Select Page ::

The aging brain: Exploring the connection between neurology and elevation – Summit Daily News

Posted on September 16, 2020 by Danzig

ASPEN It isnt noticeable at first. It starts with changes for which the brain can compensate, meaning no real impact on day-to-day functions or cognition.

But as time passes, the brain can no longer compensate for the damage its experiencing. Subtle problems with memory and thinking begin to pop up. Subtle turns to noticeable. Noticeable turns to difficulty carrying out everyday activities. Eventually, around-the-clock care is required.

This is the broad view progression from preclinical to severe Alzheimers disease, a degenerative brain disease that becomes worse with time and age, and is the most common cause of dementia, according to the Alzheimers Association.

In Colorado, an estimated 76,000 people are living with Alzheimers dementia, and that number is expected to increase 21% to 92,000 by 2025, a 2020 Alzheimers Association report states. As of July 2019, 14.6% of Coloradans, or about 840,000 people, were 65 or older, U.S. Census Bureau data shows.

While its been shown that living in higher elevation communities can lead to a more active, healthier lifestyle and even prolonged life, its less clear how living at high elevation correlates with degenerative brain diseases.

In short, the answer is complicated and not well researched.

As far as I know, there isnt a lot of evidence one way or another about high altitudes versus low altitudes for Alzheimers disease risk, said Dr. Huntington Potter, director of the Alzheimers and Cognition Center at the University of Colorado Anschutz Medical Campus. We cant say one way or another whether high altitude is a risk factor for Alzheimers.

At the Alzheimers and Cognition Center, which is part of the CU Anschutz Medical Campus and School of Medicine, clinicians and researchers are dedicated to discovering effective early diagnostics, preventions, treatments and ultimately cures for Alzheimers disease and related neurodegenerative disorders, according to its website.

For Potter, that means looking at biomarkers or diagnostic proteins in the blood that can help clinicians predict the disease earlier, conducting projects that look at the lifespan of people with Alzheimers disease, and other research that can quickly be translated to better care, treatment and hopefully a cure.

Right now, the center is studying a drug called Leukine, which preliminary data shows might improve Alzheimers disease in the short term, Potter explained. The center also is studying other drugs that attack the disease.

Leukine may be the first one we found that looks promising, but we have several coming up that look promising, as well, Potter said.

When it comes to looking at the potential correlation between living at high elevation and the risk for dementia-inducing diseases, Potter and Dr. Peter Pressman of the Alzheimers and Cognition Center said it would take great effort, time and funding to research.

Assistant professor for the Department of Neurology, Dr. Peter S. Pressman works in his office at the University of Colorados Anschutz Medical Campus in Aurora on Thursday, Sept. 10. Photo by Liz Copan / Studio Copan

Assistant professor for the Department of Neurology, Dr. Peter S. Pressman is pictured outside his office building at the University of Colorados Anschutz Medical Campus in Aurora on Thursday, Sept. 10.Photo by Liz Copan / Studio Copan

Show CaptionsHide Captions

Pressman, who is a behavioral neurologist and researcher with the center, said on top of securing and carefully selecting a large group of people living at elevation to participate in a study, researchers also would have to follow that group for about a decade to get meaningful results.

Its easy to fund a study for a few years, Pressman said. People give you money to do something for two to three years, but two to three years is not enough time for a process as slow as Alzheimers and dementia to really even pick up. Im not saying thats not possible. Its doable, but it would take some effort.

Dr. Brooke Allen, neurologist, founder of Roaring Fork Neurology in Basalt and medical director at Renew Roaring Fork, an assisted living and memory care center in Glenwood Springs, expressed similar thoughts.

As a part of any mild cognitive impairment or dementia evaluation, Allen said her team checks the oxygen level a patient has and considers the elevation at which that person spends most of their time.

Lower oxygen levels can contribute to people experiencing confusion, dizziness and mild short-term memory issues. But outside of looking at oxygen levels and how they could be contributing to symptoms, Allen said she doesnt consider elevation a higher risk situation.

Allen said she feels High Country residents 65 and older tend to be much younger than their age in terms of their lifestyle, which is a positive in terms of dementia prevention.

About four years ago, Allen and her team conducted a long-term preclinical Alzheimers trial as part of the Alzheimers Prevention Initiatives Generation Program, a study that looked at the effectiveness of preventative treatments for individuals between 65 and 75 who had no symptoms of dementia.

Allen said more than 250 people came in to participate in the study and all generally led healthy, active lifestyles.

I think in our valley, Ive experienced meeting those kinds of people and not thinking of altitude as a risk factor but as a lifestyle opportunity in a rural area like ours, Allen said about the people who participated in the study.

Looking at the potential correlation between living at high elevation and risk of degenerative brain diseases is not just a difficult feat for Colorado researchers. Little research with concrete findings exists nationally or globally.

One study published in 2015 by Dr. Stephen Thielke in JAMA Psychiatry looked at deaths attributed to Alzheimers dementia reported in 58 counties in California to try to determine whether rates of dementia were associated with average elevation of residence. The study found that the counties at higher elevation generally had lower rates of dementia mortality.

Additional work is needed to determine whether this relationship holds in other populations, the study notes.

But beyond this study, there isnt much conclusive evidence for or against a correlation, as emphasized by Dr. Brent Kious, a psychiatrist, assistant professor and researcher with University of Utah Health and the schools Department of Psychiatry.

Kious has studied the link between living at high elevations and major depressive disorder, anxiety and suicide, and he said he and his research team have been interested in the impact of elevation on the incidence and median age of onset of Parkinsons disease.

However, Kious said decrements in cognitive performance due to chronic exposure to moderately high elevation might not necessarily translate into an increased risk of dementia.

It is not clear whether altitude would affect those neurodegenerative processes or not, though there is some reason to think that they involve oxidative damage so relative hypoxia might slow them, Kious wrote in an email. He went on to note that relative and prolonged hypoxia, or a lack of oxygen, has been associated with dementia risk. In any case, a good epidemiological study of the association between altitude and dementia should control for things that might be associated with both.

Karen Eck, 60, of Silverthorne, picks tomatoes at the Timberline Adult Day Program garden in Frisco on Thursday, Sept. 10. Eck, who was diagnosed with early onset Alzheimers, attends programs three to four times a week at the center.Photo by Jason Connolly / Jason Connolly Photography

Karen Eck, 60, of Silverthorne, waters tomatoes at the Timberline Adult Day Program garden in Frisco on Thursday, Sept. 10. Eck, who was diagnosed with early onset Alzheimers, attends programs three to four times a week at the center.Photo by Jason Connolly / Jason Connolly Photography

Karen Eck, 60, of Silverthorne, poses for a portrait at the Timberline Adult Day Program garden in Frisco on Thursday, Sept. 10. Eck, who was diagnosed with early onset Alzheimers, attends programs three to four times a week at the center.Photo by Jason Connolly / Jason Connolly Photography

Karen Eck, 60, of Silverthorne, enters the Timberline Adult Day Program in Frisco on Thursday, Sept. 10. Eck has early onset Alzheimers.Photo by Jason Connolly / Jason Connolly Photography

Karen Eck, 60, of Silverthorne, leaves the Timberline Adult Day Program garden in Frisco after watering tomatoes on Thursday, Sept. 10. Jason ConnollyPhoto by Jason Connolly / Jason Connolly Photography

Show CaptionsHide Captions

While theres not good data for or against high elevation as a risk factor for degenerative brain diseases, there is evidence that people living in more rural communities do not have the same access to dementia care and treatment as those living in urban areas.

According to the 2020 Snapshot of Rural Health in Colorado, produced by the Colorado Rural Health Center, 721,500 people are living in rural Colorado and 19% of the rural population is age 65 or older. Rural is defined as a nonmetropolitan county with no cities over 50,000 residents.

Chad Federwitz a gerontologist, or specialist in the study of aging, and manager of Pitkin County senior services said he hasnt seen any correlation between living at high elevation and dementia risk. Anecdotally, he does know that people move to Grand Junction or the Front Range if they have dementia because of a lack of care resources in the High Country.

Given the nature of our rural-ish community, we dont have the same resources, Federwitz said, referring to things like long-term assisted living and memory care options. You can go to Grand Junction or the Front Range and have pages and pages of resources as opposed to here.

While there are some dementia care resources in more rural Colorado communities, the Alzheimers and Cognition Center is working to do more to develop meaningful relationships with health care providers and dementia patients in the states mountain communities as part of its mission.

According to Pressman, who is heading this charge on behalf of the CU center, a lot of projects are in the planning stages but include virtually educating medical providers, nurse practitioners and primary care doctors on Alzheimers and general healthy brain aging as well as mutual, participatory research with rural Colorado communities and communities of color.

Pressman explained that a lot of research related to Alzheimers overwhelmingly is based on middle-class, well-educated, white participants. And so while researchers think they know a lot about the disease in general, they really only know about the disease related to this demographic group.

Through the centers outreach and efforts to better connect with underrepresented communities, Pressman hopes to conduct better science and better serve the larger Colorado community.

What motivates me is trying to do good work, trying to do good science and to make sure our results actually represent real life, Pressman said. We want to make sure were helping everybody, not just a niche group, and that our services are available equitably to as many people as possible.

Editors note: This is Part 2 of a four-part series on longevity in the High Country. The series is being produced in partnership with The Aspen Times, Glenwood Springs Post Independent, Steamboat Pilot & Today and Vail Daily. Read more at SummitDaily.com/longevity.

Go here to see the original:
The aging brain: Exploring the connection between neurology and elevation - Summit Daily News

What you need to know about neurological symptoms after COVID-19 – Patch.com

Posted on September 20, 2020 by Danzig

By Dr. Paul Wright, Senior Vice President and System Chair of Neurosciences, Nuvance Health

Summary:

At Nuvance Health, we're seeing patients who are thankful because they recovered from COVID-19, but are now worried because they have lingering neurological symptoms. Nationwide, a small number of people who recovered from COVID-19 are reporting neurological concerns such as headache, dizziness, lingering loss of smell or taste, muscle weakness, nerve damage, and trouble thinking or concentrating sometimes called "COVID fog" or "brain fog".

There's still much to learn about COVID-19 because it's a new virus, including possible long-term neurological complications. What we do know is that it's important to talk with your healthcare clinician if you have any health concerns after recovering from the virus.

Here's what you can do if you or a loved one experiences lingering neurological concerns after COVID-19 infection.

Neurological concerns after recovering from COVID-19

Patients of all ages are reporting lingering neurological symptoms after COVID-19 infection. At Nuvance Health, most of the patients we're seeing with these symptoms are between the ages of 30 and 60. It's important to stress that only a small number of patients are experiencing these neurological after-effects and although neurological symptoms are certainly possible, they aren't common.

In most cases, patients with neurological symptoms report brain fog or feeling as if they aren't quite back to normal weeks or months after recovering from COVID-19. Other lingering symptoms are headaches that affect their quality of life and ability to function, and loss of taste or smell.

The COVID-19 virus itself, as well as the symptom of fever and chills, can lead to muscle aches that usually resolve within a few days or weeks after contracting the virus. However, neurological specialists are also seeing some patients who experience increasing muscle weakness after recovering from COVID-19.

