.V.), Department of Medicine, Boston University School of Medicine; Departments of Biostatistics (J.J.H., A.S.B.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Department of Neurology (P.M., C.S.D.), University of California, Davis, Sacramento; and Glenn Biggs Institute of Alzheimer's and Neurodegenerative Diseases (S.S.), University of Texas Health Sciences Center, San Antonio.

Alexa S. Beiser

From the Division of Endocrinology, Diabetes and Hypertension (J.B.E.-T.), Brigham and Women's Hospital/Harvard Medical School, Boston; National Heart, Lung, and Blood Institute (J.B.E.-T., S.C.C., J.J.H., A.S.B., R.S.V., S.S.), Framingham Heart Study, MA; Department of Neurology (S.C.C., J.J.H., A.S.B., S.S.) and Sections of Preventive Medicine and Epidemiology (R.S.V.) and Cardiology (R.S.V.), Department of Medicine, Boston University School of Medicine; Departments of Biostatistics (J.J.H., A.S.B.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Department of Neurology (P.M., C.S.D.), University of California, Davis, Sacramento; and Glenn Biggs Institute of Alzheimer's and Neurodegenerative Diseases (S.S.), University of Texas Health Sciences Center, San Antonio.

Ramachandran S. Vasan

From the Division of Endocrinology, Diabetes and Hypertension (J.B.E.-T.), Brigham and Women's Hospital/Harvard Medical School, Boston; National Heart, Lung, and Blood Institute (J.B.E.-T., S.C.C., J.J.H., A.S.B., R.S.V., S.S.), Framingham Heart Study, MA; Department of Neurology (S.C.C., J.J.H., A.S.B., S.S.) and Sections of Preventive Medicine and Epidemiology (R.S.V.) and Cardiology (R.S.V.), Department of Medicine, Boston University School of Medicine; Departments of Biostatistics (J.J.H., A.S.B.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Department of Neurology (P.M., C.S.D.), University of California, Davis, Sacramento; and Glenn Biggs Institute of Alzheimer's and Neurodegenerative Diseases (S.S.), University of Texas Health Sciences Center, San Antonio.

Sudha Seshadri

From the Division of Endocrinology, Diabetes and Hypertension (J.B.E.-T.), Brigham and Women's Hospital/Harvard Medical School, Boston; National Heart, Lung, and Blood Institute (J.B.E.-T., S.C.C., J.J.H., A.S.B., R.S.V., S.S.), Framingham Heart Study, MA; Department of Neurology (S.C.C., J.J.H., A.S.B., S.S.) and Sections of Preventive Medicine and Epidemiology (R.S.V.) and Cardiology (R.S.V.), Department of Medicine, Boston University School of Medicine; Departments of Biostatistics (J.J.H., A.S.B.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Department of Neurology (P.M., C.S.D.), University of California, Davis, Sacramento; and Glenn Biggs Institute of Alzheimer's and Neurodegenerative Diseases (S.S.), University of Texas Health Sciences Center, San Antonio.

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Circulating cortisol and cognitive and ... - n.neurology.org

After two years of worsening symptoms, the Kargers found Dr. Murray Grossman at the University of Pennsylvania. Dr. Grossman is short and charismatic, a quick-witted Montreal native who has mentored me since I began training in neurology. For the past several decades, he has pioneered research on neurodegenerative diseases that change behavior and language. When he saw Mr. Karger in 2007, the diagnosis was clear within the hour: Mr. Karger had a type of frontotemporal dementia.

Frontotemporal dementia attacks people in their fifth or sixth decade, just as retirement comes within reach. Doctors believe the disease affects 60,000 people in the United States alone. Neurons in the front and side of the brain wilt, and along with them, images of peacefully growing old fade. Judgment and complex planning yields to chaotic disorganization. Inhibitions give way to impulsivity and hypersexuality, so that longtime faithful partners look to affairs and excessive pornography. Empathy turns to apathy. Obsessions and compulsions erupt. Language can become laborious; the meaning of words and objects can be lost, and fluent speech can dissolve into fragments of sentences with nonsensical grammar. Jarringly, memory remains largely untouched. Since brain areas that dictate personality are often the first to suffer, most people end up on a therapists couch long before finding their way to a neurologist.

