Residents living with neurological conditions in Twickenham can now access Integrated Neurological Services (INS) that have been provided by the Otakar Kraus Music Trust (OKMT).

The INS service - which is also supported by the People's Postcode Lottery, has provided music therapy to people living in the borough since 1991, however its Twickenham service launched on February 3.

Each music therapy session is aimed at improving the physical and mental well-being of children and adults living with learning, physical neurological or emotional difficulties.

Clare Lawrence, Director of OKMT said, We are very grateful to players of Peoples Postcode Lottery and Postcode Community Trust for the Grant which will enable us to provide a safe therapeutic space for clients at INS, where we can use music therapy to help them explore emotional expression, engage in social interaction and adjust to their disability.

Neurological music therapy is an evidence-based treatment which can help those with neurological conditions to have improved cognition, communication and movement.

A qualified music therapist will provide small group music therapy sessions for over 30 people with neurological conditions such as stroke, Parkinsons and MS, many of whom have mobility, cognitive and communication issues and may suffer isolation and depression.

Each student learns breathing and signing techniques that are aimed at improving the flow of speech as some residents often sing words they cannot say.

Creating songs about every day activities can also help improve a student's cognition and memory.

Students are also encouraged work on their movement by playing an instrument or walking to a beat which strengthens any weakened muscles.

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Music therapy sessions available to residents living with neurological conditions in Twickenham - Richmond and Twickenham Times

The "Mexico Neurology Procedures Outlook to 2025 - Hydrocephalus Shunting Procedures, Neurovascular Thrombectomy Procedures, ICP Procedures and Others." report has been added to ResearchAndMarkets.com's offering.

Summary

The publisher's new report, Mexico Neurology Procedures Outlook to 2025, provides key procedures data on the Mexico Neurology Procedures. The report provides procedure volumes within market segments - Hydrocephalus Shunting Procedures, Neurovascular Thrombectomy Procedures, Neurovascular Embolization Procedures, Neurovascular Coiling Assist Procedures, Neurovascular Accessory Procedures, Intracranial Stenting Procedures, ICP Procedures, Dura Substitute Procedures, Neuromodulation Procedures and Minimally Invasive Neurosurgery Procedures.

The data in the report is derived from dynamic market forecast models. The objective is to provide information that represents the most up-to-date data of the industry possible.

The epidemiology-based forecasting model makes use of epidemiology data gathered from research publications and primary interviews with physicians to establish the target patient population and treatment flow patterns for individual diseases and therapies. Using prevalence and incidence data and diagnosed and treated population, the epidemiology-based forecasting model arrives at the final numbers.

Extensive interviews are conducted with key opinion leaders (KOLs), physicians and industry experts to validate the procedure volumes.

Scope

Mexico Neurology Procedures volumes by segments Hydrocephalus Shunting Procedures, Neurovascular Thrombectomy Procedures, Neurovascular Embolization Procedures, Neurovascular Coiling Assist Procedures, Neurovascular Accessory Procedures, Intracranial Stenting Procedures, ICP Procedures, Dura Substitute Procedures, Neuromodulation Procedures and Minimally Invasive Neurosurgery Procedures.

Projections for each of the market segments. Data is provided from 2015 to 2025.

Develop business and investment strategies by identifying the key market segments expected to register strong growth in the near future.

Develop market-entry and market expansion strategies.

Reasons to buy

Story continues

Develop business and investment strategies by identifying the key market segment expected to register strong growth in the near future.

Develop market-entry and market expansion strategies.

Key Topics Covered:

1 Table of Contents

1.1 List of Tables

1.2 List of Figures

2 Introduction

2.1 What Is This Report About?

2.2 Neurology Procedures Segmentation

2.3 Definitions of Procedures Covered in the Report

3 Neurology Procedures, Mexico

3.1 Neurology Procedures, Mexico, 2015-2025

3.2 Neurology Procedures, Mexico, 2015-2025

4 Dura Substitute Procedures, Mexico

4.1 Dura Substitute Procedures, Mexico, 2015-2025

5 Hydrocephalus Shunting Procedures, Mexico

5.1 Hydrocephalus Shunting Procedures, Mexico, 2015-2025

5.1.1 Revision Hydrocephalus Shunts Procedures, Mexico, 2015-2025

6 ICP Procedures, Mexico

6.1 ICP Procedures, Mexico, 2015-2025

7 Intracranial Stenting Procedures, Mexico

7.1 Intracranial Stenting Procedures, Mexico, 2015-2025

8 Minimally Invasive Neurosurgery Procedures, Mexico

8.1 Minimally Invasive Neurosurgery Procedures, Mexico, 2015-2025

8.1.1 Minimally Invasive Neurosurgical Devices Procedures, Mexico, 2015-2025

9 Neuromodulation Procedures, Mexico

9.1 Neuromodulation Procedures, Mexico, 2015-2025

10 Neurovascular Accessory Procedures, Mexico

10.1 Neurovascular Accessory Procedures, Mexico, 2015-2025

11 Neurovascular Coiling Assist Procedures, Mexico

11.1 Neurovascular Coiling Assist Procedures, Mexico, 2015-2025

12 Neurovascular Embolization Procedures, Mexico

12.1 Neurovascular Embolization Procedures, Mexico, 2015-2025

12.1.1 Flow Diversion Stent Procedures, Mexico, 2015-2025

13 Neurovascular Thrombectomy Procedures, Mexico

13.1 Neurovascular Thrombectomy Procedures, Mexico, 2015-2025

14 Appendix

For more information about this report visit https://www.researchandmarkets.com/r/3rr42v

View source version on businesswire.com: https://www.businesswire.com/news/home/20200214005336/en/

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Mexico Neurology Procedures Outlook to 2025 - Epidemiology Based models are Used to Estimate & Forecast the Procedure Volumes -...

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A North Carolina State University professor says Bartonella infection is one of the most important untold medical stories.

Ed Breitschwerdt, a professor of veterinary sciences at North Carolina State University, keeps waiting for the tipping point. For the last 30 years, Breitschwerdt has been studying Bartonella, a genus of bacteria found in animals, ticks and humans.

Its frustrating, said Breitschwerdt. I believed we would hit a tipping point two years ago with this.

Laura Hoppers tipping point came in 2006, when she was 15 years old. The Raleigh teen lost her peripheral vision. She next began to suffer bouts of joint and muscle pain and numbness in her hands. Then came the headaches, memory loss and hallucinations.

As a mother, its so hard to watch your child have all these symptoms, said Maria Hopper. It was a couple years of going to all kinds of doctors.

But no neurologist, rheumatologist or psychiatrist could explain all of Lauras symptoms. And it wasnt until 2008, when the Hoppers read a news article about Bartonella and Breitschwerdts work, that a lightbulb went off in their heads.

Though people have known of cat scratch disease the most public of the human diseases caused by Bartonella infection for more than 100 years, Breitschwerdt said hes convinced that Bartonella is the stealth cause of many neurological, inflammatory and chronic diseases in humans.

And, unlike Lyme disease, another tick-borne illness that can cause an array of distressing symptoms, Bartonella is right in the backyard of most North Carolinians.

Its a medically important bacteria in animals and humans in the state. If you took every stray cat along the coast of North Carolina, three quarters of them would have Bartonella, said Breitschwerdt. Thats because the bacteria is commonly transmitted to animals by fleas.

He said that, historically, vets have considered common cat flea a nuisance but have under-appreciated it as a disease vector. For several years, Breitschwerdt has seen all sorts of animals and mites, ticks, fleas and even spiders test positive for Bartonella.

Animals are the primary reservoir for the Bartonella species, he said.

Breitschwerdt has worked with the One Health Commission, a collective that looks at the links between environmental, human and animal health. Though his professional and personal life has been guided by his care for animals, his most recent work is geared towards detecting and treating Bartonella infection in humans.

The recovery processThe Hoppers contacted Breitschwerdt at a fortunate time: He was developing new human diagnostic method for Bartonella. Laura tested positive, and after three courses of months-long antibiotic treatments, her symptoms have all but disappeared.

By the end of the first cycle [of antibiotics], the feeling in her hands came back, said Maria. By the end of the second cycle, hallucinations stopped. Though Laura still suffers some muscle pain, she considers herself 80 to 90 percent healed.