What to do about lingering neurological symptoms

If you or a loved one is experiencing lingering or unexplained neurological symptoms after recovering from COVID-19, you should make an appointment with your primary care clinician or a neurologist.

Early evidence shows that some lingering symptoms, such as brain fog, may improve over time, and lingering symptoms could be related to the virus itself. However, you could have an underlying health condition that was previously undiagnosed or an autoimmune problem that was triggered by the COVID-19 infection, which is why it's important to have a medical exam. Your healthcare clinician will take a thorough personal and family history and conduct an exam to make sure there's no other cause for your symptoms.

In some cases, you may be able to have a Virtual Visit, which is a safe and secure way to remotely connect with your healthcare clinician. If an in-person visit is required, Nuvance Health is taking precautions to reduce the risk of COVID-19 transmission in its facilities. Precautions include:

Mental health concerns

COVID-19 has affected nearly every aspect of our lives, from how we shop for food and access healthcare services to how we work and whether we send our kids to school. It's common for individuals to be afraid of the virus's unknown effects, which can cause anxiety that may manifest itself in different ways, such as inability to sleep, sadness, and feelings of dread.

It's important to be vigilant and protect yourself, your loved ones, and your fellow community members from COVID-19 infection. Still, you also need to make sure you're eating healthy, exercising, and taking care of your mental health by connecting with others and doing things you enjoy.

If you're experiencing symptoms of anxiety or depression whether you are recovering from COVID-19 or not you should seek help by reporting it to your healthcare clinician.

It may also help to remember that as we learn more about COVID-19, we're developing effective ways to prevent transmission and treat the virus. We're also learning more about possible complications and how the virus may effect individuals differently. For example, even though some initial reports stated that strokes were common among younger patients with COVID-19, the stroke rate among younger patients across the country doesn't appear to be as high as originally thought.

The bottom line: COVID-19 is still new, and experts don't fully understand the potential long-term health effects of the virus. If you're experiencing neurological symptoms or mental health concerns after COVID-19 infection, an evaluation by a healthcare clinician is your next step toward recovery.

Dr. Paul Wright has more than 18 years of experience in neurology. Board certified in psychiatry and neurology, Dr. Wright has extensive research experience including studying the effectiveness of novel therapies such as electroceuticals to treat neurological diseases.

To learn more about neurology at Nuvance Health, visit our websites: Connecticut Neurology | New York Neurology

CONTACTAmy Forni, Manager, Public Relations(203) 739 7478 | Amy.Forni@nuvancehealth.org

About Nuvance HealthNuvance Health is a family of award-winning nonprofit hospitals and healthcare professionals in the Hudson Valley and western Connecticut. Nuvance Health combines highly skilled physicians, state-of-the-art facilities and technology, and compassionate caregivers dedicated to providing quality care across a variety of clinical areas, including Cardiovascular, Neurosciences, Oncology, Orthopedics, and Primary Care.

Nuvance Health has a network of convenient hospital and outpatient locations Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital and Vassar Brothers Medical Center in New York plus multiple primary and specialty care physician practice locations, including The Heart Center, a leading provider of cardiology care, and two urgent care offices. Non-acute care is offered through various affiliates, including the Thompson House for rehabilitation and skilled nursing services, and the Home Care organizations. For more information about Nuvance Health, visit our website. TTY: 1-800-421-1220

Excerpt from:
What you need to know about neurological symptoms after COVID-19 - Patch.com

Emory investigates how COVID-19 affects the… – SaportaReport

Posted on September 16, 2020 by Danzig

Featured Image: (L-R) Barbara Johnson, Elizabeth Matthews and Mikisha Johnson. When Elizabeth Matthews (center, pictured with daughter Barbara Johnson, left, and Mikisha Johnson, right) had a stroke, doctors discovered she also had COVID-19. From strokes to mental health, the Emory Brain Health Center is leading research on the neurological effects of the pandemic.

By Emory University

Mikisha Johnson hung up the phone. On the call, her 83-year-old grandmother, Elizabeth Matthews, had struggled to string words together and sounded disoriented.

Grandmama doesnt sound right, Mikisha told her mother, Barbara.

When Barbara Johnson arrived the following morning at her parents home in the southwest Atlanta neighborhood of Collier Heights, her mother didntlookright either.

I said Mama, youre slurring your words, your mouth is twisted and your hand is trembling, Barbara Johnson said. You are going to the hospital.

Elizabeth Matthews already had a pretty good idea what was wrong, but she didnt want to worry her daughter.

I said to my husband, I believe I had a stroke, she recalled.

She was right. But that wasnt all. At that visit in early August, doctors at Emory St. Josephs Hospital told Matthews shed also tested positive for COVID-19.

I got real emotional when they told me that, Matthews said. I was thinking, Am I going to die?

Since the COVID-19 outbreak began late last year, it has largely been understood as an assault on the respiratory system. Telltale symptoms are often a fever, hacking cough and difficulty breathing; patients in the worst shape end up on respirators.

What is still less understood, but just as alarming, is the damage the virus may be doing to the brain, from strokes like Matthews to reports of headaches, seizures and confusion. And that doesnt even take into account the staggering toll of the pandemic on our mental health.

Today, more than 300 studies from around the world have looked at links between neurological problems and COVID-19. More are underway.

We are now recognizing COVID-19 disease actually has a significant neurological implication or neurologic effect, said Byron Milton III, MD, a physiatrist, or physical medicine and rehabilitation doctor, at Emory University Hospital who has helped COVID patients cope with dementia-like symptoms and other neurological problems.

(L-R) Barbara Johnson, Elizabeth Matthews and Mikisha Johnson. Elizabeth Matthews (center, with daughter Barbara Johnson, left, and granddaughter Mikisha Johnson, right) battled back from stroke and COVID-19. Shes looking forward to a new grandchild, due in late September.

Even as they care for patients, researchers and health care providers at the Emory Brain Health Center are among those leading the way toward understanding the short- and long-term neurological implications of the pandemic on the brain and the mind.

Those efforts are featured in Season 2 of the Your Fantastic Mind television series from Georgia Public Broadcasting and Emory University, which debuted Sept. 9 and continues through Oct. 14.

One of the things that really sets Emory apart is the multi-disciplinary way the Brain Health Center works, said Jonathan Lewin, MD, Emorys executive vice president for health affairs and executive director of the Woodruff Health Sciences Center.

Emory combines neurology, psychiatry and behavioral sciences, neurosurgery, rehabilitation medicine and sleep medicine. Thats proving to have a real benefit during this pandemic, where were learning so much about the virus every day and the ways it can impact us in ways we might not expect.

Read the full story at news.emory.edu >>

Anti-NMDA Receptor Encephalitis With Visual Hallucinations and Cognitive Impairment – Psychiatric Times

Posted on September 16, 2020 by Danzig

FROM THE ACADEMY OF CONSULTATION-LIAISON PSYCHIATRY

CASE REPORT

Ms Zorn was a 45-year-old woman with no previous psychiatric history who presented with a 2-month period of feeling like I am losing myself and seeing visually distorted faces. Faces of people she was looking at would appear to be hideously elongated, with the facial components distorted, as if it was melting. Cars would also appear to be more round than usual.

She was admitted to an inpatient psychiatry unit for unspecified psychosis, but after 2 days she was transferred to a general medical unit for additional medical evaluation. She was started on 25-mg quetiapine bid, which was titrated to 200 mg bid. Lumbar puncture was completed to rule out central nervous system infection or autoimmune encephalopathy, with results pending at the time of transfer to an academic medical center for higher level of multispecialty care.

On interview, she said that she felt like she was losing herself and reported visual distortions of faces melting. Ms Zorn was able to recognize faces and colors. She reported photophobia. She had headaches, which were relieved with ketorolac. Her husband reported that she had new onset of episodes of shaking her arms in a circular motion. She would also walk around the room in circular patterns while saying to herself that she was lost.

Ms Zorn had decreased appetite, weight loss, and decreased sleep. She denied depressed mood, decreased energy, mania, trauma, or previous problems with memory. She denied auditory hallucinations and suicidal/homicidal ideation. She denied a family history of suicide and psychiatric illness. Developmental history was unremarkable. She had no history of substance abuse.

On mental status examination, she was awake, alert, oriented to person, time, place, and situation. She continued to experience visual distortions of faces melting. Ms Zorns thought process was linear and coherent. Affect was mildly anxiously perplexed, non-labile, and non-tearful. Speech was normal. Insight and judgment were marginal. Her Montreal Cognitive Assessment (MoCA) score was 10/30. Her decisional capacity was impaired, and the screening neurological examination was non-focal.

Due to the atypical presentation of psychotic disorder, the full workup included a neurology consultation; brain MRI and lumbar puncture results were normal, except for autoimmune encephalitis results that were pending. Serum HIV, syphilis, vitamin B12, lead, rapid plasma regain (RPR), anti-nuclear antibody ammonia, and thyroid stimulating hormone (TSH) levels were normal; EEG was unremarkable. Pelvic ultrasound and CT were ordered to rule out ovarian teratoma. Quetiapine regimen was changed to 100 mg in the morning and 300 mg in the evening.

Ms Zorn was seen in follow-up on hospital day 2. Neurology had started her on 1-g methylprednisolone daily for a 5-day course for presumed autoimmune encephalitis. She was placed on a continuous EEG. On exam, she reported feeling better compared with the previous day. She no longer reported any distortions of faces or objects in the room, although she did report some blue dots in her field of view. She had 3 hours of sleep the previous night. Her husband noted that the she had decreased episodes of her aimless pattern of waving her arms in a circular motion. Her MoCA score was 14/30. Due to the significant improvement in her hallucinations following the first dose of methylprednisolone, the scheduled quetiapine was held.

When seen on hospital day 3, Ms Zorn said that she could fall asleep, but had trouble staying asleep. She had an episode where she got up and walked around the room purposelessly. Her MoCA score was 13/30 and decisional capacity was impaired. Quetiapine 50 mg post merdien (PM) was started to address poor sleep. On hospital day 4, she reported that her visual phenomena had returned, with her seeing pixels (flashing punctate lights) and faces melting. She had had difficulty sleeping. MoCA was 12/30 with continued limited insight, judgment, and decisional capacity. Quetiapine was increased to 100 mg pm and mirtazapine 7.5 mg pm was started to improve sleep.

On hospital day 5, her husband reported that she had had continued visual phenomena of pixels and faces melting. Ms Zorn was only able to sleep for 1.5 hours after receiving quetiapine and mirtazapine. On exam, she reported the visual hallucinations and had a MoCA score of 12/30. Continuous EEG was reported as normal and abdomen CT was negative for ovarian teratoma. To address continued psychosis and poor sleep, quetiapine was increased to 100 mg am and 300 mg pm. Mirtazapine was increased to 15 mg pm.

Ms Zorn was seen again on hospital day 6. She reported that she had been able to sleep for 8 hours. She denied any visual melting of faces but stated that the world looked pixelated at times. MoCA score was 14/30. Subsequently, when seen on hospital day 8, she stated that she was still seeing pixels in the periphery of her visual field. MoCA score improved to 17/30. Quetiapine was consolidated to 400 mg pm.