In the throes of the disease, many families seek out others who might be experiencing something similar. The support group is helpful, because this can be a very lonely thing, said Ms. Karger, now 80, who is a co-leader of a support group for caregivers of those with frontotemporal dementia. She paused, then repeated, it can be very, very lonely.

When I visited Ms. Kargers support group this spring, members shared practical advice. Im having trouble getting my wife to shower, one man said, describing a common manifestation of apathy. Its been five weeks. Another man said he gets his wife to bathe by putting her toe or finger under the faucet first, so the wetness doesnt feel as foreign. A third person recommended giving up altogether in favor of dry shampoo and baby wipes.

A man asked about obsessions. With a tinge of humor, people recounted items their partners had fixated on: organizing glasses at a family wedding, aligning dirty dishes at Panera, fluffing pillows. You could be bleeding to death, and all shed want to do is rearrange the pillows, another man said.

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The Loneliness of Frontotemporal Dementia - The New York Times

GenentechsOcrevus(ocrelizumab) continues to be the most prescribed medication to reduce inflammatory disease in people with active secondary progressive multiple sclerosis(SPMS) amongU.S. neurologists, even though NovartisMayzent(siponimod) and EMD SeronosMavenclad(cladribine) were approved in March to treat this same MS group, according to a 2019 report bySpherix Global Insights.

Ocrevus, the only treatment approved for primary progressive MS, is also the choice for delaying disability progression in people with PPMS.

But Spherixs latest report, titled RealWorld Dynamix: Progressive Forms of Multiple Sclerosis (US) and based on asurvey of 157 U.S. neurologists and prescription data they provided, suggests that Mayzent and Mavenclad are gaining on Ocrevus for active SPMS patients.

Mayzent and Mavencladwere the first MS therapies whose U.S. Food and Drug Administration (FDA) approvals explicitly included both active SPMS and relapsing-remitting MS (RRMS) under the umbrella of relapsing MS forms.

Older MS medications subsequently had updates to their labels as well, adding clinically isolated syndrome (CIS) and active SPMS indications to be consistent with the revised definition of relapsing MS.

Possibly influenced by these updates, a shift appears to be underway in how neurologists identify and treat active SPMS patients. These doctors were more likely to estimate that patients had transitioned from RRMS to SPMS in 2019 than they were in last years report.

According to a press release summarizing the report, a majority of neurologists surveyed (more than two-thirds) are now confident they can tell if an RRMS patient is transitioning. Compared to one year ago, more are also likely to agree that relapsing MS treatments are effective for active SPMS.

SPMS patients continue to switch their medications mostly due to efficacy concerns, especially in terms of disability progression, the report showed. Many patients switch from an injectable, such asTevas Copaxone(glatiramer acetate) or Biogens Tecfidera (dimethyl fumarate). The use of Mayzent already the second most-preferred therapy for active SPMS and biologics (monoclonal antibodies) for these patients has been raising as well.

In fact, neurologists said they favor Mayzent, Mavenclad, or Sanofi Genzymes Lemtrada (alemtuzumab) when a next-line switch is needed in people with active SPMS. (Mavenclads approval came with a general recommendation that it be a second-line therapy option.) This trend will likely weigh on Ocrevus in this patient group.

Nonactive, or non-relapsing, SPMS is currently the MS type with the greatest unmet need. No approved therapies exist for these patients, in stark contrast to those with other disease types.

Several companies are trying to fill this gap, with clinical development programs ongoing in several investigational treatments. But neurologists remain skeptical about their likely success.

MedDay Pharmaceuticals Qizenday (MD-1003, high-dose biotin), AB Sciences masitinib, and MediciNovas ibudilast are either in or readying Phase 3 trials for nonactive SPMS.

Pivotal trials for MD-1003(NCT02936037) and masitinib (NCT01433497) are fully enrolled, while ibudilasts trial has yet to launch.

MediciNovaannounced that its Phase 3 study aiming for ibudilasts approval would enroll only SPMS patients without relapses, clearly focusing on the high need for therapies here.

However, the neurologists surveyed did not appear to see much value in potential treatments for nonactive SPMS, largely comfortable with off-label therapies. Clinical trials for this SPMS population will need to show compelling data to convince the medical community these treatments effectively slow disability progression in the absence of ongoing inflammation.

Novartis Gilenya (fingolimod) is currently more favored for nonactive MS patients than Ocrevus, possibly indicating that neurologists will want to transition patients to Mayzent.

