Treatment with statins in the elderly population is not associated with accelerated memory dysfunction, greater decline in global cognitive function, or brain volume changes over 2 years, according to study results published in The Journal of the American College of Cardiology.

While many guidelines recommend statin treatment to prevent cardiovascular and cerebrovascular morbidity and mortality, there are consumer concerns regarding the possible effect of this treatment on cognitive function, because memory and/or cognitive changes are the second most common reported adverse event with statins.

The goal of the study, the Sydney Memory and Ageing Study (MAS), was to investigate the changes in memory and global cognition associated with statin therapy over 6 years and changes in brain volume over 2 years.

The MAS was a longitudinal, prospective, observational, population-derived cohort of non-demented Australians aged 70 to 90 years at baseline. Data were collected every 2 years over a 6-year period.

The study cohort included 1037 patients: 395 were statin nave and 642 had ever used statins. The mean duration of statin use at baseline was 9.1 years. At baseline, patients who had reported ever using statins were slightly younger, had higher body mass index, and had lower diastolic blood pressure than did never users. Over the observation period, 68% of patients who had used statin were continuous users.

The primary outcome measures included 2 end points: memory and global cognition, as assessed by neuropsychologic testing every 2 years. In a subgroup of 526 patients, magnetic resonance imaging was used to assess changes in total brain, hippocampal, and parahippocampal volume.

Over 6 years of observation, there was no significant difference in the rate of decline in memory and global function between patients who had ever used statins and patients who had never used statins. The trend was similar between continuous statin users and never users. Furthermore, there was no difference in rates of decline in memory and global cognition over 6 years between each statin subgroup (atorvastatin, simvastatin, and pravastatin) and the group of patients who never used statins.

Statin initiation was not associated with a change in global cognition performance or rate of decline, but was associated with an attenuation in the rate of decline of memory (P =.038).

Analyses to examine the possibility that statins may unmask memory difficulties in patients predisposed to cognitive impairment revealed no interaction between statins, risk factors for dementia, and changes over 6 years in memory and global cognition.

The researchers noted protective associations were found for some aspects of memory testing. Exploratory analyses of specific memory tests revealed a significant interaction between statin ever use and heart disease on decline in total learning. There was also evidence that supported apolipoprotein E4 carriage and slower decline in long-delayed recall in men who reported statin use compared with men who never used statins.

No difference in brain volume changes was found between statin users and never users.

The researchers acknowledged several study limitations, including its observational design, potential selection bias and survivor bias, as well as baseline differences between the groups for dementia risk factors. In addition, patients with advanced cognitive impairment were excluded from the study.

This study offers reassurance to consumers who hold concerns about harmful statin effects on memory and cognition, concluded the researchers.

Reference

Samaras K, Makkar SR, Crawford JD, et al. Effects of statins on memory, cognition, and brain volume in the elderly. J Am Coll Cardiol. 2019;74(21):2554-2568. doi:10.1016/j.jacc.2019.09.041

Go here to read the rest:
Statin Therapy and Cognitive Function in Elderly Patients - Neurology Advisor

A new study has found that people who eat more foods with the antioxidant flavonol, which is found in nearly all fruits and vegetables, as well as tea, may be less likely to develop Alzheimers years later.

Flavonols are a type of flavonoid, a group of phytochemicals found in plant pigments known for its beneficial effects on health, researchers explained.

More research is needed to confirm these results, but these are promising findings, said study author Thomas M. Holland, M.D., of Rush University in Chicago. Eating more fruits and vegetables and drinking more tea could be a fairly inexpensive and easy way for people to help stave off Alzheimers dementia.

With the elderly population increasing worldwide, any decrease in the number of people with this devastating disease, or even delaying it for a few years, could have an enormous benefit on public health.

The study included 921 people with an average age of 81 who did not have Alzheimers dementia. They filled out a questionnaire each year on how often they ate certain foods. They were also asked about other factors, such as their level of education, how much time they spent doing physical activities, and how much time they spent doing mentally engaging activities, such as reading and playing games.

The group was followed for an average of six years, with yearly tests to see if they had developed Alzheimers dementia.

The researchers reported they used various tests to determine that 220 people developed Alzheimers dementia during the study.

The researchers found that the average amount of flavonol intake in U.S. adults is about 16 to 20 milligrams per day. In the study, people in the lowest group had an intake of about 5.3 mg per day, while the highest group consumed an average of 15.3 mg per day.

The studys findings showed that people who consumed the highest amount of flavonols were 48 percent less likely to later develop Alzheimers dementia than the people in the lowest group, after adjusting for genetic predisposition and demographic and lifestyle factors.

Of the 186 people in the highest group, 28 people, or 15 percent, developed Alzheimers dementia, compared to 54 people, or 30 percent, of the 182 people in the lowest group, according to the researchers.

The results were the same after researchers adjusted for other factors that could affect the risk of Alzheimers, such as diabetes, previous heart attack, stroke, and high blood pressure.

The study also broke the flavonols down into four types: isorhamnetin, kaempferol, myricetin and quercetin. The top food contributors for each category were: Pears, olive oil, wine, and tomato sauce for isorhamnetin; kale, beans, tea, spinach, and broccoli for kaempferol; tea, wine, kale, oranges, and tomatoes for myricetin; and tomatoes, kale, apples, and tea for quercetin.

According to the researchers, people who had a high intake of isorhamnetin were 38 percent less likely to develop Alzheimers, as well as those with a high intake of myricetin. Those with a high intake of kaempferol were 51 percent less likely to develop dementia. However, quercetin was not tied to a lower risk of Alzheimers dementia.

Holland noted that the study shows an association between dietary flavonols and Alzheimers risk, but does not prove that flavonols directly cause a reduction in disease risk.

Other limitations of the study are that the food frequency questionnaire, although valid, was self-reported, so people may not accurately remember what they eat. The majority of participants in the study were white people, so the results may not reflect the general population, the researcher added.

The study was published in Neurology, the medical journal of the American Academy of Neurology.

Source: The American Academy of Neurology

Related Articles

Here is the original post:
Antioxidant in Fruits, Vegetables, Tea Linked to Lower Risk of Alzheimer's - PsychCentral.com

Article In Brief

With the right training, advanced practice providers (APPs) can obtain the knowledge needed to be effective team members in inpatient or outpatient neurology. APPs and neurologists discuss the opportunities for greater training and collaboration.

When they start their first job in neurology, advanced practice providers (APP) may not know how to perform the detailed examination needed to localize the neurological lesion and make a diagnosis. The nuances of headache, spine disorders, multiple sclerosis, and other common neurological conditions may be unfamiliar to them, let alone the treatment options and how to create a specific neurology treatment plan.

Their graduate education trains them well to be generalists in medicine, several physician assistants (PAs) and nurse practitioners (NPs) told Neurology Today in interviews, but that does not necessarily include a focus on neurology.

With the right training, however, they can obtain the knowledge needed to be effective team members in the settinginpatient or outpatient, general neurology or subspecialtyin which they are working, said Robert D. Brown, Jr., MD, MPH, FAAN, chair of the Division of Stroke and Cerebrovascular Disease and professor of neurology at Mayo Clinic College of Medicine.

APP staff members are integral to the care of neurology patients, and that is increasingly the case at small and large neurology practices, he said.

But the right training is key. An AAN survey of APPs practicing in neurology completed in 2018 found that, during their formal APP schooling, 87 percent attended neurology lectures but only 30 percent had a neurology course and just 25 percent had a clinical rotation in neurology.

It's apparent that on-the-job training is essential, Dr. Brown said.

That is the basic approach used for most advanced APPsnurse practitioners and PAsworking in neurology. But every APP's training needs are different, said Jessica Erfan, MPAS, PA-C, APP manager at Ascension Seton. Their graduate education prepares them to be generalists, so their neurology-specific training is limited to what they learned in their previous work experiences.

I think some neurologists have trouble understanding the different backgrounds and that every advanced practice nurse is not the same, every PA is not [the] same, said Erfan, a PA at Seton Brain & Spine Institute in Austin, TX. That can make it difficult when a neurologist wants to hire an APP. They have to factor in the training time [in neurology] to make APPs successful so that ultimately they can become [productive] members of the practice.

That is why training in neurology is a critical need. This past October, the AAN stepped in to help address that need by sponsoring the Academy's first APP conferencea one-day education event that preceded the AAN Fall Conference in October. Approximately 175 PAs, NPs, and clinical nurse specialists attended the conferencefar surpassing the goal of 100 APPs, said Calli Cook, DNP, APRN, FNP-C, chair of the Academy's Consortium of Neurology APPs. Because of the participants' enthusiasm, a multi-day standalone conference for APPs will take place in 2020.

Most attendees at the initial event had been practicing in neurology for three years or less.

APPs who are practicing in neurology are really hungry for information and education, said Bryan Walker, PA-C, associate director for the APP residency program in neurology at Duke University School of Medicine. These are folks who are now coming into the specialty or have been in practice for just a little while they are figuring out what they know and what they need to know.

APPs make up the fastest-growing membership category for the AAN, said Cook, a NP at Emory Brain Health and co-director of the October pre-conference. As of last month, the consortium included more than 1,400 members, up from about 350 when Cook joined just four years ago.

That growth reflects the increasing role that APPs are playing in the delivery of neurological care in both private and academic practices. By working together to deliver team-based care, APPs and neurologists can shorten the waits for patients seeking appointments and make sure all patients get the high-quality care they need, she said.

I see a lot of my physician colleagues really embracing this concept, valuing the APP's role and understanding the positive effect it has on their practice and on their patient population, she said.

When fully trained, APPs and neurologists often work in teams, although there is no standard model for team-based care, Cook said. In some practices, the neurologist sees a patient in the first few visits to establish the diagnosis and create the treatment plan; the APP provides follow-up care, adjusting the treatment plan as needed; the patient is scheduled with the neurologist perhaps once a year or at another routine interval.