She was next seen on hospital day 10. The cerebrospinal (CSF) encephalopathy panel came back positive for anti-NMDA receptor antibody R1, confirming a diagnosis of anti-NMDA (N-methyl-D-aspartate)-receptor encephalopathy (ANMDARE). Neurology started plasmapheresis for 7 treatments, every other day. She had no hallucinations. She reported that she was getting deep sleep. MoCA score was 16/30. A quetiapine 50 mg am dose was added.

Plasmapheresis started on hospital day 11. The patient denied any visual distortions. She said that she felt significantly better than the previous week; MoCA score was 16/30. When next seen on hospital day 15, Ms Zorn reported sleeping from 11:00 pm to 5:30 am. She denied visual distortions. MoCA score had improved to 21/30; however, decisional capacity continued to be impaired. On hospital day 18, she was doing well. She had declined her scheduled quetiapine the previous day to give it a try. She no longer saw distorted faces. She had no gait disturbance. MoCA score improved further to 25/30. Given her improved mental status, the psychiatry team decided that she had recovered her decision-making capacity. Mirtaza-pine was decreased to 7.5 mg pm and quetiapine held.

Ms Zorn was seen for the last time on day 22 of hospital admission. After her final plasmapheresis treatment, she continued to be free of psychotic symptoms. She stated that she was doing better than last week, and that she was 80% back to normal. She was sleeping well and was increasingly physically active during the day. She was excited to return home; MoCA score was 22/30. Decisional capacity continued to be intact. Mirtazapine 7.5 mg bedtime was continued.

As she was medically stable for discharge, she was referred for psychiatric follow-up near her home. She was advised that any future recurrence of psychosis should first be addressed as if it was a recurrence of delirium and/or ANMDARE.

Discussion

ANMDARE is a relatively recently described illness that may present with psychiatric symptoms, neurologic symptoms, or both (either simultaneously or sequentially).1-5 While the exact mechanism remains obscure, antibodies to the NMDA receptor (on CSF and/or serum assay) is confirmatory.2 Management includes empiric treatment of manifest symptoms and immunomodulation systemic therapies.4,5

ANMDARE is important to the consultation-liaison psychiatrist for a number of reasons. First, its presentation lies in the neuropsychiatric borderland involving collaboration between psychiatry and neurology (as in other neuropsychiatric illnesses like Parkinson disease, Huntington disease, and multiple sclerosis). Second is its importance in the often hard-to-define syndrome of atypical psychotic disorder. In comparison to the classic presentation of schizophrenia, ANMDARE features a later age of onset, female predominance, visual hallucinations, relative lack of cognitive disorganization, and a lack of an extended prodromal period.

This case illustrates the atypical presentation of psychotic illness rather well. Ms Zorn was in her mid-40s, of high academic and professional achievement, adaptive social function; without a clear prodrome, she relatively promptly developed a psychotic picture with striking and disturbing visual hallucinatory phenomena. Clinical suspicion for ANMDARE was confirmed with reference laboratory (Mayo Clinic) results of + R1 antibody to NMDA receptor on CSF analysis. This was accomplished in the context of a thorough laboratory evaluation for other esoteric causes of atypical psychotic illness.

Empiric treatment of the psychiatric symptoms with mirtazapine and quetiapine, concurrent with 2 rounds of immunomodulation therapy, led to amelioration of symptoms and near complete cognitive recovery in a period of 2.5 weeks. Her cognitive status based on objective measure with the Montreal Cognitive Assessment (MoCA) was initially in the moderate to severely impaired range.6 With comprehensive treatment, Ms Zorns cognitive status improved to a level of only mild impairment. Correspondingly, her decisional capacity improved from significantly impaired to largely intact over the same period.

Psychiatrists assessing and treating patients with atypical presentation of psychotic illness should actively consider a diagnosis of ANMDARE as explanatory.3,4 In female patients with suspicion of ANMDARE, pelvic ultrasonography and/or CT scan should be ordered to rule out commonly co-occurring ovarian teratoma.1 Patients with ANMDARE who are treated with high-dose intravenous corticosteroids should be monitored (and treated for) any corticosteroid-associated psychiatric adverse effects, which can overlap with the atypical psychotic symptoms at illness onset. Empiric treatment with psychopharmacology for psychotic and/or depressive symptoms should be pursued, although such medications may not be necessary indefinitely once definitive immunomodulation therapy is completed.4

ANMDARE should be on the differential for atypical psychosis, with an expectation of a thorough search for laboratory and systemic clinical (especially neurologic) findings, empiric treatment of psychiatric symptoms, and reassessment of the patient as immunomodulation therapy is completed. Prospective study of ANMDARE illness cohorts are needed to quantify recurrence risk, need for ongoing intervention, and ultimate prognosis.

Consultation-liaison psychiatrists working in academic medical centers may be in a position to assist multispecialty teams in the identification, diagnosis, management, and ongoing follow-up of these patients. As with any illness that affects cognitive function, attention to and serial assessment of decisional capacity is a critical part of C-L psychiatry care, especially as pertains to patient consent for major immunomodulation therapies.

Dr Bourgeois is chair, Department of Psychiatry, Baylor Scott & White Health, Central Texas Division, and clinical professor for medical education, Texas A&M University Health Science Center, Temple, TX. Mr Li is a medical student, Texas A&M University Health Science Center, Temple, TX. The authors report no conflicts of interest concerning the subject matter of this article.

References

1. Tuzun E, Zhou L, Baehring JM, et al. Evidence for antibody-mediated pathogenesis in anti-NMDAR encephalitis associated with ovarian teratoma. Acta Neuropathol. 2009;118:737-743.

2. Gresa-Arribas N, Titulaer MJ, Torrents A, et al. Antibody titres at diagnosis and during follow-up of anti-NMDA receptor encephalitis: a retrospective study. Lancet Neurol. 2014;13:167-177.

3. Kayser MS, Titulaer MJ, Gresa-Arribas N, Dalmau J. Frequency and characteristics of isolated psychiatric episodes in anti-N-methyl-d-aspartate receptor encephalitis. JAMA Neurol. 2013;70:1133-1139.

4. Warren N, OGorman C, McKeon G, et al. Psychiatric management of anti-NMDAR encephalitis: a cohort analysis. Psychol Med. November 19, 2019; Epub ahead of print.

5. Titulaer MJ, McCracken L, Gabilondo I, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol. 2013;12:157-165.

6. Nasreddine Z. Montreal Cognitive Assessment (MoCA) Administration and Scoring Instructions. Montreal Cognitive Assessment. Accessed July 9, 2020. http://www.mocatest.org/wp-content/uploads/2015/tests-instructions/MoCA-Instructions-English_2010.pdf .

Read the rest here:
Anti-NMDA Receptor Encephalitis With Visual Hallucinations and Cognitive Impairment - Psychiatric Times

Study Published in JAMA Neurology Confirms Low-Field MR Imaging Using Hyperfines Swoop Portable MRI Successfully Detects Abnormalities at Bedside of…

Posted on September 16, 2020 by Danzig

Single-center prospective study evaluated feasibility of bedside MR neuroimaging in the intensive care settings for 50 critically-ill patients with COVID-19, stroke, hemorrhage, traumatic brain injury and tumors.

A recent study published in the Journal of the American Medical Association Neurology demonstrates for the first time the feasibility of Hyperfines Swoop Portable MRI System to obtain bedside neuroimaging for critically-ill patients in the intensive care unit settings. Researchers tested the feasibility and demonstrated the clinical utility of the Swoop system in 50 patients, including COVID-19 patients, to assess brain injury and detect abnormalities. These patients were critically ill and presented challenges for transport to conventional MRI suites in the Radiology Department.

This press release features multimedia. View the full release here: https://www.businesswire.com/news/home/20200909005243/en/

Hyperfines Swoop Portable MRI System successfully detects abnormalities at bedside of critically-ill patients in intensive care unit settings. (Photo: Business Wire)

Results from the prospective, observational single-center study, Assessment of Brain Injury Using Portable, Low Field Magnetic Resonance Imaging at the Bedside of Critically Ill Patients, were published on September 8, 2020.

Investigators used the Swoop system from October 2019 through May 2020 and successfully detected abnormal neuroimaging findings at the bedside of patients presenting with ischemic stroke, hemorrhagic stroke, subarachnoid hemorrhage, traumatic brain injury, brain tumor and COVID-19 patients with altered mental status.

According to the studys senior author, Kevin N. Sheth, MD (Yale University School of Medicine, Department of Neurology), the use of traditional MRI units presents accessibility and transportation challenges in the care of critically-ill patients. Furthermore, the highly contagious nature of COVID-19 patients makes bedside MR imaging compelling for infection control protocols.

This study the first of its kind demonstrates that deployment of portable MR imaging to patients' bedsides could fill an important gap for time-sensitive neuroimaging, a cornerstone of triage and treatment pathways.

The study authors conclude, "This experience demonstrates that low-field, portable MRI can be deployed successfully into intensive care settings. This approach may hold promise for portable assessment of neurological injury in other scenarios, including the emergency department, mobile stroke units, and resource-limited environments."

Magnetic Resonance Imaging uses a magnetic field, radio waves and a computer to produce detailed pictures of the body's internal structures that are clearer, more detailed and more likely in some instances to identify and accurately characterize disease than other imaging methods. However, fixed MRI systems can be inconvenient and inaccessible for providers and patients, particularly when time is critical. Transport to the MR suite demands complicated scheduling coordination, moving patients, and, often, 4 to 6 hour patient backlogs all which compromise the utility of MRI as a diagnostic tool in time-sensitive settings such as intensive care units and emergency rooms. Furthermore, high capital investments, electrical power needs and significant maintenance requirements present a barrier to adoption across all populations, acutely so for developing countries and rural geographies.

Story continues

About the Swoop Portable MRI System

Hyperfines Swoop system was designed to address the limitations of current imaging technologies and make MRI accessible anytime, anywhere, to any patient. Swoop wheels directly to the patients bedside, plugs into a standard electrical wall outlet, and is controlled by a wireless tablet such as Apple iPad. Images are captured at the patients bedside, with results in minutes, enabling critical decision-making capabilities across a variety of clinical settings including neuro intensive care units, emergency departments, pediatrics, ambulatory outpatient surgery centers and more. The complete Hyperfine system costs less than the annual service contract alone for most current MRI systems, and it consumes 35 times less power than those same systems. Designed as a complementary system to traditional MRIs, new users can be trained on system operation, device navigation and device safety in about 30 minutes, helping clinicians to streamline workflow.

About Hyperfine Research

Hyperfine lives to make MR imaging available to everyone. The Swoop Portable MR Imaging System is the result of a total rethink of MRs potential in the healthcare landscape. What if MR imaging didnt require a dedicated suite, extensive training or expensive upkeep? Lets use the wonders of high-field MRI for the appropriate patients, and deploy Swoop system at the point-of-care for everyone else. Hyperfine received market-ready FDA clearance for its portable MR imaging for the brain and head of patients of all ages in August 2020. Hyperfine is part of 4Catalyzer, a health technology incubator with facilities in CT, NY, CA and Taiwan. http://www.hyperfine.io.