Both Mayzent and Gilenya belong to the same class of medications, that ofsphingosine 1-phosphate (S1P) receptormodulators. Ocrevus works through a differentmechanism, inducing immune B-cell depletion.

Ana is a molecular biologist with a passion for discovery and communication. As a science writer she looks for connecting the public, in particular patient and healthcare communities, with clear and quality information about the latest medical advances. Ana holds a PhD in Biomedical Sciences from the University of Lisbon, Portugal, where she specialized in genetics, molecular biology, and infectious diseases

Total Posts: 1,053

Patrcia holds her PhD in Medical Microbiology and Infectious Diseases from the Leiden University Medical Center in Leiden, The Netherlands. She has studied Applied Biology at Universidade do Minho and was a postdoctoral research fellow at Instituto de Medicina Molecular in Lisbon, Portugal. Her work has been focused on molecular genetic traits of infectious agents such as viruses and parasites.

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Ocrevus Top Choice of US Neurologists for Active SPMS, But Mayzent and Mavenclad Gaining Interest, Report Says - Multiple Sclerosis News Today

In light of important new information reported on menstrual migraine (MM) in recent years, including evidence that has led to a revision of the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria for MM, a narrative review aimed to summarize recent data on pathophysiology, epidemiology, burden of disease and treatment of MM was published in the Journal of Neurology.

The goal of this review was to provide an updated overview on the topic of MM. Researchers conducted a literature search to identify relevant studies, reviews and abstracts from MEDLINE, PubMed, Cochrane Library and EMBASE databases published between 1972 and October 2019.

According to the ICHD-3 classification, a diagnosis of MM includes both migraine related to menstruation (MRM) and pure menstrual migraine (PMM) and there are criteria for PMM and MRM with and without aura. In both cases, women reported that migraines occur more frequently during menses, and that those are more severe than other migraines. The diagnostic criteria included migraine attacks in a menstruating woman that occur in a range of 2 days before to 3 days after menstruation in 2 of 3 menstrual cycles.

Estrogens play multiple actions in migraine when intense hormonal fluctuations occur leading up to and immediately after menstruation. The estrogen withdrawal hypothesis, described more than 40 years ago, relates to estrogen fluctuations across the menstrual cycle and has been implicated in the initiation of migraine attack. The drop in estrogen levels mid-cycle can lead to a significant increase in prostaglandins, resulting in neurogenic inflammation, release of various neuropeptides, including substance P, neurokinins and calcitonin gene-related peptide (CGRP). Furthermore, estrogens and estrogen receptors are widely expressed in the brain and in

the trigeminovascular system. A clear association between progesterone fluctuations and migraine attacks was not appreciated.

As for the genetic aspects of MM, polymorphisms in tumor necrosis factor alpha (TNF), Spectrin Repeat Containing Nuclear Envelope 1 (SYNE1), and neurophilin 1 (NRP1) gene were found to be associated with MM.

MRM is more common than PMM and studies have reported wide variations in the prevalence MM, with one Norwegian study reporting a prevalence of 7.6%. Of note, a higher occurrence of MM along with menstrual cycle synchrony was evident among women living together, compared with those living alone.

It is noted that MM may change over a womans reproductive life. Higher headache intensity was reported among women with MM during early pregnancy and postpartum period, compared with those without MM. Although serum estradiol levels are low during the perimenopausal period, MM can appear during menopausal transition.

Compared with nonmenstrual migraine, attacks of MM are frequently more debilitating with longer duration, higher recurrence rate and lower response rate to acute treatment. However, there are no specific treatment options for MM approved by the United States Food and Drug Administration or the European Medicine Agency.

The available treatment options for acute migraine including triptans, nonsteroidal anti-inflammatory drugs (NSAID) and ergot derivatives. Triptans have the strongest evidence for acute MM treatment, with positive reports on the use of almotriptan, naratriptan, sumatriptan, and zolmitriptan.

Preventive treatment may be important as the response to acute treatment is frequently limited. Short-term prophylactic therapies administered only during the perimenstrual period include triptans, estrogen, and naproxen. Triptans also have the strongest evidence for preventive MM treatment, including frovatriptan, naratriptan, and zomitriptan.

