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ICNA) Virtual Congress – GlobeNewswire

Posted on October 16, 2020 by Danzig

NEW YORK, Oct. 12, 2020 (GLOBE NEWSWIRE) -- Ovid Therapeutics Inc.(NASDAQ: OVID), a biopharmaceutical company committed to developing medicines that transform the lives of people with rare neurological diseases, today announced that four abstracts from the OV101 (gaboxadol) clinical development program will be presented at the Child Neurology Society/International Child Neurology Association (CNS/ICNA) 2020 Virtual Congress, taking place October 12 October 23, 2020.

The presentations include additional data and analyses from the Phase 2 ROCKET clinical trial of OV101 in individuals with Fragile X Syndrome; data on seizure and EEG outcomes from the Phase 2 STARS clinical trial in individuals with Angelman Syndrome; encore presentations of a study of caregiver insights in Angelman Syndrome; and the utility of the Clinical Global Impression (CGI) scale for studying outcomes in neurodevelopmental conditions.

Ovid is passionately committed to the development of OV101 to address the significant unmet medical need in individuals with both Angelman and Fragile X Syndromes two neurological conditions with tremendous caregiver and family impact with no approved treatment options for either, said Amit Rakhit, MD, MBA, President and Chief Medical Officer at Ovid. These data will contribute to evolving scientific exchange and advancing discussion around neurodevelopmental conditions, caregiver concerns, and the urgency to develop new medicines for these conditions.

Details of the presentations are as follows:

Title: Caregiver Insight on the Core Domains in Angelman Syndrome; Adera, et alPoster Number: #587

Title: The Phase 2a ROCKET Trial Investigating Gaboxadol (OV101) in Adolescents and Young Adults with Fragile X Syndrome; Berry-Kravis, et alPoster Number: #676

Title: The Adaptation and Utility of the Clinical Global Impression Scale for Studying Treatment Outcomes in Neurodevelopmental Conditions; Jaeger, et alPoster Number: #46

Title: STARS, a Phase 2 Safety, Tolerability, and Exploratory Efficacy Study of Gaboxadol in Adolescents and Adults with Angelman Syndrome: Seizure and EEG Outcomes; Wang, et alPoster Number: #588

AboutOvid TherapeuticsOvid Therapeutics Inc.is aNew York-based biopharmaceutical company using its BoldMedicineapproach to develop medicines that transform the lives of patients with rare neurological disorders. Ovid has a broad pipeline of potential first-in-class medicines. The Companys most advanced investigational medicine, OV101 (gaboxadol), is currently in clinical development for the treatment of Angelman syndrome and Fragile X syndrome. Ovid is also developing OV935 (soticlestat) in collaboration with Takeda Pharmaceutical Company Limited for the potential treatment of rare developmental and epileptic encephalopathies (DEE). For more information on Ovid, please visitwww.ovidrx.com.

About OV101 (gaboxadol)OV101 is believed to be the only delta ()-selective GABAAreceptor agonist in development and the first investigational drug to specifically target the disruption of tonic inhibition, a central physiological process of the brain that is thought to be the underlying cause of certain neurodevelopmental disorders. OV101 has demonstrated in laboratory studies and animal models to selectively activate the -subunit of GABAAreceptors, which are found in the extrasynaptic space (outside of the synapse), and thereby impact neuronal activity through modulation of tonic inhibition.

Ovid is developing OV101 for the treatment of Angelman syndrome and Fragile X syndrome to potentially restore tonic inhibition and thereby address several core symptoms of these conditions. In both these syndromes, the underlying pathophysiology includes disruption of tonic inhibition modulated through the -subunit of GABAAreceptors. In preclinical studies, it was observed that OV101 improved symptoms of Angelman syndrome and Fragile X syndrome. This compound has also previously been tested in more than 4,000 patients (more than 1,000 patient-years of exposure) and was observed to have favorable safety and bioavailability profiles. Ovid is conducting a pivotal Phase 3 clinical trial with OV101 in Angelman syndrome (NEPTUNE) and has completed a Phase 2 signal-finding clinical trial with OV101 in Fragile X syndrome (ROCKET).

OV101 has received Rare Pediatric Disease Designation from the FDA for the treatment of Angelman syndrome. The FDA has also granted Orphan Drug and Fast Track designations for OV101 for both the treatment of Angelman syndrome and Fragile X syndrome. In addition, theEuropean Commission(EC) has granted orphan drug designation to OV101 for the treatment of Angelman syndrome. TheU.S. Patent and Trademark Officehas granted Ovid patents directed to methods of treating Angelman syndrome and Fragile X syndrome using OV101. The issued patents expire in 2035 without regulatory extensions.

Forward-Looking StatementsThis press release includes certain disclosures that contain forward-looking statements, including, without limitation, statements regarding the potential benefits, clinical and regulatory development, the likelihood that data will support future development, and the association of data with treatment outcomes. You can identify forward-looking statements because they contain words such as will, appears, believes and expects. Forward-looking statements are based on Ovids current expectations and assumptions. Because forward-looking statements relate to the future, they are subject to inherent uncertainties, risks and changes in circumstances that may differ materially from those contemplated by the forward-looking statements, which are neither statements of historical fact nor guarantees or assurances of future performance. Important factors that could cause actual results to differ materially from those in the forward-looking statements include uncertainties in the development and regulatory approval processes, and the fact that initial data from clinical trials may not be indicative, and are not guarantees, of the final results of the clinical trials and are subject to the risk that one or more of the clinical outcomes may materially change as patient enrollment continues and/or more patient data become available. Additional risks that could cause actual results to differ materially from those in the forward-looking statements are set forth in Ovids filings with the Securities and Exchange Commission under the caption Risk Factors. Such risks may be amplified by the COVID-19 pandemic and its potential impact on Ovids business and the global economy. Ovid assumes no obligation to update any forward-looking statements contained herein to reflect any change in expectations, even as new information becomes available.

Contacts

Investors and Media:Ovid Therapeutics Inc.Investor Relations & Public Relationsirpr@ovidrx.com

Investors:Argot PartnersMaeve Conneighton212-600-1902ovid@argotpartners.com

Media:Argot PartnersJoshua R. Mansbach212-600-1902ovid@argotpartners.com

Media:Dan Budwick1ABdan@1abmedia.com

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Ovid Therapeutics to Present at the Child Neurology Society/International Child Neurology Association (CNS/ICNA) Virtual Congress - GlobeNewswire

People With HIV Have High Burden of HIV-Associated Neurocognitive Disorder – Neurology Advisor

Posted on October 16, 2020 by Danzig

People with HIV, particularly patients in sub-Saharan Africa and Latin America, have a high burden of HIV-associated neurocognitive disorder (HAND). This indicates the need for earlier neurologic care and initiation of antiretroviral therapy in this population, according to study results published in Neurology.

HIV, being a neurotropic virus, can invade the central nervous system during early infection, which is often associated with neurological complications like HAND. Study researchers sought to evaluate the burden and prevalence of HAND, as well as related factors in the global community living with the HIV.

This study was a meta-analysis of data from 123 cross-sectional and cohort studies that reported the prevalence of HAND in 35513 adults with HIV from 32 different countries. The pooled prevalence of HAND was estimated, and the overall worldwide burden of the disorder was evaluated.

Across studies, the diagnostic criteria for HAND consisted of the 2007 Frascati criteria in 64 studies, Global Deficit Score in 25 studies, and mental status examinations in 34 studies. Overall, the estimated prevalence of HAND in adults living with HIV was 42.6% (95% CI, 39.7-45.5). The prevalence of asymptomatic neurocognitive impairment (ANI) was 23.5% (95% CI, 20.3-26.8). Additionally, the prevalence of mild neurocognitive disorder (MND) was 13.3% (95% CI, 10.6-16.3) and of HIV-associated dementia (HAD) was 5.0% (95% CI, 3.5-6.8).

The prevalence of HAND was lower in individuals with a high level of nadir CD4 count (mean/median CD4 nadir <200, 45.2%; 95% CI, 40.5-49.9) compared with individuals with a low level of nadir CD4 count (mean/median CD4 nadir 200, 37.1%; 95% CI, 32.7-41.7).

The estimated worldwide number of patients with HIV and HAND was approximately 16,145,400 (95% CI, 15,046,300-17,244,500). The majority of cases were in sub-Saharan Africa, which was estimated to be in 72% of this population (n=11,571,200; 95% CI, 9,600,000-13,568,000).

Limitations of this meta-analysis were the inclusion of studies with varying definitions and diagnostic criteria for HAND and the use of screening tools that were limited when applied to certain target populations. Additionally, the use of Frascati criteria and the inclusion of patients with comorbidities that potentially contribute to cognitive impairment may have led to an overestimation of HAND prevalence in adults with HIV.

Based on the findings, the study researchers concluded that HAND should be prioritised among policy makers and HIV health-care providers for improved detection and efficient management of HAND integrated into routine clinical care in people with HIV.

Reference

Wang Y, Liu M, Lu Q, et al. Global prevalence and burden of HIV-associated neurocognitive disorder: a meta-analysis. Published online September 4, 2020. Neurology. doi:10.1212/WNL.0000000000010752

Scribe Therapeutics to Collaborate With Biogen to Develop CRISPR-based Genetic Medicines for Neurological Diseases, Including Amyotrophic Lateral…

Posted on October 9, 2020 by Danzig

ALAMEDA, Calif.--(BUSINESS WIRE)--Scribe Therapeutics Inc., the company focused on engineering the most advanced platform for CRISPR-based genetic medicine, today announced a research collaboration with Biogen Inc. (Nasdaq:BIIB) to develop and commercialize CRISPR-based therapies that address an underlying genetic cause of Amyotrophic Lateral Sclerosis (ALS).

Scribes platform is focused on engineering, delivering, and developing novel, custom CRISPR molecules. The companys first technology, X-Editing (XE), provides greater editing activity, specificity and deliverability than other CRISPR genome editing tools currently available.