View source version on businesswire.com: https://www.businesswire.com/news/home/20200909005243/en/

Contacts

Chris Ward, cward@hyperfine.io, (203) 905-0412

No pain, still gain (of function): the relation between sensory profiles and the presence or absence of self-reported pain in a large multicenter…

Posted on September 3, 2020 by Danzig

The pathophysiology of pain in neuropathy is complex and may be linked to sensory phenotypes. Quantitative sensory testing, a standardized method to evaluate sensory profiles in response to defined stimuli, assesses functional integrity of small and large nerve fiber afferents and central somatosensory pathways. It has revealed detailed insights into mechanisms of neuropathy, yet, it remains unclear if pain directly affects sensory profiles. The main objective of this study was to investigate sensory profiles in patients with various neuropathic conditions, including polyneuropathy, mononeuropathy, and lesions to the central nervous system, in relation to self-reported presence or absence of pain and pain sensitivity using the Pain Sensitivity Questionnaire.A total of 443 patients (332 painful and 111 painless) and 112 healthy participants were investigated. Overall, loss of sensation was equally prevalent in patients with and without spontaneous pain. Pain thresholds were equally lowered in both patient groups, demonstrating that hyperalgesia and allodynia is just as present in patients not reporting any pain. Remarkably, this was similar for dynamic mechanical allodynia. Hypoalgesia was more pronounced in painful polyneuropathy whereas hyperalgesia was more frequent in painful mononeuropathy (compared to painless conditions). Self-reported pain sensitivity was significantly higher in painful than in painless neuropathic conditions.Our results reveal the presence of hyperalgesia and allodynia in patients with central and peripheral lesions of the somatosensory system not reporting spontaneous pain. This shows that symptoms and signs of hypersensitivity may not necessarily coincide, and that painful and painless neuropathic conditions may mechanistically blend into one another.

PubMed

View original post here:
No pain, still gain (of function): the relation between sensory profiles and the presence or absence of self-reported pain in a large multicenter...

Patient Groups Issue Guidelines for Ensuring Access to Care and Treatment for Rare Disease Patients, Citing Critical Needs and Gaps Further Exposed…

Posted on September 3, 2020 by Danzig

ALISO VIEJO, Calif.--(BUSINESS WIRE)--Global Genes and the Child Neurology Foundation, as part of the Rare Access to Critical Therapies (ACT) collaboration, announced today the joint release of a report highlighting and supporting guiding principles of rare disease care and access which the groups assert are universally relevant to all patients with rare diseases. This report is based on multi-stakeholder workshops and rare disease landscape and literature evaluations led by ACT, which involves leading patient, provider, research, and industry organizations.

ACT was founded in late 2018 based on evidence of significant unmet need and care variability in patients with rare diseases, to ensure the rare disease patient perspective was fully considered as part of broader public discussions and policy formation that could impact and improve patient access to needed therapies, immediately and in the future.

Certain gaps in access to rare disease care, trials and treatment have widened, and others have been exposed during COVID-19. At the same time, weve seen an advancement in the pace and productivity of treatment discovery and drug development in response to a public health crisis, which offers hope, and perhaps a model for rare diseases. These developments and others on the policy front make the release of the report all the more timely.

The report, entitled Guiding Principles of Rare Disease Care and Patient Access, characterizes five fundamental expectations for rare disease patient care that all health stakeholders should acknowledge and act upon. Key areas where progress has and has not been made toward achieving these Guiding Principles are highlighted, as are areas where challenges and/or additional work remains to achieve the intention of each Guiding Principle.

The aggregate impact of rare diseases is as significant as diseases considered national priorities, though individual patient impact is often more profound. As such, our approaches to achieving each Guiding Principle must consider the efficiencies of broader solutions, while not missing the variability of individual patient needs. This report shows that there remains much work to do to strike the right balance for rare disease patients, despite breakthrough areas of progress, said Eric Faulkner, vice president, precision and transformative medicine at Evidera and executive director of the Genomics, Biotech and Emerging Technology Institute of the National Association of Managed Care Physicians, who served as the lead author for this publication.

Global Genes has been dedicated to supporting rare disease patients and their families since its inception, collectively bringing forward the community as one, increasing the voice and influence of those impacted every day, said Nicole Boice, co-founder of RARE-X and visionary for this effort, on behalf of Global Genes. We believe the Guiding Principles outlined in this report are a meaningful step forward to ensure that the patient perspective is front and center and included in all decisions related to access to treatments and care.

The five Guiding Principles that the multi-stakeholder leadership group believes are the right of every rare disease patient include:

Of the 7,000 rare diseases identified, 50% of them have a neurologic component and of those, 75% originate in childhood, stated Amy Brin, executive director/CEO of the Child Neurology Foundation. This robust intersection between rare disease and the child neurology community has provided a foundational alignment for our organization to co-lead this initiative with Global Genes since 2018, and calls for patients to be seen and heard first within all conversations about access to critical therapies.

We hope readers find this manuscript to be enlightening in the clear identification of the core principles that are due all patients, while also highlighting key areas where stakeholders must come together to collectively address and solve for desperately needed care and access solutions, said Timothy M. Miller, vice president and global therapeutic area head, leader of the Rare Disease and Pediatrics Center of Excellence at Evidera/PPD and a co-author.

The full report, jointly presented by Global Genes and the Child Neurology Foundation, is available to download here: https://globalgenes.org/resources/guiding-principles-of-rare-disease-care-and-patient-access/.

About Global Genes

Global Genes is a 501(c)(3) nonprofit organization that connects, empowers, and inspires the rare disease community, with the ultimate goal of eliminating the burdens of rare disease for patients and families everywhere. We provide hope for the more than 400 million people affected by rare disease around the globe. We fulfill our mission by helping patients find and build communities, gain access to information and resources, connect to researchers, clinicians, industry, government and other stakeholders, share data and experiences, and stand up, stand out, and become effective advocates on their own behalf. If you or someone you love have a rare disease or are searching for a diagnosis, contact Global Genes at 949-248-RARE or visit the resource hub at http://www.Globalgenes.org.

About the Child Neurology Foundation

The Child Neurology Foundation serves as a collaborative center of education and support for children living with neurologic conditions and their families. We connect partners from all areas of the child neurology community so that those navigating the journey of disease diagnosis, management, and care have ongoing support from those dedicated to treatments and cures. Our expanding network of patients and caregivers, advocates, partners, researchers, and physicians is committed to helping one another along the path that leads to the best quality of care and the highest quality of life for every child. For more information, check out CNFs website!

The rest is here:
Patient Groups Issue Guidelines for Ensuring Access to Care and Treatment for Rare Disease Patients, Citing Critical Needs and Gaps Further Exposed...

‘There’s a lot of confusion inside of me’: COVID-19 ‘long-haulers’ suffering from neurological symptoms months later – CTV News

Posted on September 3, 2020 by Danzig

TORONTO -- A growing number of so-called COVID-19 "long-haulers" who believe they had the disease before testing was widely available are complaining of new neurological symptoms including confusion, trouble concentrating and memory loss that persist weeks and even months after their initial sickness.

Ruth Castellanos says she has developed an unnerving tremor in her hands after a suspected COVID-19 infection in mid May

"I'm jolted out of sleep and I feel like my body just vibrates at night," Castellanos said in an interview with CTV News.

Castellanos, who lives in Troy, Ont., said she is no longer able to work as a college instructor as the tremors are just one of the troubling neurological symptoms she suffers from.

Once fit and healthy, Castellanos now describes days where she is confused and has trouble reading.

"I have been experiencing a lot of brain fog and this is what happens I sometimes stutter. I lose my train of thought. I get confused reading. Even simple instructions becomes hard and frustrating. I have to re-read things," Castellanos said.

She says doctors don't know what is causing her neurological symptoms or how to help her.

"Not only am I scared of the unknown, but I'm scared now of what my symptoms are, and there's a lot of confusion inside of me," Castellanos said.

She fears the brain fog and tremors may become her "new normal."

"It's has been very debilitating, and it has been very trying on myself as a person, let alone on my body," Castellanos said.

But Canadian long-hauler patients like Suzie Golding say getting recognition or help from doctors has been difficult.

The Oakville, Ont. resident said contracting the coronavirus has been "a life-altering experience" for her. She says she has been plagued with short-term memory deficits, brain fog and fatigue since developing what appeared to be COVID-19 in March. She is unable to work as a floral designer and the single mom is doing her best to raise her son while battling her illness.

"I'm really just living my life at a very basic level, trying to get through each day with great difficulty," Goulding said. "It's terrible."

In hopes of providing some relief to other long-haulers like herself, Goulding started an online group called COVID Long Haulers Support Group Canada. The support group has over 2,800 members and the numbers are growing.

"A lot of people are having doctors that say to them 'This is just anxiety and we can't help you. There's nothing we can do. You're just anxious,' and really dismissing the fact that [this] is something that is happening," Goulding said.

The group is also asking the federal and provincial governments to provide more help for those who develop these disabling neurological symptoms.

"We need rehabilitation. We need COVID care clinics set up for us so that we don't have to wait in emergency wards for six to eight hours to be told that there's nothing that they can do for us," Goulding said.

In two labs in Ontario, Canadian researchers are focusing on this group of patients.

Dr. Adrian Owen, a cognitive neuroscience professor at Western University in London, Ont. suspects that the issue of COVID-19 long-haulers may be greater than initially thought.

"This is something that is ongoing. If these issues are long-term or permanent, we have a very, very large societal and economical problem on our hands," Owen said in an interview with CTV News.

To help address the issue, Owen is part of a team of Canadian neuroscientists who have launched the online COVID-19 Brain Study -- the world's largest project to consider the "direct and indirect effects of the disease on the brain."

The study, launched by Western University and the University of Toronto, provide online tests to 50,000 post-COVID patients worldwide over the course of a year in an attempt to measure their brain function.

Owen explained that the tests are more like online games that last about a minute and a half and assess brain functions including memory, concentration and problem-solving abilities.

"Look at all those pieces of information together and will be able to work out how COVID-19 is affecting cognitive function and whether it's affecting some people more than others," he said.

Owen hopes to have some results from the study early this fall to better understand the effects of COVID-19 on the brain and find ways to help those suffering from neurological symptoms.

In Hamilton, McMaster University scientist Dr. John Connolly is also looking at the impact the novel coronavirus can have on brain function.

"From preliminary research being published around the world, it appears the virus is capable of passing the blood-brain barrier, attacking the brain directly," wrote Connolly in an email to CTV News. He is chair of cognitive neuroscience of language at McMaster.

"This means that many of the complications from the illness, such as lung and other organ failure, may be due to brain dysfunction as opposed to the virus directly attacking these other organs."

Connolly's lab has partnered with McMaster neurotech start-up VoxNeuro and will use electroencephalogram-based (EEG) neuroimaging to assess brain function over time.

Connolly said patient enrollment in the study is expected to begin soon.

"As we specialize in cognitive health, and COVID has been proven to have lasting neurological consequences, we are able to quantify that, and provide data that differentiates between true cognitive decline and perceived decline due to symptoms caused by situational factors, such as stress, general fatigue or mood," Connolly said.