If the bacteria is positively detected, treating Bartonella infection is a daunting task for even otherwise healthy patients

You cannot float humans or horses in enough Doxycycline to kill this bacteria, said Breitschwerdt. Treatment, such as Lauras, requires weeks of multi-antibiotic therapies.

Laura was also lucky in that she tested positive for Bartonella immediately.

A patient infected can have a negative test on a Monday and positive test by Wednesday.

People are tested several times, but Bartonella can hide in the body, Breitschwerdt said.

Thats because an animal scratch or bug bite (or a vets needle stick) results in Bartonella infection in red blood cells and endothelial cells, which line blood vessels. The bacteria can hide out for many infectious cycles, causing symptoms and eventually affecting every organ system in the body.

Most people can clear Bartonella from their bloodstreams effectively. But among the subset of people who cant eliminate the bacteria, help in mainstream medicine will be difficult to come by.

I often talk with veterinarians who have these vague complaints who say theyve been sick for weeks or months, said Breitschwerdt.

Many of the vets receive diagnoses of Lyme disease, chronic fatigue, rheumatoid arthritis, or are sent to a psychiatrist and told their symptoms are untreated depression. But Breitschwerdt cautions them to get tested for Bartonella.

Breitschwerdt has ventured into industry with Galaxy Diagnostics, a company he founded to offer Bartonella testing kits to doctors. The company launched into human testing two years ago, and has received orders from 300 doctors across the country.

At this stage, said Amanda Elam, Galaxys president, the companys goal is to educate people about Bartonella.

Were dong continuing medical education courses, working with people in public health and doing education with veterinarians, she said. Id really like the medical community to keep an open mind about this.

While Breitschwerdt waits for the public tipping point for Bartonella, he said he too is focused on disease education.

It takes 10 years before something added to the medical textbooks gets widely spread in practice, he said. Were working on changing those textbooks.

This article first appeared on North Carolina Health News and is republished here under a Creative Commons license.

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Bartonella infection everywhere, but we don't know about it - Charlotte Post

Marinella Paciello,1 Giulia Ballarotto,2 Luca Cerniglia,1 Pietro Muratori3

1Faculty of Psychology, Uninettuno Telematic International University, Rome, Italy; 2Department of Dynamic and Clinical Psychology, Sapienza University, Rome, Italy; 3IRCCS Fondazione Stella Maris, Scientific, Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy

Correspondence: Marinella PacielloFaculty of Psychology, Uninettuno Telematic International University, Corso Vittorio Emanule II, Rome 39 00186, ItalyEmail m.paciello@uninettunouniversity.net

Abstract: Disruptive behavior could represent an (un)moral behavioral component of multi-dimensional construct of morality that includes affective and cognitive aspects. Thus, it is pivotal to investigate their interplay between affective and cognitive processes the better to understand how to intervene to contrast disruptive behavior and its antisocial outcomes. The present review has examined the relationship between affective and cognitive processes implied in moral functioning by focusing on callous-unemotional traits (CU) and moral disengagement. Starting from 1005 records identified by PsycINFO, Pubmed, and Pubpsych, only 13 studies have been selected. These studies show different theoretical approaches and methodologies and put in evidence the nuances of possible interactions of CU and moral disengagement during adolescence based on different research field. Overall, most of the scholars seem to conclude that different interplay can be plausible, suggesting that it is likely that during the adolescence the influence of moral disengagement and CU is reciprocal and longitudinal. Specifically, in adolescents with Disruptive Behavior DisordersCU and moral disengagement can move together in organizing and becoming chronic of antisocial affective-cognitive system, and in particular moral disengagement may give a free way to engage in disruptive behavior.

Keywords: disruptive behavior, callous-unemotional traits, moral disengagement, adolescence, morality

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License.By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

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Does the Interplay of Callous-Unemotional Traits and Moral Disengageme | AHMT - Dove Medical Press

DUBLIN--(BUSINESS WIRE)--The "Drug Discovery Services Market by Process (Target Selection, Validation, Lead Optimization), Type (Medicinal Chemistry, DMPK), Drug Type (Biologics, Small Molecules), Therapeutic (Oncology, Neurology), Company (Tier 1, 2, 3) - Global Forecast to 2025" report has been added to ResearchAndMarkets.com's offering.

Drug discovery services market to register a CAGR of 12.1% from 2020 to 2025.

The growth of the industry is driven primarily by factors such as growing R&D expenditure in the pharmaceutical & biopharmaceutical industry, increasing demand for outsourcing analytical testing and clinical trial services, initiatives for research on rare diseases and orphan drugs, and focus on drug discovery. Growth in the biologics market and patent expiries will further provide opportunities in the drug discovery services industry. Developing economies are expected to offer a wide range of growth opportunities for players in the market.

The Hit-to-Lead process segment is anticipated to grow at the fastest growth rate during the forecast period.

Based on the process, the drug discovery services market is segmented into target selection, target validation, hit-to-lead identification, lead optimization, and candidate validation. Hit-to-lead identification process is anticipated to be the fastest-growing segment due to the high outsourcing of these services to CROs by the pharmaceutical companies and the emerging advanced technologies for high-throughput screening (HTS) and H2L as well as reductions in development time.

Medicinal Chemistry segment is estimated to account for the largest share of the drug discovery services market in 2020.

Based on type, the drug discovery services market is segmented into medicinal chemistry services, biology services, and drug metabolism and pharmacokinetics (DMPK). The medicinal chemistry services segment is estimated to account for the largest share of the drug discovery services market due to the widespread application of medicinal chemistry in various phases of preclinical drug discovery to deliver robust candidates.

Oncology segment is anticipated to grow at the fastest growth rate during the forecast period.

Based on the therapeutic area, the drug discovery services market is segmented into oncology, cardiovascular diseases, neurology, infectious and immune system diseases, digestive system diseases, and other therapeutic areas. Of all these therapeutic segments, oncology will grow at the fastest CAGR in the drug discovery services market in 2019. The high growth of the oncology segment can be attributed to factors such as the increasing number of patients who have cancer, the subsequent increase in the demand for cancer therapies and the growing R&D expenditure by pharmaceutical companies in this therapeutic area.

North America is expected to dominate the drug discovery services market in 2020.

North America, which includes the US and Canada, is estimated to account for the largest share of the drug discovery services market. The large share of this region can primarily be attributed to the presence of well-established CROs; rising R&D expenditure by pharmaceutical & biopharmaceutical companies and the availability of latest techniques, instruments, and facilities for drug discovery research are driving the growth of this region.

Reasons to Buy the Report:

Key Topics Covered:

1 Introduction

1.1 Objectives of the Study

1.2 Market Definition

1.3 Market Scope

1.4 Currency

1.5 Limitations

1.6 Stakeholders

2 Research Methodology

2.1 Research Data

2.2 Market Size Estimation

2.3 Market Breakdown and Data Triangulation

2.4 Assumptions for the Study

3 Executive Summary

4 Premium Insights

4.1 Drug Discovery Services Market Overview

4.2 North America: Market, By Drug Type & Country (2020)

4.3 Market: Geographic Growth Opportunities

5 Market Overview

5.1 Introduction

5.2 Market Dynamics

5.2.1 Drivers

5.2.2 Restraints

5.2.3 Opportunities

5.2.4 Trends

6 Drug Discovery Services Market, By Process

6.1 Introduction

6.2 Target Selection

6.3 Target Validation

6.4 Hit-To-Lead Identification

6.5 Lead Optimization

6.6 Candidate Validation

7 Drug Discovery Services Market, By Type

7.1 Introduction

7.2 Medicinal Chemistry Services

7.3 Biology Services

7.4 Drug Metabolism & Pharmacokinetics

8 Drug Discovery Services Market, By Drug Type

8.1 Introduction

8.2 Small-Molecule Drugs

8.3 Biologic Drugs

9 Drug Discovery Services Market, By Therapeutic Area

9.1 Introduction

9.2 Oncology

9.3 Neurology

9.4 Infectious and Immune System Diseases

9.5 Digestive System Diseases

9.6 Cardiovascular Diseases

9.7 Other Therapeutic Areas

10 Drug Discovery Services Market, By Company Type

10.1 Introduction

10.2 Tier 1 Pharmaceutical Companies

10.3 Tier 2 Pharmaceutical Companies

10.4 Tier 3 Pharmaceutical Companies

11 Drug Discovery Services Market, By Region

11.1 Introduction

11.2 North America

11.3 Europe

11.4 Asia Pacific

11.5 Rest of the World

12 Competitive Landscape

12.1 Overview

12.2 Market Share Analysis

12.3 Competitive Scenario

12.4 Competitive Leadership Mapping

13 Company Profiles

13.1 Laboratory Corporation of America Holdings

13.2 Eurofins Scientific Se

13.3 Charles River Laboratories International

13.4 Evotec SE

13.5 Thermo Fisher Scientific

13.6 Albany Molecular Research, Inc.

13.7 Syngene International Limited

13.8 Jubilant Lifesciences

13.9 Genscript Biotech Corporation

13.10 Piramal Enterprises Limited

13.11 Selvita S.A.

13.12 Aurigene Discovery Technologies

13.13 Domainex Ltd.

13.14 WuXi AppTec

13.15 Chempartner Co., Ltd.

13.16 Frontage Holdings

13.17 Pharmaceutical Product Development, LLC

13.18 Shanghai Medicilon, Inc.

13.19 TCG Lifesciences Pvt. Limited

13.20 Viva Biotech (Shanghai) Ltd.

For more information about this report visit https://www.researchandmarkets.com/r/i0k3fl