Scribe has designed, engineered and tested thousands of evolved CRISPR enzymes to build an advanced platform for creating breakthrough in vivo treatments, said Benjamin Oakes, CEO and co-founder of Scribe Therapeutics. Were proud to collaborate with Biogen and apply our uniquely customized approaches with the goal of developing new, safe and effective genetic medicines for neurodegenerative disease.

Under the terms of the collaboration, Scribe will work with Biogen to create therapeutics for genetically-driven ALS, with an option to pursue an additional neurological disease target with high, unmet need. Scribe will receive $15 million upfront and is eligible for more than $400 million in potential development and commercial milestone payments between the two targets of interest. Scribe is also eligible to receive tiered, high single digit to sub-teen royalties.

About Scribe Therapeutics

Scribe Therapeutics is a molecular engineering company focused on building best-in-class in vivo therapies to permanently treat the underlying cause of disease. Founded by CRISPR inventors and leading molecular engineers Benjamin Oakes, Brett Staahl, David Savage, and Jennifer Doudna, Scribe is overcoming the limitations of current genome editing technologies by developing custom engineered enzymes and delivery modalities as part of a proprietary, evergreen platform for CRISPR-based genetic medicine. The company is backed by leading individual and institutional investors including Andreessen Horowitz. To learn more about Scribes mission to rewrite the story of disease, visit http://www.scribetx.com

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Scribe Therapeutics to Collaborate With Biogen to Develop CRISPR-based Genetic Medicines for Neurological Diseases, Including Amyotrophic Lateral...

Neurological, Cardiac Issues Linger in COVID-19 Youth – Voice of America

Posted on October 9, 2020 by Danzig

Young people have suffered less under the COVID-19 virus than older people medically, but experts say the gap has narrowed, and so-called superspreading among the young is a factor.

The epidemic is changing. People in their 20s, 30s and 40s are increasingly driving its spread, said Dr. Takeshi Kasai, World Health Organization regional director for the Western Pacific, in a virtual press conference Aug. 18.

Many are unaware theyre infected with very mild symptoms or none at all. This can result in them unknowingly passing on the virus to others, he added.

But on Sept. 28, a 19-year-old college student died, apparently of neurological complications related to the coronavirus.

Chad Dorrill, a sophomore at Appalachian State University in Boone, North Carolina, was diagnosed with COVID-19 in early September and suffered from later complications.

Dorrill developed additional complications even after being cleared by his doctor to return to Boone from his home county, according to an announcement from Appalachian State University Chancellor Sheri Everts.

All of us must remain vigilant with our safety behaviors wherever we are in our community. We must flatten the curve, but to do so, we must persevere, Everts said.

Research published Sept. 23 from the Centers for Disease Control and Prevention (CDC) in Atlanta reports that the COVID-19 incidence was highest in adults ages 20 to 29 years during June to August 2020 in the United States.

The report states that younger adults likely contribute to community transmission of COVID-19, and that increases in positive test results among adults ages 20 to 39 preceded increases among those 60 and older by an average of 8.7 days across the southern United States in June 2020.

As of Oct. 5, the 18-to-29 age group led all positive cases in the United States with 23.7%, or 1,269,397 cases, according to CDC data. The 50-to-64 age group followed in second with 20.6% of positive cases, or 1,000,476 cases.

Research shows that the coronavirus carries long-term health implications, even in younger adults.

A multistate telephone survey of adults who had symptoms and tested positive for COVID-19 showed 35% had not returned to their usual state of health when interviewed two to three weeks after testing, according to a report by the CDC.

Twenty percent of 18-to-34-year-olds with no chronic medical conditions reported they had not returned to their usual state of health.

A study published this month in the Journal of the American Heart Association found that pediatric patients 18 and younger with acute or prior coronavirus infection can have a broad range of cardiac findings, even though they are experiencing mild symptoms.

While data show that cases were the highest among older adults in the early stages of the pandemic, German epidemiologist Karl Lauterbach suggested in April, when the pandemic was widespread in China and Italy, that thousands of young people may have helped seed the COVID-19 pandemic since last December.

Experience maybe believes that its a severe disease for older people, Lauterbach told VOA in March. But we now know that many of the younger people also get severely ill and may sustain long-term consequences.

They get a very severe and atypical pneumonia and may end up in the [intensive care unit], Lauterbach, a scientist and member of Germanys Bundestag Parliament, said. And they have way more severe disease than we initially believed.

In December 2019, as COVID-19 was emerging in China, colleges and universities worldwide released hundreds of thousands of students home for winter break. Many of the more than 360,000 Chinese students who study in the U.S. returned to China for the holiday.

A month later, they and other international students returned to their campuses in the U.S. and around the world as COVID-19 was gaining speed.

In March, U.S. colleges and universities began their spring breaks, times when students traditionally head to warm beach destinations, such as in Florida, Texas and Mexico, to blow off steam after studying for midterms.

Dr. Sean OLeary, associate professor of pediatrics-infectious diseases at the University of Colorado Anschutz Medical Campus, told VOA that in response to the wave of COVID-19 cases in the U.S., many universities shut down their campuses, sent students home or asked them to return from spring break to clean out their rooms, and then put them on airplanes for points around the country.

From the perspective of the U.S. as a country, was that the best choice? OLeary asked. Campuses were one place where we knew there was widespread transmission.

Lauterbach said the disease is insidious in younger people because they typically show only mild or no symptoms, and scientists now believe that 80% of COVID-19 transmission occurs among those who dont seem ill.

A study by the American Academy of Pediatrics looked at more than 2,000 youths ages 18 and younger in China.

Doctors from Shanghai Childrens Medical Center and Shanghai Jiao Tong University School of Medicine wrote that where the virus first emerged, in Hubei province, 13% of confirmed cases had asymptomatic infection, a rate that almost certainly understates the true rate of asymptomatic infection, since many asymptomatic children are unlikely to be tested.

Research published Aug. 6 by JAMA Internal Medicine found that many COVID-19 patients remained asymptomatic for a prolonged period, and the viral load was similar to that of symptomatic patients.

Older children have also been shown to transmit the coronavirus as much as adults, according to a large study from South Korea.

The study, which analyzed nearly 65,000 people in South Korea, found that children younger than 10 were around half as likely to spread the virus as adults. However, young people ages 10 to 19 years old are more likely than other age groups to disperse COVID-19 into households.

Of 10,592 household contacts, 11.8% had COVID-19, with 18.6% being index patients ages 10 to 19. It was 1.9% for the 48,481 non-household contacts.

We should make it clear to younger people that if they behave in a careless fashion, that they are not only putting themselves, their peers, older people and peers [with underlying conditions] at risk, Lauterbach said, but they put themselves at risk and their best friends. So, we need to convey a message that this is a serious disease for all age groups.

It is quite clear that not many young people die from the disease, Lauterbach said.

But it is astonishing that we see very, let's say, remarkable numbers of younger people in the ICU and also often on ventilator support, he said.

Currently, we do not know whether they will fully recover their lung function or not. We definitely do not know that for certain. So, we have to take this way more seriously than we did in the past.

Kathleen Struck contributed to this report.

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Neurological, Cardiac Issues Linger in COVID-19 Youth - Voice of America

Study Highlights Clinical Features and Prevalence of… : Neurology Today – LWW Journals

Posted on September 18, 2020 by Danzig

Article In Brief

Double-seronegative myasthenia gravis patients (DNMG), who were antibody positive for both lipoprotein receptor-related protein 4 and agrin, had a more severe case of the condition than those who were antibody-negative. Experts discuss whether currently approved treatment options would also benefit DNMG patients who are positive for both antibodies.

Patients with double-seronegative myasthenia gravis (DNMG) who were antibody positive for both lipoprotein receptor-related protein 4 (LRP4) and agrin had a more severe case of the condition than those were antibody-negative, a multicenter study found.

Patients identified as DNMG lack autoantibodies against the nicotinic acetylcholine receptor (AChR) detected in about 80 percent of patients with generalized MG and to muscle-specific tyrosine kinase (MuSK) found in about 10 percent of generalized MG cases.

Whether currently approved treatment options would also benefit these DNMG patients who are positive for LRP4 and agrin would be worth examining in future studies, neuromuscular experts not involved with the current research told Neurology Today.

In the study published in the September issue of Muscle and Nerve, the investigators, led by Michael H. Rivner, MD, the Charbonnier professor of neurology and director of electrodiagnostic medicine laboratory at Augusta University in Georgia, and colleagues, sought to identify the clinical characteristics, prognosis, and prevalence of LRP4 or agrin-antibodies in DNMG patients from 16 clinical sites.

Of 181 DNMG patients, 14.9 percent were positive for either agrin or LRP4, and 12.7 percent were positive for both LRP4 and agrin antibodies.

Although antibody-positive patients had more severe disease than antibody-negative patients, most DNMG patients responded to standard therapy regardless of their antibody status, the researchers reported.

Also, 43 percent of antibody-negative patients had ocular or mild generalized symptoms compared with 69 percent of antibody-positive patients, the investigators found.

These findings are similar to the rates seen in other reports, the researchers noted. Although patients positive for both [LRP4 and agrin] have been reported previously, this is not a commonly observed finding among the few patients who have been tested for both antibodies, the authors wrote.

There have been a few papers published in the literature that have looked at MG patients, that were positive for LRP4 and agrin, but the numbers of patients studied were limited, Dr. Rivner told Neurology Today.

The prevalence of LRP4 antibodies have been very variable in previous studies reported in the literature. Most of these studies were relatively small; only one study had a sizable number of patients.

Dr. Rivner noted that the prevalence of LRP4 antibodies in other studies in patients with myasthenia gravis ranged from less than 1 percent to as high as 40 percent. For double negative MG patients, the prevalence rate varied from less than 1 percent to as high as 50 percent. So pretty much, we really didn't know what the prevalence was.