He added that the goal of this study is to better understand what types of patients are most vulnerable to neurological symptoms and which medical interventions are most effective for treatment.

Researchers will be able to draw conclusions from the study in a year but Connolly said they will likely start to see trends in the data within three to six months. However, if more long-haulers participate in the study, then results and possible treatments may come sooner.

"The more patients we can test and the faster we can test them, the faster we can get definitive answers to these questions," Connolly said.

While these symptoms may only affect a minority of COVID-19 patients, Connolly said that reliable neurocognitive assessment procedures will be essential in accurately gauging active and post-COVID patients' cognitive abilities, and in tracking their recovery.

"With the perspective that our world will not return to normal, and that instead we will be living in a post-COVID world from here on, we must understand what we're up against," Connolly said.

"Not just in the short term of mitigating death, but ensuring that life beyond COVID is healthy and meaningful for its survivors."

More here:
'There's a lot of confusion inside of me': COVID-19 'long-haulers' suffering from neurological symptoms months later - CTV News

Social Neurology Software Market Research Methodology Focuses On Exploring Major Factors Influencing the Industry Development 2025 – Galus Australis

Posted on September 3, 2020 by Danzig

The Social Neurology Software Market which explains the future and present measurements of the market as for the patterns in play. The principle reason for the investigation is to legitimize the occurrences in the market by giving reader helpful and suitable bits of knowledge on the particulars of the market for the future extent of development and accessible prospects at the current situation with the market. The statistical surveying production additionally manages features, for example, drivers, restrictions, and prospects to measure the result of the market amid the conjecture time frame specified in the report.

Top Key Vendors: Epic,Brainlab,healthfusion,Athenahealth,Practice Fusion,Nextgen,Bizmatics,Greenway Health,Allscripts,Kareo,Advanced Data Systems,NueMD

Get Sample Copy @ https://www.itintelligencemarkets.com/request_sample.php?id=937

An analysis of the major trends in the global Social Neurology Software Market in the past years, which have significantly contributed in shaping the current state of the market, and the important trends of the current times is also included in the report, allowing the reader to formulate winning strategies. The data has been gathered with the help of a number of primary and secondary research methodologies and narrowed-down with the help of industry-best analytical methods.

Segmenting the global Social Neurology Software Market on several fronts, the research report examines the strengths and weaknesses of each category and sub-category in the operating environments. The report also analyses the impact of several internal and external forces such as consumer preferences, government regulations, laws and policies, technological developments, and economic environment for each segment.

Get Reasonable Discount on This Premium Report @

https://www.itintelligencemarkets.com/ask_for_discount.php?id=937

The regions North America, Global, Asia Pacific, Middle East & Africa and Latin America have been studied in depth to gain better market penetration and assure exact analysis. Top manufacturers have been given prime importance to make sure their strategies are understood and their position in this particular market can be elucidated.

The conclusions of this report illustrate the potential of the global Social Neurology Software Market in terms of investment potential in various segments of the market and illustrate the feasibility of explaining the feasibility of a new project to be successful in the near future. The core segmentation of the global market is based on product types, SMEs and large corporations. The report also collects data for each major player in the market based on current company profiles, gross margins, sales prices, sales revenue, sales volume, photos, product specifications and up-to-date contact information.

If You Have Any Query, Ask Our Experts @ https://www.itintelligencemarkets.com/enquiry_before_buying.php?id=937

Key Points Covered in TOC:

Global Social Neurology Software Market Research Report

Chapter 1 Global Social Neurology Software Market Overview

Chapter 2 Global Economic Impact on Industry

Chapter 3 Global Market Competition by Manufacturers

Chapter 4 Global Productions, Revenue (Value) by Region

Chapter 5 Global Supplies (Production), Consumption, Export, Import by Regions

Chapter 6 Global Productions, Revenue (Value), Price Trend by Type

Chapter 7 Global Market Analysis by Application

Chapter 8 Manufacturing Cost Analysis

Chapter 9 Industrial Chain, Sourcing Strategy and Downstream Buyers

Chapter 10 Marketing Strategy Analysis, Distributors/Traders

Chapter 11 Market Effect Factors Analysis

Chapter 12 Global Social Neurology Software Market Forecast.

Thanks for reading this article; you can also get individual chapter wise section or region wise report version like North America, Europe, or Asia.

About Us:

At IT Intelligence Markets, we model all our work on our core philosophy that believes in customer satisfaction. We serve a global clientele by supplying market intelligence research reports after conducting exhaustive research. Our reports are replete with productive insights & recent market dynamics as the healthcare industry is constantly undergoing changes like ever-changing consumer preferences, supply channels and latest technologies. Our market research analysts not only investigate the market for drivers, restraints & challenges but also gauge the overall progress of the market by comparing chief market players. Our report forms a crucial piece of intelligence using which our clients can unleash their potential & tap their capacity to harness the correct technologies & surpass their competitors.

Erika Thomas

76 AT US 19 & HWY

129 Murphy Highway,

Blairsville, GA, USA

Email:[emailprotected]

Phone: +1 888-312-3102

View post:
Social Neurology Software Market Research Methodology Focuses On Exploring Major Factors Influencing the Industry Development 2025 - Galus Australis

Global Enteral Feeding Device Used for Neurology Market 2020 Top Manufactures, Growth Opportunities and Investment Feasibility 2025 – The Daily…

Posted on November 20, 2020 by Danzig

Global Enteral Feeding Device Used for Neurology Market 2020 by Manufacturers, Type and Application, Forecast to 2025 released by MarketsandResearch.biz is the most important research for those who look for complete and authenticate information on the Enteral Feeding Device Used for Neurology market. The report compiles data on market size, market growth trends that will help its buyer to capture opportunities, to know and minimize probable risks, as well as to analyze the strategies of key companies in the market. The report offers a detailed assessment of the market to understand the current trend of the market and figure outs the expected market trend for the market for the forecast period from 2020 to 2025. Then, an in-depth competitive landscape, defined growth opportunities, market share coupled with product type and applications, key companies responsible for the production have been highlighted in the report.

Competitive Landscape:

The in-depth analysis of the industrial chain supporting the Enteral Feeding Device Used for Neurology market in the globe incorporates factual information about every aspect of the market such as information about manufacturers profiles, sales volume, price, gross margin, the contribution to the global industry in terms of revenue. The degree of competition among leading global companies has been elaborated by examining various leading key players operating across the global regions. The leading manufacturers have been analyzed by using research methodologies for getting insight views on global competition. The data related to each of the companies has been presented from historic years and is projected forecast period.

DOWNLOAD FREE SAMPLE REPORT: https://www.marketsandresearch.biz/sample-request/103551

NOTE: Our report highlights the major issues and hazards that companies might come across due to the unprecedented outbreak of COVID-19.

In the global Enteral Feeding Device Used for Neurology market, the following companies are covered: Fresenius Kabi, Moog, Nestle, Danone, Abbott, Cardinal Health, Cook Medical, B. Braun, Avanos Medical, Applied Medical Technology, Alcor Scientific, Boston Scientific, BARD, Vygon, ConMed

On the basis of product types, the market report offers insight into major adoption trends for the following segments: , Enteral Feeding Pumps, Enteral Feeding Tubes, Consumables

Market segment by applications considering consumption growth rate and market share: , Hospitals, Home Care

The research offers an analysis of the geographical landscape of the global Enteral Feeding Device Used for Neurology market, which is divided into regions such as: North America (United States, Canada and Mexico), Europe (Germany, France, UK, Russia and Italy), Asia-Pacific (China, Japan, Korea, India, Southeast Asia and Australia), South America (Brazil, Argentina, Colombia), Middle East and Africa (Saudi Arabia, UAE, Egypt, Nigeria and South Africa)

The report has added comprehensive segmentation with respect to the component, functionality, end-user, and geography. Research and development activities and new product development and other trending factors are highlighted. It also aims to forecast the volume and value of the market in terms of key regions and countries. The restraints that are posing a threat to the global Enteral Feeding Device Used for Neurology market are further listed. From raw materials to end-users of this global Enteral Feeding Device Used for Neurology industry are analyzed.

ACCESS FULL REPORT: https://www.marketsandresearch.biz/report/103551/global-enteral-feeding-device-used-for-neurology-market-2020-by-manufacturers-type-and-application-forecast-to-2025

Why Should You Buy This Report?

Customization of the Report:

This report can be customized to meet the clients requirements. Please connect with our sales team ([emailprotected]), who will ensure that you get a report that suits your needs. You can also get in touch with our executives on +1-201-465-4211 to share your research requirements.

Contact UsMark StoneHead of Business DevelopmentPhone: +1-201-465-4211Email: [emailprotected]Web: http://www.marketsandresearch.biz

Other Related Reports:

Global Ophthalmic Diagnostic Equipment Market 2020 Key Business Strategies, Technology Innovation and Regional Data Analysis to 2026

Global Industrial Fork Lift Trucks Market 2020 Competitive Dynamics, Growth Analysis, Segmentation and Worldwide Players Strategies up to 2026

Global Flight Support Systems Market 2020 Key Stakeholders, Growth Opportunities, Value Chain and Sales Channels Analysis 2026

Global Sorafenib Market 2020 Key Drivers and Restraints, Regional Outlook, End-User Applicants by 2026

Global Para Tertiary Butyl Phenol Market 2020 Segmented by Product, Application, Key Players and Regional Analysis to 2026

Originally posted here:
Global Enteral Feeding Device Used for Neurology Market 2020 Top Manufactures, Growth Opportunities and Investment Feasibility 2025 - The Daily...

Remote Ischemic Post-Conditioning With IVT May Improve Acute Ischemic Stroke Recovery – Neurology Advisor

Posted on December 1, 2020 by Danzig

Repeated remote ischemic post-conditioning (RIPC) combined with intravenous thrombolysis (IVT) can promote nerve function recovery and improve prognosis in patients with acute ischemic stroke, according to study results published in Neurology.

RIPC has recently been suggested for stroke treatment, and has been well tolerated and safe in patients when administered in a single episode following acute stroke. Study researchers sought to evaluate the impact of RIPC on patients with acute ischemic stroke undergoing IVT.

To achieve this, they conducted a single-center study which included patients with acute ischemic stroke who were receiving IVT at a hospital in China (ClinicalTrials.gov Identifier: NCT03218293). Patients were randomly assigned to an RIPC treatment group (n=34) or a non-RIPC control group (n=34).

The studys primary outcome was the percentage of patients with a favorable outcome (a score of 0 or 1 on the modified Rankin scale [mRS]) at 90 days. Each patient had received IVT within approximately 4.5 hours of symptom onset. The study researchers also assessed the safety and tolerability of RIPC and examined the neuroprotection biomarkers associated with this approach.

The mean duration of RIPC was 11.2 days (range, 8-14 days). At admission, there were no significant differences between the RIPC and control groups in terms of the National Institute of Health stroke scale score (6.5 vs 4.5, respectively; P =.364) or time to treatment (181.2 vs 179.2 minutes; P =.889).