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Global Drug Discovery Services Market is Projected to Reach USD 19.1 Billion By 2025 at a CAGR of 12.1% from 2020 to 2025 - ResearchAndMarkets.com -...

SAN FRANCISCO Pharmaceutical companies and their investors have grown accustomed to big news kicking off the year, specifically multibillion-dollar deals.

The last three J.P. Morgan Healthcare Conferences, considered a sort of Opening Day for the industry, were hallmarked by the acquisitions of Ariad Pharmaceuticals, Impact Biomedicines and Loxo Oncology. (And that's not including Bristol-Myers Squibb's $74 billion deal for Celgene the week before the meeting last year.)

In fact, Eli Lilly pressed Loxo for a quick buyout to have something flashy to announce at last year's conference. Such enthusiasm was noticeably absent this time around, though, resulting in a quieter first day than biotech shareholders had hoped for.

The Nasdaq Biotechnology Index fell almost 2%, with Sage Therapeutics, Clovis Oncology and other potential takeover targets trading down by market's close. Brad Loncar, a founder of biotech exchange-traded funds, noted on Twitter how even shares of MorphoSys fell despite the German drugmaker having the most positive news of the day.

While major M&A announcements seem unlikely for the rest of the week, industry experts still expect the challenges facing bigger companies will result in a healthy number of deals in 2020. In the meantime, biotechs will be busy trying to deliver on their development plans some of which were provided in more detail during Monday's presentations.

Connecticut-based Alexion Pharmaceuticals is best known for its high-priced rare disease drugs Soliris and Ultomiris. On Monday, the company gave an early look at full-year financials, reporting a top line revenue increase of more than 20% between 2018 and 2019. That growth correlates to, at the very least, roughly $4.96 billion in annual revenue, which would be slightly higher than the average analyst estimate.

For Stifel's Paul Matteis, more surprising than the revenue beat was Alexion's plan to treat four times as many U.S. neurology patients with Soliris and Ultomiris by 2025. If successful, the plan would create a "substantial upside" to revenue estimates, according to the analyst.

"This of course raises a number of natural questions," Matteis wrote in a note to investors, "such as where will this growth come from, and what does it assume (if anything) for additional neuro indications where Soliris/Ultomiris isn't derisked."

Shareholders, however, responded positively to the updates, sending Alexion shares up 4%.

Soliris is approved to treat several diseases, including a chronic neuromuscular illness known as gMG and a type of central nervous system inflammation abbreviated as NMOSD. Alexion says that, in less than two years time, these neurology indications have become its largest franchise by patient volume. By the end of 2019, almost 1,900 U.S. neurology patients were taking Soliris.

Ultomiris, a follow-on to Soliris, is under investigation as a treatment for gMG and NMOSD across a couple of late-stage studies. And on Tuesday, Alexion announced it will soon begin a Phase 3 study of the drug in ALS, with plans to enroll 350 adults in a 50-week trial.

Selling new paths to growth is particularly important for Alexion now, as the company has come under pressure from activist investor Elliott Advisors to seek a sale.

BioMarin could bring the first hemophilia gene therapy to market later this year. While waiting for regulators to confirm its approval application is under review, the California biotech announced Monday it has more than doubled capacity at a gene therapy plant. Altogether, the facility can make up to 10,000 doses each year of either the hemophilia treatment or a separate BioMarin gene therapy that's about to begin human testing.

That capacity level, according to executives, would allow the company to treat all U.S. hemophilia A patients in roughly two year's time. The update increases the competitive pressure on drugmakers with marketed products, such as Takeda and Novo Nordisk, as well as those working on rival hemophilia gene therapies. Swiss pharma giant Roche falls into both buckets, and could lose out on many patients because of BioMarin, according to a recent doctor survey from Citi Research.

Sarepta Therapeutics also had a manufacturing update, announcing that production for its experimental micro-dystrophin gene therapy is now large enough to be considered commercially viable.

RBC Capital Markets analyst Brian Abrahams called this a "critical manufacturing milestone" for Sarepta, one that shores up the timeline for a pivotal study scheduled to start sometime in the middle of the year.

Despite launching one of the industry's largest initial public offerings in 2018, Rubius Therapeutics has struggled out of the gate in getting its first clinical data. While its ambitions are large, the Flagship Pioneering-backed biotech failed to meet expectations it set for delivering early Phase 1 data from its lead asset, a PKU drug, by the end of 2019.

"We understand what we didn't do right in 2019, and we are doing it differently in 2020," CEO Pablo Cagnoni told a half-filled breakout room at the JPM conference. "We will deliver in 2020."

While Cagnoni and other executives emphasized cancer therapies set to enter clinical testing in 2020 and speedy progress on its own manufacturing plant, the biotech also admitted it still has not dosed a single PKU patient to date, calling into question the company's ability to execute.

Pressuring Rubius further is BioMarin's announcement that it will develop a PKU gene therapy, with plans to dose its first patient this quarter. BioMarin already sells two PKU drugs and could be a formidable competitor.

Shares in Rubius ticked down by about 5% Monday and have shed two-thirds of their value since the company went public.

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Alexion's neuro bet, Rubius' trial troubles and biotech's gene therapy milestones - BioPharma Dive

The phrase crippling headache is as accurate as it gets for millions around the globe -- a bad headache can get in the way of everything.

Last Thursday, the Headache Chapter of the Egyptian Society of Neurology, Psychiatry and Neurosurgery (ESNPN) and pharmaceutical firm Novartis held a conference in Cairo to discuss migraines, including causes and treatments.

The conference organisers also launched the hashtag #BalashSuda3 to raise public awareness of different kinds of headaches, their causes and their treatment options, with a special focus on migraines.

Migraines decoded

Dr. Mohamed Osama Abdelghany, the head of the Headache Chapter, explained that migraines are a neurological disease in which genetics and environmental factors appear to play a role, although the exact causes are still shrouded in mystery.

"Migraine in Arabic historically had a very significant name el-shakeeka -- meaning 'what splits the head into two'. With such accuracy, our ancestors explained its effect, he said.

"It is typically a severe throbbing recurring pain, usually on one side of the head, and is often accompanied by debilitating symptoms such as nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch and smell.

A common disease

Understanding the magnitude of the problem requires a look at the data.

Migraine affects more than 10 percent of the global population and is two to three times more common in women than in men. Research suggests that 3,000 migraine attacks occur every day for each million of the general population. The disease is most common between the ages of 25 and 55, said Abdelghany.

Comprehensive data is not available for the whole of Egypt, so experts tend to rely on two key studies conducted in the governorates of Assiut and Fayoum.

"A study on primary headache disorders in Fayoum on 2,600 patients and in Assiut on 5,000 patients revealed that more than 60 percent of respondents did not seek medical advice for their headaches, with the percentage higher in rural areas. Those people thought that over-the-counter pills could be a solution, and that migraines are incurable. The prevalence of symptomatic migraines reached 17.3 percent and peaked in middle age, according to the survey."

"Migraine is the third most common disease in the world, with an estimated global prevalence of 14.7 percent -- affecting nearly one in seven people," Abdelghany explained.

Finding a way out

The experts then turned to the topic of understanding the ailment and the treatments commonly used, as well as tackling the new scientific breakthroughs in the field.