If you look at the situation with agrin, we knew even less, he added.

Finding these antibodies likely indicates that these patients have a more severe course of the disease, noted Dr. Rivner. Of course, finding a new antibody makes it a little bit easier to take care of these patients because a lot of times, patients present with vague symptoms. We can do some physiological testing, which is helpful, but finding an antibody is also helpful in diagnosing the disease.

In the current analysis, all patients showed clinical symptoms of MG, received either rituximab within six months of their antibody test or intravenous immunoglobulin or plasma exchange within six weeks of their antibody test.

Nearly 90 percent of patients who tested positive for LRP4 or agrin developed generalized MG. However, after an average follow-up period of 11 years, 81.5 percent of these antibody-positive patients, who received standard MG therapy, improved on MG rating scales.

I think the most interesting thing and something that we didn't knowwas that patients who had antibodies for LRP4 or agrin, had a more severe form of myasthenia than patients who did not have antibodies. We termed these as quad-negative patients because they did not have antibodies to acetylcholine, MuSK, LRP4, and agrin, and those patients had a milder course of the disease than the patients who had antibodies to LRP4 and agrin, Dr. Rivner told Neurology Today.

While the researchers had access to clinical exam data on antibody-positive patients, Dr. Rivner said, we don't have physical exam findings on antibody-negative patients.

Having information from exams would allow the investigators to compare antibody positive and negative patients, Dr. Rivner said.

The study focuses on the clinical presentation of patients with agrin and LRP4 antibodies in a more systematic way, said Julie Rowin, MD, FAAN, DABMA, of Integrative Neurology in Westchester, IL.

It is interesting that the majority of patients in this study had both LRP4 and agrin antibodies (85 percent), Dr. Rowin told Neurology Today in an email. The coexistence of these two antibodies in MG patients had not really been assessed previously. Having said that, LRP4 interacts with agrin forming a complex with MuSK, so there are structural relationships between these proteins.

In addition, Dr. Rowin said, agrin and LRP4 antibodies are present in other neurological disorders such as ALS and MS as well as some AChR and MuSK seropositive patients, so it remains unclear at this point if these antibodies are directly involved in the pathogenesis of MG or are a secondary result of the neuromuscular junction damage that occurs in myasthenic disorders.

Dr. Rowin said that both the LRP4/agrin antibody-positive patients and the double seronegative patients responded equally well to standard therapy and that the paper does not offer any indication that treatment decisions should be impacted by a patients LRP4/agrin antibody status. The role of newer therapeutic options in these patients (e.g., complement inhibition) cannot be gleaned from this study, she added.

Although the authors recommend testing for LRP4/agrin antibodies in double seronegative patients, at this point, there doesn't appear to be a compelling reason to do this routinely, as the response to standard therapy is no different for LRP4/agrin positive patients versus seronegative patients; the two groups are comparable in the response to standard medical management, Dr. Rowin said.

The current literature consists mainly of case reports, and the data are inconsistent, but this paper provides us with a more rigorous and consistent approach, agreed Alejandro Tobon, MD, chief of the neurology section at South Texas Veterans Health Care System.

It was interesting that most patients that tested positive were positive for both LRP4 and agrin, Dr. Tobon said. Most of the case reports that we've seen in the literature were either patients that were LRP4 positive or agrin positive and the fact that they found that most patients had both raises interesting questions. We still don't know much, but it may have implications in the future for better diagnostic testing and for treatment possibilities.

For example, we have FDA-approved medications such as eculizumab for MG, which is approved only for AChR antibody-positive myasthenia gravis, said Dr. Tobon. Now that we have identified another group of patients that are antibody positive, it will be interesting to determine through research whether a medication like eculizumab or others in development affect treatment in this group. It opens the door to see other treatment options that are not routinely available for seronegative myasthenia patients.

Dr. Rivner disclosed relationships with Allergan, Alexion, Ra Pharmaceuticals, Cytokinetics, Catalyst, Biohaven, UCB, Momenta, Shire Takeda, Mallinckrodt, Seikagaku, Grifols, and Orion. Dr. Rowin disclosed relationships with AveXis and Novartis. Dr. Tobon did not report any conflicts of interest.

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Study Highlights Clinical Features and Prevalence of... : Neurology Today - LWW Journals

New treatment option brings hope to patients with neurological disease – WCVB Boston

Posted on September 25, 2020 by Danzig

Neurological diseases, like Parkinson's, are often devastating. The symptoms, including tremors and twisting limbs, can be painful and embarrassing, but a new treatment device is giving patients hope and doctors access to information they've never had before.At 12 years old, John Caldwell received a difficult diagnosis."They called it an essential tremor which means you have a tremor but they don't know why you have it," Caldwell said.His hands would shake and over the years, he developed dystonia, a painful twisting in his neck. He was unable to turn his head. At one point, he was taking 25 pills a day to manage his symptoms.Last fall, his wife Diane heard about a new treatment option: a deep brain stimulation implant that would allow doctors to treat his symptoms and record his brain activity after the operation."It really can provide hope to people when they reach a stage where the medicine isn't working," said Dr. Mark Richardson, director of functional neurosurgery at Massachusetts General Hospital.He said deep brain stimulation has been a successful treatment option for neurological disease for 20 years but they didn't know the effect of that stimulation on a day-to-day basis."Now we have an additional tool we can use, which is we can see the person's own brain activity and how that's responding to stimulation," Richardson said.In July, Caldwell became the first patient in New England to undergo the minimally-invasive procedure. Richardson and his team used real-time MRI guidance to insert a wire the size of a spaghetti string into his brain. It delivers electrical stimulation to treat his symptoms and connects to a pacemaker-like device to track his brain activity."This is really a whole new window into brain function. This is data, information, we've never been able to see before," said Dr. Todd Herrington, director of the deep brain stimulation program at MGH.He said that new data will help them treat each specific patient in precisely the right way."For the first time, the device can actually record activity from the brain, which we think is going to be the brain activity underlying some of these symptoms, and we think that activity may help guide us in how we adjust the stimulator for each person," Herrington said.Herrington had told Caldwell it might take two to three months to find the right setting and bring relief but at this first follow up appointment, he was amazed."Like a wave of warm just came down my body, from my head and I was sitting there like 'What is this?'" Caldwell said."Dr. Herrington asked John to hold his hands out and I looked and one hand was tremoring and one hand was not and it was absolutely amazing to me that it worked. That it was possible and it happened and it was right before my very eyes," Diane Caldwell said.His dystonia also dramatically improved. He tracks any symptoms on this device to share at his follow-up appointments but says it's a miracle to have come so far. "What they gave me more than anything is hope. I never had hope that I could ever get out of this," Caldwell said.The hope is the device could one day read brain activity and provide stimulation in real time to treat symptoms. Richardson called it "The Holy Grail" of brain modulation.

At 12 years old, John Caldwell received a difficult diagnosis.

"They called it an essential tremor which means you have a tremor but they don't know why you have it," Caldwell said.

His hands would shake and over the years, he developed dystonia, a painful twisting in his neck. He was unable to turn his head. At one point, he was taking 25 pills a day to manage his symptoms.

Last fall, his wife Diane heard about a new treatment option: a deep brain stimulation implant that would allow doctors to treat his symptoms and record his brain activity after the operation.

"It really can provide hope to people when they reach a stage where the medicine isn't working," said Dr. Mark Richardson, director of functional neurosurgery at Massachusetts General Hospital.

He said deep brain stimulation has been a successful treatment option for neurological disease for 20 years but they didn't know the effect of that stimulation on a day-to-day basis.

"Now we have an additional tool we can use, which is we can see the person's own brain activity and how that's responding to stimulation," Richardson said.

In July, Caldwell became the first patient in New England to undergo the minimally-invasive procedure. Richardson and his team used real-time MRI guidance to insert a wire the size of a spaghetti string into his brain. It delivers electrical stimulation to treat his symptoms and connects to a pacemaker-like device to track his brain activity.

"This is really a whole new window into brain function. This is data, information, we've never been able to see before," said Dr. Todd Herrington, director of the deep brain stimulation program at MGH.

He said that new data will help them treat each specific patient in precisely the right way.

"For the first time, the device can actually record activity from the brain, which we think is going to be the brain activity underlying some of these symptoms, and we think that activity may help guide us in how we adjust the stimulator for each person," Herrington said.

Herrington had told Caldwell it might take two to three months to find the right setting and bring relief but at this first follow up appointment, he was amazed.

"Like a wave of warm just came down my body, from my head and I was sitting there like 'What is this?'" Caldwell said.

"Dr. Herrington asked John to hold his hands out and I looked and one hand was tremoring and one hand was not and it was absolutely amazing to me that it worked. That it was possible and it happened and it was right before my very eyes," Diane Caldwell said.

His dystonia also dramatically improved. He tracks any symptoms on this device to share at his follow-up appointments but says it's a miracle to have come so far.

"What they gave me more than anything is hope. I never had hope that I could ever get out of this," Caldwell said.

The hope is the device could one day read brain activity and provide stimulation in real time to treat symptoms. Richardson called it "The Holy Grail" of brain modulation.

Originally posted here:
New treatment option brings hope to patients with neurological disease - WCVB Boston

NIH study details self-reported experiences with post-exertional malaise in ME/CFS – National Institutes of Health

Posted on September 25, 2020 by Danzig

News Release

Monday, September 21, 2020

First publication from NIH ME/CFS study takes deep dive into key feature of the disease.

One of the major symptoms of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is post-exertional malaise (PEM), the worsening of symptoms after physical or mental activities. Using their own words and experiences, people with ME/CFS described how debilitating PEM can be in a study in Frontiers in Neurology. This is the first publication to come out of the National Institutes of Healths intramural post-infectious ME/CFS study.