Another approach is for the APP to evaluate a patient on their first visit and order the appropriate tests needed for diagnosis. Armed with that information, the neurologist sees the patient on a second visit to establish the diagnosis and treatment plan. In another model, patients are scheduled so that both the neurologist and APP, operating in tag-team fashion, will see each patient during each visit, sharing responsibilities so that high-quality care is delivered in an efficient fashion.

All of these models can be successfulit depends on what works best for the culture that these two people are going to be practicing in together, Cook said.

But attracting APPs to neurology, equipping them with the clinical knowledge they need to succeed and retaining them in the specialty can be a challenge.

AAN President James C. Stevens, MD, FAAN, said neurology education to support APP careers is an essential component to overcoming that challenge.

The need is there, and I think it's our responsibility as an organization to meet these education needs and to show examples of how this team concept of neurologist and APP working together can be done in a successful manner, Dr. Stevens said.

The importance of APPs became clear to AAN leaders when its Workforce Task Force Report, published in 2013, revealed that demand for neurologic services exceeded the supply of neurologists and projected that the shortfall will increase substantially by 2025, Dr. Stevens said.

With too few neurology residency slots available to meet demand, the focus turned to another way to increase patients' access to care.

Many neurologists, who for decades have been utilizing advanced practice providers to help shorten waiting lists, found that it was very successful in doing so and could be done with excellent patient satisfaction concerning their care, Dr. Stevens said.

He was one of them. Since the 1990s, NPs and PAs have worked in his practice, learning their neurologic clinical skills by shadowing him for at least six months before seeing patients on their own.

On-the-job training is common for APPs working in neurology because graduate education programs for NPs and PAs typically provide little or no education specific to the specialty, said Walker, a PA at Duke Neurology.

PA programs are standardized because there is a single accrediting body nationally, he said. During the first year, students take didactic courses which will include, at most, four weeks of neurology content. During the second year, students do clinical rotations and while a neurology rotation may be an option, it is not required. NP programs vary in content because there are multiple accrediting bodies, he said. In general, neurology content is not included in the required curriculum.

In PA programs, neurology education is minimal; in NP programs, it's variable from none to minimal, he said. So we find that folks coming out of either PA school or NP school really have to rely on on-the-job training.

While that worked well for Walker and many APPs, that training model has its limits. For one thing, the variability of on-the-job training may worry inexperienced APPs, who know that neurology is a particularly complex field.

It's challenging, Erfan said. There are a lot of things you have to put together compared to other specialties.

And, unlike physicians, who are tied to the specialty in which they completed a residency, APPs are trained as generalists and can easily move to a different field if they are unsatisfied with their on-the-job training or other aspects of the work, she said.

The AAN wants to address that stickiness issue by increasing the likelihood that APPs working in neurology are pleased with their choice of specialty, Dr. Stevens said.

Many of our members have observed over the years that APPs have a tendency to rotate out of neurology and go to some other specialty or back to primary care, he said. We really want to create a home for them where they can get their academic needs met and be successful in a rewarding career.

Joel C. Morgenlander, MD, FAAN, chief of general and community neurology at Duke University School of Medicine, became interested in creating a formal one-year training program after seeing his fellow neurologists and APPs get frustrated with each other because of unrealistic expectations about what the APPs should be able to do.

An in-depth training program, he believed, would help APPs have greater job satisfactionand longer tenuresbecause they would be able to think like a neurologist.

The hope was that they would feel more comfortable and be a bigger part of the team, working on many aspects of what we do, including patient care, education and research, Dr. Morgenlander said. And that would give our faculty better job satisfaction because they would have valuable partners in practice that they can share patients with as a team.

That has proven to be the case, he said. Now in its fifth year, Duke's Neurology APP Residency program has trained two to three APPs in each class. The program works because our neurology faculty has bought into the concept and is a critical part of the APP resident education, he said.

The APP residents receive a salary but do not bill for any patients.

We see them and treat them as true residents because I felt that to do anything less was doing them a disservice, he said. To keep them in the learner mindset was really important to me.

The residents, who take an online neuroscience course before they join the program, do clinical rotations through the neurology subspecialties and attend the same lectures that neurology residents do. Because their training overlaps, APP and physician residents form relationships that make it easy for them to work together after their training programs end.

This, to me has been a great plus because these are the kind of teams that we need in the future to be successful, Dr. Morgenlander said.

Several APP residents have taken positions in Duke Neurology subspecialty clinics after completing the program. The Duke residency is one of only a handful of APP neurology post-graduate training programs in the country, each of which varies in content and training approach. Dr. Morgenlander is working to encourage other neurology departments at other academic medical centers to establish APP residencies of their own.

The Medical College of South Carolina (MUSC) takes a different approach in its one-year fellowship program for neurology APPs. That program, now in its second year, trains APPs to do outpatient general neurology, said Kimberly Robeson, MD, the program's faculty director.

The program was started to address two challenges: the difficulty of recruiting enough general neurologists to MUSC and the difficulty of onboarding APPs with no experience in neurology.

We don't necessarily have people who have the time to train them, she said.

Dr. Robeson, who also serves as associate program director for MUSC's neurology residency program, said the APP curriculum includes hands-on training and didactic learning. The APP fellows see new patients in mentored clinicsthe APP examines the patient alone, then with the attendingand sees follow-up patients on their own. They shadow APPs working in subspecialty clinics, attend lectures with neurology residents, and have two half-days a week dedicated for studying. Each APP in the first class received AAN membership as part of the fellowship, providing access to online education materials offered by the Academy.

The APP trainees in the MUSC program bill for patient visits, so the program pays for itself, she said.

Meanwhile, the AAN intends to provide increased short-term opportunities for APPs, starting with next year's conference. The standalone conference will be relevant for all APPs, whether they are new as a neurology APP or have been in practice for many years, Dr. Brown said.

Presentations will include neurology fundamentals, including localizing the lesion, anatomical and clinical correlations, and the basics of the neurologic history and exam. Attendees will learn also diagnostic fundamentals, including the appropriate use of neuroimaging studies, EMG, EEG, and other exams, as well as how to read test results and key findings that might be detected.

Excerpt from:
For APPs, Now There Are More Training Opportunities in... : Neurology Today - LWW Journals

A peripherally acting opioid with multifunctional agonistic properties has shown to provide peripheral pain relief in morphine-tolerant mice with minimal side effects associated with classic opioids. The drug could serve as a potential candidate for treating pain disorders in humans, according to a study in the August 2019 issue of the British Journal of Pharmacology.

Wolfgang B. Liedtke,MD, PhD, a Duke neurologist and pain medicine specialist, senior co-author and co-corresponding author of the study, explains that the subcutaneous dose of DN-9, a multifunctional agonist for opioid and neuropeptide FF receptors, produced potent antinociceptive effects via peripheral opioid receptors. The study was a collaboration between Duke University (including Liedtke and Yong Chen, PhD, from the Liedtke Lab in the Duke Department of Neurology) and a group of investigators at Lanzhou University and the Shanghai Jiao Tong University School of Medicine in China.

We are lookingperhaps more urgently than beforefor what could at least partially replace opioids, and this collaboration is a highly welcome opportunity to do so because the approach is based on peptides that naturally occur, Liedtke says. The ingenuity of the process is to engineer a new peptide out of two naturally occurring ones by fusing them together, tweaking the way the opioid is signaling in the organism and defusing the toxicity while still providing anti-pain effects.

Results from the study also indicated that the DN-9 administration via peripheral opioid receptors shows less antinociceptive tolerance, constipation, motor impairment, and reward/abuse liability compared with morphine.

The continuous development of this multifunctional opioid peptide has significantly added to the research in that the molecule is applied subcutaneously peripherally and has no apparent direct effects on microglial activation of the brain or spinal cord. Via peripheral site of action, this approach is similar to new self-injectable treatments for migraines, Liedtke says.

This novel peripherally acting opioid with multifunctional agonistic properties has significant potential for translational medical development in the near future, Liedtke says. This study is the result of a longer-term, dedicated effort, that is bearing fruition, and it indicates that this is a result of a research pipeline that could very well lead to the opioid 2.0 of the 21st century, he adds.

(This article originally appeared in Clinical Practice Today. Read it in its original context, or other CPT articles, here.)

While a future therapy for pain that relies only on non-opioids is desirable, Liedtke says that the opioid system should still be considered as an ally in the battle against chronic pain. Chronic pain is an epic, large-scale, high prevalence disorder that is unresolved for too many patients, so the mandate to come up with more safe and effective treatments also stems from that. We are moving forward toward new practical solutions.

Go here to see the original:
Novel peripherally acting opioid eases pain in mice without related side effects - Duke Department of Neurology

For any type of brain tumor, our neurological specialists at University Hospitals provide the expert diagnosis and specialized treatments you or a loved one may need. Brain tumors include a wide range of types of tumors and can be cancerous or non-cancerous. If a tumor originates in the brain, its called a primary brain tumor. If a tumor travels to the brain from another location, like the lungs, its called a metastatic brain tumor.

Regardless of the type of tumor, our multidisciplinary team at University Hospitals leads the way in offering our patients comprehensive care with the latest surgical and non-surgical interventions to stop tumor growth and maintain brain health.

For any suspected neurological issue, including potential brain tumors, it is important to see a neurological specialist as quickly as possible for an accurate diagnosis to begin treatment toward recovery. Brain tumor symptoms may easily be confused with less serious conditions, so you want to be sure of the diagnosis as soon as possible.

Our neurologists and neurosurgeons are integral members ofUH Seidman Cancer Centerfor comprehensive brain tumor care. We are available to see potential patients within 24 hours to conduct a full examination. During this visit, you will meet with several specialists who are experts in their fields, including:

Once we determine if you have a brain tumor and identify the specific type, our team will work together to develop a personalized treatment plan based on our latest research and innovative technology available.