Continuous prophylactic treatment with hormonal contraceptives may be effective, but there are concerns regarding the risk for vascular disease and stroke associated with these agents. Furthermore, oral contraceptives should not be used for MM with aura, as they may further increase the vascular risk. Limited data are available on the use of phytoestrogens, Vagus Nerve Simulation and Onabotulinium A for MM prophylaxis.

Additional studies have suggested a potential benefit for perimenstrual use of telcagepant, a CGRP receptor antagonist. Several additional antibodies directed against CGRP or CGRP receptor may prove to be useful in these cases. The development of ditans and gepants might represent a major progress, not only in the treatment of migraine, but also in the treatment of MM.

Understanding the mechanisms that contribute to neuroendocrine vulnerability in some women and some menstrual cycles may yield possible marker of the disease opening treatment options specifically targeting MM, concluded the study authors. They also note that, An increased interest for future research on the subject will further elucidate how to manage this debilitating type of migraine.

Reference

Cupini LM, Corbelli I, Sarchelli P. Menstrual migraine: what it is and does it matter? [published online January 28, 2020]. J Neurol. doi:10.1007/s00415-020-09726-2

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Menstrual Migraine: Revisiting the Relationship Between Hormonal Events and Migraine - Neurology Advisor

Neurological services available at St. Peter's include treatment and rehabilitation for patients who suffer strokes, seizures, epilepsy and other diseases of the brain, nerves, spinal cord and muscles. Our neurologists and neurosurgeons also treat headaches, dementia (including Alzheimer's disease), multiple sclerosis (MS), Parkinson's disease, carpal tunnel syndrome, migraines and chronic pain. Because of its comprehensive stroke program, St. Peter's has been named by the NYS Department of Health as a Designated Stroke Center.

Similar to a heart attack, a stroke (or "brain attack") occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. This interruption of blood flow deprives the brain cells of oxygen and glucose, and they die. As a result,all body functions controlled by the affected area of the brainare impaired.

Stroke is the leading cause of disability among adults in New York State and the third leading cause of death in the United States. However, strokes can be prevented, and, if a stroke occurs, fast and effective treatment can minimize the damage.

Visit the followingpages formore information on stroke and stroke prevention.

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Neurology - sphcs.org

Migraines are the second leading cause of disability worldwide, with more than 30 million adults affected. They can be painful, incapacitating and can last up to 72 hours without medication and often require some trial and error before finding the best treatment to control the pain.

Thats why doctors and patients are excited when a new anti-migraine option is available. In this case, it's medicine called Reyvow.

Reyvow is a new prescription medication that was recently approved by the Drug Enforcement Administration and is now available at pharmacies. Its believed to act both centrally and peripherally, (which means it acts on the brain as well as on all the other nerves throughout the body). And its the first medication that has been shown to provide pain freedom from headaches and freedom from associated symptoms like nausea and sensitivity to light and sound.

"Reyvow is a new alternative treatment for acute migraines in patients not responding to medicine who have disabling problems. Having a migraine is like waiting for a hurricane to come and trying to close the windows," Dr. Peter Goadsby, Neurologist and Headache specialist at the University of California San Francisco told ABC news.

The Food and Drug Administration and the DEA have approved Eli Lillys Reyvow (lasmiditan) as the first oral medication of its class to treat acute migraines and bothersome symptoms in adults with or without aura (visual or sensory sensations before a migraine).

"We know that the migraine community is keenly interested in additional treatment options, and we remain committed to continuing to work with stakeholders to promote the development of new therapies for the acute and preventive treatment of migraine," Dr. Nick Kozauer, acting deputy director of the Division of Neurology Products in the FDAs Center for Drug Evaluation and Research, said in a statement following the FDA's approval.

A migraine is a neurological disease characterized by recurrent attacks of severe headache that can cause intense pain, nausea, vomiting, sensitivity to light and sensitivity to sound.

Although the American Headache Society currently recommends triptans (anti-migraine medicine) for immediate relief in certain patients, a survey of 183 patients from three headache centers showed that 79% of patients were willing to try another acute treatment.

Prior to Reyvow, triptans have been on the market since the early '90s and have accounted for almost 80% of migraine treatments prescribed at office visits. Reyvow is unique because it is a new, fast anti-migraine oral medication that eliminates pain and other symptoms within two hours of treatment, according to the FDA.

There is a need for Reyvow because migraines remain under-recognized and undertreated.