The causes of the disease have long been unclear, and sufferers have often resorted to painkillers that are not effective. Doctors prescribed medications that are usually used for treating other medical problems like heart disease, depression and epilepsy, which could scare patients off and led them to discontinue treatment.

"Many factors contributed to under-recognition and under-treatment, some of which were the absence of specialised headache centres, underestimating headache disorders by family members and even by health care practitioners, insufficient patient education and the availability of over-the-counter pain relievers," said Dr. Maged Abdel Nasser, professor and head of neurology at Kasr Al-Ainy, and general secretary of the Egyptian Society of Neurology, Psychiatry and Neurosurgery.

Though migraine causes are not understood, genetics and environmental factors appear to play a role. Migraines may be caused by changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway," he added.

This was until a new discovery surfaced.

"Clinical studies have proven that the a certain protein, CGRP, is associated with the migraines and plays an important and active role in causing an attack, and new treatments in the form of monthly shots made use of this scientific breakthrough, and paved the way for the first preventive medication to appear in Egypt when it comes to migraines, Abdel Nasser noted.

Leading cause of disability

The day concluded with attendees drawing attention to the importance of raising awareness of the possibility of preventing and treating migraines, which take a huge toll on economies and societies.

The doctors explained that, between 1990 and 2016, migraines were classified globally as the second leading cause of disability.

They added that more than 90 percent of those who suffer from migraines are unable to work or lead normal lives, and up to 46 percent of migraine patients visit emergency rooms for treatment. Studies show that migraines with aura, a sensation that sufferers get before the onset of an attack, are associated with a twofold increased risk of ischemic stroke.

"In addition to that, migraine patients are at a greater risk of developing anxiety and/or depression than non-sufferers, and the disease is also associated with a high economic and societal burden, Abdelghany said.

"The huge impact of migraine, which affects women three times more than men, on patients lives, translates into significant economic and social burdens," he stressed.

More awareness

Commenting on the lack of proper awareness even among health care providers, Abdelghany, said: Across medical schools all over the world, a minimal amount of hours are dedicated to migraine, despite the fact that severe headaches and migraines are highly prevalent among the younger segment of the population.

"Migraine remains under-diagnosed and under-treated in at least 50 percent of patients, and less than 50 percent of migraine patients consult a physician.

"Awareness should be raised in order for health care professionals, family members and friends to be able to identify the symptoms of migraine and understand that there are treatments, and yes, now there could be prevention," he concluded.

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Migraines at the forefront of Cairo conference - Health - Life & Style - Ahram Online

A new study shows no association between intracranial atherosclerotic plaque and brain beta-amyloid deposition in a community-based cohort of older adults without dementia.

"We know vascular risk factors are associated with later dementia, but our current results suggest that the mechanism by which vascularrisk might act on dementia risk is probably not, at least entirely, through intracranial atherosclerosis," lead study author Rebecca Gottesman, MD, PhD, Johns Hopkins Hospital, Baltimore, Maryland, told Medscape Medical News.

The study was published online December 20 in JAMA Neurology.

"There has been some evidence that vascular risk factors are associated with elevated brain amyloid, and in particular, in some autopsy studiesthat cholesterol buildup in the arteries in the brain was associated with Alzheimer's-type changes," Gottesman explained.

"We wanted to study the relationship between atherosclerosis in the arteries of the brain in living individuals without dementia to see if it was associated with these Alzheimer's-type changes because this might identify an important potentially modifiable risk factor for Alzheimer's brain changes," she said.

For the study, researchers analyzed data from a subset of 300 individuals aged 70-90 years (mean age 76 years) without dementia from the Atherosclerosis Risk in Communities (ARIC) cohort study who underwent PET scanning to detect amyloid buildup. The same individuals also underwent brain MRI to evaluate intracranial atherosclerosis.

Results showed no evidence of an association between plaque presence and global cerebral beta-amyloid. Furthermore, modest stenosis of the intracranial vessels was not associated with amyloid levels.

"We had hypothesized that we might find evidence of an association between intracranial atherosclerosis and brain amyloid based on earlier studies," Gottesman said. "However, this was a cross-sectional analysis these sets of scans were basically done during the same time period for all study participants which means we may have failed to find an association because the relationship may take years to occur. It is also possible, however, that vascular risk factors themselves act on risk for dementia and Alzheimer's," she added.

Gottesman points out that intracranial atherosclerosis is known to be associated with dementia risk more broadly, emphasizing that more needs to be done to understand how this elevated risk occurs.

"We need to understand more about the longer-term effect of intracranial atherosclerosis and how it impacts dementia and Alzheimer's risk over years to decades. Also, it is important to understand if certain subgroups of people might be especially susceptible to adverse effects of having intracranial atherosclerosisand how stroke fits in with these relationships," she commented.

Gottesman says the current results should not be taken as evidence that vascular dementia and Alzheimer's have completely different causes.

"Intracranial atherosclerosis is just one type of vasculareffect in the brain, and other studies demonstrate that midlife vascular risk factors are more strongly associated with later-life cognition and even later-life brain amyloid, so we may just need to consider longer-term relationships between the two," she explained.

It could also be just one additional consequence of vascular risk factors that might act on the brain and on Alzheimer's risk in different ways, she added.

Furthermore, this study did not address how the relative amounts of intracranial atherosclerosis and brain amyloid each contribute to dementia risk, and thus, did not address how these affect clinically relevant dementia, Gottesman noted.

"We know there is a lot of overlap in the pathology of people with dementia, and other studies suggest that this applies to intracranial atherosclerosis and Alzheimer's changes in the brain in addition to other types of vascular changes that can be observed," she said.

The researchers suggest that potential mechanisms for an association between intracranial atherosclerosis and beta-amyloid may depend on a greater degree of stenosis than what was found in this generally healthy cohort or with a more cognitively impaired population at later stages in disease.

The ARIC study was funded by the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), and US Department of Health and Human Services. Gottesman has reported receiving grants from the NIH/National Institute on Aging.

JAMA Neurol. Published online December 20, 2019. Abstract

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Intracranial Atherosclerosis Not Linked to Amyloid - Medscape

Wayne State University School of Medicine Professor of Neurology Robert Lisak, M.D., FRCP, FAAN, received the Healthcare Professional Champion Award from the Michigan Chapter of the National Multiple Sclerosis Society.

The award is presented to an individual who has demonstrated their commitment to helping people meet the challenges of Multiple Sclerosis, including improving access to and quality of MS clinical care. Recipients must have demonstrated leadership in establishing relationships with other health care providers and professional organizations, increasing referrals to the society and improving MS knowledge in the health care workforce.

It is nice to be recognized for doing things that you enjoy doing for others, said Dr. Lisak, who received the honor Jan. 11 at the chapters annual Breakthroughs in MS meeting in Novi. Mich.

Mirela Cerghet, M.D., Ph.D., a neurologist with the Henry Ford Health System, presented Dr. Lisak, also a professor of Biochemistry, Microbiology and Immunology, and former chair of WSU Neurology, with the award on behalf of the chapter.

Dr. Lisak, said Dr. Cerghet, has been a champion for patients living with MS for the entire span of his distinguished career. His involvement with the National MS Society spans decades, and over the years of his service great strides have been made toward creating a world free of MS, including the development of all the disease-modifying medications.

A member of the societys Board of Trustees and chair of the Healthcare Provider Council, Dr. Lisak has played a critical role in attracting new talent to the field through his involvement in MS professional education, medical student mentoring, clinical training programs and engagement with clinical fellows, Dr. Cerghet said.

Most recently, Dr. Lisak, representing both WSU and the Consortium of Multiple Sclerosis Centers in his role on the AAN Guideline Development, Dissemination and Implementation Subcommittee, helped develop new guidelines for disease-modifying therapy for multiple sclerosis. The Consortium of Multiple Sclerosis Centers is a professional organization of MS centers and health care providers and researchers in the United States and Canada committed to a comprehensive multidisciplinary approach to treatment and care, education and research and advocacy for MS so that the centers can provide the best care and outcomes for patients and their families. The consortium also is an international clearinghouse for research results, the latest treatments, clinical trials and patient education programs.

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Dr. Lisak honored with Healthcare Professional Champion Award for efforts against MS - The South End

Sarepta Therapeutics' chief Doug Ingram has come out against accusations that the FDA is biased against the company after its recent drug rejection but offered no timing on when the agency's concerns will be fixed.