Post-exertional malaise following normal activities is unique to ME/CFS and we do not understand the biology underlying this severe and harmful feature of the disease, said Walter Koroshetz, M.D., director of NIHs National Institute of Neurological Disorders and Stroke (NINDS). In-depth conversations with people who experienced post-exertional malaise and listening to them describe their individual experiences can provide a perspective not achieved through surveys. This study provides a window into just how much post-exertional malaise can affect a persons quality of life.

Researchers led by Avindra Nath, M.D., clinical director of NINDS, recruited 43 individuals with ME/CFS to participate in nine focus groups discussing their experiences with post-exertional malaise, including activities that led to it, how long it lasted, and techniques they used to help decrease their symptoms. Five out of the nine focus groups included participants who experienced PEM following a cardiopulmonary exercise test (CPET), which can measure how the body reacts to exercise and is often conducted using a stationary bike.

The focus groups were part of a larger study taking place at the NIH Clinical Center designed to take a comprehensive look at ME/CFS preceded by an infection. The goal of the larger study is to identify clinical and biological aspects of ME/CFS that may improve understanding of causes and how the disease changes over time. Dr. Nath and his colleagues will also examine the progression of PEM in study participants who undergo a CPET. The researchers included CPET experience in the PEM focus groups to assist in the design of the exercise challenge of the NIH ME/CFS study.

ME/CFS is a debilitating, chronic disease that may affect between 836,000 and 2.5 million people in the United States. In addition to PEM, people with ME/CFS will often experience pain, cognitive difficulties, and severe fatigue that does not improve with rest. The disease can affect all parts of the body including the immune, metabolic, cardiovascular, and neurological systems. There is no treatment for ME/CFS.

Qualitative analysis from the focus groups revealed that although the participants used a wide range of phrases to describe their experiences, many of their PEM symptoms fell into three core categories: exhaustion, cognitive difficulties, and neuromuscular complaints. Additional PEM symptoms included headaches, pain, nausea, sore throat, and sensitivity to light and sound. The onset of PEM is generally between 24 and 48 hours after exertion and can last from 24 hours to several weeks.

Almost everyone in the study indicated that complete rest, often in a dark and quiet room, was required to reduce the symptoms.

In addition, many participants described efforts to plan ahead and limit activities to avoid PEM, while also acknowledging that it can occur unexpectedly.

It was quite striking to hear the extent to which PEM can affect their quality of life, said Barbara Stussman, statistician at the NIHs National Center for Complementary and Integrative Health and lead author of the study. The widespread body symptoms, the unpredictability of PEM, and the sometimes-lengthy recovery greatly hindered individuals ability to live a normal life.

The study also identified, for the first time, differences between PEM caused by daily activities, such as grocery shopping or going to a doctors appointment, and PEM caused by the lab test CPET. The results suggest that the overall symptoms were similar, but PEM caused by the exercise test came on faster and lasted longer.

Additional research is required to learn more about the causes of PEM in people with ME/CFS. Future studies may identify sub-types of PEM, which may help guide targeted treatments.

This study was supported by the NIH Intramural Program.

The NINDS is the nations leading funder of research on the brain and nervous system.The mission of NINDS is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease.

About the National Institutes of Health (NIH):NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

NIHTurning Discovery Into Health

B Stussman et al. Characterization of Post-Exertional Malaise in Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Frontiers in Neurology, 2020.

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NIH study details self-reported experiences with post-exertional malaise in ME/CFS - National Institutes of Health

Gutmann receives award from neurological association – Washington University School of Medicine in St. Louis

Posted on September 18, 2020 by Danzig

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Honored for work on role of immune system in brain tumors

Gutmann

David H. Gutmann, MD, PhD, the Donald O. Schnuck Family Professor and vice chair for research affairs in the Department of Neurology at Washington University School of Medicine in St. Louis, has received the George W. Jacoby Award from the American Neurological Association for his discoveries on the role of the immune system in brain tumors.

The award is given once every three years to a scientist who has done especially noteworthy experimental work on any neurologic or psychiatric subject. Gutmann was recognized for a body of research showing that two kinds of immune cells microglia and T cells control the formation and growth of brain tumors in mice, similar to those arising in children with neurofibromatosis type 1 (NF1). The findings could lead to new ways to help doctors predict which brain tumors are most likely to become life-threatening, and opens up new avenues to prevent or treat brain tumors.

Gutmann will accept the award at the American Neurological Association annual meeting in October, which will be held online.

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Gutmann receives award from neurological association - Washington University School of Medicine in St. Louis

Extended-Release Amantadine Improves Walking Speed in Patients With MS – Neurology Advisor

Posted on September 18, 2020 by Danzig

The following article is part of conference coverage from the 8th Joint American Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) and European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) MSVirtual2020 event. Neurology Advisors staff will be reporting breaking news associated with research conducted by leading experts in neurology. .

The extended release capsule form of amantadine (ADS-5102), FDA approved as Gocovri for the treatment of dyskinesia in Parkinson disease, displayed a dose-response for both tolerability and efficacy. This suggests potential clinically meaningful benefits for walking speed in patients with multiple sclerosis (MS), according to study results presented at the 8th Joint American Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) and European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) MSVirtual2020 event, held September 11-13, 2020.

The pharmacokinetic profile of ADS-5102 enables once-daily bedtime dosing, providing a higher drug concentration throughout the day and lower concentrations at night. This phase 3 study, INROADS, was designed to assess the benefits of ADS-5102 on walking speed in patients with MS, as well as the drugs safety.

The INROADS study began with 4 weeks of placebo followed by 12 weeks of double-blind testing. Of 594 patients from Canada or the United States with MS and walking impairment, 560 were randomly assigned, 1:1:1, to placebo (n=186), 274 mg ADS-5102 (n=185), or 137 mg ADS-5102 (n=187). The primary study endpoint was the proportion at week 16 showing a statistically significant increase in response rate. This was defined as 20% improvement from baseline in timed 25-foot walk [T25FW], measured in feet/second, compared to performance on placebo. Patients without an assessment at week 16 were considered nonresponders.

At week 16, 274 mg ADS-5102 displayed 21.1% (P =.01) improvement, 137 mg ADS-5102 displayed 17.6% (P =.08) improvement, and placebo displayed 11.3% improvement in response rate. Results indicated that 274 mg ADS-5102 met the primary objective of a statistically significantly greater response rate vs placebo. Among the subjects completing the study, response rates were 11.9% for placebo vs 28.3% (P <.001) for 274 mg, and 19.6% (P =.049) for 137 mg. Most observed adverse events (AEs) included dry mouth, peripheral edema, constipation, urinary tract infection, fall, and insomnia. These AEs led study researchers to discontinue the study for 20.5% of 274 mg participants, 6.4% of 137 mg participants, and 3.8% of placebo participants.

Study investigators concluded, INROADS met its primary objective of showing clinically meaningful benefit in MS walking speed for 274 mg ADS-5102. A dose-response was seen for both efficacy and tolerability. They added that observed AEs matched the known safety profile of amantadine, and that results indicated that ADS-5102 may help improve walking in patients in MS, particularly those who have tried and discontinued dalfampridine.

Visit Neurology Advisors conference section for continuous coverage from the ACTRIMS/ECTRIMS MSVirtual2020 Forum.

Reference

Cohen J, Cameron M, Goldman M, et al. Phase 3 Study Results Assessing the Efficacy and Safety of ADS-5102 (Amantadine) Extended Release Capsules in MS Patients With Walking Impairment. Presented at: 8th Joint American Committee for Treatment and Research in Multiple Sclerosis and European Committee for Treatment and Research in Multiple Sclerosis MSVirtual2020 event; September 11-13, 2020; Poster P0225.

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Extended-Release Amantadine Improves Walking Speed in Patients With MS - Neurology Advisor

New Technology Promises to Restore Movement in Paralyzed Arms – UPMC

Posted on January 20, 2021 by Danzig

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In a paper published today in Nature Communications, Dr. Marco Capogrosso, assistant professor in the Department of Neurological Surgery at the University of Pittsburgh School of Medicine, proposed a new technology to improve arm and hand movements in individuals with arm paralysis due to spinal cord injury, stroke or other movement disorders.

In collaboration with colleagues in Switzerland, Capogrosso and his team combined physics simulations with experiments in macaque monkeys and humans to demonstrate that epidural electrical stimulation of specific regions in the spinal cord can be used to activate arm and hand muscles.

This work is very important for clinical applications, said Capogrosso, senior author of the paper, who is also part of the Pitt Rehab Neural Engineering Labs. To design effective therapies for paralysis, we need to selectively engage hand and arm muscles by providing the surviving neural circuits with appropriate electrical signals. In practice, this means that we need to know where to implant electrodes and how to design them and our work provides guidance to that.

Epidural stimulation is a neurotechnology that is used to treat pain caused by damage or injury to the nerves in thousands of patients every year. For this procedure, a surgeon implants a small neurostimulation device consisting of thin electrode wires over the spinal cords protective coating. When the device is turned on, it can send electric signals to the damaged nerve fibers and stimulate them, restoring the spinal circuits and dampening the feeling of pain after the injury.

However, modern spinal cord stimulators are not intended to target the cervical neural circuits necessary for arm and hand movement. Therefore, the scientists proposed and tested a modified design of multi-electrode spinal implants that were fitted to monkeys spinal cord dimensions.

To determine the optimal placement of electrodes in the cervical spinal cord where neural circuits that control arm movements are located researchers used insights from in silico, or computer, experiments and reproduced them in monkeys. Combining computer simulation with animal studies allowed researchers to reduce the number of animals needed to collect meaningful data as part of an effort called the Three Rs (Replacement, Reduction, Refinement) that strives to minimize the use of animals in research. And, because the monkeys cervical spine is anatomically and functionally similar to the humans, scientists were able to approximate the arm and hand movement in people very closely.

I think our graduate students Nathan Greiner, Beatrice Barra and the other members of the team did great work in building up from basic science concepts to design this practical technology while minimizing the number of animals used in this research, added Capogrosso.

However, there is still significant work to do to optimize this technology for use in people.