"Results from the OVERCOME study revealed that more than 40% of people who know at least one person with migraine felt that the disease is used as an excuse to avoid family, work, or school commitments, and almost 1 in 3 people believed those with migraine make things more difficult for their co-workers. These findings indicate ripple effects from the lack of understanding and respect for the disability faced by people with migraine," Dr. Eric Pearlman, senior medical director, Eli Lilly, told ABC news.

Another study of 5591 people with migraines found that approximately 40% of people had 1 or more unmet needs.

"Pain relief is not enough. Patients want to get back to their life. They want pain freedom from headaches and no associated symptoms," Pearlman said.

Reyvow is taken as a single dose (50mg, 100mg, or 200mg) with or without food at the onset of migraine. Studies, according to the company, showed that 28-39% of patients achieved fast and complete elimination of migraine pain at two hours compared to 15- 20% with placebo. Among individuals who took these doses, 41-49% of achieved freedom from their most bothersome symptoms.

The Food and Drug Administration headquarters in White Oak, Md.

Unlike triptans, patients who have heart disease, peripheral vascular disease, uncontrolled high blood pressure, or history of stroke can take Reyvow as long as their heart rate and blood pressure are monitored because the drug targets nerves rather than blood vessels. Reyvow activates the (5-HT) 1F receptors that increase serotonin (neurotransmitters) and inhibiting pain pathways although the exact mechanism is unknown.

Side effects of Reyvow include dizziness, sedation, headache, fatigue, nausea, vomiting, muscle weakness and serotonin syndrome. Given the side effects, it is not recommended that individuals on this medicine drive or operate heavy machinery within eight hours of taking the medicine. Also caution is warranted when taken in combination with alcohol or other central nervous system depressants.

While Reyvow is the first of a new class, it contains lasmiditan, which is a controlled substance, and at low doses, can create feelings of relaxation, euphoria and possibly hallucinations. However, Eli Lillys Reyvow received a scheduled V drug rating. Scheduling of drugs refers to the abuse and or dependence potential and accessibility of medications from health care providers. Lower scheduled drugs (I and II) have higher abuse and / or dependence potential and do not allow for prescription refills due to tighter regulations.

Reyvow is approximately $640 for a package of 8 tablets. It is expected to be covered by insurance companies and out-of-pocket cost can vary depending on the insurance type. It is important to note that Reyvow.com has a co-pay assistance program on its website.

If you suffer from migraines, it is important to establish a good relationship with your healthcare provider to discuss the effectiveness of your migraine treatment. Talk to your healthcare provider for more information and to see if Reyvow is right for you.

"Have a next best step and a plan B," Goadsby recommends.

Dr. Blair Chance is a resident physician in preventive medicine at the University of South Carolina and member of the ABC News Medical Unit.

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New migraine medication given the green light - ABC News

Acquire Market has introduced a new market research study, titled Artificial Intelligence in Medical Imaging MarketReport which provides detailed coverage of the specialty Artificial Intelligence in Medical Imaging product industry and main market trends. The Artificial Intelligence in Medical Imaging research report studies the market size, Artificial Intelligence in Medical Imaging industry share, key drivers for growth, major segments, and CAGR. The leading players are competing on the basis of product differentiation, states a new research report by Acquire Market Research [AMR]. The market segmentation has been done on the basis of consensus made, product type, key industrial players, competitive landscapes, applications, end-user, topological players, and more.

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Acquire Market Research is a market research-based company empowering companies with data-driven insights. We provide Market Research Reports with accurate and well-informed data, Real-Time with Real Application. A good research methodology proves to be powerful and simplified information that applied right from day-to-day lives to complex decisions helps us navigate through with vision, purpose and well-armed strategies. At Acquire Market Research, we constantly strive for innovation in the techniques and the quality of analysis that goes into our reports.

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Global Artificial Intelligence in Medical Imaging Market Trends 2020 by Applications: Neurology, Cardiovascular, Breast & Lung, Other - Nyse...

Menlo Park, Calif.-Based Foundation Receives Key Funding to Support Goal to Cure Genetic Form of Epilepsy in Children

Today, TESS Research Foundation (TESS) was announced as an awardee of the Chan Zuckerberg Initiative (CZI) Rare As One Project. TESS was selected due to its innovative, patient-led approach to finding a cure and treatments for SLC13A5 Deficiency, a rare genetic epilepsy that causes a lifetime of debilitating seizures that begin within hours of birth. TESS Research Foundation was one of only 30 patient-led organizations in the country to be selected and was awarded $450,000 in grant funding.