Despite not being directly mentioned in its third-quarter press release Thursday night, Ingram did address the FDAs complete response letter (CRL) to its second Duchenne muscular dystrophy (DMD) hopeful golodirsen right off the bat in his call to analysts and journalists.

He said: I must also acknowledge what we all know, that we had a setback in the third quarter. And rather than baring it among or after a discussion of our successes, I will begin by commenting our CRL disappointment that occurred in August.

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Having worked diligently on our submission for VYONDYS 53, the generic name for golodirsen for well over a year, and based on all of our interactions with the division of neurology products, we were very confident that we would obtain an approval on our PDUFA date, which was August 19.

Instead, as you know we were surprised to have received a complete response letter, also known as the CRL, signed by the Office of Drug Evaluation I. Our disappointed extends beyond Sarepta to the 8% of exon 53 amenable DMD patients in the United States to generate every day, while they await access to this therapy.

Ingram said that the biotech will now work with the agency to address the reasons for the CRL and to turn in a pathway for a potential approval, if one is possible, but offered no prediction on outcome or on timing, or to provide interim views during the process.

However, I will provide an update to the patient, physician and investment communities, once we have definitive clarity on the outcome of those discussions.

RELATED: Sarepta's Golodirsen snub highlights 'atypical communications,' heralds higher bar at FDA: analysts

The FDA rejected the New Drug Application for golodirsen, the follow-up to Exondys 51, Sareptas first treatment for DMD, in the summer over worries over the risk of infection linked to intravenous infusion portsdevices placed just under the skin to give doctors access to a veinand kidney toxicity seen in animal studies.

Like Exondys 51, golodirsen is designed to treat a group of Duchenne patients with a certain type of mutation. Exondys 51 works for about 13% of DMD patientsthose whose disease is amenable to exon 51 skipping. If approved, golodirsen would offer treatment to patients with a mutation in exon 53about 8% of the DMD population.

Sarepta has a bullish following from a vocal set of investors, who have raised concerns that the FDA may have rejected this drug because of the questionable approval it got for its first DMD drug, Exondys 51, back in 2016.

There was a lot of hand-wringing from the FDA internally about whether this met the clinical parameters needed for a regulatory green light, and some believe the CRL for Vyondys 53 has come as payback" for Exondys 51.

Ingram rejected the idea: To those may believe that the CRL suggest some sort of bias on behalf of the division of neurology towards Sarepta, I would unequivocally and emphatically disagree. Let me reiterate that I remain convinced that we were treated very fairly and professionally by the division of neurology.

He added that the CRL does have implications beyond Vyondys 53, notably for its next planned submission for PMO casimersen. As they are closely related, we will await clarity on the Vyondys matter before we submit for casimersen in the United States. But let me disabuse anyone who might have concerns.

He added, however, that the CRL does not have any read through to our microdystrophin gene therapy program. The CRL involved two safety signals in connection with an application for accelerated approval. Our microdystrophin program is overseen by a different part of the FDA, Sedar, and we are not seeking accelerated approval there. There is simply no overlap in either substance or personnel.

In a nod to the vocal investors, he also said that the noises around applying external pressure to bring this therapy a lot faster onto the market will not be coming from him.

I have no intention of doing either of those things, he said. If we can win the day with this therapy and with this issue, we will have done so on the size and on the regulation and in collaborative evidence-based discussions with our reviewers at the FDA.

Sarepta dipped slightly in the red by 0.2% after hours last night.

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Sarepta CEO dispels FDA 'bias' theory, but no update on when CRL will be resolved - FierceBiotech

November 09, 2019

In preparation for my recent trip to Ireland, I made sure I had my annual flu shot since I knew I would be in close quarters on the flight overseas. I very rarely get sick but figured I should error on the side of caution. Despite the flu shot, a combination of airplane air, change of climate, and one of my travel mates bringing her crud along for the trip, I ended up with some kind of chest cold.

Since my return I have tried just about everything to ditch this crud, from riding my Harley Davidson Softail really fast in order to blow the germs away, to sweating it out at CrossFit. I am happy to report that nearly two weeks later I can almost sleep through the night without coughing.

Cold season, unlike flu season, is really a 12-month affair. Anytime you get lots of people together in a space airplane, mall, movie theater, etc. chances are some of them have a cold and the germs are just waiting to jump on you.

Colds are the result of a viral infection, and there are several different types. The one that usually causes a cold in grown-ups like us is called the coronavirus and happens most often in early spring and winter. Colds cause sneezing, coughing, stuffy or runny nose and sometimes fever and chills. For the most part, colds will work their way out in three to five days, but some of the effects may linger longer.

If you are wondering about how colds affect our fitness routine, you are in the right place. Lets look at three questions regarding colds and fitness:

Does exercise prevent colds?

Regular exercise appears to have the advantage of being able to jump-start the immune system, and that can help reduce the number of colds you get. With exercise, the number and aggressiveness of certain immune cells, such as the ones called natural killer cells, increase by as much as 50% to 300%. If you exercise regularly, this temporary increase can help make the immune system more efficient at destroying intruders that cause illness such as colds. In one study reported in the American Journal of Medicine, women who walked for a half-hour every day for one year had half the number of colds as women who did not exercise. In this study, researchers associated regular walking with increasing levels of infection-fighting.

Does too much exercise make you catch a cold?

While for most of us over-exercising is not an issue, for some elite athletes it can be. Research indicates that athletes that participate in high-intensity sports marathon running, triathlons, etc. can actually get more colds. When an athlete trains too hard, the very white blood cells that help prevent illness decrease, leaving the body more vulnerable to getting sick. These ultra-athletes need to be aware and make sure they build in recovery days to their workouts to prevent illness.

Can you exercise with a cold?

Because exercise may help to boost immune function, its usually safe to exercise with a cold as long as you listen to your body. Sometimes cold medications, such as decongestants, can increase your heart rate. In addition, your heart rate is increased with exercise. The combination of exercise and decongestants can cause your heart to pump very hard. You may become short of breath and have difficulty breathing.

If you have a fever with a cold, exercise may stress your body even more. Thats why its important to wait a few days to get back to your regular exercise regimen. Working out too hard with a cold could stress your body, causing you to feel worse. This additional stress may hinder your recovery. It is best to back your exercise down a notch until you are 100%. Consult with your health-care provider if you have any questions or concerns about exercising while you are under the weather.

So there you have it. Exercise to prevent colds, keep exercising a little when you are under the weather, and dont work out so hard that your immune system crashes. My advice is to keep the hand sanitizer handy, dont drink behind your family or friends, and stay out of crowds until the sniffling season passes.

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Southeastern Multi-Specialty and Urgent Care Whitevilles open house/ribbon cutting set for Friday - The Robesonian

Residents in northwest Georgia can now receive neurology and stroke diagnosis closer to home through a telemedicine partnership between Floyd Medical Center and Erlanger Health System.

We are pleased to work with Erlanger Health System to offer our patients tele-neurology care, said Kurt Stuenkel, president and CEO of Floyd Medical Center. This collaboration will enhance the immediate excellent care our award-winning Primary Stroke Center already provides.

"This innovative new program will improve access to specialty trained stroke neurologists to consult and diagnose, reducing the time for lifesaving treatment for patients suffering from stroke," officials said. "By offering access to neurology specialists through telemedicine, some patients may even have the opportunity to receive stroke treatment closer to home rather than transferring to another medical facility."

This tele-neurology collaboration highlights our shared commitment with Floyd to provide excellent care to those suffering from an acute neurological emergency, such as stroke, said Matthew Shafer, Erlangers administrative director of telemedicine. Tele-medicine has proven time and time again to be a powerful tool in expanding lifesaving specialty care throughout a larger region.

Officials said, "Stroke is the fifth leading cause of death and the leading cause of disability in the United States. It affects patients of all ages. The disease happens when a blood vessel carrying blood and oxygen to the brain is blocked or ruptures, decreasing the amount of blood flow to the brain cells. Risk factors for stroke disease can include high blood pressure, diabetes, heart disease, high cholesterol, obesity, smoking, family history of stroke and prior stroke or transient ischemic attack.

"In order to receive faster diagnosis and medical treatment, people must first recognize the signs of stroke and act F.A.S.T.:

Face: Ask the person to smile. Does one side of the face droop?; Arms: Ask the person to raise both arms. Does one arm drift downward?; Speech: Ask the person to repeat a simple phrase. Is her speech slurred or strange?; and Time: If you observe any of these signs, call 911 immediately."Floyd has Advanced Certification for its Primary Stroke Center from The Joint Commission. The certification recognizes centers that have the critical elements to achieve long-term success in improving outcomes for stroke patients.