Our nationally recognized cancer specialists offer a range of brain tumor treatment options when designing your personalized treatment plan:

University Hospitals has access to groundbreaking brain and nervous system specific clinical trials which offer new and emerging therapies. But rest assured that once a brain tumor treatment path is chosen, our team meets every week to share information about your specific case, discuss progress and collaborate on next steps. This lets us view your care from various clinical perspectives - which means you have the experience and expertise of an entire team working toward an optimal recovery.

Throughout the care experience, our patients have access to comprehensive UH services to help navigate the physical, emotional and financial consequences of a serious illness such as a brain tumor. Our neurology team closely partners with all of the clinical services and resources throughout the UH system to ensure we fully meet all your needs.

Some of our patients have been told that their brain tumor is inoperable. We offer a fresh look at the diagnosis and treatment plan. In many cases, we have found ways to help patients who thought they were out of options, extending their quality of life for many years.

For more information about University Hospitals neurology, neurosurgery and oncology services at a range of convenient locations across the region, contact one of our team members.

Read the rest here:
Brain Tumors l Neurology l University Hospitals l ...

Both atrial fibrillation (AF) and dementia are highly prevalent pathologies, with reported rates of approximately 33.5 million and 40 million worldwide.1,2 Experts anticipate that the prevalence of both conditions will continue to increase along with the growing elderly population, and accumulating research suggests that AF may increase the risk for cognitive decline and dementia.2,3

Thereare many studies showing an increased rate of all types of dementia in patientswith [AF], said Hugh Calkins, MD, FHRS, FACC, FAHA, FESC, the Catherine Ellen Poindexter Professor of Cardiology and director ofthe electrophysiology laboratory and arrhythmia service at Johns Hopkins University.New data [have] also shown thattreatment of AF lowers the risk of cognitive dysfunction, he told NeurologyAdvisor.

However,findings on the topic have been mixed overall, which may be the result of methodologicdifferences such as variation in age ranges and methods used to assess AF and dementia.2In addition, most of these studies focused on prevalent AF rather than incidentAF, as noted by the authors of a study published in the July 2019 issue of the EuropeanHeart Journal.2

To addressthis gap, these researchers conducted a longitudinal, community-based study in SouthKorea to examine associations between incident AF and the risk for dementia, aswell as the influence of stroke and the administration of oral anticoagulants on theseassociations. The sample consistedof 262,611 participants aged 60years who did not have AF, dementia, valvular heartdisease, or stroke at the time of enrollment.

The following results were observed:

Based on these findings, clinicians should be vigilant for clinical manifestations implying any cognitive decline and functional impairment in [patients with AF], especially those with a high CHA2DS2-VASc score,the authors wrote.2

These results alignwith those of a 2018 population-based cohort study (n=2685) which found an associationbetween AF and rapid decline on the Mini-Mental State Examination (, 0.24; 95% CI, 0.31 to 0.16) and an increasedrisk for all-cause dementia (HR,1.40; 95% CI, 1.11-1.77) and vascular and mixed dementia (HR, 1.88; 95% CI, 1.09-3.23).4Findings further revealed that the use of anticoagulants was associated with a 60%reduction in dementia risk among patients with both prevalent and incident AF (HR,0.40; 95% CI, 0.18-0.92).

Similarly, resultsof an epidemiologic review published in 2018 reinforced these findings, with investigatorsreporting that the available evidence largely suggests that AF contributes to cognitivedecline and dementia, independent of a history of stroke.3

According to Paul JWang, MD, professor of medicine in the division of cardiology at Stanford UniversityMedical Center and director of the Stanford Cardiac Arrythmia Service, theproposed mechanisms underlying the AF-dementia link include ischemic stroke, chronic inflammation, andhypoperfusion of the brain.

Despite these findings, however, there is currently not enoughevidence to treat AF purely with a goal of reducing or preventing dementia, DrCalkin noted. It is important to follow anticoagulation guidelines in all [peoplewith] AF, and if a patient with AF has symptoms, then a rhythm control strategywith medications or catheter ablation is warranted.

Thisis an important topic, but needs to be further elucidated. Prospective trials areneeded and underway, Dr Wang told Neurology Advisor.

Dr Calkinsechoed this notion and added that additional large-scale randomized trials areneeded to confirm that treatment of AF prevents or slows the development of dementia.

To gain furtherinsight into this topic and its related clinical implications, Neurology Advisorinterviewed Rebecca Gottesman, MD, PhD, professor of neurology and epidemiologyin the division of cerebrovascular neurology at Johns Hopkins University and director of research at Johns Hopkins Bayview Neurology.

Neurology Advisor: What isknown thus far about associations between AF and dementia, including proposed mechanismsby which AF might influence the development of cognitive dysfunction and dementia?

Dr Gottesman: A number of studieshave shown that AF is an independent risk factor for cognitive decline and perhapseven dementia. The association appears to extend beyond just having shared riskfactors for both AF and cognitive decline.

The most well-documented mechanism is through strokes, which canlead to cognitive problems and even dementia. It is also probable that many patientswith AF have silent infarcts, which similarly adversely affect cognition. But theremay be other mechanisms that dont involve these structural changes, perhaps relatedto hypoperfusion in patients with AF.

Neurology Advisor: What arethe relevant screening and treatment recommendations that clinicians shouldfollow?

Dr Gottesman: The steps thatclinicians take to reduce stroke risk are likely the most important things thatcan be done to reduce dementia risk. Anticoagulation to reduce stroke risk willprobably also reduce silent infarction risk, so it is likely to help preserve cognitivefunction in patients with AF. There is no evidence that rate control makes a differencein either stroke risk or dementia risk, however.

The American Heart Associations recommendation for screeningin primary stroke prevention consists of pulsepalpation in older adults, with an electrocardiogram in the event of an irregularpulse, but with no other recommendations for active AF screening needed.5For dementia and cognitive impairment, its likely that a similar screening approachis best.

Neurology Advisor: What areremaining research needs pertaining to the link between AF and cognitive declineand dementia?

Dr Gottesman: We still verymuch need to understand the underlying mechanisms. Furthermore, I mentioned thattheres no evidence that rate control reduces cognitive impairment or dementia frequency,yet if episodes of rapid ventricular response contribute to hypoperfusion, for example,perhaps there are meaningful sequelae of alterations in rate.

Finally, although it is likely that reducing stroke risk withanticoagulation will also reduce cognitive impairment and dementia, there isntevidence specifically proving this. It is also important to study whether differentcriteria differentially identify the level of risk for cognitive decline and dementia.For example, a CHA2DS2-VASc score is definedbased on stroke risk and informs the clinician about risk for stroke, thus informingdecisions about anticoagulation, but a lower threshold might need to be consideredfor risk for dementia, which might warrant initiation of anticoagulation at a differentrisk level, at least theoretically.

In addition, there is increasing interest inatrial structural changes that can have an impact on stroke risk. As more researchis done about these changes as a cause of embolic stroke of undetermined source,it will be important to consider whether there is also an increased risk for cognitivedecline and dementia with these cardiac non-AF structural changes.

References

1. Patel NJ, Atti V, Mitrani RD, Viles-Gonzalez JF, Goldberger AJ. Global rising trends of atrial fibrillation: a major public health concern. Heart. 2018;104(24):1989-1990.

2. Kim D, Yang PS, Yu HT, et al. Risk of dementia in stroke-free patients diagnosed with atrial fibrillation: data from a population-based cohort. Eur Heart J. 2019;40(28):2313-2323.

3. Ding M, Qiu C. Atrial fibrillation, cognitive decline, and dementia: an epidemiologic review. Curr Epidemiol Rep. 2018;5(3):252-261.

4. Ding M, Fratiglioni L, Johnell K, et al. Atrial fibrillation, antithrombotic treatment, and cognitive aging: a population-based study. Neurology. 2018;91(19):e1732-e1740.

5. Meschia JF, Bushnell C, Boden-Albala B, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(12):3754-3832.

Read this article:
Exploring the Link Between Atrial Fibrillation and Dementia - Neurology Advisor

Article In Brief

Wellness officersa new executive position established by many health systems to address the burnout epidemicshare the initiatives they've taken their institutions.

Many health systems across the country are establishing a new executive positionchief wellness officeras a strategy to address the burnout epidemic among physicians and other clinicians.

Jonathan Ripp MD, MPH, chief wellness officer at the Icahn School of Medicine at Mount Sinai, said there were only a handful of chief wellness officer positions when he was appointed to the role in May 2018.

There have been at least a dozen more who have been named in the past year, and several more places that are looking to create the position, said Dr. Ripp, professor of medicine, medical education and geriatrics and palliative medicine. I would not be surprised if, 10 years from now, it's commonplace for most large organizations to have a chief wellness officer or equivalent, taking this challenge on, and doing so in a way that is effective.

Dr. Ripp was a co-author, along with Neil Busis, MD, FAAN, director of community neurology at the University of Pittsburgh Physicians, and others in a 2018 Health Affairs blog post that issued a call for action for executive leadership to address clinician burnout.

Working on behalf of the National Academy of Medicine (NAM) Action Collaborative on Clinician Well-being and Resilience, the authors encouraged health systems to create the position of chief wellness officer to give wellness the attention it needs.

This individual should facilitate system-wide changes, including the implementation of evidence-based interventions that enable clinicians to effectively practice in a culture that prioritizes and promotes their well-being, the blog post said. This leadera Chief Wellness Officer (CWO)would have the authority, budget, staff, and mandate to implement an ambitious agenda.

Dr. Busis said the chief wellness officer position is analogous to the positions of chief patient-safety officer, chief quality officer, and chief medical informatics officer.

It's not that the person in that position does everything, but they lead a team responsible for wellness, he said. And by being in the C suite, it makes a statement that the organization takes this seriously and is willing to devote resources.

Children's Mercy Hospital in Kansas City does not currently have a chief wellness officer position, but neurologist Jennifer Bickel, MD, FAAN, serves as medical director of the hospital's Center for Professional Well-Being. That position reports directly to the executive leadership and serves on the hospital's Physician Administration Council and Quality and Safety Council.