Capogrosso moved to Pittsburgh in January 2020 and joined the Department of Neurological Surgery to use the impressive resources of UPMC to bring this technology to patients as soon as possible. Thanks to collaborations with neurosurgeons such as Dr. Peter Gerszten, Capogrosso hopes to start testing the implant in patients soon.

Using the tools developed by other researchers, such as Dr. Fang-Cheng Yeh at the Department of Neurological Surgery and Dr. Elvira Pirondini at the Department of Physical Medicine and Rehabilitation, they will use precise MRI imaging to target electrode implantation in humans and reproduce the results obtained in monkeys.

Hopefully, well see the first results in humans in 2021, Capogrosso said.

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New Technology Promises to Restore Movement in Paralyzed Arms - UPMC

Study Examines Neurologic Emergencies at the Extremes of Age – Pharmacy Times

Posted on February 6, 2021 by Danzig

Raquel S. Mateus, PharmD Candidate

PediatricsInvestigators highlighted 4 emergency conditions in the pediatric population: acute ischemic stroke (AIS), intracranial hemorrhage, fever and altered mental status (AMS), and seizures.1

Pediatric stroke is rare, and children younger than 5 years are the most likely to experience AIS. Children with AIS can also present with AMS, fever, or seizure. The management of pediatric stroke requires administering weight-based tPA.1

In intracranial hemorrhage, many principles of adult care are the same in pediatric patients. However, guidelines are less clear about target blood pressure in the pediatric population. In cases of cerebral edema or impending herniation, administration of either mannitol or hypertonic saline are equally acceptable.1

When a pediatric patient presents with AMS, pharmacists and other health care providers should consider acute disseminated encephalomyelitis (ADEM) and antiN-methyl-D-aspartate receptor encephalitis (NMDAR). Both ADEM and anti-NMDAR encephalitis require early initiation of steroids and empiric treatment for bacterial and viral meningitis.

In pediatric patients, seizures can take many forms, such as neonatal seizures and nonconvulsive status epilepticus. Neonatal seizures can present with mouthing (touching hands and objects to the lips or placing them in the mouth), horizontal eye deviation, blinking, or single limb extension. First-line treatment is phenobarbital 20 mg/kg.1,2

Nonconvulsive status epilepticus is associated with higher mortality, longer pediatric ICU stays, and increased long-term disability. Treatment includes a trial of a short-acting antiepileptic medications and close observation.1

ElderlyThe researchers also focused on 4 neurologic conditions in the elderly: AIS, AMS, Parkinson disease, and meningitis.1

Some atypical AIS presentations in the elderly include dizziness, falls, headache, nausea, vomiting, difficulty walking, seizure, and urinary incontinence. Advanced age alone is not a contraindication for IV tPA within 3 hours. Around 25% of older adults in the ED have some form of AMS. The Delirium Triage Screen is a valid tool to diagnose delirium, another form of cognitive impairment.1

Parkinson disease is a neurodegenerative disorder affecting 1% of the population above the age of 60 years. Acute worsening in Parkinson disease is usually due to a medication change, infection, or missed subdural hemorrhage.1

In bacterial meningitis, the elderly present with atypical symptoms and are less likely to have a fever, neck stiffness, rash, or leukocytosis. Empiric antibiotics should include vancomycin and a third-generation cephalosporin.1

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Study Examines Neurologic Emergencies at the Extremes of Age - Pharmacy Times

Global Interventional Neurology Device Market 2020 COVID-19 Updated Analysis By Product (Carotid artery angioplasty & stenting, Embolization &…

Posted on October 28, 2020 by Danzig

Global Interventional Neurology Device Market Report Details Out Market Overview, Market Valuation, And Future Market Prospective

The Interventional Neurology Device markets growth and development is significantly skyrocketing due to the current modernization and innovative futuristic scopes. TheInterventional Neurology Device marketreport mentions all the details regarding the latest techniques that are followed in order to meet the customers demand and supply. Some of the most important and intricate data including the market share, supply and demand statistics, growth factors, and investment dynamics are mentioned in such a clear format that the clients can grab the growth and development facets from the dossier for a piece of better global market knowledge. The current report helps open new doors for the global Interventional Neurology Device market. Some of the vital players W.L. Gore & Associates, Microport Scientific Corporation, Medikit Co., Ltd., Medtronic, Penumbra, Inc., Merit Medical Systems, Inc, Terumo Corporation, Stryker, Johnson and Johnson that are at present dominating the global platform include.

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To study and analyze the global valuation (size, revenue,& volume) based on key regions/countries, product type, application, and history data To understand the breakdown structure of Interventional Neurology Device market Studying the market valuation, competitive landscape, and recent development plans help gain better insight of the market Analyzing ample information such as opportunities, drivers, industry-specific challenges and risks that prompt the Interventional Neurology Device market growth To study competitive advances such as expansions, agreements, new product launches, and acquisitions, mergers among the key market players To analyze the strategic business strategies and its impact on the market growth rate

The informative research report has summarized even the government stringent rules and regulations, market segmentation, and expert practices. The transparency portrayed in the current dossier is bliss for both clients and other business players. Along with the current and forecast trends, even the historical details are penciled down for grasping a better outlook of the entire market on a global scale. The most important part is the regional segmentation North America (United States, Canada and Mexico), Europe (Germany, UK, France, Italy, Russia and Turkey etc.), Asia-Pacific (China, Japan, Korea, India, Australia, Indonesia, Thailand, Philippines, Malaysia and Vietnam), South America (Brazil, Argentina, Columbia etc.), Middle East and Africa (Saudi Arabia, UAE, Egypt, Nigeria and South Africa) of the Interventional Neurology Device market as the scale of growth across the globe can easily be depicted and understood.

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An Overview About the Table of Contents:

Global Interventional Neurology Device Market Overview Target Audience for the Interventional Neurology Device Market Economic Impact on the Interventional Neurology Device Market Global Interventional Neurology Device Market Forecast Business Competition by Manufacturers Production, Revenue (Value) by Region Production, Revenue (Value), Price Trend by Type Market Analysis by Application Cost Analysis Industrial Chain, Sourcing Strategy, and Downstream Buyers Marketing Strategy Analysis, Distributors/Traders Market Effect Factors Analysis

The Interventional Neurology Device market report has a paragraph dedicated to the market segmentation {Carotid artery angioplasty & stenting, Embolization & coiling, Neurothrombectomy Devices}; {Treatment of Cerebral Aneurysms, Treatment of Cerebral Vasospasm, Vertebroplasty} mentioned in a bifurcated form for an easy grip on the global market. From the current contextual report, the clients get knowledge about the trade and industry, stringent industrial practices, profit and loss statistics, growth benefits, product demand and supply, economic fluctuations, and future market scope. The current research report basically aims towards only providing the customers with the entire market study and ongoing trends with just a single click in a simple and brief format.

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Global Interventional Neurology Device Market 2020 COVID-19 Updated Analysis By Product (Carotid artery angioplasty & stenting, Embolization &...

8 foods and drinks that are common migraine triggers, according to a neurologist – Insider – INSIDER

Posted on November 20, 2020 by Danzig

Have you ever wondered if that glass of red wine with dinner might have triggered the pounding headache you felt later that night? The answer might be yes.

"Several studies show a link between food and beverages and migraines," says Thomas Berk, MD, neurologist and headache specialist at NYU Langone Health and Assistant Professor of Neurology at NYU Grossman School of Medicine.

Migraine affects over one billion people worldwide, and 39 million in the US alone. Learn more about the disease, including the most common foods that can trigger a migraine.

The difference between headaches and migraines is largely to do with the severity of the pain.

A headache can be uncomfortable and last for hours to days. Whereas a migraine is considered to be a neurological disease and the most debilitating type of headache, with more than 90% of sufferers incapable of working or doing normal activities during a migraine attack.

"A headache is any kind of pain in the head or face, and there are over 120 different kinds of headaches, which include migraines," says Berk.

A migraine generally includes severe throbbing pain, typically on one side of the head, and it can last from four to 72 hours. Additional symptoms may include sensitivity to light, sound, and smell, nausea, vomiting, and a visual disturbance known as an aura.

"There is no universal food or beverage that triggers migraines," says Berk. Everyone predisposed to migraines has different triggers, some of which may be food or drink-related. Whatever the trigger may be, all migraine triggers affect the brain in the same way by lowering the threshold to migraines.

Here's an example of what could happen. You drink a glass of wine, which is a migraine trigger for you. That drink leads to the creation of inflammatory neurotransmitters that are produced in the brain. Those neurotransmitters make the blood vessels around the brain dilate, and the nerve endings send signals back to the brain to feel symptoms such as pain, sensitivity to light, nausea, and more.

Based on Berk's research and discussions with patients, here is his list of the eight most common foods, drinks, and food-related triggers for migraine headaches:

"Migraine disease is complex and affected by many factors," says Simy Parikh, MD, program director of Thomas Jefferson University's Post-Graduate Certificate Program in Advanced Headache Diagnosis and Management and Assistant Professor in the Department of Neurology at Thomas Jefferson University.

Here Parikh offers some steps you can take to potentially reduce migraine triggers:

Eat healthily and consistently. You may have noticed that the migraine trigger list was lacking a few major food groups "healthy" foods such as fruits, vegetables, and protein, in particular. A 2020 review showed that most "migraine-friendly" healthy eating plans, such as low-fat diets, provided a decrease in the frequency of migraine attacks.

In addition to eating healthy foods, it's important to keep a consistent eating schedule to avoid migraines.

"Low blood glucose can trigger headaches," says Parikh. To keep your blood sugar steady, eat at roughly the same time every day without an extended amount of time between meals, she says. Parikh also suggests to all of her patients to maintain a healthy diet and weight.

Track food triggers and eliminate them from your diet. Since multiple factors contribute to migraines, many sufferers keep a headache diary. This is where they can list the frequency, duration, and intensity of migraines, as well as possible triggers, including food and drink.