"Additionally, the American Heart Association/American Stroke Association has honored Floyd with its Get with the Guidelines - Stroke GOLD PLUS Recognition. Hospitals receiving this award have reached an aggressive goal of treating stroke patients with 85 percent or higher compliance to core standard levels of care as outlined by the American Heart Association/American Stroke Association for 12 months. In addition, those hospitals have demonstrated 75 percent compliance to seven out of 10 stroke quality measures during the 12-month period."

Excerpt from:
Floyd Medical Center Partners With Erlanger Health System To Offer Telemedicine Technology In Neurology And Stroke Care - The Chattanoogan

Neurology Expertise. Compassionate Care.

At the University of Maryland Medical Center, our neurology experts do more than evaluate and treat issues related to the central nervous system. Our team understands the impact of your condition on your life and helps you manage it with an individualized treatment plan.

Nationally recognized as pioneers in their fields, our neurologists work with all types ofneurological conditionsand conduct groundbreaking neurology research.

Our neurologists work closely with UMMCneurosurgeonsto provide our patients with the latest surgical procedures. For more severe-response situations, our Neurocritical Care Unit provides timely care.

As a leader in stroke care for the state and surrounding areas, our Comprehensive Stroke Center offers patients and health providers 24/7 access to stroke physicians for questions and care.

Nerve pain can be debilitating. At the University of Maryland Medical Center, our specialists provide comprehensive care for conditions related to spinal and peripheral nerves and for all types of neuropathy.

Headaches and migraines can have a big impact on your life. Pinpointing their cause and best treatment takes a headache expert. We see patients with all types of headaches, including migraine, tension and cluster headaches.

Our Parkinsons disease program offers diagnostic, medical, surgical and rehabilitative services for patients with Parkinson's disease and other movement disorders.

At UMMC, our multiple sclerosis team works closely with patients, families and primary care physicians to help patients manage their conditions effectively so they can lead active, productive lives.

As a Level 4 Epilepsy Center, UMMC hasprofessional expertise and facilities to provide the highest level of care for patients with the most complex epilepsy. Our physicians can offer comprehensive evaluation, including EEG monitoring, as they work with you to create a treatment plan for your seizures.

Call 410-328-4323 to make an appointment with one of our neurology specialists. Need a second opinion? We can help you with that, too.

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Neurology | Baltimore | University of Maryland Medical Center

Washington University Neurologists strive to provide outstanding clinical care and train the leading neurological doctors and scientists of the future. Our neurologists are international leaders in clinical and basic research on the disorders of the nervous system. Our goal is to bring scientific research and discovery from the bench to the bedside to improve the lives of our patients.

Each of our neurologists provide outstanding clinical care for patients of all ages, and a wide range of conditions, disorders, and diseases. While it is never easy to have a loved one dealing with any medical issue, we are here to put you at ease knowing we can provide compassionate care.

Our neurologist team offers the best in specialized procedures including:

Our PET scanner is an innovative brain imaging technique invented and developed at Washington University, and used in the neurology intensive care unit at Barnes-Jewish Hospital. The unit is one of the largest and most sophisticated in the United States.

Visit the department of neurology to learn more about a variety of conditions and to find a St. Louis neurologist near you.

For appointments, call:

AIDS Neurology - (314) 747-8423EEG Video Monitoring - (314) 362-7174Electromyography Studies (EMG) - (314) 362-3324Epilepsy - (314) 362-7845 General Adult Neurology - (314) 362-7241Memory Diagnostic Center - (314) 286-1967Multiple Sclerosis - (314) 362-3293Neuromuscular Disorders - (314) 362-6981Neurologic Rehabilitation - (314) 362-4503Pediatric Neurology - (314) 454-6120Sleep Medicine Center - (314) 362-4342Stroke - (314) 362-7382

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Neurologists in St. Louis | Wash U Physicians

Peripheral Nerve Disorders includes other areas of care:

- Acute Inflammatory Demyelinating Polyradiculoneuropathy

- Alcoholic Neuropathy

- Alcoholic Polyneuropathy

- Anterior Ischemic Optic Neuropathy

- Auditory Neuropathy

- Autonomic Disorders

- Autonomic Dysreflexia

- Autonomic Neuropathy

- Carcinomatous Polyneuropathy

- Carotid Sinus Syncope

- Chronic Demyelinating Neuropathy With IgM Monoclonal Gammapathy

- Chronic Inflammatory Demyelinating Polyneuropathy

- Chronic Inflammatory Demyelinating Polyradiculoneuropathy

- Congenital Neuropathy With Arthrogryposis Multiplex Congenita

- Congenital Sensory Neuropathy With Neurotrophic Keratitis

- Demyelinating Polyneuropathy

- Diabetic Neuropathy

- Diabetic Polyneuropathy

- Hand Neuropathy

- Hereditary Neuropathy With Liability to Pressure Palsies

- Hereditary Sensory and Autonomic Neuropathy, Type I

- Infantile Refsum Disease

- Inflammatory and Toxic Neuropathy

- Inflammatory Neuropathies

- Leber Hereditary Optic Neuropathy

- Metabolic Neuropathy

- Motor and Sensory Neuropathy With Sensorineural Hearing Loss, Bouldin Type

- Motor Neuropathy

- Motor Neuropathy, Peripheral With Dysautonomia

- Multifocal Motor Neuropathy

- Multifocal Motor Neuropathy With Conduction Block

- Neuropathy, Distal Hereditary Motor

- Neuropathy, Distal Hereditary Motor, Jerash Type

- Neuropathy, Distal Hereditary Motor, Type III

- Neuropathy, Distal Hereditary Motor, Type VIIa

- Neuropathy, Hereditary Motor and Sensory, Lom Type

- Neuropathy, Hereditary Motor and Sensory, Okinawa Type

- Neuropathy, Hereditary Sensory, Radicular

- Neuropathy, Hereditary Sensory, Type I

- Neuropathy, Hereditary Sensory, Type II

- Neuropathy, Hereditary Sensory, Type IV

- Neuropathy, Motor & Sensory

- Optic Neuropathy

- Peripheral Neuropathy

- Peroneal Muscular Atrophy

- Polyneuropathy

- Polyradiculoneuropathy

- Pudenal Neuropathy

- Reflex Sympathetic Dystrophy

- Retrobulbar Neuropathy

- Sensory Neuropathy With Spastic Paraplegia

- Spinal Bulbar Motor Neuropathy

- Spinocerebellar Ataxia With Axonal Neuropathy, Type 2

- Spinocerebellar Ataxia, Autosomal Recessive, With Axonal Neuropathy

- Toxic Polyneuropathy Due to Acrylamide

- Ulnar Neuropathy

- Vascular Neuropathy

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Dr. Ruben Cintron Jr, MD - Reston, VA - Neurology ...

At The University of Vermont Medical Center in Burlington, VT, our University of Vermont Medical Group neurology doctors and specialists offer comprehensive, compassionate care for patients with neurological disorders and diseases - conditions affecting the nervous system including the brain, spinal cord and nerves.

Our multidisciplinary neurology team, comprised of neurologists, registered nurses and nurse practitioners, social workers and technologists, is specially trained to diagnose, evaluate and treat all types of neurological conditions in children and adults. Specialties include:

Across our services, we work collaboratively with specialists in neurosurgery, neuroradiology and neuropsychology, bringing together the expertise of multiple disciplines, centered on the needs of each patient.

Because we're a university hospital, you and your family have access to new and emerging treatments and technologies, and the latest scientific knowledge in neurology.

Our expert Neurology team is specially trained to diagnose, evaluate and treat all types of neurological problems in children and adults. The team includes:

Throughout all our services, we work collaboratively with specialists in neurosurgery, neuroradiology and neuropsychology, bringing together the expertise of multiple disciplines, centered on the needs of each patient.

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Neurology - University of Vermont Medical Center ...

WEST PALM BEACH, Florida Women who have no history of a full-term pregnancy show an earlier onset of progressive multiple sclerosis (MS) compared with those who have had pregnancies, and the apparent onset-delaying effect appears to increase with the number of pregnancies, new research suggests.

The results add to speculation on the effects of pregnancy in MS.