A significantly greater proportion of patients in the RIPC arm experienced an excellent recovery at 3 months, defined as an mRS of 0 to 1, compared with the control group (71.9% vs 50.0%, respectively; adjusted risk ratio, 9.85; 95% CI, 1.54-63.16; P =.016). Compared to patients in the control group, those randomly assigned to RIPC also had lower plasma S100- (P =.007) and higher vascular endothelial growth factor (P =.003) levels.

Limitations of this study included its single-center design, the relatively small number of patients included, and the lack of assessment of infarct size and its relation to RIPC.

Ultimately, study researchers concluded that this novel treatment of combined IV tPA and RIPC mayimprove the prognosis of patients with AIS [acute ischemic stroke].

Reference

An JQ, Cheng YW, Guo YC, et al. Safety and efficacy of remote ischemic postconditioning after thrombolysis in patients with stroke. Published online October 7, 2020. Neurology. doi:10.1212/WNL.0000000000010884

Follow this link:
Remote Ischemic Post-Conditioning With IVT May Improve Acute Ischemic Stroke Recovery - Neurology Advisor

In-Home Telehealth Model for Epilepsy Is Highly Rated by NPs and MDs – Clinical Advisor

Posted on February 6, 2021 by Danzig

An in-home telemedicine model implemented at the Comprehensive Epilepsy Center of Childrens Mercy Kansas City showed high rates of satisfaction among advanced practice registered nurses (APRNs) and other clinicians, according to preliminary data presented by Erin Fecske, DNP, APRN, CNRN, CPNP-PC, FAES, at AES2020.1

The telehealth model was initiated in March 2020 in response to the coronavirus 19 disease (COVID-19) pandemic. At 3 months after implementation of the intervention, Dr Fecske and colleagues sent surveys to 36 clinicians at the epilepsy center to assess satisfaction with the model. A total of 24 providers responded, including 12 attending physicians, 11 advanced practice registered nurses (APRNs), and 1 resident physician.

Nearly all respondents (96%) said that in-home telehealth provided them with an adequate evaluation of patients with epilepsy. Of the 2901 patients with epilepsy seen via in-home telehealth visits within the 3-month period, 66 patients (2%) required an in-person visit within 2 weeks of the virtual visit.

Clinicians at the Comprehensive Epilepsy Center are using telehealth in various ways and settings for epilepsy visits. The first modality is in-home telehealth for new or follow-up visits, Dr Fecske said in an interview. These visits are unfacilitated, meaning that a clinician is not at the patient location to assist with the visit. Although in-home follow-up visits typically do not involve use of ancillary devices (eg, stethoscope, handheld camera), new patient visits conducted in-home are somewhat limited as they require camera use by families to allow for a visual examination.

The second modality is facilitated telehealth at an offsite location with telehealth-trained registered nurses and ancillary equipment assisting the patient, said Dr Fecske. These visits are utilized by new and follow-up patients as we would utilize a traditional clinic visit since the examination is not limited, she noted.

Alternatively, facilitated visits may occur at one of our regional primary care partners offices, Dr Fecske explained. The telemedicine visit [using Microsoft Teams] occurs in the patients primary care office. This facilitated visit includes a staff member from the primary care office, which we hope will improve engagement of the primary care provider in the care of patients with epilepsy.

In all of these modalities, we can engage with our consult services such as dietitians and social workers to provide the same support we would provide for a traditional in-person visit, Dr Fecske said. In situations where I would have a joint visit with an epileptologist [such as presurgical planning], the epileptologist can attend the telehealth appointment with the epilepsy APRN.

We have an APRN run a multidisciplinary ketogenic diet screening clinic that preCOVID required a 2+ hour in-person clinic visit from families, Dr Fecske said. With the use of telemedicine, we created videos for families to watch ahead of time and the actual time in clinic is reduced to about an hour during an in-home telemedicine visit. During that time we are able to have an occupational therapist, dietitian, social worker, chef educator, pharmacist, and epilepsy APRN meet with the family and complete appropriate assessments for ketogenic diet readiness.

Other members of the care team also can be added at the request of the patient, Dr Fecske said. Ive had children in group home settings, and we are able to include care team members as identified by the family, which has been very beneficial.

The decision to use telehealth over an in-person visit is at the discretion of the provider, who selects the modality when placing an order for follow-up. In-person visits may be preferred for infants or patients with epileptic spasms, Dr Fecske explained. Additionally, most new patients seen via in-home telehealth for their first visit will be seen in-person for their next visit to allow for a complete neurologic examination to be conducted, she said.

Before the COVID-19 pandemic, telehealth at the epilepsy center was limited to facilitated visits where patients presented to off-site locations and ancillary devices were required. At that time, only a small number of providers were credentialed for telemedicine, according to Dr Fecske.

With the original stay-at-home orders for our states we had to pivot to a more inclusive telemedicine model quickly, Dr Fecske explained. Now all of our neurology providers are credentialed to provide telemedicine. As we work to provide more in-person visits, we also are monitoring spacing in the clinic to ensure that we can follow Centers for Disease Control and Prevention recommendations. Therefore, weve continued to utilize our telemedicine offerings to ensure that patients continue to be seen regularly and monitored appropriately.

Technology limitations were one of the most commonly cited issues by the survey respondents. Families may not have a camera with a high enough resolution, may have poor internet connectivity or no internet access, or may have difficulties using video applications, Dr. Fecske noted. Additionally, while some caregivers may be able to assist in obtaining portions of the examination, other components such as reflexes are difficult to obtain.

Thus, although we may consider telemedicine a great way to improve access, we also need to consider how it can be another barrier to access for our patients and families, Dr Fecske said.

One of the biggest benefits of shifting to this telemedicine model is that it allowed us to continue to provide care to patients in a safe manner during an unusual situation, Dr Fecske said. I have patients that continue to request in-home visits as they feel that is the safest option for them at this time. In addition, epilepsy involves so much history taking that much of our visits are spent talking to families and patients and getting accurate descriptions, all of which we can accomplish during an in-home telemedicine model.

Additionally, telehealth for epilepsy may reduce the number of missed work hours for adult patients and parents as well as missed school time for children with epilepsy, Dr Feckse noted. She advised clinicians who practice telehealth for epilepsy visits to recognize what aspects of care they are and are not comfortable using the technology for.

If you need an in-person visit to get a better assessment, advocate for what you feel is going to be safest for your patient, Dr Feckse said.

1. Fecske E, Le Pichon JB, Wellman C, Waller M, Abdelmoity A. Transition to telemedicine: being nimble during COVID-19. Poster presented at: AES2020; December 4-8, 2020.

Read the original:
In-Home Telehealth Model for Epilepsy Is Highly Rated by NPs and MDs - Clinical Advisor

Doctors contemplating plasma therapy to improve neurological condition of Soumitra Chatterjee – The Indian Express

Posted on October 25, 2020 by Danzig

By: PTI | Kolkata | Updated: October 25, 2020 9:08:54 amSoumitra Chatterjee is undergoing treatment at a private hospital in Kolkata for the past 18 days after he tested COVID-19 positive. (Photo: Express archive)

Doctors are contemplating whether plasma therapy can be useful to improve the neurological condition of legendary actor Soumitra Chatterjee who is undergoing treatment at a private hospital in the city for past 18 days after he tested COVID-19 positive.

Dr Arindam Kar, who is leading the team of doctors in treating the veteran actor said in a statement on Friday evening, that the other organ functions like liver, kidney and heart conditions of Chatterjee are okay but he is barely arousable.

As he has responded briefly for steroids our neurology panel is contemplating whether plasma therapy can be useful and we are mulling future plan of action, Kar said.

The doctor said since Chatterjee has been in ICU for three weeks, it is always challenging to prevent secondary complications.

The present neurological condition of the octogenarian was due to Covid encephalopathy extended for a while, he said. It will be huge effort to get him out of this situation with other therapies for neurological complications. We hope he should recover, Kar said.

Also Read | Soumitra Chatterjees health a cause of concern, says doctor

The doctors are also administering anti-convulsants and stimulants to get him up and to rule out any auto immune disorder, post covid, he said.

The critically acclaimed actor, who has worked with renowned filmmakers like Satyajit Ray, Mrinal Sen, Tapan Sinha and Tarun Mazumdar, was admitted to the hospital on October 6 after he tested COVID-19 positive.

The Indian Express is now on Telegram. Click here to join our channel (@indianexpress) and stay updated with the latest headlines

For all the latest Entertainment News, download Indian Express App.

Read this article:
Doctors contemplating plasma therapy to improve neurological condition of Soumitra Chatterjee - The Indian Express

Global Interventional Neurology Device Market Seeking Growth from Emerging Markets, Growth Revenue, Study Drivers, Restraints and Forecast 2024 -…

Posted on November 2, 2020 by Danzig

Global Interventional Neurology Device market presents an in-depth scenario which is segmented according to Interventional Neurology Device manufacturers, product type, applications, and regions. This segmentation will provide deep-dive analysis of the Interventional Neurology Device industry for identifying the growth opportunities, Interventional Neurology Device development trends and factors limiting the growth of the market. This report offers forecast market information based on past and present Interventional Neurology Device industry situations and growth aspects.

Initially, the report presents the Interventional Neurology Device market overview covering product description, market analysis, market dynamics, Interventional Neurology Device opportunities and market share. Secondly, global Interventional Neurology Device report conducts a qualitative analysis to present the key manufacturers profile, Interventional Neurology Device market share, market size, sales volume, gross margin analysis.

Get A Free Sample Copy Here:

https://www.reportspedia.com/report/life-sciences/global-interventional-neurology-device-market-report-2019,-competitive-landscape,-trends-and-opportunities/28771#request_sample

All the key regions covered in Interventional Neurology Device report are North America, Europe, Asia-Pacific, South America, Middle East and Africa. The Interventional Neurology Device market share and market outlook of each region from 2019-2026 are presented in this report. A deep study of Interventional Neurology Device market dynamics will help the market aspirants in identifying the business opportunities which will lead to accumulation of revenue. This segment can effectively determine the Interventional Neurology Device risk and key market driving forces.

The Interventional Neurology Device report is segmented to provide a clear and precise view of the global Interventional Neurology Device market statistics and market estimates. Interventional Neurology Device report Data represented in the form of graphs, charts, and figures will show the Interventional Neurology Device growth rate, volume, target consumer analysis. This report presents the crucial data to all Interventional Neurology Device industry aspirants which will facilitate useful business decisions.

Interventional Neurology Device Market Breakdown By Manufacturers (2019-2026):

Merit Medical Systems, IncW.L. Gore & AssociatesJohnson and JohnsonPenumbra, Inc.MedtronicMedikit Co., Ltd.StrykerTerumo CorporationMicroport Scientific Corporation

Inquire Before Buying Or Ask For Custom Requirement:

https://www.reportspedia.com/report/life-sciences/global-interventional-neurology-device-market-report-2019,-competitive-landscape,-trends-and-opportunities/28771#inquiry_before_buying

Global Interventional Neurology Device Market Details Based on Product Category:

Carotid artery angioplasty & stentingEmbolization & coilingNeurothrombectomy Devices

Global Interventional Neurology Device Market Details Based On Key Product Applications:

Treatment of Cerebral AneurysmsTreatment of Cerebral VasospasmVertebroplasty

Region-Wise Interventional Neurology Device Market Analysis Can Be Represented As Follows:

Get Up to 40% Off on purchasing this report, Ask Here for Discount @:

https://www.reportspedia.com/discount_inquiry/discount/28771

Part 1: This part enlists the global Interventional Neurology Device market overview, covering the basic market introduction, market analysis by type, applications, regions. The major Interventional Neurology Device producing regions include North America, Europe, Asia-Pacific, Middle-East, and Africa. Interventional Neurology Device industry states and outlook(2019-2026) is presented in this part. In addition, Interventional Neurology Device market dynamics stating the opportunities, market risk, key driving forces are studied.