If a food, beverage, or additive is identified as a possible trigger, Parikh suggests avoiding it for a month to see what happens. It's important to eliminate only one potential exposure each month, otherwise, you won't be certain what is triggering an attack.

Tracking the impact of a dietary change can help distinguish actual food triggers from migraine-associated food cravings. It's also important to work with a doctor when making any diet changes, says Parikh.

Get your sleep. Sleep and migraine are closely linked. A 2020 review showed the two-way relationship between sleep disorders and migraines. In other words, poor sleep quality is a trigger for migraines, and migraine sufferers are also at an increased risk of sleep disorders. To reduce the risk of sleep as a trigger for migraines, Parikh recommends that her patients stick to a specific sleep schedule.

Reduce stress. Stress can also trigger migraines. In fact, in one study, four out of every five people with migraines reported stress as a trigger. Here are some ways to reduce stress:

Certain foods, drinks, and additives may trigger migraines, and tracking them in a headache diary with one elimination per month may be helpful. Getting good quality sleep, exercise, and reducing stress can also reduce migraine attacks.

Migraines can be brutally painful and life-altering. The causes of migraines are complex and not always known. However, research has shown that there are ways to potentially lessen the frequency, duration, and intensity of attacks.

Parikh emphasizes that it's important to support migraine sufferers and not blame them for trigger exposures that may provoke migraine attacks. "There are many factors that come together to cause migraines, and you can do everything 'right' and still get them," she says.

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8 foods and drinks that are common migraine triggers, according to a neurologist - Insider - INSIDER

What is Trending in Neurovascular Devices Interventional Neurology Market? What are the Strategies to Boost Business in Near Years? – The Daily…

Posted on November 20, 2020 by Danzig

Latest Neurovascular Devices Interventional Neurology Market Research Report Cover Covid-19 Impact:

The Neurovascular Devices Interventional Neurology report provides an independent information about the Neurovascular Devices Interventional Neurology industry supported by extensive research on factors such as industry segments size & trends, inhibitors, dynamics, drivers, opportunities & challenges, environment & policy, cost overview, porters five force analysis, and key companies

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In this report, our team offers a thorough investigation of Neurovascular Devices Interventional Neurology Market, SWOT examination of the most prominent players right now. Alongside an industrial chain, market measurements regarding revenue, sales, value, capacity, regional market examination, section insightful information, and market forecast are offered in the full investigation, and so forth.

Scope of Neurovascular Devices Interventional Neurology Market: Products in the Neurovascular Devices Interventional Neurology classification furnish clients with assets to get ready for tests, tests, and evaluations.

Major Company Profiles Covered in This Report

Stryker Corporation , Medtronic PLC , Johnson & Johnson , Terumo Corporation , Penumbra, Inc. , Boston Scientific Corporation , Microport Scientific Corporation , Merit Medical Systems, Inc. , W.L. Gore & Associates, Inc. , Abbott Laboratories

Have Any Query Or Specific Requirement?Ask Our Industry Experts!

Neurovascular Devices Interventional Neurology Market Report Covers the Following Segments:

Segmentation by Type:Aneurysm Coiling & Embolization DevicesEmbolic CoilsBare Detachable CoilsCoated Detachable CoilsFlow Diversion DevicesLiquid Embolic AgentsCerebral Balloon Angioplasty and Stenting SystemsCarotid Artery StentsEmbolic Protection SystemsDistal Filter DevicesBalloon Occlusion DevicesSupport DevicesMicrocathetersMicroguidewiresNeurothrombectomy DevicesClot Retrieval DevicesSuction and Aspiration DevicesSnaresSegmentation by Application:Ischemic StrokesCerebral AneurysmsArteriovenous Malformation and FistulasOther Disease pathology

Market Size Segmentation by Region & Countries (Customizable):

North America

Europe

Asia-Pacific

South America

Center East and Africa

United States, Canada and Mexico

Germany, France, UK, Russia and Italy

China, Japan, Korea, India and Southeast Asia

Brazil, Argentina, Colombia

Saudi Arabia, UAE, Egypt, Nigeria and South Africa

Table of Content:

Market Overview:The report begins with this section where product overview and highlights of product and application segments of the global Neurovascular Devices Interventional Neurology Market are provided. Highlights of the segmentation study include price, revenue, sales, sales growth rate, and market share by product.

Competition by Company:Here, the competition in the Worldwide Neurovascular Devices Interventional Neurology Market is analyzed, By price, revenue, sales, and market share by company, market rate, competitive situations Landscape, and latest trends, merger, expansion, acquisition, and market shares of top companies.

Company Profiles and Sales Data:As the name suggests, this section gives the sales data of key players of the global Neurovascular Devices Interventional Neurology Market as well as some useful information on their business. It talks about the gross margin, price, revenue, products, and their specifications, type, applications, competitors, manufacturing base, and the main business of key players operating in the global Neurovascular Devices Interventional Neurology Market.

Market Status and Outlook by Region:In this section, the report discusses about gross margin, sales, revenue, production, market share, CAGR, and market size by region. Here, the global Neurovascular Devices Interventional Neurology Market is deeply analyzed on the basis of regions and countries such as North America, Europe, China, India, Japan, and the MEA.

Application or End User:This section of the research study shows how different end-user/application segments contribute to the global Neurovascular Devices Interventional Neurology Market.

Market Forecast:Here, the report offers a complete forecast of the global Neurovascular Devices Interventional Neurology Market by product, application, and region. It also offers global sales and revenue forecast for all years of the forecast period.

Research Findings and Conclusion:This is one of the last sections of the report where the findings of the analysts and the conclusion of the research study are provided.

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Neurology Devices Market Revenue, Growth Rate, Customer Needs, Trend, Manufacturers and Forecast to 2025 – Express Journal

Posted on October 25, 2020 by Danzig

Latest research with COVID-19 impact analysis of Global Neurology Devices Industry 2025 Situations, Growth, Prospects, & Sales Market is analyzed. The deep-dive analysis of Neurology Devices market development factors, risks & market maturity analysis is conducted. The research study is segmented based on top product types, applications, companies, & end-users. The Neurology Devices industry share & size analysis is conducted. The forecast strategies, Neurology Devices business plans, changing dynamics & policies are studied comprehensively. The crucial opportunities to focus on, market driving forces & statistics are evaluated.

The research report on Neurology Devices market offers a complete assessment of this business landscape while highlighting the production as well as the consumption aspects. Factors including growth drivers, limitations, and opportunities impacting the market dynamics are also specified in the document. A detailed five Porters analysis of each company operating in this industry is conducted to conclude emerging prospects.

The study specifies the major business strategies which offer a robust profit potential. However, the advent of COVID-19 outbreak may have major modifications in the expansion of the overall market. Thus, the report assesses and provides detailed assessment of the impact of COVID-19 pandemic on the market remuneration.

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Neurology Devices research provides answers to the following key questions:

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Meet the Doctor: Deep Brain Stimulation at Memorial Hermann The Woodlands – hellowoodlands.com

Posted on October 28, 2020 by Danzig

Meet the Doctors of Memorial Hermann The Woodlands Medical Center who share information and experience on Deep Brain Stimulation, a surgical treatment option for patients suffering from Parkinsons disease and essential tremors.

Watch the video below with the Hello Woodlands interview with Dr. Allison Boyle and Dr. Saman Javedan:

Video produced by Rod Prado and Jennifer Bruse of Hello Woodlands

Dr. Allison Boyle is a board-certified neurologist specializing in neurology and movement disorders. Dr. Boyle is certified in botulinum toxin injections for dystonia, muscle spasm, sialorrhea or tremor; intrathecal baclofen pump therapy for the control of significant or severe spastic or dystonic tone; deep brain stimulation therapies for the control of tremor, signs and symptoms of Parkinsons disease and focal, segmental or generalized dystonia; and lumbar punctures.

Dr. Saman Javedan is a board-certified neurosurgeon and is board certified by the American Board of Neurological Surgery (ABNS). His areas of expertise include complex cranial tumors, complex spinal tumors, spinal reconstruction, spinal fusions, minimally invasive spine surgery, movement disorders, deep brain stimulation (DBS) and stereotactic radiosurgery (SRS).

Memorial Hermann-Texas Medical Center was the first hospital in Texas to implant the Food and Drug Administration (FDA) approved Percept PC Deep Brain Stimulation system by Medtronic in patients with neurologic disorders. With the investment of new technology and experienced doctors, the procedure is now available at Memorial Hermann The Woodlands Medical Center. The first-of-its-kind neurostimulator uses BrainSense Technology and has the ability to capture and record the users brain signals while delivering therapy to patients with neurologic disorders associated with such conditions as Parkinsons disease, essential tremor, dystonia, epilepsy or obsessive-compulsive disorder.

Patients undergo the deep brain stimulation system implantation in two phases over two hospital visits. During the first visit, the patient undergoes surgery to have electrodes implanted in their brain. On the patients second visit, connecting wires and neurostimulator is implanted.

Deep brain stimulation is a surgical treatment option for patients suffering from Parkinsons disease and other movement disorders. Through a small pacemaker-like device, the brain is sent mild electrical signals to a targeted area in the brain related to the symptoms of a neurological disorder. The signals help reorganize the brains electrical impulses and results in improved symptoms for many neurological conditions.

For more information on deep brain stimulation treatment at Memorial Hermann The Woodlands Medical Center visit http://neuro.memorialhermann.org/conditions-treatments/deep-brain-stimulation/.

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Stroke Incidence Slightly Higher in Hospitalized Patients With COVID-19 – Neurology Advisor

Posted on October 10, 2020 by Danzig

In patients hospitalized with coronavirus disease 2019 (COVID-19), stroke was associated with those who were older and presented with stroke risk factors. They were found to have a slightly higher frequency of stroke compared with the estimation for the general population, according to study results published in the Journal of Stroke and Cerebrovascular Diseases.