"Our results suggest that a higher number of full-term pregnancies than average is associated with later onset of progressive MS, while having no full-term pregnancies is associated with significantly younger age at progressive MS onset," first author Burcu Zeydan, MD, an assistant professor of radiology in the Center for MS and Autoimmune Neurology at the Mayo Clinic in Rochester, Minnesota, told Medscape Medical News.

The study was presented here at the 5th annual Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2020.

The findings, which also link early menopause with faster disease progression, offer important insights into the broader effects of pregnancy on MS, commented ACTRIMS president Jeffrey A. Cohen, MD, who is the director of Experimental Therapeutics at the Mellen Center for MS Treatment and Research, Cleveland Clinic, Ohio.

"We know pregnancy affects the short term disease activity relapses tend to quiet down during pregnancy but what has been somewhat conflicting is whether it affects the long-term prognosis or is just a temporary effect," he told Medscape Medical News.

"So that is the main interest in this study, and it does indicate that pregnancy affects the long-term prognosis and provides some insight into the mechanism by which it might do that."

While being female is in fact considered the most important risk factor for MS susceptibility, pregnancy has been suggested to have a protective role in disease progression. However, more research is needed on the nature of the effect and its mechanisms.

For this study, Zeydan and colleagues evaluated data on 202 patients (134 women, 68 men) with MS who were part of a Mayo Clinic survey.

They found that women who had no full-term pregnancies (n = 32), had an earlier onset of progressive MS (mean age 41.4 12.6 years) compared with women giving birth to one or more children (n = 95; 47.1 9.7 years; P = .012).

In addition, the mean age of progressive MS onset increased with a dose-effect trend according to the number of full pregnancies (no children, 41.4 12.6 years; 1-3 children: 46.4 9.2 years; 4 or more children: 52.6 12.9 years; P = .002).

A look at a subgroup of patients with secondary progressive MS also showed an earlier mean age of onset among women who had no full pregnancies(n = 19; 41.5 9.2 years) compared with women who had one or more full pregnancies (n = 57; 47.3 10.6 years; P = .049).

The later disease onset associated with pregnancy was also seen in relapsing-remitting MS: Mean age of onset was earlier women with no pregnancies (27.5 7.0 years) compared with those with one or more children (33.0 9.4 years;P = .021).

The mean duration of time from relapsing-remitting MS to secondary progressive MS was also shorter among women with premature or early menopause (n = 26; 12.9 9.0 years) compared with those who had menopause at a normal age (n = 39; 17.8 10.3 years).

The pattern was similar for women experiencing the onset of secondary progressive MS after menopause, with a shorter progression among those with early menopause (P = .012).

The trends of later onset with more pregnancies was also observed with the mean age of onset of secondary progressive MS (no full pregnancies: onset at 41.5 9.2 years; 1-3 pregnancies: onset 46.2 9.9 years; 4 or more pregnancies: onset 52.6 12.9 years; P = .010).

And likewise, the later mean age of onset of relapsing-remitting MS was seen with additional pregnancies (no full pregnancies: 27.5 7.0 years; 1-3 pregnancies: 32.4 9.3 years; 4 or more pregnancies: 35.8 9.8 years;P = .012).

"The dose effect was clearly a surprise (having no full-term pregnancies vs 1-3 vs 4 or more)," Zeydan said.

"In addition to the significant difference between having no vs 1 or more full-term pregnancies, the clear dose-effect consolidates our results related to the association between the number of pregnancies and age at progressive MS onset."

The study also showed that women with premature or early menopause had a shorter duration of progression from relapsing-remitting MS to secondary progressive MS (n = 26; 12.9 9.0 years) compared with women who experienced menopause at a normal age (n = 39; 17.8 10.3 years).

The patterns in early menopause are consistent with previous observations regarding menopause and MS progression, Cohen said.

"When women go through menopause, estradiol and pregnancy-related factors further decline and we know this coincides temporally with the development of progressive MS in women," he noted.

Compared with men, women with premature or early menopause furthermore had a longer duration from relapsing-remitting MS to secondary progressive MS (P = .008), and women with secondary progressive MS also had also had an earlier age of relapsing-remitting MS onset than men (P = .018).

The mechanisms of pregnancy could include a complex interaction between estrogen and factors such as astrocyte and microglia function, Zeydan explained.

"Estrogen, through various mechanisms of eliminating toxicity of highly activated neurons including preventing pro-inflammatory molecule release, supporting mitochondria function thereby eliminating energy failure, and promoting remyelination helps neuronal plasticity and delays neurodegeneration, which is closely related to the progressive phase of MS," she said.

"One could easily make the probable association, while yet to be proven, that our findings may relate to these mechanisms," Zeydan said.

The logical question of whether hormone replacement or some type of therapy that could mimic the effects of pregnancy could also benefit in delaying MS onset remain to be seen, Zeydan said.

"While we believe that is possible, particularly for delaying the onset of progressive phase, definitive evidence is lacking at this time," Zeydan said. "However, our study ultimately may lead to such a trial."

In the meantime, the findings provide additional insights that may be beneficial in sharing with patients regarding pregnancy, she said.

"As the contemporary problem in MS care is to delay or prevent progressive MS onset, our findings may suggest that how we counsel women with MS who are planning to get pregnant, or contemplating surgically induced menopause, or how we consider hormone therapies during perimenopause, may impact the course of their disease."

Zeydan cautions, however, that "our findings do not confirm causality beyond an association."

"More studies are needed in this important issue in a disease that affects women three times more than men," she stressed.

Zeydan has disclosed no relevant financial relationships. Cohen reports personal compensation for consulting for Adamas, Convelo, MedDay, Mylan, and Population Council; and serving as an editor of Multiple Sclerosis Journal.

Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2020: Abstract P135. Presented February 27, 2020.

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Pregnancy Linked to Later Onset of Progressive MS - Medscape

WEST PALM BEACH, FL More patients with early relapsing-remitting multiple sclerosis (RRMS) treated with natalizumab experienced confirmed disability improvement than confirmed disability worsening, with the majority of improvement occurring in the first year and most patients maintaining confirmed disability improvement through the end of a 4-year study, according to research presented at the 5th annual Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2020, held February 27-29 in West Palm Beach, Florida.

This 4-year, multicenter, observational, open-label, single-arm study of patients initiating natalizumab therapy <3 years postdiagnosis of RRMS (STRIVE), was designed to evaluate disability improvement over 4 years of treatment. Confirmed disability improvement was defined as a >1.0 decrease in Expanded Disability Status Scale (EDSS) score from a baseline score >2.0, confirmed after 24 weeks. Confirmed disability worsening was defined as a >0.5 increase in EDSS from a baseline score > 6.0, or a >1.0 increase from a baseline score of 1.0 to 5.5, or a >1.5 from a baseline score of 0.0, confirmed after 24 weeks.

Cumulative confirmed disability improvement or disability worsening probabilities were assessed with Kaplan-Meier methods. Confirmed disability improvement maintenance was defined by a continued EDSS reduction by >1 point. A multivariate spline-based accelerated failure time model was used to evaluate baseline characteristics (age, multiple sclerosis disease duration, EDSS score, T2 lesion volume, number of gadolinium-enhancing lesions, and relapses in the prior year) as confirmed disability improvement predictors.

A total of 222 participants were included in the intent-to-treat population, of whom 133 had a baseline EDSS score of >2.0. During the 4-year study, 32.3% of participants with such an EDSS score experienced confirmed disability improvement; 62.8% had an EDSS score reduction of >1.5, and 44.2% had a reduction of >2.0 points. The cumulative probability of confirmed disability improvement was 19.9% at 1 year, 28.4% at 2 years, 38.5% at 3 years, and 43.9% at 4 years.

Among those with confirmed disability improvement, 62.8% maintained improvement through all 4 years of the study. No baseline characteristics were found to be confirmed disability improvement predictors, and the cumulative confirmed disability worsening probability at 4 years was 19.3%.

The investigators concluded, In this analysis of patients treated with natalizumab in STRIVE, more patients experienced [confirmed disability improvement] than CDW. [Confirmed disability improvement] occurred during each year of the study with most improvement taking place in the first yearThese results are consistent with findings from other real-world studies and support the effectiveness of natalizumab in patients with early RRMS.

Visit Neurology Advisors conference section for continuous coverage from the ACTRIMS 2020 Forum.