The fact that this role was going to be inserted into the fabric of administration in order to have an influence was really important to me, said Dr. Bickel, chief of the headache section at Children's Mercy and professor of pediatrics at the University of Missouri-Kansas City.

One of her first priorities after assuming the job in January 2019 was formalizing the hospital's commitment to the NAM Action Collaborative. Like the other institutions that have made formal commitments, Children's Mercy identified specific tactics it is undertaking. They include reducing non-meaningful work for clinicians, evaluating policies and procedures that decrease clinician autonomy and professionalism, and coaching leaders on how to identify and reduce burnout.

Dr. Bickel is working to understand the specific causes of burnout among her colleagues and identify mitigation strategies that target them.

While there are, of course, national drivers of burnout-the way we are reimbursed, prior authorizations, regulatory hasslesall of which are major issues, I am a big believer that we should focus on what we can do within our sphere of influence as a hospital or as department leaders or as individual physicians, she said.

For example, Children's Mercy Hospital is making some improvements to the medical staff lounge at the main facility and creating lounge spaces in other locations to make it easier for physicians to build a sense of community with their colleagues.

A hospital-wide survey for physicians, advanced practice providers, psychologists, and trainees to measure burnout rates and perceived causes was underway before Dr. Bickel stepped into the new position. She met with every physician leader to discuss the results for his or her work unit and identify hospital-level issues that might contribute to clinician burnout.

She also blocks time in her schedule each week for appointments with physicians to discuss any concerns and issues, and she has already met with about 10 percent of the faculty one-on-one.

Most of these situations are people telling me about different system-level problems that they see contributing to burnout, she said. The vast majority of people are coming not just to complain; they are there because they want to be better doctors, they love their work, they want to be able to be connected with their patients more.

To help prepare for her new role, Dr. Bickel participated in a weeklong chief wellness officer workshop at Stanford Medicine WellMD Center, which brought together a wide range of individuals interested in becoming wellness leaders.

It was incredibly eye-opening to see the wide variety of titles and responsibilities and degrees of influences within the room, she said. Some people were truly just starting to learn about wellness; some people were already in a wellness leadership role, perhaps for their department but not for their hospital. And there were others who are system-level leaders in their organizations.

Cormac O'Donovan, MD, associate professor of neurology in the department of neurology and internal medicine at Wake Forest University Baptist Medical Center, attended the chief wellness officer training to advance his own knowledge of wellness leadership and to expand his network of clinicians working to address clinician burnout.

Dr. O'Donovan, director of the Peer Support Program at Wake Forest Baptist, started educating himself about physician wellness after his own experience with burnout. One takeaway from the Stanford course was that health systems are addressing the burnout epidemic in a variety of ways.

There is no one-size-fits-all, he said. The way each organization tackles this is very different and based on the strengths that their institution brings to the task.

Organizations also have different structureshospitals with nurse unions, for example, have a different culture than those that do notand different dynamics that may contribute to burnout, Dr. Bickel said. Thus, wellness leaders need expertise in change management, strategic planning, and leadership development.

I appreciated that the workshop was not about providing a bunch of patches for solving burnout because the solution is going to be different in each hospital or even each department, she said.

At Mount Sinai, for example, Dr. Ripp is focused on workplace efficiencymaking the electronic health record system less cumbersome and limiting physicians' administrative burdenand workplace culture. Each of 24 departments, including neurology, has a wellness champion that works on department-level issues and serves as an information conduit with the Office of Well-being and Resilience, which Dr. Ripp leads.

At Ohio State University, the chief wellness officer co-chairs a university-wide health and well-being council that is in the fourth year of a multifaceted wellness plan.

According to a case study written by Dr. Busis and co-authors, the plan tracks outcomes in three categories: the culture and environment of health and wellness; population health; and fiscal health/value of investment in wellness.

Since starting the wellness plan, the university has seen increased productivity and its cost for health insurance is actually decreasing; indeed, for every dollar invested in wellness, the university is seeing a $3.65 return on investment.

At Children's Mercy, a second survey to measure burnout rates was sent out this fall, and Dr. Bickel hopes to continue surveying clinicians every year. She does not expect dramatic or quick changes from one year to the next, but each survey is an opportunity to get feedback from staff and ideas for new programs or initiatives.

Of course, I hope to see the numbers start to trend down over the next few years, but that's going to take some time, she said. More than anything, I hope people know we are sincerely working on making the system better and providing support services for those who need it. This is a long game.

Read the original:
Meet the Wellness OfficersWhat They're Doing About Burnout : Neurology Today - LWW Journals

Select a Location Aberdeen, SD Alexandria, MN Armour, SD Arthur, ND Bagley, MN Barnesville, MN Bemidji, MN Bemidji, SD Beresford, SD Beulah, ND Bismarck, ND Blackduck, MN Brandon, SD Breckenridge, MN Brookings, SD Buffalo, ND Burke, SD Canby, MN Canton, SD Cass Lake, MN Chamberlain, SD Christine, ND Clark, SD Clear Lake, SD Clearbrook, MN Currie, MN Dakota Dunes, SD Deadwood, SD Dell Rapids, SD DeSmet, SD Detroit Lakes, MN Dickinson, ND Dilworth, MN Eagle Butte, SD East Grand Forks, MN Edgeley, ND Edgerton, MN Ellendale, ND Enderlin, ND Fargo, ND Fergus Falls, MN Forman, ND Fort Thompson, SD Gettysburg, SD Grand Forks, ND Gwinner, ND Halstad, MN Harrisburg, SD Hartford, SD Hawley, MN Hazen, ND Hebron, ND Hillsboro, ND Horace, ND Hunter, ND Huron, SD International Falls, MN Inwood, IA Ipswich, SD Jackson, MN Jamestown, ND Kimball, SD Lake Norden, MN Lake Park, MN LaMoure, ND Laporte, MN Lennox, SD Lidgerwood, ND Lisbon, ND Luverne, MN Madison, MN Madison, SD Mahnomen, MN Mandan, ND Mayville, ND McClusky, ND McLeod, ND Medora, ND Minot, ND Mitchell, SD Mobridge, SD Moorhead, MN Morris, MN Napoleon, ND New York Mills, MN NW, Bemidji, MN Oacoma, SD Oakes, ND Ortonville, MN Ottertail, MN Oxbow, ND Park Rapids, MN Parker, SD Parkers Prarie, ND Pelican Rapids, MN Perham, MN Pierre, SD Red Lake, MN Redfield, SD Rock Rapids, IA Sabin, MN Sanford 26th & Sycamore - Sioux Falls, SD Sheldon, IA Sioux City, IA Sioux Falls, SD Sioux Falls Acute Care Clinics, SD Slayton, MN Spirit Lake, IA Steele, ND Thief River Falls, MN Thief River Falls , SD Tracy, MN Twin Valley, MN Ulen, MN Valley City, ND Various Locations, MN Vergas, MN Vermillion, SD Viborg, SD Wagner, SD Wahpeton, ND Walker, MN Warroad, MN Washburn, ND Watertown, SD Watford City, ND Webster, SD West Fargo, ND Westbrook, MN Wheaton, MN Williston, ND Wilton, ND Windom, MN Winner, SD Worthington, MN Yankton, SD Go

Read more from the original source:
Neurology | Sanford Health

Souvik Sen, MD, MS, MPH, currently serves as Chair of Neurology at Palmetto Health-USC Neurology and is a professor of neurology with the University of South Carolina School of Medicine. He joined the University of South Carolina School of Medicine in January, 2010.

Dr. Sen earned his medical degree from the University of Calcutta R. G. Kar Medical College in Calcutta, India. After completing medical training in India, he completed a Masters in Science in cardiovascular pharmacology at Wayne State University in Detroit, and then completed a medical internship at Henry Ford Hospital, also in Detroit. He completed a neurology residency at Temple University Health Science Center in Philadelphia, and a vascular neurology fellowship at Johns Hopkins University Hospital in Baltimore. After his fellowship he served as co-director and subsequently director of the stroke center at the NJ Neuroscience Institute in Edison, New Jersey. He then served as the founding director of the UNC Hospitals Comprehensive Stroke Center at the University of North Carolina in Chapel Hill. While there, he completed a Masters in Public Health with an epidemiology major.

Dr. Sen is board certified in neurology, and subspecialty board certified in Vascular Neurology. He is a recipient of the prestigious Center of Economic Excellence Stroke Chair in South Carolina, and has published in peer reviewed journals including Circulation, Stroke and the New England Journal of Medicine. He has received research funding from the American Heart Association and the National Institutes of Health. In 2004, he was nominated as a Fellow of the American Heart Association. He serves on several national and international committees, and his specific research interests include acute stroke treatment, stroke and TIA pathophysiology, stroke prevention and epidemiology.

Visit link:
Neurology - Palmetto Health-USC Medical Group

HUNTINGTON TheMarshall University Joan C. Edwards School of Medicinehas been awarded initial accreditation by the Accreditation Council for Graduate Medical Education (ACGME) to offera neurology residency training program beginningJuly 1, 2018, Joseph I. Shapiro, M.D., dean of the School of Medicine, announced last week.

The ACGME is the national accrediting body for post-M.D. training programs in the United States.

The approval of neurology residency training here at Marshall adds a fundamental program to our offerings, Shapiro said.

In addition to giving our medical students an option to train here, the new program provides increased capacity to care for patients with neurological disease. I want to commend Drs. Paulette Wehner and Paul Ferguson, as well as their staff members, for preparing a stellar application and bringing this program to fruition.

Paulette S. Wehner, M.D., vice dean for graduate medical education at Marshall, said the four-year program will train up to three residents per year, for a total of 12 resident physicians when the program reaches capacity.

The development of an ACGME-approved residency program is a lengthy process requiring detailed annual plans, a review of faculty members and their qualifications as well as a comprehensive site visit, Wehner said. We couldnt be more pleased with todays announcement.