Study researchers sought to investigate the frequency and clinical characteristics of patients with both COVID-19 and stroke. This analysis was a systematic review of observational studies, case series, and case reports that disclosed the incidence of ischemic or hemorrhagic stroke in patients with COVID-19. In total, 10 retrospective cohort studies, 10 case reports, and 6 case series were included in the final meta-analysis. A pooled cohort of 183 patients with both COVID-19 and stroke were assessed.

Among the 6368 hospitalized patients with COVID-19, the reported frequency of stroke was 1.1% (95% CI, 95% CI, 0.6-1.6; I2=62.9%). The mean age of the study cohort was 66.6 years (95% CI, 58.4-74.9; I2=95.2%), and over half of the patients were men (65.6%). Comorbidities included hypertension (69.4%), dyslipidemia (44.4%), diabetes (43.5%), acute coronary syndrome/coronary artery disease (26.9%), atrial fibrillation (23.1%), prior stroke/transient ischemic attack (10.4%), and malignancy (14.8%).

In patients who had data describing their stroke type, approximately 96.6% had ischemic stroke. The mean number of days from the onset of COVID-19 symptoms to stroke was 8 days (95% CI, 4.1-11.9; I2=93.1%; I2=93.1%; P <.001). The mean D-dimer was 3.3 g/mL (95%CI, 1.7-4.9; I2=86.3%), and the mean C-reactive protein level was 127.8 mg/L (95% CI, 100.9-154.6; I2=0%).

In 50.7% of patients, the etiology of stroke was cryptogenic (95% CI, 31.0-70.4; I2=64.1%). Among 100 patients, the case fatality rate was 44.2% (95% CI, 27.9-60.5; I2=66.7%).

Limitations of this study included the small sample size, potential publication bias in the included case reports and series, and the presence of considerable heterogeneity in the pooled patient population.

The study researchers concluded that additional studies could be helpful to decipher the pathophysiology and prognosis of stroke in COVID-19 to achieve the most effective care for this population to decrease mortality.

Reference

Yamakawa M, Kuno T, Mikami T, Takagi H, Gronseth G. Clinical characteristics of stroke with COVID-19: A systematic review and meta-analysis. J Stroke Cerebrovasc Dis. 2020;29(12):105288. doi:10.1016/j.jstrokecerebrovasdis.2020.105288

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Stroke Incidence Slightly Higher in Hospitalized Patients With COVID-19 - Neurology Advisor

Amicus Therapeutics Announces Additional Positive Interim Clinical Data for CLN6 Batten Disease Gene Therapy at 49th Annual Meeting of the Child…

Posted on October 16, 2020 by Danzig

CRANBURY, N.J., Oct. 12, 2020 (GLOBE NEWSWIRE) -- Amicus Therapeutics (Nasdaq: FOLD) today announced additional positive interim results from its CLN6 Batten disease gene therapy program, AT-GTX-501. The results are featured in a virtual poster presentation at the Joint 16th International Child Neurology Congress and 49th Annual Child Neurology Society Meeting being held October 12-23, 2020. The presentation is also available in the Events and Presentations section of the Amicus Therapeutics corporate website at http://ir.amicusrx.com/events-and-presentations.

The Abigail Wexner Research Institute (AWRI) at Nationwide Childrens Hospital is conducting the ongoing Phase 1/2 clinical study of a single one-time intrathecal administration of AT-GTX-501 gene therapy for variant late-infantile neuronal ceroid lipofuscinosis 6 (vLINCL6) disease, also known as CLN6 Batten disease. With no approved treatments, CLN6 Batten disease is a fatal neurologic disease that rapidly robs children of their ability to walk, speak, think, and see.

Clinical Data Highlights:Interim safety data are available for 13 children with CLN6 Batten disease. Interim efficacy data are available for the first 12 children reaching the 12-month timepoint and for eight children up to 24 months, post-administration of the AAV-CLN6 gene therapy.

Jeff Castelli, Ph.D., Chief Development Officer ofAmicus Therapeutics, stated, We are pleased to share these positive interim clinical data for our intrathecal AAV gene therapy with the CLN6 community. The data continues to suggest that our gene therapy has the potential to be a treatment option for children living with CLN6 Batten disease, an ultra-rare, debilitating condition that leads to progressive declines in cognitive and motor function, and often results in death early in life.

Emily de los Reyes, M.D., Ph.D., Principal Investigator of the CLN6 clinical trial at AWRI at Nationwide Childrens andProfessor of Clinical Pediatrics and Neurology at The Ohio State University College of Medicine, stated, I remain pleased with the progress of this trial as well as our collection of natural history data to further inform the results for the AAV-CLN6 gene therapy. The interim results show that this investigational gene therapy has the potential to slow the neurological disease progression in children with CLN6 Batten disease.

Regulatory interactions for AT-GTX-501 are ongoing and the Company expects to provide feedback on the path forward in 2021.

Amicus has exclusive rights to the CLN6 gene therapy program developed at the Abigail Wexner Research Institute at Nationwide Childrens Hospital.

About AT-GTX-501AT-GTX-501 is a novel gene therapy in Phase 1/2 development for CLN6 Batten disease, a rare, fatal, inherited lysosomal disorder with no approved treatment that primarily affects the nervous system. AT-GTX-501 is dosed in a one-time intrathecal infusion to deliver a functional copy of the CLN6 gene to cells of the central nervous system. The therapy is designed to address the underlying enzyme deficiency that results in progressive cell damage and neurodevelopmental and physical decline. In the U.S., AT-GTX-501 was granted Rare Pediatric Disease and Orphan Drug designations by the United States Food and Drug Administration. In the EU, the Company holds PRIME and orphan medicinal product designations.

About Batten DiseaseBatten disease is the common name for a broad class of rare, fatal, inherited disorders of the nervous system also known as neuronal ceroid lipofuscinoses, or NCLs. In these disorders, a defect in a specific gene triggers a cascade of problems that interferes with a cells ability to recycle certain molecules. Each gene is called CLN (ceroid lipofuscinosis, neuronal) and given a different number designation as its subtype. There are 13 known forms of Batten disease often referred to as CLN1-8; 10-14. The various types of Batten disease have similar features and symptoms but vary in severity and age of onset.

Most forms of Batten disease/NCLs usually begin during childhood. The clinical course often involves progressive loss of independent adaptive skills such as mobility, feeding and communication. Patients may also experience vision loss, personality changes, behavioral problems, learning impairment and seizures. Patients typically experience progressive loss of motor function and eventually become wheelchair-bound, are then bedridden and die prematurely.

About Amicus Therapeutics Amicus Therapeutics (Nasdaq: FOLD) is a global, patient-dedicated biotechnology company focused on discovering, developing and delivering novel high-quality medicines for people living with rare metabolic diseases. With extraordinary patient focus, Amicus Therapeutics is committed to advancing and expanding a robust pipeline of cutting-edge, first- or best-in-class medicines for rare metabolic diseases. For more information please visit the companys website at http://www.amicusrx.com, and follow on Twitter and LinkedIn.

Forward-Looking StatementsThis press release contains "forward-looking statements" within the meaning of the Private Securities Litigation Reform Act of 1995 relating to preclinical and clinical development of our product candidates, the timing and reporting of results from preclinical studies and clinical trials and the prospects and timing of the potential regulatory approval of our product candidates. In particular, this press release relates to interim data from an ongoing Phase 1/2 study to investigate intrathecal administration of AAV-CLN6 gene therapy. The inclusion of forward-looking statements arising from this interim data, ongoing study and natural history preliminary data should not be regarded as a representation by us that any of our plans will be achieved. Any or all of the forward-looking statements in this press release may turn out to be wrong and can be affected by inaccurate assumptions we might make or by known or unknown risks and uncertainties. For example, with respect to statements regarding the goals, progress, timing, and outcomes of discussions with regulatory authorities, and in particular the potential goals, progress, timing, and results of preclinical studies and clinical trials, actual results may differ materially from those set forth in this release due to the risks and uncertainties inherent in our business, including, without limitation: the potential that results of clinical or preclinical studies indicate that the product candidates are unsafe or ineffective; the potential that it may be difficult to enroll patients in our clinical trials; the potential that regulatory authorities, including the FDA, EMA, and PMDA, may not grant or may delay approval for our product candidates; the potential that preclinical and clinical studies could be delayed because we identify serious side effects or other safety issues; and the potential that we will need additional funding to complete all of our studies. Further, the results of earlier preclinical studies and/or clinical trials may not be predictive of future results. The interim data and Phase 1/2 study discussed herein is inherently preliminary and early in the study, derived from a limited patient set, and later trial results with this patient set or others may not be consistent with these preliminary results. In addition, all forward-looking statements are subject to other risks detailed in our Annual Report on Form 10-K for the year ended December 31, 2019 and Quarterly Report on Form 10-Q for the quarter ended June 30, 2020. You are cautioned not to place undue reliance on these forward-looking statements, which speak only as of the date hereof. All forward-looking statements are qualified in their entirety by this cautionary statement, and we undertake no obligation to revise or update this news release to reflect events or circumstances after the date hereof.

CONTACTS:

Investors:Amicus TherapeuticsAndrew FaughnanDirector, Investor Relationsafaughnan@amicusrx.com(609) 662-3809

Media:Amicus TherapeuticsDiana MooreHead of Global Corporate Communicationsdmoore@amicusrx.com(609) 662-5079

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Amicus Therapeutics Announces Additional Positive Interim Clinical Data for CLN6 Batten Disease Gene Therapy at 49th Annual Meeting of the Child...

Opera Steamboat virtual seminars to tackle neurological health with discussion of 1985 book-turned-opera – Steamboat Pilot and Today

Posted on October 9, 2020 by Danzig

STEAMBOAT SPRINGS Opera Steamboat has announced plans to host two virtual seminars this month discussing neurological health themes from the book The Man Who Mistook His Wife for a Hat. The book was published in 1985 by neurologist Oliver Sacks and was subsequently turned into an opera the following year by composer Michael Nyman.