This press release features multimedia. View the full release here: https://www.businesswire.com/news/home/20200203005601/en/

Maggie (10), Tessa (16, has SLC13A5 Deficiency), Zach (Dad, Founder), Kim (Mom, Founder), Colton (6, has SLC13A5 Deficiency) and Lily (12) (Photo: Business Wire)

As CZI states in their announcement: "Rare disease is anything but rare: as many as 7,000 rare diseases affect 400 million people worldwide. The vast majority of these diseases are not well known or understood, and fewer than five percent have any FDA-approved therapy. The knowledge and learnings of patients suffering from these diseases are key to driving breakthroughs in research and treatment, but a lack of funding and infrastructure to support such patient-led research is holding that progress back."

TESS Research Foundation knows this story all too well. TESS was founded by Kim and Zach Nye, parents of four young children who live in Menlo Park, California. Two of their children, Tessa (age 16) and Colton (age 6), suffer from a rare genetic disorder that was previously unknown and caused the children to have hundreds of seizures daily since birth. The Nyes launched TESS Research Foundation in 2015 to fund research to better understand why mutations in the SLC13A5 gene cause neurological disease and to find the best treatment options. Thanks to the research and collaborations spearheaded by TESS, treatments for the disorder are ready to move into clinical trials within the next two years with sufficient funding. Children around the world have been diagnosed with this disease, which causes chronic seizures, a movement disorder and a severe communication disorder.

"We are so grateful to CZI for their vision and leadership, helping organizations like ours develop cures for diseases like SLC13A5 Deficiency," said Kim Nye, Co-Founder and Executive Director of TESS Research Foundation. "As the mother of two children with SLC13A5 Deficiency, I have watched my children suffer from hundreds of thousands of seizuressomething I hope fewer moms will be able to say in the near future as we discover new cures for genetic epilepsy."

CZI announced $13.5 million in funding to 30 patient-led organizations that are working to find treatments and cures for rare disease. These grants are part of CZIs Rare As One Project, aimed at supporting and lifting up the work that patient communities are doing to accelerate research and drive progress in the fight against rare diseases.

"No one is more committed to finding cures for rare diseases than the patients and families of those affected by these disorders," said Priscilla Chan, Co-Founder & Co-CEO of CZI. "We are proud to support patient-led organizations as they pursue diagnoses, information, and treatment options in partnership with researchers and clinicians."

Story continues

The grant funding will allow TESS to build the infrastructure necessary to raise funding for collaborative research and a cure. The grant will also bring together key stakeholders patients, clinicians, researchers, and industry at the International SLC13A5 Deficiency Research Roundtable March 22-23, 2020 in Dallas, Texas. The TESS Board of Directors and Scientific Advisory Board will remain all-volunteer. Its members include Brenda Porter, MD, PhD, Professor of Neurology and Matthew Bainbridge, PhD, Associate Director of Clinical Genomics Research at Rady Childrens Hospital San Diego, who will also serve as the Primary Clinician and Primary Researcher, respectively, on the TESS Rare As One grant.

"As a pediatric neurologist for the past 23 years, I have taken care of many children with severe neurologic disorders, and the quest for a cure seemed like an unrealistic vision," said Brenda Porter, MD, PhD, Professor of Neurology and head of the TESS Research Foundation Scientific Advisory Board. "Today, I am excited as the path forward for curing genetic disorders including SLC13A5 may be attainable with tools under development. Watching Tessa and Colton, who understand so much but are stuck in bodies they cannot control, is heartbreaking and I look forward to them being able to share who they are with all of us."

For more information about TESS Research Foundation and for complete bios on the Scientific Advisory Board, visit http://www.TESSresearch.org.

For more information about Rare As One, click here.

For more information about the Chan Zuckerberg Initiative, click here.

View source version on businesswire.com: https://www.businesswire.com/news/home/20200203005601/en/

Contacts

Lilly Iffert Singer Associates (415) 227-9700 Lillian@singersf.com

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TESS Research Foundation Selected as Part of Chan Zuckerberg Initiative Rare As One Project - Yahoo Finance