Neurology is the branch of medicine that studies the anatomy, functions and organic disorders of the brain and nervous system. Neurologists treat a myriad of diseases including Parkinsons, epilepsy, stroke, headaches, brain infections, Alzheimers and multiple sclerosis.

Neurology department chair Paul B. Ferguson, M.D., says the addition of neurology resident physicians means continued advancements in neurologic care for patients across the region.

The demand for neurologic care in the United States continues to increase, Ferguson said.

The incidence of stroke, Alzheimers disease and Parkinsons disease is rising, and we will now be better positioned to meet that growing need. I want to thank all of our staff in the department, particularly residency program director Justin Nolte, M.D., and residency coordinator Amanda Jones, for their significant contributions to the process.

Neurology residents will see patients at Marshall Neurology, Cabell Huntington Hospital, St. Marys Medical Center and the Huntington VA Medical Center.

With the approval of the neurology residency, the Joan C. Edwards School of Medicine now offers nine accredited residency programs and seven fellowships.

Read the original here:
Marshall University School of Medicine approved for neurology residency program - The Montgomery Herald

Robinson, Richard

doi: 10.1097/01.NT.0000521716.95578.ef

Features

In large clinical trials, researchers reported that four calcintonin-gene related peptide antibodies three that bind to the peptide itself, and one that binds to the receptor were safe and effective for reducing migraine days.

BOSTONThe mood at the American Headache Society (AHS) annual scientific meeting here in June was decidedly upbeat, with experts in the field declaring a paradigm shift and the start of a new era in the treatment of migraine. The excitement was generated by announcements of positive trial results across the board for four antibodies, from four competing companies, targeting the calcitonin gene-related peptide (CGRP) or its receptor.

Three agents eptinezumab from Alder Biosciences, fremanezumab from Teva, and galcanezumab from Lilly bind to the peptide itself, while erenumab, from Amgen, binds to the receptor. While not all the companies have submitted data for final regulatory review, all have completed large-scale trials, and all, according to results presented at the meeting, met their primary and secondary endpoints rapid, significant, and long-lasting relief of migraine with adverse-effect profiles identical or close to placebo.

We are about to enter an era where we have preventive treatments specifically for migraine. We are standing at the edge of an incredible development, predicted Peter Goadsby, MD, PhD, FAHS, professor of neurology at Kings College London and chair of the AHS science program committee.

CGRP was discovered in the early 1980s as an alternatively-spliced transcript of the calcitonin gene. Soon thereafter it was found to be abundantly produced by trigeminal nerve endings, and was elevated during migraine attacks. While the exact pathophysiological role of CGRP in migraine remains unknown, it is clear that its elevation and interaction with its receptor directly contributes to migraine intensity, through enhancing both peripheral and central nociception pathways, possibly through increasing mast cell degranulation, neurogenic inflammation, and vasodilation.

Small-molecule CGRP antagonists were developed early on, but have been limited by concerns over adverse effects, including liver toxicity. That set the stage for development of monoclonal antibodies targeting either the peptide of its receptor.

None of the four monoclonal antibodies against the CGRP system are immunomodulatory, since their target is not the immune system. A small percentage of patients, ranging from 1 percent to 14 percent, depending on the drug and the study, do carry antibodies against the monoclonal antibody, but so far none has been shown to affect the ability of the treatment to reduce migraine.

The clinical programs for the four agents have proceeded rapidly, culminating in the recently completed phase 3 trials announced at the AHS meeting.

A single dose of eptinezumab reduced migraine days by 75 percent after three months in a third of patients with chronic migraine, according to the results of a phase 2B trial presented here. The trial enrolled 616 patients who had 15 to 28 headache days per month, at least eight of which were migraine. As in each of the other studies presented at the meeting with monoclonals targeting the CGRP system, patients were primarily female, with a history of migraine often of a decade or more.

Patients received a single intravenous dose of eptinezumab (300 mg, 100 mg, 30 mg, or 10 mg) or placebo. The primary endpoint was the percentage of patients with a 75% or greater reduction in migraine days over three months.

At baseline, patients had 16 migraine days per month. The primary endpoint was achieved by 33 percent of patients in the 300-mg dose group and 31 percent of those in the 100-mg group, versus 21 percent receiving placebo (both comparisons p<0.05).

Neither of the low-dose groups were different from placebo. In a post-hoc analysis, there was a dose-dependent reduction in the severity of migraine compared to placebo as well, and the separation from placebo for frequency began to appear within the first 24 hours of treatment.

It might not just be frequency that is affected, said Jeffrey Smith, MD, lead author and senior vice president at Alder. This is an exploratory endpoint, but it may be important as well. In addition, he noted, migraine reduction was extremely rapid, with a separation from placebo beginning to appear within the first 24 hours of treatment.

Eptinezumab is now in phase 3 trials, with the final results expected in early 2018.

Sheena Aurora, MD, a medical fellow and global launch leader at Eli Lilly Company, reported that monthly injections with galcanezumab reduced headache days by an average of four days per month for six months, compared to two days for placebo, according to results from a phase 3 trial that enrolled more than 900 patients. Participants were randomized 2:1:1 to placebo or galcanezumab at 120 mg or 240 mg, delivered by subcutaneous injection once monthly for six months. At baseline, patients had about nine migraine headache days per month.

After six months, patients on placebo had a decline in mean migraine headache days of 2.25 days, while those on galcanezumab declined by 4.29 days at 120 mg and 4.18 days at 240 mg. Both were significant compared to placebo at p<0.001. Both doses outperformed placebo at each monthly assessment.

In a secondary analysis, there were significantly more patients on active treatment who achieved a 50 percent or more reduction in the number of migraine headache days 36 percent of those on placebo compared with 59 percent for those taking 120 mg and 56 percent, 240 mg as well as a 75 percent or more reduction (18 percent of those on placebo; 33 percent on 120 mg, and 34 on 240 mg. Injection-site reactions were more common in active treatment than placebo. Eli Lilly, which is developing the drug, is planning to submit data for approval to the US Food and Drug Administration (FDA) later this year.

Patients receiving a single injection of fremanezumab began to experience relief within one week of administration, and continued to experience significant reduction in migraine for up to three months compared to placebo, according to data from a phase 3 trial presented here.

The trial included three arms: placebo injections once a month for three months; a single 675 mg subcutaneous injection of fremanezumab, followed by two monthly placebo injections (designed to test the efficacy of quarterly injections); and one 675 mg injection of fremanezumab followed by two monthly injections of 225 mg fremanezumab.

The primary endpoint was the change from baseline in the number of monthly headache days of at least moderate severity over three months: 1,130 patients were randomized 1:1:1 to each of the three treatment arms.

Placebo-treated patients experienced an average of 2.5 fewer headache days per month during the study. Monthly headache days declined by 4.6 days in patients receiving monthly fremanezumab, and by 4.3 days in those receiving the single dose (both results p<0.001 versus placebo). Injection-site effects were similar in placebo and active-treatment groups.

Active treatment was associated with at least a 50% reduction in headache days in 41% of those on monthly treatment and 38% of those on quarterly treatment, versus 18% on placebo (both results p<0.001 versus placebo). Benefits emerged within one week of initial treatment.

In patients with chronic migraine, erenumab reduced monthly migraine days by 6.6 days, versus 4.2 days for placebo, according to a phase 3 study presented here. Successful phase 3 trials of erenumab for episodic migraine have been previously presented.

To test its potential in chronic migraine, defined as headache for 15 or more days per month, and migraine for eight or more days per month, investigators enrolled 667 patients, randomized 3:2:2 to monthly placebo, erenumab 70 mg or erenumab 140 mg, administered subcutaneously. The primary endpoint was the change from baseline in monthly migraine days over three months of treatment, a measure meant to account for expected month-to-month fluctuations in severity.

The researchers used the mean of the three months, rather than the reduction in the final month, because experience has shown that the response rate fluctuates somewhat from month to month, said the lead investigator, Stewart J. Tepper, MD, FAHS, professor of neurology at the Geisel School of Medicine at Dartmouth in Hanover, NH.

At baseline, patients in each group had a mean of 18 monthly migraine days. Both doses of erenumab reduced that by a mean of 6.6 days, versus 4.2 days for placebo (p<0.001 for both). Active treatment was also associated with a greater response rate, with 40 percent and 41 percent in the low- and high-dose groups experiencing a 50 percent or greater reduction in monthly migraine days, versus 23 percent for placebo (p< 0.001 for both).

Adverse event profiles were similar for active treatment and placebo, except for a small increase in injection-site pain in those receiving erenumab. The results of the trial were published recently in June in Lancet Neurology. The company has submitted data to the FDA for an indication for both episodic and chronic migraine.

The results reported for these drugs are very exciting, commented Kathleen B.Digre, MD, FAAN, professor of neurology and ophthalmology and director of the division of headache and neuro-ophthalmology at the University of Utah in Salt Lake City. The safety profile looks very promising, compared to current preventive treatments, and the speed of response is extraordinary, she said. Typically we've needed to wait four to eight weeks to see a response, whereas each of the CGRP antibodies appear to show some kind of signal by one week. That's remarkable.

David W. Dodick, MD, FAAN, professor of neurology at the Mayo Clinic in Scottsdale, AZ, said that, because of their ease of administration and tolerability, the monoclonals are likely to greatly improve adherence over current migraine preventives. This is going to be changing the way neurologists practice.

Stephen D. Silberstein, MD, FAAN, professor of neurology and director of the Headache Center at Jefferson University Hospital at Thomas Jefferson University in Philadelphia, said, I would look at them all as a group. They are all effective, and they all look safe and tolerable.

Absent head-to-head studies, he continued, it is difficult to determine what nuances there may be between these drugs. Instead, the global message from these trials is that we have a new series of drugs that are powerful and effective, and have a side-effect profile similar to placebo. For one of the most disabling of disorders, which affects millions of people in their most productive years, this allows hope.