Part 2: This part covers Interventional Neurology Device manufacturers profile based on their business overview, product type, and application. Also, the sales volume, Interventional Neurology Device product price, gross margin analysis, and Interventional Neurology Device market share of each player is profiled in this report.

Part 3 and Part 4: This part presents the Interventional Neurology Device competition based on sales, revenue, and market share of each manufacturer. Part 4 covers the Interventional Neurology Device market scenario based on regions. Region-wise Interventional Neurology Device sales and growth (2029-2026) is studied in this report.

Part 5 and Part 6: These two sections cover the North America and Europes Interventional Neurology Device industry by countries. Under this the Interventional Neurology Device revenue, market share of the countries like USA, Canada, and Mexico is provided. Under Europe Interventional Neurology Device report includes, the countries like Germany, UK, France, Russia, Italy, Russia and their sales and growth is covered.

Part 7, Part 8 and Part 9: These 3 sections covers Interventional Neurology Device sales revenue and growth for the regions like Asia-Pacific, South America, Middle East & Africa. Under these regions Interventional Neurology Device report covered, the countries like China, Japan, Korea, India, Brazil, Columbia, Argentina, Egypt, Saudi Arabia, Nigeria and South Africa. The sales and growth in these regions are presented in this Interventional Neurology Device industry report.

Part 10 and Part 11: This part depicts the Interventional Neurology Device market share, revenue, sales by product type and application. The Interventional Neurology Device sales growth seen during 2015-2019 is covered in this report.

Part 12 and Part 13: This part provides forecast information related to Interventional Neurology Device market(2029-2026) for each region. The sales channels including direct and indirect Interventional Neurology Device marketing, traders, distributors, and future trends are presented in this report.

Part 14 and Part 15: These parts present Interventional Neurology Device market key research findings and conclusion, research methodology, and data sources are covered.

Thus, Global Interventional Neurology Device report is a complete blend covering all the vital market aspects.

To know More Details About Interventional Neurology Device Market research Report @:

https://www.reportspedia.com/report/life-sciences/global-interventional-neurology-device-market-report-2019,-competitive-landscape,-trends-and-opportunities/28771#table_of_contents

Name: Alex White

Phone: US: +1(806)4400782/ UK: +44 33 3303 4979

Email: [emailprotected]

View original post here:
Global Interventional Neurology Device Market Seeking Growth from Emerging Markets, Growth Revenue, Study Drivers, Restraints and Forecast 2024 -...

Neurology care during the COVID-19 pandemic, an interventional neurologist’s perspective – Boca Newspaper

Posted on September 3, 2020 by Danzig

By: David DiPinoContributing Writer

Nils Mueller-Kronast, MD, an interventional neurologist with Palm Beach Neuroscience Institute (PBNI) continues to provide care during the COVID-19 Pandemic for a wide variety of neurological ailments and neurovascular diseases including stroke and brain aneurysm treatment.

At Dr. Nils Mueller-Kronasts PBNI office, safety protocols and guidelines continue to be in place and telehealth appointments are available. Those safety procedures include patient screening for fever and cough, following the Centers for Disease Control and Preventions (CDC) guidelines for social distancing by maintaining six-feet of distance between individuals in the waiting area and exam room and continuous wearing of masks by staff. In addition, Dr. Mueller-Kronast and his care staff wear gloves and masks during patient consultations, and the offices and waiting areas are routinely sanitized.

Healthcare providers take great efforts to ensure patient and staff safety during an office consultation by limiting the physical exam when appropriate, maintaining social distance during the consultation while wearing personal protective equipment (PPE) throughout the encounter. We also provide telehealth for new patients and follow-up appointments for added convenience and patient safety, said Dr. Mueller-Kronast.

Telehealth appointments may be appropriate when the neurological disease does not require a physical exam.

Bi-directional video and audio conferences provide an excellent patient experience without the inconvenience and perceived uncertainty of an in-person visit. If chosen for the correct patient and condition, there does not have to be a negative impact to not being in-person with the patient during the interaction and telehealth can allow us to determine the correct diagnosis and treatment, said Dr. Mueller-Kronast.

Additionally, Dr. Mueller-Kronast encourages going to the hospital for serious ailments and elective procedures.

In the hospital patients who are suspected of COVID-19, or are COVID-19 positive, are managed by separate staff in separate areas of the hospital. We also use telehealth to minimize staff exposure when feasible. All elective surgery patients are COVID-19 tested, said Dr. Mueller-Kronast.

As for the link between COVID-19 and stroke, Dr. Mueller-Kronast has seen rare occurrences.

Early during the first months of the epidemic, in certain hot spots, some hospitals reported a spike in embolic large vessel occlusion in COVID-19 positive patients. We have seen a few COVID-19 positive stroke patients with typically more severe disease but, as in many parts of the country, there appeared to be a hesitancy of patients to present to the emergency room, said Dr.Mueller-Kronast.

Lastly, Dr. Mueller-Kronast encourages our communities to continue making efforts in preventing the spread of the COVID-19 virus.

These are difficult times, and we have to take this disease seriously. Everyones efforts are required to minimize the risk of exposure for our most vulnerable members of society. I feel that wearing a mask to protect someone else from a potentially deadly disease is a small burden which I will happily shoulder, said Dr. Mueller-Kronast.

Dr. Nils Mueller-Kronast is an interventional neurologist with the Palm Beach Neuroscience Institute and is on-staff at Delray Medical Center in Delray Beach, St. Marys Medical Center in West Palm Beach and Florida Medical Center, a campus of North Shore located in Fort Lauderdale. In addition, Dr. Mueller-Kronast is the Regional Medical Director of Neurosciences for Tenet Healthcares Florida Region.

Dr. Mueller-Kronast specializes in stroke, vascular neurology office consultations, endovascular management of elective and ruptured aneurysm, endovascular management of vascular malformations (dural AV fistulas, arteriovenous malformations), intra-arterial stroke treatment, carotid, intracranial and other cerebrovascular stents. His Palm Beach Neuroscience Institutes offices are located in Boynton Beach, West Palm Beach and Sunrise, FL. Dr. Mueller-Kronasts Boynton Beach office is located at: 8756 Boynton Beach Blvd., Suite 2500, Boynton Beach, FL 33472. For more information visit: http://www.PBNI.com or call 561-499-7551.

Original post:
Neurology care during the COVID-19 pandemic, an interventional neurologist's perspective - Boca Newspaper

DMTs Most Effective Among Certain Subgroups of Individuals With MS – Neurology Advisor

Posted on September 16, 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. .

Disease modifying therapies (DMTs) show the greatest effectiveness among those with multiple sclerosis (MS) who have shorter MS duration, lower scores on the Expanded Disability Status Scale (EDSS), lower rate of relapse, and the relapsing MS phenotype, according to research 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.

This retrospective study included 26,329 individuals with relapsing or progressive MS selected from the international MSBase registry. Inclusion criteria consisted of being followed for 1 year, with 3 visits, and 1 visit per year. Study researchers compared the hazard ratios (HR) of EDSS improvement and 6-month confirmed worsening, as well as relapse rates between treated and untreated periods. Marginal structural models were used to do so and were continuously readjusted to take into account participant sex, age, date, pregnancy, previous relapse history, time from first symptom, MRI activity, and disability.

Among 23,687 individuals with relapsing MS, those treated with DMTs were 20% more likely to experience disability improvement (HR 1.20; 95% CI, 1.0-1.5), 47% less likely to experience worsening disability (HR 0.53; 95% CI, 0.39-0.71), and had a 51% decrease in relapses (HR 0.49; 95% CI, 0.43-0.55). However, longer MS duration and higher previous rate of relapse reduced the effect of DMTs on relapses and EDSS worsening; the effect of DMTs on these factors was stronger among those in lower EDSS categories.

The use of DMTs was associated with greater EDSS improvement among those without new MRI lesions (HR 1.51; 95% CI, 1.00-2.28) than those with MRI activity (HR 1.04; 95% CI, 0.88-1.24). Among the 26,329 individuals with either relapsing or progressive MS, those with relapsing MS treated with DMTs showed reductions in both EDSS worsening (HR 0.75; 95% CI, 0.65-0.86) and relapses (HR 0.58; 95% CI, 0.54-0.62). However, these benefits were not observed in those with progressive MS.

The study researchers concluded, DMTs are associated with reduction in relapse frequency, progression of disability, and increased chance of recovery from disability. however, subgroups with shorter MS duration, lower EDSS, lower relapse rate and relapsing MS phenotype appear more likely to experience benefits from DMTs.

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

Diouf I, Malpas C, Horakova D, et al. Variability of the response to immunotherapy among sub-groups of patients with multiple sclerosis. 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. Abstract P0018.

See the original post:
DMTs Most Effective Among Certain Subgroups of Individuals With MS - Neurology Advisor

Improvements Are Needed to Measure Impact of Pediatric MS – Neurology Advisor

Posted on September 16, 2020 by Danzig

For youths with pediatric multiple sclerosis (MS), activities and participation are more important life domains than disease-related impairments. As a result,

a health-related quality of life (HRQoL) measure should include variables of MS-related impairments that require targeted therapies, as well as the activities and roles important to these patients, 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.

While generic HRQoL measures are used to evaluate the impact of pediatric MS, these measures do not always provide insight into domains of health that are relevant to children and parents alike. The goals of this study were to identify domains of life significant to youths with pediatric MS and to contribute to building a better condition-specific measure for this population.

To achieve these, study researchers used an online survey based on the Patient Generated Index (PGI), an approach which relies on open-ended responses to assess HRQoL. They then mapped text threads formed by the PGI onto the International Classification of Functioning, Disability and Health (ICF), and the Comprehensive ICF Core Set for MS.

A total of 19 participants completed the survey, 10 of whom were youths with MS between the ages of 14 and 22 years. This group had a median onset age of 13.5 years. More than 80% of the areas in the survey nominated by youths with MS were associated with activities and participation, while just 20% of these areas related to impairments. 62% of the areas nominated by parents, however, related to impairments. Taken together, these findings suggest that a HRQoL measure should include variables of MS-related impairments that require targeted therapies as well as activities and roles important to youths.

The researchers noted that the new assessment approach has a disability component which addresses such impairments related to MS, and is completed with the PGI system. In this component, the youth or parent chooses a total of 5 disability areas impacted by MS, rates its severity, and prioritizes each area for improvement. Additionally, the assessment has a youth-completed quality of life component that asks respondents about areas going well.