The seminars will introduce the content of the book and help set the stage for Opera Steamboats 2021 performance of the opera.

These seminars came as an idea to address the health issues around rural Colorado that as an organization we see on a regular basis, said Andres Cladera, general and artistic director of Opera Steamboat. Specifically, we wanted to address the neurological illnesses and mental health issues that our community are experiencing, while having difficulty getting treatment and/or support for the caregivers and families.

Cladera pointed out that up until recently, Steamboat did not have a regular neurologist on staff and patients would have to travel to Denver on a regular basis to seek treatment.

We have a lot of patrons and community members in Steamboat who have gone through neurological illnesses themselves or have taken care of a family member who has Parkinsons disease or Alzheimers, Cladera said. We want to bring awareness to the topic so that people can think about it and discuss it. Its not always easy to find treatment or care in rural Colorado.

The Man Who Mistook His Wife for a Hat describes the case histories of several of Sacks patients with the title based on one case in particular of a patient whom he refers to as Dr. P, who suffers from visual agnosia, a neurological condition that leaves him unable to recognize faces and objects.

Speakersfor the two seminars will include Dr. Ron Krall, a retired neurologist who lives in Steamboat; Dr. Samantha K. Holden, who is the assistant professor of neurology and medical director of the Memory Disorders Clinic at UCHealth, and Barbara Bronner, a retired licensed medical social worker focusing on issues of aging and caregiver support groups for the Alzheimers Association. Cladera will be a fourth speaker, discussing minimalism in the opera and how it relates to neuro illness.

Using music as a way of coping and understanding the world is a main theme, Cladera explained. When people suffer from neurological disorders, music can help them communicate and cope with their lives.

Dr. Krall, who owns Off the Beaten Path bookstore with his wife, will discuss the book.

From a literary standpoint, this is a book that is a piece of remarkable writing and reporting that makes for a wonderful education, he said. It illustrates the potential value of art in the treatment of the disease, in particular music, as it enables persons who have experienced some loss of neuro function to engage in relatively normal activities. Additionally, it teaches the importance of empathy for persons who have experienced a loss of function and support for them in obtaining care.

Those who wish to participate in the seminars can register for the two free seminars on Opera Steamboats website at operasteamboat.org/the-man-who-mistook-his-wife-for-a-hat.

The first seminar will take place at 5:30 p.m. Monday and the second at 5:30 p.m. Monday, Oct. 19. Participants will be emailed a Zoom link once they have registered.

Sophie Dingle is a contributing writer for Steamboat Pilot & Today.

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More Research Is Needed to Understand How Racism… : Neurology Today – LWW Journals

Posted on October 9, 2020 by Danzig

By Stephanie Cajigal October 8, 2020

Two neurologists contennd that stroke disparities are only partially explained by differences in the prevalence of traditional stroke risk factors between Black and White patients. They discuss the framework for understanding the effects of racism on stroke risk and where the field needs to go from here.

Black Americans are twice as likely to have a stroke and 40 percent more likely to die from one as compared with White Americans, according to the Centers for Disease Control and Prevention. Although decades of research have highlighted racial stroke disparities, there is a dearth of evidence on why they exist.

Now two prominent stroke neurologists are calling on the field to investigate how racism may impact vascular health. In an opinion article published online on August 21st in JAMA Neurology, Bruce Ovbiagele, MD, FAAN, and Olajide A. Williams, MD, note that stroke disparities are only partially explained by differences in the prevalence of traditional stroke risk factors between Black and White patients.

Dr. Ovbiagele, professor of neurology at the University of California San Francisco Weill Institute for Neurosciences, and Dr. Williams, professor and chief of staff of the department of neurology at the Columbia University Vagelos College of Physicians and Surgeons, recently spoke with Neurology Today about a framework for understanding the effects of racism on stroke risk and where the field needs to go from here.

Dr. Ovbiagele: While stroke disparities have been well documented, we haven't fully resolved what all the explanations or solutions are. This is an issue that has been pervasive for five decades. As you saw from the article, we can only explain about half of what seems to be contributing to Black-White disparity in terms of stroke outcomes.

Dr. Williams: I think the nation is sensitized, the world is sensitized, given the events of George Floyd in addition to the devastating disparities that were illuminated by COVID-19. Bruce and I have been working within the world of health disparities for decades, but it's amazing just how few Americans understand the severity of these disparities and how they impact all of us. I think COVID really showed the interconnectedness of all of us in society, whether you are the cleaning person going into a patient's room, or whether you are the physician walking into it, or a nurse, or a nursing aide. If one of those people in that chain has COVID, everyone is at risk. It shows we have to take care of the least among us. We thought we should take advantage of this moment by expanding the knowledge of the academic community on this topic.

Dr. Williams: Institutionalized racism is the codification of discrimination and bias into the structures of societies. These structural biases are driven by individual-level biases. For example, if I put a group of biased individuals on the governance committee of a particular organization, those individuals will translate their bias into policies and procedures. And then there is internalized racism, which is the effect of chronic racism on an individual. Chronic discrimination, chronic dehumanization, chronic marginalization causes the individual on the receiving end to ask, what is my worth? Before you know it, that individual will start internalizing the worth that society has placed on him. Once you internalize racism, it can be self-destructive.

What happens across these different levels is the systematic denial of opportunities such as access to health care. There is also the denial of diversity within health care by discriminating against people of color seeking admission into the medical field. This was highlighted by the Flexner Report [on medical education in the United States and Canada, originally published in 2010].

So structurally, you're being denied access, denied opportunities, and denied the ability to improve diversity within medicine. Personally, you're experiencing daily discrimination. Bruce and I included the Everyday Discrimination Scale in our paper to highlight the daily injustices experienced by people of color as a result of personally mediated racism. That in itself can be quite traumatic; it can generate anxiety, it can generate chronic stress responses, which in turn can lead to higher levels of inflammation, hypertension, etc. Couple that with decreased access to get these things fixed; couple that with decreased motivation to get these things addressed because you don't value yourself. Now you're dealing with a perfect storm that may lead to strokes and earlier mortality among people of color.

Dr. Ovbiagele: What we do know is that on the surface, at least, there are clearly differences in the timeliness and appropriateness of care that is delivered to Black people either at risk for stroke or who have experienced stroke. Can you categorically say that is due to racism? It is very hard to say. But that is what we are trying to call people to look into. If we don't have clear evidence pointing in one direction, it would be hard to design interventions or solutions to address it.

Dr. Williams: The 2013 Institute of Medicine report, Unequal Treatment, reviewed examples of implicit biases in medicine and showed quite tangibly that due to implicit bias, Black individuals may not receive the same level of pain treatment as White individuals. They showed that Black individuals may not get appropriate referrals for cardiac catherization compared to White individuals. We need much more rigorous research into this area in order to best determine where our resources should be focused.

Dr. Ovbiagele: Specifically, for stroke, as noted in the American Stroke Association Racial-Ethnic Disparities in Stroke Care statement in 2011. Black individuals have longer waiting times in the emergency department and are less likely to receive tPA or carotid revascularization procedures than White individuals.

Dr. Williams: I think the vascular effects of racism need to be better studied. For example, we now know the effects of rumination on blood pressure. We know that among people who are exposed to a racist eventsuch as when police pull someone over, grab him/her out of their car, and handcuff that person because he/she is Blackblood pressure surges due to the acute stress response at that moment. But these events are not isolated experiences, and so the cycle repeats itself. Moreover, the events are also replayed in your mind in the form of recurrent nightmares, the post-traumatic stress disorder of that experience. So not only is the experience continuing to happen in the real world, you're also being assaulted by the memory of the experience over and over again. All this causes vascular effects and inflammatory responses.

Dr. Ovbiagele: We need more representation of people of color but especially African-Americans in trials... I think we need to incorporate measures of discrimination and racism into trials as well. I would like to see those as endpoints in trials. I think those are the things that could be done almost immediately, and it would be wonderful to get the NIH to encourage that. I think grooming more researchers of all stripes; it doesn't have to be just people of color, who are interested in health inequities, to consider studying the issue of racism, would also be very important. We need more training programs to help people develop their careers in stroke disparities research. We need all hands-on deck if we are actually going to successfully tackle this issue.

Dr. Williams: There aren't enough Black neurologists, certainly not enough Black stroke neurologists to do the volume of work required. Because this is a societal problem, it's critically important for us to mobilize not just people of color, but allies who feel passionate about this injustice to join hands and help with the research and solutions.

Dr. Ovbiagele: Advocacy with nongovernmental organizations, professional organizations like the American Academy of Neurology, the American Neurological Association, the American Stroke Association, as well as major funders like the NIH. And, also not to just make this an American issue...this is a call to motivate a global cohort of people to address potentially racism-contributing stroke disparities in their countries.

Dr. Williams: There have been many acts of racism in medicine against the Black community, such as [the Tuskegee Study of Untreated Syphilis in the Negro Male] that have really drowned the confidence that people of color have with the health care system. They need truth and reconciliation. They need to be told that it's not in their minds; it's not in their heads. This is real, and it happened, and it is still happening. There needs to be acknowledgment before there is that recovery.

Dr. Williams: It all begins with the individual. I would say, listen, learn, and become an ally.

Dr. Ovbiagele: Undergo implicit bias and cultural sensitivity awareness training. Look at your own practice and routinely examine whether there are racial differences in care and outcomes among the stroke patients you see and address them. Lend your voice to support studies and programs aiming to eliminate this prominent and long-standing health disparity in our country. In Forecasting the Future of Stroke in the United States (Stroke. 2013;44:2361-2375), it's been projected that racial/ethnic disparities in stroke will likely worsen with time, without new concerted efforts, so there is no time like the present to strongly address this issue.

Drs. Williams and Ovbiagele reported no relevant disclosures.

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