Link:
News from the American Headache Society Annual Meeting: Positive Trial Results for Anti-migraine Drugs Targeting ... - LWW Journals

Message from the Chair, Michael Gruenthal, MD, PhD

Welcome to the Neurosciences Institute at Albany Medical Center. We are proud to be the regions first choice for the diagnosis, treatment and care of disorders and diseases affecting the brain, spine and peripheral nervous system. As members of the Albany Medical College faculty, our providers specialize in the diagnosis and treatment of specific diseases, and many are national leaders defining new standards of care.

Our multidisciplinary team of expert neurologists, neurosurgeons and physiatrists treats everyone from newborns to adults with disorders including brain tumors, epilepsy, Parkinsons disease, stroke, aneurysms, Alzheimers disease, muscular dystrophy, multiple sclerosis, ALS (Lou Gehrigs disease) and neuropathic pain.

Our achievements are many.

In addition to earning the Get With The Guidelines Gold Plus Quality Achievement Award from the American Stroke Association, Albany Medical Center is the only hospital in the region, and one of only 13 statewide, to be certified by both the New York State Department of Health as a Stroke Center and by the Joint Commission as a Primary Stroke Center with the organizations Gold Seal of Approval as an accredited institution with an advanced certification in stroke care. Along with programs at other prestigious institutions including the Cleveland Clinic and Johns Hopkins, Albany Meds Epilepsy and Human Brain Mapping Program is designated Level 4, the highest distinction authorized by the National Association of Epilepsy Centers.

Our Alzheimers Center is the Capital Regions Alzheimers Disease Assistance Center as designated by the New York State Department of Health.

And, our neuromuscular program is the only one in the area recognized by the Muscular Dystrophy Association.

With our comprehensive array of services and team of experts, Albany Medical Center is uniquely qualified to bring world-class care to people of all ages with neurological disorders.

Read the rest here:
Neurology - amc.edu

E-mail This

AMC Neurology Group, is dedicated to serving the neurological needs of Albany, New York and the surrounding communities. We strive to provide state-of-the-art diagnosis and treatment. We are doctors who offer the finest neurological care and a team who is both supportive and compassionate and puts the patient first. We offer our patients and their families superior service because we put our patients at the center of all we do.

Neurologists diagnose and treat disorders of the nervous system, which include diseases of the brain, spinal cord, nerves, and muscles. Some of the more common conditions that neurologists diagnose and treat are as follows:

The neurologists at AMC Neurology Group have expertise providing evaluation and treatment of the central nervous system and muscle disorders. We have many years of combined experience in Neuro-physiology and Neuro-rehabilitation, as well as in the use of electrodiagnostic medicine.

Neurologists may serve as consultants to other physicians and can provide long-term care to patients with chronic neurological disorders.

Our subspecialties include epilepsy and neuro-physiology, as well as electrodiagnostic medicine and neuro-rehabilitation. We also have special skill in the diagnosis and treatment of Alzheimer's disease, Parkinson's disease, neuropathy, Multiple Sclerosis (MS), migraine, and other central nervous system abnormalities.

Please bookmark this page as your home base for neurological information. All other pages of our website can be accessed on the left side navigation bar. We hope you find this information helpful in your health and medical care decisions. Please contact us with any questions or for an appointment.

See original here:
AMC Neurology Group - Neurology - Albany, NY - Welcome

I am writing to share a story with you, specifically for you. My hope is that it will help you understand your patients along with their spouses and caregivers a little more. And as for the research you do, perhaps this will add a few more faces behind the why you do what you do. I am sure there are already so many.

This is a personal story, sadly tragic and heartbreaking, but by sharing this information with you I know that you can help make a difference in the lives of others.

As you may know, my husband Robin Williams had the little-known but deadly Lewy body disease (LBD). He died from suicide in 2014 at the end of an intense, confusing, and relatively swift persecution at the hand of this disease's symptoms and pathology. He was not alone in his traumatic experience with this neurologic disease. As you may know, almost 1.5 million nationwide are suffering similarly right now.

Although not alone, his case was extreme. Not until the coroner's report, 3 months after his death, would I learn that it was diffuse LBD that took him. All 4 of the doctors I met with afterwards and who had reviewed his records indicated his was one of the worst pathologies they had seen. He had about 40% loss of dopamine neurons and almost no neurons were free of Lewy bodies throughout the entire brain and brainstem.

Robin is and will always be a larger-than-life spirit who was inside the body of a normal man with a human brain. He just happened to be that 1 in 6 who is affected by brain disease.

Not only did I lose my husband to LBD, I lost my best friend. Robin and I had in each other a safe harbor of unconditional love that we had both always longed for. For 7 years together, we got to tell each other our greatest hopes and fears without any judgment, just safety. As we said often to one another, we were each other's anchor and mojo: that magical elixir of feeling grounded and inspired at the same time by each other's presence.

One of my favorite bedrock things we would do together was review how our days went. Often, this was more than just at the end of the day. It did not matter if we were both working at home, traveling together, or if he was on the road. We would discuss our joys and triumphs, our fears and insecurities, and our concerns. Any obstacles life threw at us individually or as a couple were somehow surmountable because we had each other.

When LBD began sending a firestorm of symptoms our way, this foundation of friendship and love was our armor.

The colors were changing and the air was crisp; it was already late October of 2013 and our second wedding anniversary. Robin had been under his doctors' care. He had been struggling with symptoms that seemed unrelated: constipation, urinary difficulty, heartburn, sleeplessness and insomnia, and a poor sense of smelland lots of stress. He also had a slight tremor in his left hand that would come and go. For the time being, that was attributed to a previous shoulder injury.

On this particular weekend, he started having gut discomfort. Having been by my husband's side for many years already, I knew his normal reactions when it came to fear and anxiety. What would follow was markedly out of character for him. His fear and anxiety skyrocketed to a point that was alarming. I wondered privately, Is my husband a hypochondriac? Not until after Robin left us would I discover that a sudden and prolonged spike in fear and anxiety can be an early indication of LBD.

He was tested for diverticulitis and the results were negative. Like the rest of the symptoms that followed, they seemed to come and go at random times. Some symptoms were more prevalent than others, but these increased in frequency and severity over the next 10 months.

By wintertime, problems with paranoia, delusions and looping, insomnia, memory, and high cortisol levelsjust to name a fewwere settling in hard. Psychotherapy and other medical help was becoming a constant in trying to manage and solve these seemingly disparate conditions.

I was getting accustomed to the two of us spending more time in reviewing our days. The subjects though were starting to fall predominantly in the category of fear and anxiety. These concerns that used to have a normal range of tenor were beginning to lodge at a high frequency for him. Once the coroner's report was reviewed, a doctor was able to point out to me that there was a high concentration of Lewy bodies within the amygdala. This likely caused the acute paranoia and out-of-character emotional responses he was having. How I wish he could have known why he was struggling, that it was not a weakness in his heart, spirit, or character.

In early April, Robin had a panic attack. He was in Vancouver, filming Night at the Museum 3. His doctor recommended an antipsychotic medication to help with the anxiety. It seemed to make things better in some ways, but far worse in others. Quickly we searched for something else. Not until after he left us would I discover that antipsychotic medications often make things worse for people with LBD. Also, Robin had a high sensitivity to medications and sometimes his reactions were unpredictable. This is apparently a common theme in people with LBD.

During the filming of the movie, Robin was having trouble remembering even one line for his scenes, while just 3 years prior he had played in a full 5-month season of the Broadway production Bengal Tiger at the Baghdad Zoo, often doing two shows a day with hundreds of linesand not one mistake. This loss of memory and inability to control his anxiety was devastating to him.

While I was on a photo shoot at Phoenix Lake, capturing scenes to paint, he called several times. He was very concerned with insecurities he was having about himself and interactions with others. We went over every detail. The fears were unfounded and I could not convince him otherwise. I was powerless in helping him see his own brilliance.

For the first time, my own reasoning had no effect in helping my husband find the light through the tunnels of his fear. I felt his disbelief in the truths I was saying. My heart and my hope were shattered temporarily. We had reached a place we had never been before. My husband was trapped in the twisted architecture of his neurons and no matter what I did I could not pull him out.

In early May, the movie wrapped and he came home from Vancouverlike a 747 airplane coming in with no landing gear. I have since learned that people with LBD who are highly intelligent may appear to be okay for longer initially, but then, it is as though the dam suddenly breaks and they cannot hold it back anymore. In Robin's case, on top of being a genius, he was a Julliard-trained actor. I will never know the true depth of his suffering, nor just how hard he was fighting. But from where I stood, I saw the bravest man in the world playing the hardest role of his life.

Robin was losing his mind and he was aware of it. Can you imagine the pain he felt as he experienced himself disintegrating? And not from something he would ever know the name of, or understand? Neither he, nor anyone could stop itno amount of intelligence or love could hold it back.

Powerless and frozen, I stood in the darkness of not knowing what was happening to my husband. Was it a single source, a single terrorist, or was this a combo pack of disease raining down on him?

He kept saying, I just want to reboot my brain. Doctor appointments, testing, and psychiatry kept us in perpetual motion. Countless blood tests, urine tests, plus rechecks of cortisol levels and lymph nodes. A brain scan was done, looking for a possible tumor on his pituitary gland, and his cardiologist rechecked his heart. Everything came back negative, except for high cortisol levels. We wanted to be happy about all the negative test results, but Robin and I both had a deep sense that something was terribly wrong.

On May 28th, he was diagnosed with Parkinson disease (PD).

We had an answer. My heart swelled with hope. But somehow I knew Robin was not buying it.

When we were in the neurologist's office learning exactly what this meant, Robin had a chance to ask some burning questions. He asked, Do I have Alzheimer's? Dementia? Am I schizophrenic? The answers were the best we could have gotten: No, no, and no. There were no indications of these other diseases. It is apparent to me now that he was most likely keeping the depth of his symptoms to himself.