Reference

Perumal J, Fox R, Balabanov R, et al. Disability improvement in early multiple sclerosis patients treated with natalizumab in STRIVE, a phase 4 multicenter observational study. Presented at: ACTRIMS Forum 2020; February 27-29, 2020; West Palm Beach, FL. Abstract P056.

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Natalizumab Linked to Disability Improvement in Early Relapsing-Remitting MS - Neurology Advisor

Treatment with galcanezumab in patients with episodic and chronic migraine does not result in changes in hemodynamic parameters or increase the risk of cardiovascular (CV) events, according to study results published in Headache.

Galcanezumab, a humanized IgG4 monoclonal antibody that binds calcitonin gene-related peptide, is approved for the preventive treatment of migraine in adults. Because the CV effects of galcanezumab are not clear, the researchers assessed the effect of galcanezumab, compared with placebo, on blood pressure, changes in electrocardiograms, and CV events in patients with episodic or chronic migraine.

The researchers used data from 3 phase 3, double-blind, placebo-controlled studies of patients aged 18-65 years: 2 similar 6-month studies that included patients with episodic migraine (EVOLVE-1 and EVOLVE-2) and a single 3-month study of patients with chronic migraine (REGAIN). The subjects were randomized (1:1:2) to monthly subcutaneous injections of galcanezumab 120 mg, galcanezumab 240 mg, or placebo.

Treatment comparisons for CV treatment-emergent adverse events (TEAEs), and categorical and mean changes in blood pressure, pulse, and electrocardiograms were evaluated.

A total of 705 patients were treated with galcanezumab 120 mg, 730 patients were treated with galcanezumab 240 mg, and 1451 patients were in the placebo group. Of the 2886 adults included in the analysis, 1773 patients had episodic migraine and 1113 had chronic migraine.

The frequency of at least 1 CV TEAE was 2.6% (18 cases) for galcanezumab 120 mg, 3.3% (24 cases) for galcanezumab 240 mg, and 2.9% (42 cases) for placebo, with no significant differences between the groups (galcanezumab 120 mg vs placebo: odds ratio 0.9; 95% CI, 0.5-1.5; galcanezumab 240 mg vs placebo: odds ratio 1.1; 95% CI, 0.7-1.9).

Researchers noted there were no likely CV TEAEs documented in the 8 galcanezumab-treated patients with a history of ischemic central nervous system vascular conditions, cardiomyopathy, or cardiac failure.

Serious CV adverse events were documented in 3 patients (0.4%) treated with galcanezumab 240 mg (pulmonary embolism, myocardial infarction, and transient ischemic attack) and in 3 (0.2%) placebo-treated patients (pulmonary embolism, deep vein thrombosis, and myocardial infarction), whereas in the group of patients treated with galcanezumab 120 mg, there were no serious events.

Compared with placebo, galcanezumab treatment for up to 6 months did not lead to mean increases in blood pressure or pulse. Overall, the percentage of patients with increases in blood pressure or pulse were similar among patients treated with galcanezumab compared with those receiving placebo.

The researchers noted the study had several limitations, including short treatment duration, low frequency of CV events, and exclusion of patients with acute or serious CV risk or serious medical conditions.

The data from this integrated analysis do not suggest that galcanezumab treatment in patients with migraine resulted in hemodynamic changes consistent with vasoconstriction or an increase in CV [cardiovascular] adverse events, including those related to ischemia up to 6 months of treatment, concluded the researchers.

Disclosure: This clinical trial was supported by Eli Lilly and Company. Please see the original reference for a full list of authors disclosures

Reference

Oakes TM, Kovacs R, Rosen N, et al. Evaluation of cardiovascular outcomes in adult patients with episodic or chronic migraine treated with galcanezumab: data from three phase 3, randomized, double-blind, placebo-controlled EVOLVE-1, EVOLVE-2, and REGAIN studies. [published online ahead of print, 2019 Nov 13]. Headache. 2019;10.1111/head.13684. doi:10.1111/head.13684

Link:
Effect of Galcanezumab on Cardiovascular Outcomes in Adults With Migraine - Neurology Advisor

Both low and high levels of blood pressure during endovascular treatment of acute ischemic stroke are associated with poor functional outcome, a new study suggests.

"Our study has very clinically relevant findings that best outcomes are achieved if the mean arterial blood pressure [MABP] is kept between 70-90 mm Hg," lead author, Mads Rasmussen, MD, PhD, Aarhus University Hospital, Denmark, told Medscape Medical News.

"Our main message is that strict blood pressure protocols are needed during endovascular therapy for stroke," Rasmussen said. "We need be meticulous about blood pressure management during this procedure as patients are very sensitive to blood pressure changes. If we do not manage blood pressure well during the procedure, then this can have a meaningful adverse impact on outcomes."

The study was published online in JAMA Neurology on January 27.

It's known that blood pressure drops transiently during the endovascular procedure and previous studies have suggested that low blood pressure adversely affects outcomes, "but we haven't known what the blood pressure threshold is and for how long it can go below this threshold," Rasmussen explained.

"This is what we set out to look at in this study," he said. "We also wanted to see if there was an upper threshold for blood pressure related to outcomes."

For the current study, the researchers analyzed data from three randomized controlled trials in a total of 380 patents investigating anesthetic strategy during endovascular treatment for stroke.

"One of the main strengths of our analysis is that all the three studies we used had strict blood pressure protocols in place. This has not been the case in previous studies that have tried to investigate the effect of blood pressure on outcomes," Rasmussen noted.

Results showed that a cumulated period of a minimum 10 minutes with less than 70 mm Hg MABP was associated with a shift toward a higher 90-day modified Rankin scale (mRS) score (adjusted odds ratio [OR], 1.51; 95% confidence interval [CI], 1.02 - 2.22) and a number needed to treat to harm 1 patient of 10.

A continuous episode of a minimum 20 minutes with less than 70 mm Hg MABP had a higher risk of an increased 90-day mRS score (adjusted OR, 2.30), corresponding to a number needed to treat to harm 1 patient of 4.

At the other end of the spectrum, a cumulated period of a minimum 45 minutes with greater than 90 mm Hg MABP was associated with a shift toward a higher 90-day mRS score (adjusted OR, 1.49), corresponding to a number need to harm of 10.

And a continuous episode of a minimum 115 minutes with greater than 90 mm Hg MABP showed a greater risk of a higher mRS score (adjusted OR, 1.89), corresponding to a number needed to harm of 6.

"These results suggest These results suggest MABP may be a modifiable therapeutic target to prevent or reduce poor functional outcome in patients undergoing [endovascular treatment] for [acute ischemic stroke] and that MABP should possibly be maintained within such narrow limits," the authors conclude.

"I would say though, that from our data, mean arterial blood pressure should be kept between 70 and 90 mm Hg. There are bound to be the occasional drops below 70 mm Hg, but these should be kept to a minimum if possible," Rasmussen commented.

"This is the best data we have so far on optimum blood pressure levels during endovascular treatment for stroke, but it still needs confirmation if possible in a randomized trial," he added.

Rasmussen noted that this is the first study to have shown that higher levels of blood pressure may also lead to poor outcomes during endovascular treatment, although the relationship is much weaker than that for low blood pressure.

"Our results confirm that the previously established U-shaped blood pressure pattern is also relevant in stroke patients undergoing endovascular treatment," he stated.

"We used mean arterial blood pressure. Other studies have used systolic blood pressure, and some have suggested that this should kept above 140 mm Hg. Mean arterial blood pressure takes into consideration both systolic and diastolic levels. Further studies are needed to give information on which measurement is best," he added.

In the paper, the authors say their findings suggest that MABP is more sensitive than systolic pressure in the assessment of hypertension and hypotension.

"Cerebral perfusion pressure, defined as the difference between MABP and intracranial pressure, is considered the physiologic driving force behind cerebral blood flow. Furthermore, MABP is a combination of systolic and diastolic blood pressures and is considered a more valid index of tissue perfusion," they write.

"We hypothesize that a MABP threshold is a more appropriate indicator of hypertension and hypotension during [endovascular treatment] for [acute ischemic stroke]," they conclude.

Rasmussen was supported by a grant from the Health Research Foundation of Central Denmark Region and the National Helicopter Emergency Medical Service Foundation, Denmark. The remaining study authors' disclosures are listed in the paper.

JAMA Neurol. Published online January 27, 2020. Abstract

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Blood Pressure Key to Good Outcomes in Stroke Thrombectomy - Medscape