Study researchers concluded that the use of this new measurement approach could prove useful in overcoming challenges of measurement development for children with rare diseases like pediatric MS.

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

Reference

Ow N, Karp A, Ogeil J, Dilenge M, Sbire G, Mayo N. Pediatric MS: different disease course, different impact, different measurement approach needed. 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. Abstract P0130.

See original here:
Improvements Are Needed to Measure Impact of Pediatric MS - Neurology Advisor

Existing Class of Drugs May Improve Neurological Function in Patients with Rare, Aggressive Genetic Disorder – Newswise

Posted on September 3, 2020 by Danzig

Philadelphia, September 3, 2020 New findings from Childrens Hospital of Philadelphia (CHOP) show that some patients with a rare and aggressive form of leukodystrophy may benefit from receiving treatment with a class of targeted therapy drugs that could improve their neurological function. A correspondence about these findings was published today in the New England Journal of Medicine.

Aicardi-Goutires syndrome (AGS) is a rare genetic disorder and type of leukodystrophy that affects the brain and immune system. In patients with AGS, the bodys immune system turns on itself in a destructive way, targeting the brains white matter, causing most children with the disorder to experience mild to severe intellectual or physical impairments. Most children with AGS are unable to walk or talk and have multisystemic complications, including skin inflammation.

Prior studies have linked the activation of interferons signaling proteins that respond to various immune disruptions to exacerbated symptoms in AGS. Researchers at CHOP wanted to explore whether a class of small molecule inhibitor drugs called janus kinase (JAK) inhibitors could be used to block interferon activation in a way that helped these patients.

Because treatment options for AGS are limited and the symptoms that these patients experience are so severe, there is a need to explore a wide variety of options, said senior author Adeline Vanderver, MD, an attending physician in the Division of Neurology, Program Director of the Leukodystrophy Center, and Jacob A. Kamens Endowed Chair in Neurologic Disorders and Translational Neurotherapeutics at CHOP.

The study was conducted at CHOP with 35 international patients with genetically confirmed AGS. These patients received baricitinib, an oral JAK1 and JAK2 inhibitor, with doses based on each patients renal function, age and symptoms. Patients had their developmental histories evaluated from the onset of the disease to the end of the study, which ranged from 7.4 months to 41.5 months. The study team analyzed a variety of developmental milestones, including head control, sitting, rolling, smiling, babbling, and the use of single words and word combinations.

Before the patients in this study received treatment, 26 of the 35 had stable or declining neurologic function, and 9 of the 35 patients gained one or two of these developmental skills after disease onset. However, during the study, 20 patients met new milestones, and 12 patients gained between two to seven new skills. The improvements were typically observed within three months into the study and persisted. Children who received higher doses of the therapy appeared to achieve more of these milestones.

Some of the AGS patients who received baricitinib were at risk for developing thrombocytosis, leukopenia, and infection and therefore should be monitored closely while taking the drug.

Measuring neurologic improvements in these patients is a complex process, but the results of this study are encouraging, especially because we observed improvements even in patients with severe and long-standing disease, Vanderver said.

Eli Lilly provided the medication for the study and performed the safety laboratory tests. This work was supported by grants NINDS U01 NS106845 and NICHD U01HD082806 and the State of Pennsylvania, Commonwealth Universal Research Enhancement Program, the J.A. Kamens Chair in Translational Neurotherapeutics from CHOP; grant KL2TR001879 from the National Center for Advancing Translational Sciences of the NIH, K23NS114113 the National Institute of Neurological Disorders and Stroke of the NIH, and K08-HL140129 from the Parker B. Francis Foundation; and funding from the Department of Pediatrics at CHOP.

Vanderver et al, Janus Kinase Inhibition in the AicardiGoutires Syndrome. N Engl J Med, online September 3, 2020. DOI: 10.1056/NEJMc2001362.

About Childrens Hospital of Philadelphia: Childrens Hospital of Philadelphia was founded in 1855 as the nations first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, Childrens Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. In addition, its unique family-centered care and public service programs have brought the 564-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu

Link:
Existing Class of Drugs May Improve Neurological Function in Patients with Rare, Aggressive Genetic Disorder - Newswise

Reata Announces the Presentation of the Pivotal MOXIe Part 2 Study of Omaveloxolone in Friedreich’s Ataxia at the American Academy of Neurology -…

Posted on September 3, 2020 by Danzig

PLANO, Texas, Sept. 03, 2020 (GLOBE NEWSWIRE) -- Reata Pharmaceuticals, Inc. (Nasdaq: RETA) (Reata, the Company, or we), a clinical-stage biopharmaceutical company, today announced the forthcoming presentation of efficacy and safety results from the pivotal MOXIe Part 2 study, a randomized, double-blind, placebo-controlled trial of omaveloxolone in Friedreichs ataxia.

The presentation will take place on September 24, 2020 as part of the 2020 Emerging Science presentations hosted by the American Academy of Neurology (AAN). David Lynch, M.D., Ph.D., will present the data. Dr. Lynch is an attending physician at the Childrens Hospital of Philadelphia (CHOP), professor of neurology at the Perelman School of Medicine at the University of Pennsylvania, and the principal investigator of the MOXIe study.

The AAN Science Committee selected this as one of 12 late-breaking abstracts, chosen from more than 150 abstracts submitted to the April 2020 AAN meeting, which was converted to a virtual meeting due to the COVID-19 pandemic. More information about the AAN presentation can be found at the AAN Emerging Science webpage: https://www.aan.com/education-and-research/research/2020-aan-science-highlights/.

Separately, Dr. Lynch will present the results of the MOXIe Part 2 study at the FARA 2020 Biomarker & Clinical Endpoint Meeting, also scheduled for September 24. More information about this meeting and Dr. Lynchs presentation there can be found at https://curefa.org/pdf/research/Agenda-Biomarker2020-draft.pdf.

About Reata Pharmaceuticals, Inc.

Reata is a clinical-stage biopharmaceutical company that develops novel therapeutics for patients with serious or life-threatening diseases by targeting molecular pathways involved in the regulation of cellular metabolism and inflammation. Reatas two most advanced clinical candidates, bardoxolone methyl ("bardoxolone") and omaveloxolone, target the important transcription factor Nrf2 that promotes the resolution of inflammation by restoring mitochondrial function, reducing oxidative stress, and inhibiting pro-inflammatory signaling. Bardoxolone and omaveloxolone are investigational drugs, and their safety and efficacy have not been established by any agency.

Contact:Reata Pharmaceuticals, Inc.(972) 865-2219http://reatapharma.com

Investors:Vinny JindalVice President, Investor Relations and Corporate Communications(469) 374-8721ir@reatapharma.comhttp://reatapharma.com/contact-us/

Forward-Looking Statements

This press release includes certain disclosures that contain forward-looking statements, including, without limitation, statements regarding the success, cost and timing of our product development activities and clinical trials, our plans to research, develop and commercialize our product candidates, our plans to submit regulatory filings, and our ability to obtain and retain regulatory approval of our product candidates. You can identify forward-looking statements because they contain words such as believes, will, may, aims, plans, model, and expects. Forward-looking statements are based on Reatas 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, but are not limited to, (i) the timing, costs, conduct, and outcome of our clinical trials and future preclinical studies and clinical trials, including the timing of the initiation and availability of data from such trials; (ii) the timing and likelihood of regulatory filings and approvals for our product candidates; (iii) whether regulatory authorities determine that additional trials or data are necessary in order to obtain approval; (iv) the potential market size and the size of the patient populations for our product candidates, if approved for commercial use, and the market opportunities for our product candidates; and (v) other factors set forth in Reatas filings with the U.S. Securities and Exchange Commission, including the detailed factors discussed under the caption Risk Factors in its Annual Report on Form 10-K for the fiscal year ended December 31, 2019. The forward-looking statements speak only as of the date made and, other than as required by law, we undertake no obligation to publicly update or revise any forward-looking statements, whether as a result of new information, future events, or otherwise.

Here is the original post:
Reata Announces the Presentation of the Pivotal MOXIe Part 2 Study of Omaveloxolone in Friedreich's Ataxia at the American Academy of Neurology -...

Setting Patients with Epilepsy on the Path to Seizure Freedom Right from the Start – Neurology Advisor

Posted on August 29, 2020 by Danzig

This piece is sponsored by Eisai Inc.

The path to seizure freedom can be a long and frustrating journey. We often have to try different medications or combine several treatments before finding a suitable treatment with minimal side effects. 1,2 For this reason, it is essential that we try to get our patients on the right treatment plan right from the start. The challenge HCPs and patients face is that each patients needs are different and reaching the right dose of an anti-seizure medication (ASM) is a journey unique to every patient. Understanding the barriers patients often face can steer us to the right path for a smoother journey.

The Challenge of Dosing

One of the biggest challenges in treating epilepsy is the process of getting patients to their target dose of anti-seizure medication by increasing the dose incrementally (called titration) as quickly and safely as possible while minimizing side effects. However, reaching the target dose is a journey, and each patients journey is different.1,3 During this process, the number of doctor visits increases for the patient as the care team monitors how well the drug is working and how side effects are tolerated.1,4 Each patients response to treatment is also different and unfortunately, we cant know if a drug is effective for someone until their titration is complete. Meanwhile, the financial and time burdens associated with these additional visits and testing can add stress for patients and their families.1,3,4

Another significant part of the seizure freedom journey is finding the right dose frequency (dosage) for a patient that also fits the needs of their lifestyle. For many medications, the higher the dose, the more chances for adverse events to interfere with quality of life.5 At the same time, the complexity of the regimen, such as multiple drugs or multiple doses per day, may lead to poor compliance. Knowing details of a patients day-to-day living, such as a change in diet or a new work schedule, can be incredibly useful when making treatment decisions and considering dosing schedules right from the start.

Balancing the Effects of Dose Titration

Juggling multiple medications and adjusting to treatment schedules can be stressful for a patient. There is also the related worry that a seizure can occur while waiting for the new medication to reach its target dose.

Medications requiring shorter titration periods may help avoid uncontrolled seizures by getting patients to their target dose faster.6 Additionally, drugs that stay in the patients body longer, sometimes referred to as a longer half-life, may help in the inevitable case of missed doses.7,8 These drugs require less frequent dosage, are associated with better adherence and may mitigate concentration fluctuations in the body.7,9

As health care professionals, it is important that we consider a dosing plan as we explore an appropriate treatment regimen for each patient. Our goal is to get patients on the most effective dose of medication with the simplest regimen for them as quickly as possible while minimizing side effects.1 But to achieve that, we need to engage our patients in a clear, ongoing discussion about their lifestyle, causes of missed doses, tolerance for side effects, and potential solutions that make sense for that individual.

By having these discussions, we can help reduce the burden of repeat office visits, minimize the risk of ongoing seizures, and lower overall healthcare costs, all of which leads to an overall better patient experiencesomething we should all strive for in our practices.1,7

For resources and more information about uncontrolled seizures and approaches on achieving seizure control, visit EPILAPSEY.com.

References

View post:
Setting Patients with Epilepsy on the Path to Seizure Freedom Right from the Start - Neurology Advisor

Select Page ::