Robin continued doing all the right thingstherapy, physical therapy, bike riding, and working out with his trainer. He used all the skills he picked up and had fine-tuned from the Dan Anderson retreat in Minnesota, like deeper 12-step work, meditation, and yoga. We went to see a specialist at Stanford University who taught him self-hypnosis techniques to quell the irrational fears and anxiety. Nothing seemed to alleviate his symptoms for long.

Throughout all of this, Robin was clean and sober, and somehow, we sprinkled those summer months with happiness, joy, and the simple things we loved: meals and birthday celebrations with family and friends, meditating together, massages, and movies, but mostly just holding each other's hand.

Robin was growing weary. The parkinsonian mask was ever present and his voice was weakened. His left hand tremor was continuous now and he had a slow, shuffling gait. He hated that he could not find the words he wanted in conversations. He would thrash at night and still had terrible insomnia. At times, he would find himself stuck in a frozen stance, unable to move, and frustrated when he came out of it. He was beginning to have trouble with visual and spatial abilities in the way of judging distance and depth. His loss of basic reasoning just added to his growing confusion.

It felt like he was drowning in his symptoms, and I was drowning along with him. Typically the plethora of LBD symptoms appear and disappear at random timeseven throughout the course of a day. I experienced my brilliant husband being lucid with clear reasoning 1 minute and then, 5 minutes later, blank, lost in confusion.

Prior history can also complicate a diagnosis. In Robin's case, he had a history of depression that had not been active for 6 years. So when he showed signs of depression just months before he left, it was interpreted as a satellite issue, maybe connected to PD.

Throughout the course of Robin's battle, he had experienced nearly all of the 40-plus symptoms of LBD, except for one. He never said he had hallucinations.

A year after he left, in speaking with one of the doctors who reviewed his records, it became evident that most likely he did have hallucinations, but was keeping that to himself.

It was nearing the end of July and we were told Robin would need to have inpatient neurocognitive testing done in order to evaluate the mood disorder aspect of his condition. In the meantime, his medication was switched from Mirapex to Sinemet in an effort to reduce symptoms. We were assured Robin would be feeling better soon, and that his PD was early and mild. We felt hopeful again. What we did not know was that when these diseases start (are diagnosed) they have actually been going on for a long time.

By now, our combined sleep deficit was becoming a danger to both of us. We were instructed to sleep apart until we could catch up on our sleep. The goal was to have him begin inpatient testing free of the sleep-deprived state he was in.

As the second weekend in August approached, it seemed his delusional looping was calming down. Maybe the switch in medications was working. We did all the things we love on Saturday day and into the evening, it was perfectlike one long date. By the end of Sunday, I was feeling that he was getting better.

When we retired for sleep, in our customary way, my husband said to me, Goodnight, my love, and waited for my familiar reply: Goodnight, my love.

His words still echo through my heart today.

Monday, August 11, Robin was gone.

After Robin left, time has never functioned the same for me. My search for meaning has replicated like an inescapable spring throughout nearly every aspect of my world, including the most mundane.

Robin and I had begun our unplanned research on the brain through the door of blind experience. During the final months we shared together, our sights were locked fast on identifying and vanquishing the terrorist within his brain. Since then, I have continued our research but on the other side of that experience, in the realm of the science behind it.

Three months after Robin's death, the autopsy report was finally ready for review. When the forensic pathologist and coroner's deputy asked if I was surprised by the diffuse LBD pathology, I said, Absolutely not, even though I had no idea what it meant at the time. The mere fact that something had invaded nearly every region of my husband's brain made perfect sense to me.

In the year that followed, I set out to expand my view and understanding of LBD. I met with medical professionals who had reviewed Robin's last 2 years of medical records, the coroner's report, and brain scans. Their reactions were all the same: that Robin's was one of the worst LBD pathologies they had seen and that there was nothing else anyone could have done. Our entire medical team was on the right track and we would have gotten there eventually. In fact, we were probably close.

But would having a diagnosis while he was alive really have made a difference when there is no cure? We will never know the answer to this. I am not convinced that the knowledge would have done much more than prolong Robin's agony while he would surely become one of the most famous test subjects of new medicines and ongoing medical trials. Even if we experienced some level of comfort in knowing the name, and fleeting hope from temporary comfort with medications, the terrorist was still going to kill him. There is no cure and Robin's steep and rapid decline was assured.

The massive proliferation of Lewy bodies throughout his brain had done so much damage to neurons and neurotransmitters that in effect, you could say he had chemical warfare in his brain.

One professional stated, It was as if he had cancer throughout every organ of his body. The key problem seemed to be that no one could correctly interpret Robin's symptoms in time.

I was driven to learn everything I could about this disease that I finally had the name of. Some of what I learned surprised me.

One neuropathologist described LBD and PD as being at opposite ends of a disease spectrum. That spectrum is based on something they share in common: the presence of Lewy bodiesthe unnatural clumping of the normal protein, -synuclein, within brain neurons. I was also surprised to learn that a person is diagnosed with LBD vs PD depending on which symptoms present first.

After months and months, I was finally able to be specific about Robin's disease. Clinically he had PD, but pathologically he had diffuse LBD. The predominant symptoms Robin had were not physicalthe pathology more than backed that up. However you look at itthe presence of Lewy bodies took his life.

The journey Robin and I were on together has led me to knowing the American Academy of Neurology and other groups and doctors. It has led me to discover the American Brain Foundation, where I now serve on the Board of Directors.

This is where you come into the story.

Hopefully from this sharing of our experience you will be inspired to turn Robin's suffering into something meaningful through your work and wisdom. It is my belief that when healing comes out of Robin's experience, he will not have battled and died in vain. You are uniquely positioned to help with this.

I know you have accomplished much already in the areas of research and discovery toward cures in brain disease. And I am sure at times the progress has felt painfully slow. Do not give up. Trust that a cascade of cures and discovery is imminent in all areas of brain disease and you will be a part of making that happen.

If only Robin could have met you. He would have loved younot just because he was a genius and enjoyed science and discovery, but because he would have found a lot of material within your work to use in entertaining his audiences, including the troops. In fact, the most repeat character role he played throughout his career was a doctor, albeit different forms of practice.

You and your work have ignited a spark within the region of my brain where curiosity and interest lie and within my heart where hope lives. I want to follow you. Not like a crazed fan, but like someone who knows you just might be the one who discovers the cure for LBD and other brain diseases.

Thank you for what you have done, and for what you are about to do.

Susan Schneider Williams serves on the Board of Directors for the American Brain Foundation (americanbrainfoundation.org) but reports no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the author, if any, are provided at the end of the editorial.

Read more here:
The terrorist inside my husband's brain - neurology.org

I would like to take a moment to welcome you to the Department of Neurology at Saint Louis University School of Medicine. I am certain you will find this information both helpful and informative.

Saint Louis University School of Medicine has a long history of excellence in teaching, research and patient care. Saint Louis University established the first medical school west of the Mississippi River in 1836. In 1929, Mother Marie Kernaghan became the first woman to graduate from Saint Louis University with a Ph.D. Her degree was in physics. In 1932, the University opened the Firmin Desloge Memorial Hospital, later named Saint Louis University Hospital. Dr. Gilbert Chaddock was the first neurologist of record at Saint Louis University. He was the main consulting neurologist in the 1930s.

Our institution is rooted in tradition while looking forward to growing in new and exciting ways. Saint Louis University Hospital is now a part of SSM (Sisters of St. Mary) which will create even more diversity in patient care and in teaching experiences for our students and residents. Although our primary inpatient service is at SSM Health Saint Louis University Hospital, we also have a partnership with Saint Louis John Cochran VA Medical Center and Cardinal Glennon Childrens Medical Center.

As a graduate of Saint Louis University School of Medicine in 1997 and completing a fellowship in Child Neurology at Saint Louis University in 2007, I know first-hand of the amazing faculty, students, residents and staff we have in the Department of Neurology. Our department is dedicated to our patients, students, and residents. We strive to provide the best care possible for our patients while committing to teaching our students and residents so they will become experts in the field of neurology. I am looking forward to all that we will accomplish in the future and I encourage you to peruse our website for further information about our department.

Sincerely,

Sean Goretzke, MD

View original post here:
Department of Neurology - Department of Neurology - Home

Under the leadership of Professor and Chairman Robert M. Pascuzzi, M.D., the IU School of Medicine Department of Neurology's core mission is to advance neurological health in Indiana and beyond through innovation and excellence in education, research and patient care.

The department's foundation of values includes:

The Department of Neurology is located in the new IU Health Neuroscience Center, a state-of-the-art outpatient center that unites all the specialties that involve nervous system disorders Neurology, Neurosurgery, Psychiatry, Physical Medicine and Rehabilitation, Neuropsychology, and Neuroradiology. It is also home of the main outpatient Neurophysiology (EEG, EMG and Evoked Potentials) laboratory at IU Health. The adjoining Indiana University Neurosciences Research building enables clinicians, basic scientists and physician scientists in the neurosciences to collaborate in research, education and patient care in an environment that is rarely achieved in academic medicine.

IU Health Neuroscience Center

Goodman Hall, Suite 4700

355 W. 16th Street

Indianapolis, IN 46202

Phone: (317) 948-5450

FAX: (317) 963-7533

Read more here:
Neurology - IU School of Medicine

9625 Surveyor Court, Suite 110

Manassas, Virginia 20110

Monroe Building

Next to Prince William Hospital

Prince William Neurology

9625 Surveyor Court, Suite 110

Manassas, Virginia 20110

(703) 257-7180 phone

(703) 257-7129 fax

contactus@princewilliamneurology.com

Dr. Kroeger is a terrific physician. She always makes time to see me quickly, listens to my needs and helps me navigate my complicated symptoms.

- Margaret, Gainesville VA

I confidently refer my patients to Dr. Kroeger. They always come back with excellent feedback and progress. - Family Medicine Physician

Whether new or long-term, all my patients have personal 24/7 access to me and can make appointments quickly and on their schedule.

My missionis high quality care with empathy and compassion. Ilisten well, perform thorough exams and deeply value patient relationships.

I've practiced privately in Manassas for nearly 10 yearsafter being educated in state at William & Mary, The Medical College of Virginia and Georgetown.

Top Doctor: Washingtonian 2015, Northern Virginia Magazine 2014 and Washington Consumers Checkbook 2014

Read this article:
Dr Leah Kroeger - Prince William Neurology - Manassas, Va

Patients who experience neurological challenges are faced with an array of complex decisions concerning their care and treatment. The care and support required extends far beyond the needs of the patient because with neurological disorders, family members and loved ones also experience changes that impact their daily lives. UofL Physicians-Neurology, formerly known as University Neurologists PSC,compriseshighly trained neurologists in Louisville who specialize in conditions that negatively affect the brain and nervous system as a result of injury or disease. Additionally,UofL Physicians - Child Neurology has a team of specialists trained specifically in pediatric neurology. At UofL Physicians-Neurology, we diagnose and treat disorders that affect the brain, spinal cord, muscles and nerves throughout the body. Our array of specialized clinical services, including evaluation and management, second opinions for complex cases and diagnostic testing allows us to provide services for both minor disorders and patients who are critically ill.

The UofL Physicians - Neurology clinical subspecialties include: general neurology, stroke, epilepsy, movement disorders, neurodegenerative diseases, multiple sclerosis, neuromuscular disease, clinical neurophysiology, headache, sleep disorders, and child neurology.

UofL Physicians - Neurologys multidisciplinary staff of more than 20 clinical faculty and over 35 department members strives to provide patient-focused, world-class medical care for the entire spectrum of neurological diseases. As researchers and teachers at the University of Louisville School of Medicine, we have a passion and commitment to develop new treatments and cures for neurologic diseases. Our clinical research in stroke and multiple sclerosis are among the fastest growing programs in the country, enrolling patients in important clinical trials with potentially life-saving treatments. Our research in movement disorders, particularly in progressive supranuclear palsy and Parkinsons disease, is internationally recognized as the leading work in this subspecialty of neurology. The programs at UofL Physicians-Neurology involve a worldwide interdisciplinary network of collaboration aimed at developing preventive and corrective treatments for neurological disorders.

Find neurologists in Louisville by viewing the Our Physicians tab.

University of Louisville Physicians Child Neurology offers comprehensive diagnostic and treatment services for infants and children with disorders of the nervous system. Our specialists are devoted to promoting the optimal care and welfare of children with neurological and neurodevelopmental disorders. These disorders include epilepsy, cerebral palsy, mental retardation, learning disabilities, complex metabolic diseases, nerve and muscle diseases and a host of other highly challenging conditions.

The child neurologists at UofL Physicians are specially trained physicians who have followed up their four-year medical school education training in pediatrics, general neurology, and pediatric neurology.

UofL Physicians child neurologists diagnose, treat and manage the following conditions:

For more information on Child Neurology, visithttps://www.uoflphysicians.com/child-neurology.

Correct diagnosis of neurologic disorders in older adults can be difficult because signs of disease may mimic normal signs of aging. Also, patients frequently have more than one neurologic problem at once. It can be challenging to find the best treatment once such a problem has been diagnosed.

The team of professionals at the UofL Physicians Neurology practice is led by Dr. Robert Friedland, a nationally and internationally recognized expert, researcher and physician committed to identifying groundbreaking treatments that address the clinical and biological issues associated with Alzheimers and related diseases.

Under Dr. Friedlands leadership, the practice performs an initial comprehensive evaluation, which includes a detailed history and mental status examination; standardized cognitive, functional and depression testing; pertinent neurological and physical examination; laboratory testing; neuroimaging; and referral for neuropsychological testing and for consultation by other team members as necessary. The team identifies risk factors for future cognitive decline and protective factors that may slow future cognitive decline.

Patients then receive a holistic individualized treatment plan, which aims to reduce the impact of risk factors while promoting protective factors along with neuroprotective and cognition-enhancing drugs and supplements.

Epilepsy is diagnosed in 125,000 Americans each year. Finding the experts required to address the condition can be frustrating. With epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions and behavior or sometimes convulsions, muscle spasms and loss of consciousness.

Even mild seizures may require treatment because they can be dangerous during activities such as driving or swimming. Treatment which generally includes medications and sometimes surgery usually eliminates or reduces the frequency and intensity of seizures. Many children with epilepsy even outgrow the condition.

The UofL Physicians Epilepsy Program provides comprehensive diagnosis and management for people with epilepsy. Our team of specialists includes epileptologists, epilepsy fellows, neurosurgeons, neuroradiologists, nurses and EEG technologists committed to providing the best possible care for people with epilepsy. We treat the entire person taking in to consideration age, health and lifestyle to address a treatment that is the most effective for the patient. Education is the key to treating this condition, and our experts invest the time required to assist the patient and their families to fully understand the recommended treatment.

List of Services:

Headaches can range from minor headaches that last a few minutes to intense migraines that may be debilitating. The UofLPhysicians - Comprehensive Headache Program promotes excellence in patient care to individuals with headache and facial pain throughout the Kentuckiana region.

UofL Physicians - Parkinson's Disease and Movement Disorders, in partnership with Frazier Rehab and Neuroscience Institute, provides state-of-the art, comprehensive care to patients and families with movement disorders.

For more information, visit the UofL Physicians - Parkinson's Disease and Movement Disorders page or theUofL Medical School's Neurology page.

The University of Louisville Physicians - Neuromuscular Program provides a full complement of services ranging from clinical assessment, laboratory testing and electrodiagnosis to biopsy and histology of nerve and muscle. Currently, several clinical trials are in place for investigation of new and novel therapies of nerve, muscle and neuromuscular junction disorders.

When it comes to minimizing the effects of stroke, immediate care is vital. The University of Louisville Physicians Neurologists led two nationally recognized stroke Centers set up to make sure stroke patients receive rapid, comprehensive care; University Hospital Stroke Center and The centers offer in-house stroke team available 24 hours a day, seven days a week. Combining technology, therapy and treatment, patients receive the most comprehensive care in the region. Examination, laboratory studies, cardiac tests, and state-of-the-art imaging studies can be performed within minutes of a patient's arrival in the Emergency Care Center. A full range of medical and rehabilitation services is instantly available, from a team that includes neurologists, critical care physicians, interventional neuroradiologists, neurosurgeons, and cardiologists as well as nutritionists, physical therapists, speech-language pathologists, diabetic coordinators, and stroke nurses.

To find out more about the University of Louisville Physicians - Stroke programs please visit University Hospitals Stroke Center.

See the article here:
Neurology in Louisville, KY | Louisville Physicians

HI! I was reading all the comments and wanted to advise those who have not had one to have a spinal tap and an eye exam of the optic nerve. I have had all of the symptoms and more and was diagnosed with intracranial hypertension five years ago. I also have lupus and am in the process of being worked up for myathenia gravis.

If you can, have a spinal and brain MRI - I never got a spine one. If you are on dierutics remember that they can make you feel dizzy and tingly as can hypothyrodism and heart problems, and a few other diseases that arn't neuro based. I would advise an echocardiogram as well.

I had lupus for yeears before being diagnosed with the IH and theentire time I had the IH i kept telling them about my muscle burning and fatigue, terrible fatigue after exhertion and by the end of the day unable to even use muscles, tingling and so on and it's not until now that an EMG was done and the MG blood tests. EMG was not normal -s till don't have the blood work back.Lupus can also cause many and mostof the symptoms here but is an easy blood work up.

MS can be very deceptive for years and eyars and years but many ,many things including chronic fatigue and fibromyalgia and IH can cause your symptoms.

I havea friend with severe chronic fatigue and she has all of the symptoms including bowel problems and sleep apnea and orthstatic hypotension (another cause of dizzyness).

These things can be really hard to diagnose.

A spinal tap is good because if you have MS the cells will show up in the fluid and if you have IH you brain pressure will read too high.

Symptoms of IH

Papilledema (have you had your eyes checked for optic nerve damage)

pressure severe headache behind the eyes, vomiting, nausea, dizzyness, ear ringing, whooshing, pins and needles, fatigue, muscle fatigue blurry, double vision, visual disturbances )hallucinations), some of us have more serious neurological defects such as memory loss, confusion, trouble walking and excercising and so on - even breathing. (not everyone has all of the symptoms but everyone has increased pressure and papilledema)

Go here to read the rest:
Unusual symptoms - Neurology - MedHelp

I found this post when I was looking for an answer to this very question, after waking up around 3am with a foot and leg cramp (right side) following a nerve conduction test the previous day (the test was only on my hands which were not touching any other part of my body).My whole body felt sore. I went back to sleep and arose at my normal hour. My right shoulder/neck felt like it had been hit with a baseball bat...very stiff and sore. Right hand and forearm was also very sore and painful.I had no such symptoms before the test. In fact, I was feeling remarkably pain-free except for some pain and stiffness in my hands.My right hand was deemed "moderate" nerve damage and the left was "mild to moderate."The median nerve runs the length of the arm through the carpal tunnel so it makes sense to me that I would experience shoulder and neck pain after the nerve had been stimulated by the test.The leg pain seems strange, although I have had chronic issues off and on with my right side...neck/shoulder pain, leg pain (mid-thigh, large muscle), right hand/wrist.I'm sure it is all connected somehow but I am not an expert on anatomy.It was good to know that I am not alone, however, I was not warned at all that there would be any side effects.I feel bad for people who had much worse side effects (crawling to the bathroom).Since my nerve conduction study was only on my hands and only moderately painful I can just imagine the impact of a nerve conduction study that was either more intense (voltage?) and/or on a larger muscle group.I find the crawling part completely believable based on my limited experience.I feel like I've been in a fender bender where I got hit with "moderate" force (20-30 mph)...just enough time to see it coming, tense, and really feel it the next day.

See more here:
Nerve Conduction Test Side Effect? - Neurology - MedHelp